[Perceptions about continuous training of Chilean health care teachers].

PubMed

Pérez V, Cristhian; Fasce H, Eduardo; Coloma N, Katherine; Vaccarezza G, Giulietta; Ortega B, Javiera

2013-06-01

Continuous training of teachers, in discipline and pedagogical topics, is a key step to improve the quality of educational processes. To report the perception of Chilean teachers of undergraduate health care programs, about continuous training activities. Twenty teachers working at different undergraduate health care programs in Chile were interviewed. Maximum variation and theoretical sampling methods were used to select the sample. Data was analyzed by open coding, according to the Grounded Theory guidelines. Nine categories emerged from data analysis: Access to continuous training, meaning of training in discipline, activities of continuous training in discipline, meaning of continuous training in pedagogy, kinds of continuous training in pedagogy, quality of continuous training in pedagogy, ideal of continuous training in pedagogy, outcomes of continuous training in pedagogy and needs for continuous training in pedagogy. Teachers of health care programs prefer to participate in contextualized training activities. Also, they emphasize their need of training in evaluation and teaching strategies.

Transforming Schools: Creating a Culture of Continuous Improvement

ERIC Educational Resources Information Center

Zmuda, Allison; Kuklis, Robert; Kline, Everett

2004-01-01

How can a school become a place where all members of the staff are learning, growing, and working to increase student achievement? The answer lies in systems thinking and a focus on continuous improvement, two concepts that can transform staff development from something that people merely tolerate to something that they actively pursue to create…

42 CFR 423.162 - Quality improvement organization activities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Quality improvement organization activities. 423.162 Section 423.162 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control...

Participatory design in lean production: which contribution from employees? For what end?

PubMed

Perez Toralla, M S; Falzon, P; Morais, A

2012-01-01

The proponents of lean production have pointed to the positive effects of the work organization on employees in terms of autonomy, enhanced skills and empowerment mainly by their participation into the continuous improvement of work process. But studies that have examined this issue suggest that the increase in autonomy is not sufficient to compensate for increases work intensity. Participatory design has grown extensively in manufacturing since the 1980's under the impulsion of the Scandinavian socio-technical system approach and it's central in the model of lean production performance. Its main objectives are to improve quality, increase productivity and safety through employee's participation to the reduction of non-value added activities, such as defined by lean production. In the line of the studies on participatory design and continuous improvement the present study examines the functioning of work groups, based on the kaizen model, the aim of which was to improve the proportion of "value-added activities" and working conditions, essentially physical constraints. The main results are consistent with the literature and show that accelerated forms of re-conception activities give employees limited room for maneuver to elaborate solutions based on the analysis of the real activity. This study is part of a broader initiative that goes in the direction of continuous improvement of the design process itself so that it integrates the real constraints of work and propose changes bases on work as it actually takes place, beyond pre-established performance goals bases on the reduction of "non added value activities".

Characteristics of women with nausea and vomiting of pregnancy who chose to continue compassionate use of placebo after a randomised trial.

PubMed

Matok, I; Umans, J; Feghali, M N; Clark, S; Caritis, S; Miodovnik, M; Hankins, G; Mattison, D R; Nordeng, H; Koren, G

2013-08-01

The placebo effect has not been characterised in pregnant women suffering from nausea and vomiting of pregnancy (NVP). Our aim was to characterise determinants of the placebo effect in women treated with placebo for NVP. We analysed data from a multicentre, double blind randomised controlled trial of Diclectin (delayed release doxylamine and pyridoxine) vs placebo for the treatment of NVP. A total of 127 women in the placebo arm and 130 in the active arm provided evaluable data for this analysis. Women who chose to continue placebo on a compassionate basis (n = 41) had significantly better improvement in symptoms of NVP and higher Wellbeing scores than those who did not ask to continue compassionate use. Results were similar in the active drug arm. The request to continue compassionate use of either placebo or active drug could be predicted by greater improvement in symptoms of NVP during the trial period.

Lapse in Institutional Animal Care and Use Committee Continuing Reviews.

PubMed

Tsan, Min-Fu; Grabenbauer, Michael; Nguyen, Yen

2016-01-01

The United States federal animal welfare regulations and the Public Health Service Policy on Humane Care and Use of Laboratory Animals require that institutional animal care and use committees (IACUCs) conduct continuing reviews of all animal research activities. However, little is known about the lapse rate of IACUC continuing reviews, and how frequently investigators continue research activities during the lapse. It is also not clear what factors may contribute to an institution's lapse in IACUC continuing reviews. As part of the quality assurance program, the Department of Veterans Affairs (VA) has collected performance metric data for animal care and use programs since 2011. We analyzed IACUC continuing review performance data at 74-75 VA research facilities from 2011 through 2015. The IACUC continuing review lapse rates improved from 5.6% in 2011 to 2.7% in 2015. The rate of investigators continuing research activities during the lapse also decreased from 47.2% in 2012 to 7.4% in 2015. The type of IACUCs used and the size of animal research programs appeared to have no effect in facility's rates of lapse in IACUC continuing reviews. While approximately 80% of facilities reported no lapse in IACUC continuing reviews, approximately 14% of facilities had lapse rates of >10% each year. Some facilities appeared to be repeat offenders. Four facilities had IACUC lapse rates of >10% in at least 3 out of 5 years, suggesting a system problem in these facilities requiring remedial actions to improve their IACUC continuing review processes.

Challenges of using quality improvement methods in nursing homes that "need improvement".

PubMed

Rantz, Marilyn J; Zwygart-Stauffacher, Mary; Flesner, Marcia; Hicks, Lanis; Mehr, David; Russell, Teresa; Minner, Donna

2012-10-01

Qualitatively describe the adoption of strategies and challenges experienced by intervention facilities participating in a study targeted to improve quality of care in nursing homes "in need of improvement". To describe how staff use federal quality indicator/quality measure (QI/QM) scores and reports, quality improvement methods and activities, and how staff supported and sustained the changes recommended by their quality improvement teams. A randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes in facilities in "need of improvement". Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. A qualitative analysis revealed a subgroup of homes likely to continue quality improvement activities and readiness indicators of homes likely to improve: (1) a leadership team (nursing home administrator, director of nurses) interested in learning how to use their federal QI/QM reports as a foundation for improving resident care and outcomes; (2) one of the leaders to be a "change champion" and make sure that current QI/QM reports are consistently printed and shared monthly with each nursing unit; (3) leaders willing to involve all staff in the facility in educational activities to learn about the QI/QM process and the reports that show how their facility compares with others in the state and nation; (4) leaders willing to plan and continuously educate new staff about the MDS and federal QI/QM reports and how to do quality improvement activities; (5) leaders willing to continuously involve all staff in quality improvement committee and team activities so they "own" the process and are responsible for change. Results of this qualitative analysis can help allocate expert nurse time to facilities that are actually ready to improve. Wide-spread adoption of this intervention is feasible and could be enabled by nursing home medical directors in collaborative practice with advanced practice nurses. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Modifying the Toyota Production System for continuous performance improvement in an academic children's hospital.

PubMed

Stapleton, F Bruder; Hendricks, James; Hagan, Patrick; DelBeccaro, Mark

2009-08-01

The Toyota Production System (TPS) has become a successful model for improving efficiency and eliminating errors in manufacturing processes. In an effort to provide patients and families with the highest quality clinical care, our academic children's hospital has modified the techniques of the TPS for a program in continuous performance improvement (CPI) and has expanded its application to educational and research programs. Over a period of years, physicians, nurses, residents, administrators, and hospital staff have become actively engaged in a culture of continuous performance improvement. This article provides background into the methods of CPI and describes examples of how we have applied these methods for improvement in clinical care, resident teaching, and research administration.

42 CFR § 414.1365 - Subcategories for the improvement activities performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive...

Improving Global Precipitation Product Access at the GES DISC

NASA Technical Reports Server (NTRS)

Liu, Z.; Vollmer, B.; Savtchenko, A.; Ostrenga, D.; DeShong, B.; Fang, F.; Albayrak, R,; Sherman, E.; Greene, M.; Li, A.;

Factors Influencing Team Performance in a Continuous Quality Improvement Process in the Wisconsin Technical College System

ERIC Educational Resources Information Center

Pietz, Victoria Lynn

2014-01-01

Continuous Quality Improvement (CQI) programs are growing in popularity in higher education settings and a key component is the use of work groups, which require active employee involvement. The problem addressed in this research was the lack of employee engagement in the Quality Review Process (QRP), which is a statewide CQI model developed by…

Effect of a performance improvement CME activity on management of patients with diabetes.

PubMed

Bird, Gary C; Marian, Kathy; Bagley, Bruce

2013-01-01

Primary care in the United States faces unprecedented challenges from an aging population and the accompanying prevalence of chronic disease. In response, continuing medical education (CME) initiatives have begun to adopt the principles of performance improvement (PI) into their design, although currently there is a dearth of evidence from national initiatives supporting the effectiveness of this methodology. The specific aim of this study was to demonstrate the value of a national PI-CME activity to improve the performance of physicians treating patients with diabetes. We analyzed data from the American Academy of Family Physicians' METRIC® PI-CME activity in a cohort of family physician learners. The study utilized the 3-stage design standard approved for PI-CME. Baseline and follow-up performance data across a range of clinical and systems-based measures were compared in aggregate. Data were assessed for 509 learners who completed the activity. Statistically significant changes occurred both for self-assessment of a range of practice aspects and for diabetes care measures. Learners recognized that the organization of their practices had improved, and mechanisms were in place for better staff feedback, as well as aspects of patient self-management. Based on the clinical data obtained from 11 538 patient charts, 6 out of 8 diabetes measures were significantly improved. The activity appears to have had a positive, measurable impact on the medical practice of learners and suggests that, when appropriately designed and executed, PI-CME on a national scale can be a useful vehicle to influence performance change in physicians and to inform future CME activities. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Quality improvement in the use of medications through a drug use evaluation service.

PubMed

Stevenson, J G; Bakst, C M; Zaran, F K; Rybak, M J; Smolarek, R T; Alexander, M R

1992-10-01

Continuous quality improvement methods have the potential to improve processes that cross several disciplines. The medication system is one in which coordination of activities between physicians, pharmacists, and nurses is essential for optimal therapy to occur. DUE services can play an important role in helping to ensure that patients receive high-quality pharmaceutical care. It is necessary for pharmacy managers to review the structure, goals, and outcomes of their DUE programs to ensure that they are consistent with a philosophy of continuous improvement in the quality of drug therapy.

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

PubMed

Chatzisarantis, Nikos L D; Hagger, Martin S

2008-01-01

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

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

PubMed

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

2017-05-09

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

Teachers' Goal Orientation Profiles and Participation in Professional Development Activities

ERIC Educational Resources Information Center

Kunst, Eva M.; van Woerkom, Marianne; Poell, Rob F.

2018-01-01

Participation in professional development activities is important for teachers to continuously improve their knowledge and skills. However, teachers differ in their attitude towards learning activities. This paper examined how different goal orientation profiles are related to participation in professional development activities (acquiring…

Activity gains after reconstructions of elbow extension in patients with tetraplegia.

PubMed

Wangdell, Johanna; Fridén, Jan

2012-05-01

Reconstruction of triceps function in persons with tetraplegia is an established surgical intervention. The purpose of this study was to investigate and evaluate patient perspective of gains in activity and satisfaction after surgical reconstruction of triceps function and subsequent rehabilitation. We studied the effects of surgery and rehabilitation in 14 persons (19 arms) treated with deltoid-to-triceps transfer. We used Canadian Occupational Performance Measurement standards to capture the performance and satisfaction of patient-identified activity goals. Follow-up was performed at 6 and 12 months postoperatively. To make group analyses, we classified activity goals according to the International Classification of Function, Disability, and Health categories of activities and participation, as well as relative to the position of the arm in space. Patients reported improvement in performance after surgery, and satisfaction was rated even higher. Improvement was seen in all types of activities that patients had prioritized. No single goal was rated lower at 12 months' follow-up than before surgery. The most common activity gains were related to "driving a wheelchair" and the ability to "reach out," each of which represented 20% of expressed goals. Although "driving a wheelchair" and "moving the body" (transfers) were common goals, the smallest improvements for both performance and satisfaction after 12 months were seen in these areas. We observed the highest performance improvement in the category of "writing" and the ability to "stretch out the arm when lying down." Improvement in activity continues over the first year after triceps reconstruction. Complex activities continue to improve over a longer period than simpler activities. We saw the highest improvement in activities performed without the aid of gravity and activities highly dependent on coordination. Such actions are difficult to compensate for by technique or skills, and therefore elbow extension is essential for performance. Therapeutic IV. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

42 CFR 460.136 - Internal quality assessment and performance improvement activities.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460...

42 CFR 476.104 - Coordination of activities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Review Functions...

A Qualitative Phenomenological Study of Students' Perceptions of Classroom Practices and the Affect on Engagement

ERIC Educational Resources Information Center

Baum-Leaman, Rebekah

2013-01-01

Although teachers continue to implement an array of best practices, learners identified as unsuccessful according to criteria may lack engagement to succeed in the current curriculum activities. Even as teachers continue to apply best practices in the classroom, data does not support continued improvement of student engagement and achievement of…

Continuous delivery of ropinirole reverses motor deficits without dyskinesia induction in MPTP-treated common marmosets.

PubMed

Stockwell, K A; Virley, D J; Perren, M; Iravani, M M; Jackson, M J; Rose, S; Jenner, P

2008-05-01

L-DOPA treatment of Parkinson's disease induces a high incidence of motor complications, notably dyskinesia. Longer acting dopamine agonists, e.g. ropinirole, are thought to produce more continuous dopaminergic stimulation and less severe dyskinesia. However, standard oral administration of dopamine agonists does not result in constant plasma drug levels, therefore, more continuous drug delivery may result in both prolonged reversal of motor deficits and reduced levels of dyskinesia. Therefore, we compared the effects of repeated oral administration of ropinirole to constant subcutaneous infusion in MPTP-treated common marmosets. Animals received oral administration (0.4 mg/kg, BID) or continuous infusion of ropinirole (0.8 mg/kg/day) via osmotic minipumps for 14 days (Phase I). The treatments were then switched and continued for a further 14 days (Phase II). In Phase I, locomotor activity was similar between treatment groups but reversal of motor disability was more pronounced in animals receiving continuous infusion. Dyskinesia intensity was low in both groups however there was a trend suggestive of less marked dyskinesia in those animals receiving continuous infusion. In Phase II, increased locomotor activity was maintained but animals switched from oral to continuous treatment showing an initial period of enhanced locomotor activity. The reversal of motor disability was maintained in both groups, however, motor disability tended towards greater improvement following continuous infusion. Importantly, dyskinesia remained low in both groups suggesting that constant delivery of ropinirole neither leads to priming nor expression of dyskinesia. These results suggest that a once-daily controlled-release formulation may provide improvements over existing benefits with standard oral ropinirole in Parkinson's disease patients.

Aerospace Safety Advisory Panel

NASA Technical Reports Server (NTRS)

1992-01-01

The results of the Panel's activities are presented in a set of findings and recommendations. Highlighted here are both improvements in NASA's safety and reliability activities and specific areas where additional gains might be realized. One area of particular concern involves the curtailment or elimination of Space Shuttle safety and reliability enhancements. Several findings and recommendations address this area of concern, reflecting the opinion that safety and reliability enhancements are essential to the continued successful operation of the Space Shuttle. It is recommended that a comprehensive and continuing program of safety and reliability improvements in all areas of Space Shuttle hardware/software be considered an inherent component of ongoing Space Shuttle operations.

Improving Geography Learning in the Schools: Efforts by the National Geographic Society.

ERIC Educational Resources Information Center

Dulli, Robert E.

1994-01-01

Contends that the National Geographic Society's Geography Education Program continues to work on improving geography instruction and learning. Outlines future activities of the National Geographic Society including urban outreach and technology training. (CFR)

Quality improvement in basic histotechnology: the lean approach.

PubMed

Clark, David

2016-01-01

Lean is a comprehensive system of management based on the Toyota production system (TPS), encompassing all the activities of an organization. It focuses management activity on creating value for the end-user by continuously improving operational effectiveness and removing waste. Lean management creates a culture of continuous quality improvement with a strong emphasis on developing the problem-solving capability of staff using the scientific method (Deming's Plan, Do, Check, Act cycle). Lean management systems have been adopted by a number of histopathology departments throughout the world to simultaneously improve quality (reducing errors and shortening turnround times) and lower costs (by increasing efficiency). This article describes the key concepts that make up a lean management system, and how these concepts have been adapted from manufacturing industry and applied to histopathology using a case study of lean implementation and evidence from the literature. It discusses the benefits, limitations, and pitfalls encountered when implementing lean management systems.

Infusing and selecting V&V activities

NASA Technical Reports Server (NTRS)

Feather, M. S.

2002-01-01

The evolving nature of software development poses a continuing series of challenges for V&V. In response, the V&V community selectively adapts the use of existing V&V activities, and introduces new and improved ones.

Flipped Classroom Modules for Large Enrollment General Chemistry Courses: A Low Barrier Approach to Increase Active Learning and Improve Student Grades

ERIC Educational Resources Information Center

Eichler, Jack F.; Peeples, Junelyn

2016-01-01

In the face of mounting evidence revealing active learning approaches result in improved student learning outcomes compared to traditional passive lecturing, there is a growing need to change the way instructors teach large introductory science courses. However, a large proportion of STEM faculty continues to use traditional instructor-centered…

Prolonged mechanical noise restores tactile sense in diabetic neuropathic patients.

PubMed

Cloutier, Rachel; Horr, Samuel; Niemi, James B; D'Andrea, Susan; Lima, Christina; Harry, Jason D; Veves, Aristidis

2009-03-01

Acute application of stochastic resonance (SR), defined as a subsensory level of mechanical noise presented directly to sensory neurons, improves the vibration and tactile perception in diabetic patients with mild to moderate neuropathy. This study examined the effect of 1 hour of continuous SR stimulation on sensory nerve function. Twenty diabetic patients were studied. The effect of stimulation was measured at 2 time points, at the beginning and after 60 minutes of continual SR stimulation. This effect was measured using the vibration perception threshold (VPT) at the big toe under 2 conditions: a null (no SR) condition and active SR, defined as mechanical noise below the subject's own threshold of perception. The measurements under null and active conditions were done randomly and the examiner was blinded regarding the type of condition. Immediately after SR application, the VPT with SR in null condition was similar to baseline (32.2 +/- 13.1, P = nonsignificant) but was significantly lower during active SR (27.4 +/- 11.9) compared with both baseline (P = .018) and off position (P = .045). The 60 minutes VPT with active SR (28.7 +/- 11.1) reached significance comparing the baseline when one outlier was removed from the analysis (P = .031). It may be concluded that SR for a continuous 60-minute period can sustain the VPT improvement in diabetic patients with moderate to severe neuropathy. These results permit the conclusion that there is no short-term adaptation to the stimulation signal. Long-term application of this technique, perhaps in the form of a continually vibrating shoe insert, or insole, may result in sustained improvement of nerve function.

Maternal physical activity mode and fetal heart outcome.

PubMed

May, Linda E; Suminski, Richard R; Berry, Andrew; Langaker, Michelle D; Gustafson, Kathleen M

2014-07-01

Maternal leisure-time physical activity (LTPA) improves cardiac autonomic function in the fetus. The specific physical activity attributes (e.g., mode) that produce this benefit are not well understood. To determine if more time spent performing non-continuous LTPA during pregnancy is significantly associated with lower fetal heart rate (HR) and increased heart rate variability (HRV). This paper presents a retrospective analysis of previously reported data. Fetal magnetocardiograms (MCG) were recorded from 40 pregnant women at 36-wk gestational age. Metrics of fetal HR and HRV, self-reported min of continuous and non-continuous LTPA performed during the 3-months preceding the 36-wk assessment point and covariates (maternal weight change pre to 36-wk, age, and resting HR and fetal activity state during MCG recordings. Positive correlations were significant (p<0.05) between min of continuous LTPA, the time domain metrics that describe fetal overall HRV, short-term HRV and a frequency domain metric that reflects vagal activity. Time spent in non-continuous LTPA was positively correlated (p<0.05) with two HRV metrics that reflect fetal overall HRV. In the multiple regression analyses, minutes of non-continuous LTPA remained associated with fetal vagal activity (p<0.05) and the relationships between minutes of non-continuous LTPA and fetal overall HRV (p<0.005) persisted. These data suggest non-continuous physical activity provides unique benefits to the fetal autonomic nervous system that may give the fetus an adaptive advantage. Further studies are needed to understand the physiological mechanisms and long-term health effects of physical activity (both non-continuous and continuous) performed during pregnancy to both women and their offspring. Copyright © 2014 Elsevier Ltd. All rights reserved.

Active Reading Experience Questionnaire: Development and Validation of an Instrument for Studying Active Reading Activities

ERIC Educational Resources Information Center

Palilonis, Jennifer; Butler, Darrell

2015-01-01

The increasing adoption of mobile platforms and digital textbooks in university classrooms continues to have a profound impact on higher education. Advocates believe that providing students digital textbooks with built-in annotation features and interactive study tools will improve learning by facilitating active reading, a task essential to…

Health promotion: the impact of beliefs of health benefits, social relations and enjoyment on exercise continuation.

PubMed

Nielsen, G; Wikman, J M; Jensen, C J; Schmidt, J F; Gliemann, L; Andersen, T R

2014-08-01

The aim of this study was to explore how and why participants in structured exercise intervention programs continue or stop exercising after the program is finished. We conducted four focus group interviews with four groups of middle-aged and elderly men (total n = 28) who had participated in exercise interventions involving playing either a team sport (football) or a more individually focused activity (spinning and crossfit). Our results show that different social, organizational and material structures inherent in the different activities shape the subjects' enjoyment of exercise participation, as well as their intention and ability to continue being active. In conclusion, team sport activities seem to be intrinsically motivating to the participants through positive social interaction and play. They are therefore more likely to result in exercise continuation than activities that rely primarily on extrinsic motivation such as the expectation of improved health and well-being. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Blueprint for Early Care and Education Quality Improvement Initiatives. Publication #2015-07

ERIC Educational Resources Information Center

Tout, Kathryn; Epstein, Dale; Soli, Meg; Lowe, Claire

2015-01-01

As Quality Rating and Improvement Systems (QRIS) continue to launch and mature across states, questions emerge from stakeholders about how to design and implement effective quality improvement (QI) initiatives that accompany a QRIS. Funders, policymakers, and program developers with limited resources are looking to invest in activities that will…

42 CFR § 414.1355 - Improvement activities performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1355... comprises: (1) 15 percent of a MIPS eligible clinician's final score for MIPS payment year 2019 and for each...

Optimization of L: -methionine feeding strategy for improving S-adenosyl-L: -methionine production by methionine adenosyltransferase overexpressed Pichia pastoris.

PubMed

Hu, Hui; Qian, Jiangchao; Chu, Ju; Wang, Yonghong; Zhuang, Yingping; Zhang, Siliang

2009-07-01

The recombinant Pichia pastoris harboring an improved methionine adenosyltransferase (MAT) shuffled gene was employed to biosynthesize S-adenosyl-L: -methionine (SAM). Two L: -methionine (L: -Met) addition strategies were used to supply the precursor: the batch addition strategy (L: -Met was added separately at three time points) and the continuous feeding strategies (L: -Met was fed continuously at the rate of 0.1, 0.2, and 0.5 g l(-1) h(-1), respectively). SAM accumulation, L: -Met conversion rate, and SAM productivity with the continuous feeding strategies were all improved over the batch addition strategy, which reached 8.46 +/- 0.31 g l(-1), 41.7 +/- 1.4%, and 0.18 +/- 0.01 g l(-1) h(-1) with the best continuous feeding strategy (0.2 g l(-1) h(-1)), respectively. The bottleneck for SAM production with the low L: -Met feeding rate (0.1 g L(-1) h(-1)) was the insufficient L: -Met supply. The analysis of the key enzyme activities indicated that the tricarboxylic acid cycle and glycolytic pathway were reduced with the increasing L: -Met feeding rate, which decreased the adenosine triphosphate (ATP) synthesis. The MAT activity also decreased as the L: -Met feeding rate rose. The reduced ATP synthesis and MAT activity were probably the reason for the low SAM accumulation when the L: -Met feeding rate reached 0.5 g l(-1) h(-1).

Human Systems Integration (HSI) Associated Development Activities in Japan

DTIC Science & Technology

2008-06-12

machine learning and data mining methods. The continuous effort ( KAIZEN ) to improve the analysis phases are illustrated in Figure 14. Although there...model Extraction of a workflow Extraction of a control rule Variation analysis and improvement Plant operation KAIZEN Fig. 14

Effects of high intensity training and continuous endurance training on aerobic capacity and body composition in recreationally active runners.

PubMed

Hottenrott, Kuno; Ludyga, Sebastian; Schulze, Stephan

2012-01-01

The aim of the study was to examine the effects of two different training programs (high-intensity-training vs. continuous endurance training) on aerobic power and body composition in recreationally active men and women and to test whether or not participants were able to complete a half marathon after the intervention period. Thirty-four recreational endurance runners were randomly assigned either to a Weekend-Group (WE, n = 17) or an After-Work- Group (AW, n = 17) for a 12 week-intervention period. WE weekly completed 2 h 30 min of continuous endurance running composed of 2 sessions on the weekend. In contrast, AW performed 4 30 min sessions of high intensity training and an additional 30 min endurance run weekly, always after work. During an exhaustive treadmill test aerobic power was measured and heart rate was continuously recorded. Body composition was assessed using bio-impedance. Following the intervention period all subjects took part in a half-marathon. AW significantly improved peak oxygen uptake (VO2 peak) from 36.8 ± 4.5 to 43.6 ± 6.5 [mL.min(-1).kg(-1)], velocity at lactate threshold (VLT) from 9.7 ± 2.2 to 11.7 ± 1.8 [km.h(-1)] and visceral fat from 5.6 ± 2.2 to 4.7 ± 1.9 In WE VO2 peak signifi-cantly increased from 38.8 ± 5.0 to 41.5 ± 6.0 [mL.min(-1).kg(-1)], VLT from 9.9 ± 1.3 to 11.2 ± 1.7 [km.h(-1)] and visceral fat was reduced from 5.7 ± 2.1 to 5.4 ± 1.9 (p < 0.01). Only the improvements of VO2 peak were significantly greater in AW compared with WE (pre/post group interaction: F=15.4, p = 0.01, η(2) = 0.36). Both groups completed a half marathon with no significant differences in performance (p = 0.63). Short, intensive endurance training sessions of about 30 min are effective in improving aerobic fitness in recreationally active runners. Key pointsContinuous endurance training and high intensity training lead to significant improvements of aerobic capacity and body compositionBoth training methods enable recreationally active runners to finish a half-marathonHigh intensity training is favorable to improve VO2 peak.

Continuous Manufacturing in Pharmaceutical Process Development and Manufacturing.

PubMed

Burcham, Christopher L; Florence, Alastair J; Johnson, Martin D

2018-06-07

The pharmaceutical industry has found new applications for the use of continuous processing for the manufacture of new therapies currently in development. The transformation has been encouraged by regulatory bodies as well as driven by cost reduction, decreased development cycles, access to new chemistries not practical in batch, improved safety, flexible manufacturing platforms, and improved product quality assurance. The transformation from batch to continuous manufacturing processing is the focus of this review. The review is limited to small, chemically synthesized organic molecules and encompasses the manufacture of both active pharmaceutical ingredients (APIs) and the subsequent drug product. Continuous drug product is currently used in approved processes. A few examples of production of APIs under current good manufacturing practice conditions using continuous processing steps have been published in the past five years, but they are lagging behind continuous drug product with respect to regulatory filings.

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

Simpson, L.

ITN Energy Systems, Inc., and Global Solar Energy, Inc., with the assistance of NREL's PV Manufacturing R&D program, have continued the advancement of CIGS production technology through the development of trajectory-oriented predictive/control models, fault-tolerance control, control-platform development, in-situ sensors, and process improvements. Modeling activities to date include the development of physics-based and empirical models for CIGS and sputter-deposition processing, implementation of model-based control, and application of predictive models to the construction of new evaporation sources and for control. Model-based control is enabled through implementation of reduced or empirical models into a control platform. Reliability improvement activities include implementation of preventivemore » maintenance schedules; detection of failed sensors/equipment and reconfiguration to continue processing; and systematic development of fault prevention and reconfiguration strategies for the full range of CIGS PV production deposition processes. In-situ sensor development activities have resulted in improved control and indicated the potential for enhanced process status monitoring and control of the deposition processes. Substantial process improvements have been made, including significant improvement in CIGS uniformity, thickness control, efficiency, yield, and throughput. In large measure, these gains have been driven by process optimization, which, in turn, have been enabled by control and reliability improvements due to this PV Manufacturing R&D program. This has resulted in substantial improvements of flexible CIGS PV module performance and efficiency.« less

Collaboration between dental faculties and National Dental Associations (NDAs) within the World Dental Federation-European Regional Organization zone: an NDAs perspective.

PubMed

Yamalik, Nermin; Mersel, Alex; Cavalle, Edoardo; Margvelashvili, Vladimer

2011-12-01

Although improvements in certain oral health measures have been achieved, many global oral health matters and challenges exist. Collaborations and partnerships among various institutions are crucial in solving such problems. The main aim of the present study was to analyse the nature and extent of the partnership between dental faculties and National Dental Associations (NDAs). A questionnaire was developed, focusing on the relationship between NDAs and dental faculties within the World Dental Federation-European Regional Organization (FDI-ERO) zone with regard to major professional activities, such as dental education (both undergraduate and continuing education), workforce issues, improvement of national oral health, and science and knowledge transfer. The questionnaire was sent to all member NDAs within the ERO zone. The response rate was 21/41 (53.65%). The major activities in which NDAs were found to be involved were improvement of national oral health (100%), followed by continuing education activities (90%), whereas the activity which received least involvement was the development of an undergraduate dental curriculum (52%). The NDAs perceived their relationship with dental faculties to be quite satisfactory in the fields of continuing education, science and knowledge transfer, and the implementation of new technologies into daily dental practice. However, it was suggested that their relationship needed significant improvement with regard to the development of an undergraduate dental education curriculum, dental workforce issues and negotiations with the authorities regarding professional matters/issues. As the two important elements of organised dentistry, NDAs and dental faculties have a significant role to play in the improvement of oral health and in finding solutions to global oral health challenges; therefore, their collaboration and partnership are crucial for this purpose. On the basis of the perceptions of NDAs regarding their relationship with dental faculties, it can be concluded that their partnership can and should be further improved. © 2011 FDI World Dental Federation.

Nurses' perceptions of and participation in continuing nursing education: results from a study of psychiatric hospital nurses in Bahrain.

PubMed

Al-Majid, Sadeeka; Al-Majed, Hashmiya; Rakovski, Cyril S; Otten, Rebecca A

2012-05-01

Although many psychiatric hospital nurses in Bahrain attend at least one continuing nursing education (CNE) activity per year, many others do not. This study explored these nurses' perceptions of CNE and factors that promote or hinder participation in CNE activities. A descriptive design was used to gather data from a convenience sample of 200 nurses working at the psychiatric hospital in Bahrain. Nurses believed that CNE improved the quality of patient care and patient outcomes, increased nurses' knowledge and skills, and kept them current with advances in nursing. Participation in CNE was hindered by unavailability of CNE activities related to psychiatric nursing. The majority of nurses had positive perceptions of CNE. Their participation was hindered by unavailability of CNE activities related to psychiatric nursing. Those responsible for planning continuing education in Bahrain should consider these findings when planning future CNE activities. Copyright 2012, SLACK Incorporated.

Using activity-based costing and theory of constraints to guide continuous improvement in managed care.

PubMed

Roybal, H; Baxendale, S J; Gupta, M

1999-01-01

Activity-based costing and the theory of constraints have been applied successfully in many manufacturing organizations. Recently, those concepts have been applied in service organizations. This article describes the application of activity-based costing and the theory of constraints in a managed care mental health and substance abuse organization. One of the unique aspects of this particular application was the integration of activity-based costing and the theory of constraints to guide process improvement efforts. This article describes the activity-based costing model and the application of the theory of constraint's focusing steps with an emphasis on unused capacities of activities in the organization.

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

PubMed

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

2012-03-01

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

Older black women's experiences initiating and maintaining physical activity: implications for theory and practice.

PubMed

Price, Anna E; Greer, Beau; Tucker, Ash

2013-07-01

Using a semistructured discussion guide, the authors conducted 15 interviews with physically active older black women living in the eastern U.S. to examine what contributed to their physical activity initiation and maintenance. They used thematic analysis to organize content and constant-comparison methods to compare themes between participants. Participants initiated physical activity when a cue to action, such as weight gain or a medical issue, triggered a perceived need to exercise. When participants initiated physical activity, they experienced immediate unexpected benefits such as improved energy. They reported continuing activity because of these initial benefits. After continued physical activity over time, participants experienced the health benefits they originally hoped to achieve. Most participants also mentioned continuing physical activity because it is "me time." All participants reported needing to modify their physical activity routine at some point. Having a regular, yet adaptable, routine and planning skills helped participants maintain physical activity. These findings contribute to the refinement of theory and might be useful for professionals promoting physical activity among older black women.

Implementing quality/productivity improvement initiatives in an engineering environment

NASA Technical Reports Server (NTRS)

Ruda, R. R.

1985-01-01

Quality/Productivity Improvement (QPI) initiatives in the engineering environment at McDonnell Douglas-Houston include several different, distinct activities, each having its own application, yet all targeted toward one common goal - making continuous improvement a way of life. The chief executive and the next two levels of management demonstrate their commitment to QPI with hands-on involvement in several activities. Each is a member of a QPI Council which consists of six panels - Participative Management, Communications, Training, Performance/Productivity, Human Resources Management and Strategic Management. In addition, each manager conducts Workplace Visits and Bosstalks, to enhance communications with employees and to provide a forum for the identification of problems - both real and perceived. Quality Circles and Project Teams are well established within McConnel Douglas as useful and desirable employee involvement teams. The continued growth of voluntary membership in the circles program is strong evidence of the employee interest and management support that have developed within the organization.

High dose infusion of activated protein C (rhAPC) fails to improve neuronal damage and cognitive deficit after global cerebral ischemia in rats.

PubMed

Brückner, Melanie; Lasarzik, Irina; Jahn-Eimermacher, Antje; Peetz, Dirk; Werner, Christian; Engelhard, Kristin; Thal, Serge C

2013-09-13

Recent studies demonstrated anticoagulatory, antiinflammatory, antiapoptotic, and neuroprotective properties of activated protein C (APC) in rodent models of acute neurodegenerative diseases, suggesting APC as promising broad acting therapeutic agent. Unfortunately, continuous infusion of recombinant human APC (rhAPC) failed to improve brain damage following cardiac arrest in rats. The present study was designed to investigate the neuroprotective effect after global cerebral ischemia (GI) with an optimized infusion protocol. Rats were subjected to bilateral clip occlusion of the common carotid arteries (BCAO) and controlled hemorrhagic hypotension to 40 mm Hg for 14 min and a subsequent 5h-infusion of rhAPC (2mg/kg bolus+6 mg/kg/h continuous IV) or vehicle (0.9% NaCl). The dosage was calculated to maintain plasma hAPC activity at 150%. Cerebral inflammation, apoptosis and neuronal survival was determined at day 10. rhAPC infusion did not influence cortical cerebral perfusion during reperfusion and failed to reduce neuronal cell loss, microglia activation, and caspase 3 activity. Even an optimized rhAPC infusion protocol designed to maintain a high level of APC plasma activity failed to improve the sequels following GI. Despite positive reports about protective effects of APC following, e.g., ischemic stroke, the present study supports the notion that infusion of APC during the early reperfusion phase does not result in sustained neuroprotection and fails to improve outcome after global cerebral ischemia. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Cardiopulmonary Disease in Newborns: A Study in Continuing Medical Education.

ERIC Educational Resources Information Center

Weinberg, Armin D.; And Others

1979-01-01

A film describing tachypea as an early manifestation of congenital heart disease was shown to physicians and nurses at 27 hospitals during regular continuing medical education activities. Findings from pre-test and post-test data show that need-oriented educational programs can measurably improve the quality of patient care. (Author/LBH)

University Continuing Education for Lifelong Learning in Korea

ERIC Educational Resources Information Center

Lee, Haejoo

2008-01-01

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

Continuing Professional Development: Pedagogical Practices of Interprofessional Simulation in Health Care

ERIC Educational Resources Information Center

Nyström, Sofia; Dahlberg, Johanna; Edelbring, Samuel; Hult, Håkan; Abrandt Dahlgren, Madeleine

2017-01-01

The increasing complexity of health care practice makes continuing professional development (CPD) essential for health care professionals. Simulation-based training is a CPD activity that is often applied to improve interprofessional collaboration and the quality of care. The aim of this study is to explore simulation as a pedagogical practice for…

Promoting a team ball game (Lifeball) to older people: who does this game attract and who continues?

PubMed

Green, Sue; Campbell, Elizabeth; Barnett, Lisa; Mitchell, Rebecca; Radvan, Deborah; Van Beurden, Eric

2009-08-01

To describe the demographic and health-related characteristics (physical activity, self-reported health status, quality of life and falls history) of older people who enrol in a team-based game, Lifeball, and examine associations between continuation and participant characteristics. Reasons for stopping, participants' perceptions of the game and changes in health-related characteristics over 12 months were examined. Telephone surveys were conducted with a cohort of Lifeball players at: baseline, soon after commencing playing and 12 months later. At baseline, participants were aged 40 to 96 years (mean 67). Most were female (84%), in good to excellent health (86%) and reported being sufficiently (>150 minutes per week) physically active (69%). Almost half (43%) were still playing 12 months later (continuers). Continuers were more likely to perceive Lifeball had helped them to: feel fitter and healthier (91%); improve their social life (73%); and be more active (53%). No significant changes in continuers' physical activity, self-reported health status and quality of life measures were reported. The main reason for stopping playing was illness/injury unrelated to Lifeball. Lifeball mainly appealed to healthy, active older people.

[Effects of different crop rotations on growth of continuous cropping sorghum and its rhizosphere soil micro-environment.

PubMed

Wang, Jin Song; Fan, Fang Fang; Guo, Jun; Wu, Ai Lian; Dong, Er Wei; Bai, Wen Bin; Jiao, Xiao Yan

2016-07-01

The effects of crop rotation on sorghum [Sorghum biocolor (L) Moench] growth, rhizosphere microbial community and the activity of soil enzymes for successive crops of sorghum were evaluated. Five years of continuous monoculture sorghum as the control (CK) was compared to alfalfa and scallion planted in the fourth year. The results showed that incorporation of alfalfa and scallion into the rotation significantly improved sorghum shoot growth. Specifically, sorghum grain yield increased by 16.5% in the alfalfa rotation plots compared to the CK. The rotations also increased sorghum root system growth, with alfalfa or scallion rotation increasing sorghum total root length by 0.3 and 0.4 times, total root surface area by 0.6 and 0.5 times, root volume by 1.2 and 0.6 times, and root biomass by 1.0 and 0.3 times, respectively. Alfalfa rotation also expanded sorghum root distribution below the 10 cm soil depth. A Biolog analysis on biome functions in the sorghum flowering period indicated significantly higher microbial activity in the rotation plots. The alfalfa and scallion rotation increased the Shannon index by 0.2 and 0.1 times compared to the CK, and improved the sucrose activity in the rhizosphere soil. It was concluded that including alfalfa in rotation with sorghum improved sorghum rhizosphere soil environment, enhanced soil microbial enzyme activity, alleviated the obstacle of continuous cropping and thus increased the sorghum yield.

Accuracy of active chirp linearization for broadband frequency modulated continuous wave ladar.

PubMed

Barber, Zeb W; Babbitt, Wm Randall; Kaylor, Brant; Reibel, Randy R; Roos, Peter A

2010-01-10

As the bandwidth and linearity of frequency modulated continuous wave chirp ladar increase, the resulting range resolution, precisions, and accuracy are improved correspondingly. An analysis of a very broadband (several THz) and linear (<1 ppm) chirped ladar system based on active chirp linearization is presented. Residual chirp nonlinearity and material dispersion are analyzed as to their effect on the dynamic range, precision, and accuracy of the system. Measurement precision and accuracy approaching the part per billion level is predicted.

Training Quality: Before and after Winning the Deming Prize.

ERIC Educational Resources Information Center

Magennis, Jo P.

1995-01-01

Describes the Quality Improvement Program developed by Florida Power and Light's Nuclear Training organization that was awarded the Deming Application Prize for quality control. Training quality, team activities, training's role in business planning, customer involvement and evaluation, and continuous improvement of training are discussed. (LRW)

Kaizen and ergonomics: the perfect marriage.

PubMed

Rodriguez, Martin Antonio; Lopez, Luis Fernando

2012-01-01

This paper is an approach of how Kaizen (Continuous Improvement) and Ergonomics could be implemented in the field of work. The Toyota's Team Members are the owners of this job, applying tools and techniques to improve work conditions using the Kaizen Philosophy in a QCC Activity (Quality Control Circle).

Probability with Collaborative Data Visualization Software

ERIC Educational Resources Information Center

Willis, Melinda B. N.; Hay, Sue; Martin, Fred G.; Scribner-MacLean, Michelle; Rudnicki, Ivan

2015-01-01

Mathematics teachers continually look for ways to make the learning of mathematics more active and engaging. Hands-on activities, in particular, have been demonstrated to improve student engagement and understanding in mathematics classes. Likewise, many scholars have emphasized the growing importance of giving students experience with the…

Continuous directed evolution of aminoacyl-tRNA synthetases

PubMed Central

Bryson, David I.; Fan, Chenguang; Guo, Li-Tao; Miller, Corwin; Söll, Dieter; Liu, David R.

2017-01-01

Directed evolution of orthogonal aminoacyl-tRNA synthetases (AARSs) enables site-specific installation of non-canonical amino acids (ncAAs) into proteins. Traditional evolution techniques typically produce AARSs with greatly reduced activity and selectivity compared to their wild-type counterparts. We designed phage-assisted continuous evolution (PACE) selections to rapidly produce highly active and selective orthogonal AARSs through hundreds of generations of evolution. PACE of a chimeric Methanosarcina spp. pyrrolysyl-tRNA synthetase (PylRS) improved its enzymatic efficiency (kcat/KMtRNA) 45-fold compared to the parent enzyme. Transplantation of the evolved mutations into other PylRS-derived synthetases improved yields of proteins containing non-canonical residues up to 9.7-fold. Simultaneous positive and negative selection PACE over 48 h greatly improved the selectivity of a promiscuous Methanocaldococcus jannaschii tyrosyl-tRNA synthetase variant for site-specific incorporation of p-iodo-L-phenylalanine. These findings offer new AARSs that increase the utility of orthogonal translation systems and establish the capability of PACE to efficiently evolve orthogonal AARSs with high activity and amino acid specificity. PMID:29035361

Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients.

PubMed

Carmack Taylor, Cindy L; Demoor, Carl; Smith, Murray A; Dunn, Andrea L; Basen-Engquist, Karen; Nielsen, Ingrid; Pettaway, Curtis; Sellin, Rena; Massey, Pamela; Gritz, Ellen R

2006-10-01

Active for Life After Cancer is a randomized trial evaluating the efficacy of a 6-month group-based lifestyle physical activity program (Lifestyle) for prostate cancer patients to improve quality of life (QOL) including physical and emotional functioning compared to a group-based Educational Support Program and a Standard Care Program (no group). A total of 134 prostate cancer patients receiving continuous androgen-ablation were randomly assigned to one of the three study conditions. Results indicated no significant improvements in QOL at 6 or 12 months. Both group-based programs were positively received and yielded good attendance and retention. Lifestyle participants demonstrated significant improvements in most theoretical mediators proposed by the Transtheoretical Model and Social Cognitive Theory to affect physical activity. Despite these improvements, no significant changes were found for most physical activity measures. Results suggest a lifestyle program focusing on cognitive-behavioral skills training alone is insufficient for promoting routine physical activity in these patients.

A Wearable System for Real-Time Continuous Monitoring of Physical Activity

PubMed Central

2018-01-01

Over the last decades, wearable systems have gained interest for monitoring of physiological variables, promoting health, and improving exercise adherence in different populations ranging from elite athletes to patients. In this paper, we present a wearable system for the continuous real-time monitoring of respiratory frequency (fR), heart rate (HR), and movement cadence during physical activity. The system has been experimentally tested in the laboratory (by simulating the breathing pattern with a mechanical ventilator) and by collecting data from one healthy volunteer. Results show the feasibility of the proposed device for real-time continuous monitoring of fR, HR, and movement cadence both in resting condition and during activity. Finally, different synchronization techniques have been investigated to enable simultaneous data collection from different wearable modules. PMID:29849993

Progress toward poliomyelitis eradication - Afghanistan and Pakistan, 2009.

PubMed

2010-03-12

Afghanistan, Pakistan, India, and Nigeria are the four remaining countries where indigenous wild poliovirus (WPV) transmission has never been interrupted. This report updates previous reports and describes polio eradication activities in Afghanistan and Pakistan during January-December 2009 and proposed activities in 2010 to address challenges. During 2009, both countries continued to conduct coordinated supplemental immunization activities (SIAs) and used multiple strategies to reach previously unreached children. These strategies included 1) use of short interval additional dose (SIAD) SIAs to administer a dose of oral poliovirus vaccine (OPV) within 1-2 weeks after a prior dose during negotiated periods of security; 2) systematic engagement of local leaders; 3) negotiations with conflict parties; and 4) increased engagement of nongovernmental organizations delivering basic health services. However, security problems continued to limit access by vaccination teams to large numbers of children. In Afghanistan, poliovirus transmission during 2009 predominantly occurred in 12 high-risk districts in the conflict-affected South Region; 38 WPV cases were confirmed in 2009, compared with 31 in 2008. In Pakistan, 89 WPV cases were confirmed in 2009, compared with 118 in 2008, but transmission persisted both in security-compromised areas and in accessible areas, where managerial and operational problems continued to affect immunization coverage. Continued efforts to enhance safe access of vaccination teams in insecure areas will be required for further progress toward interruption of WPV transmission in Afghanistan and Pakistan. In addition, substantial improvements in subnational accountability and oversight are needed to improve immunization activities in Pakistan.

Overuse Injury Assessment Model

DTIC Science & Technology

2007-08-01

and reduce injuries is a continual challenge. Military researchers face challenges to develop better equipment, improve training regimens, and...performed and calculate biomechanical metrics for each activity. Hardware Challenges • Sampling the sensors sufficiently fast • Having adequate bandwidth...second is that the injury rate increases rapidly initially and, third, that the injury rate continues to climb as the cumulative distance increases

All inclusive benchmarking.

PubMed

Ellis, Judith

2006-07-01

The aim of this article is to review published descriptions of benchmarking activity and synthesize benchmarking principles to encourage the acceptance and use of Essence of Care as a new benchmarking approach to continuous quality improvement, and to promote its acceptance as an integral and effective part of benchmarking activity in health services. The Essence of Care, was launched by the Department of Health in England in 2001 to provide a benchmarking tool kit to support continuous improvement in the quality of fundamental aspects of health care, for example, privacy and dignity, nutrition and hygiene. The tool kit is now being effectively used by some frontline staff. However, use is inconsistent, with the value of the tool kit, or the support clinical practice benchmarking requires to be effective, not always recognized or provided by National Health Service managers, who are absorbed with the use of quantitative benchmarking approaches and measurability of comparative performance data. This review of published benchmarking literature, was obtained through an ever-narrowing search strategy commencing from benchmarking within quality improvement literature through to benchmarking activity in health services and including access to not only published examples of benchmarking approaches and models used but the actual consideration of web-based benchmarking data. This supported identification of how benchmarking approaches have developed and been used, remaining true to the basic benchmarking principles of continuous improvement through comparison and sharing (Camp 1989). Descriptions of models and exemplars of quantitative and specifically performance benchmarking activity in industry abound (Camp 1998), with far fewer examples of more qualitative and process benchmarking approaches in use in the public services and then applied to the health service (Bullivant 1998). The literature is also in the main descriptive in its support of the effectiveness of benchmarking activity and although this does not seem to have restricted its popularity in quantitative activity, reticence about the value of the more qualitative approaches, for example Essence of Care, needs to be overcome in order to improve the quality of patient care and experiences. The perceived immeasurability and subjectivity of Essence of Care and clinical practice benchmarks means that these benchmarking approaches are not always accepted or supported by health service organizations as valid benchmarking activity. In conclusion, Essence of Care benchmarking is a sophisticated clinical practice benchmarking approach which needs to be accepted as an integral part of health service benchmarking activity to support improvement in the quality of patient care and experiences.

Continuous detection of weak sensory signals in afferent spike trains: the role of anti-correlated interspike intervals in detection performance.

PubMed

Goense, J B M; Ratnam, R

2003-10-01

An important problem in sensory processing is deciding whether fluctuating neural activity encodes a stimulus or is due to variability in baseline activity. Neurons that subserve detection must examine incoming spike trains continuously, and quickly and reliably differentiate signals from baseline activity. Here we demonstrate that a neural integrator can perform continuous signal detection, with performance exceeding that of trial-based procedures, where spike counts in signal- and baseline windows are compared. The procedure was applied to data from electrosensory afferents of weakly electric fish (Apteronotus leptorhynchus), where weak perturbations generated by small prey add approximately 1 spike to a baseline of approximately 300 spikes s(-1). The hypothetical postsynaptic neuron, modeling an electrosensory lateral line lobe cell, could detect an added spike within 10-15 ms, achieving near ideal detection performance (80-95%) at false alarm rates of 1-2 Hz, while trial-based testing resulted in only 30-35% correct detections at that false alarm rate. The performance improvement was due to anti-correlations in the afferent spike train, which reduced both the amplitude and duration of fluctuations in postsynaptic membrane activity, and so decreased the number of false alarms. Anti-correlations can be exploited to improve detection performance only if there is memory of prior decisions.

Continuing Challenges and Potential for Collaborative Approaches to Education Reform

ERIC Educational Resources Information Center

Bodilly, Susan J.; Karam, Rita; Orr, Nate

2011-01-01

The Ford Foundation began the Collaborating for Education Reform Initiative (CERI) in 1997-1998 by issuing grants and providing grantees with funds, guidance, and technical assistance to develop collaboratives and carry out activities to improve teaching and learning. CERI's collaborative activities were directed at three possible community…

Pilates and Physical Education: A Natural Fit

ERIC Educational Resources Information Center

Kloubec, June; Banks, Aaron L.

2004-01-01

In a time period characterized by the continual decline of fitness and physical activity among American youths, Pilates can provide physical educators a unique activity that will improve fitness and stimulate the cognitive domain of today's students. Because the Pilates method of exercise encourages the development of strong and flexible muscles…

Multidimensional exercise for people with Parkinson's disease: a case report.

PubMed

Kluding, Patricia; McGinnis, Patricia Quinn

2006-06-01

The primary impairments associated with Parkinson's disease occur in combination with the secondary, preventable effects of immobility. A community-based fitness program may help increase activity and maintain function in people in the early or middle stages of the disease. This article describes a unique program designed to reduce fall risk and promote independent exercise for people with Parkinson's disease. Two 66-year-old males, both community ambulators and in early or middle stages of Parkinson's disease, participated in 3 months of various physical activities. Group balance classes were held twice weekly during the first month, participants joined a fitness center and self-directed their exercise program during the second month, and group Tai Chi classes were held twice weekly during the third month. At conclusion of the program, participants were given suggestions for continued physical fitness activities. After the 3-month program, improvements were noted for both individuals in functional reach, Timed Up and Go, and Berg Balance scores. Both participants continued to exercise regularly for at least 8 months following the program. Two individuals with Parkinson's disease demonstrated improvement in their balance test performance over a 3-month period. Perhaps most importantly, these participants independently continued exercising after completing this program.

Depressed mood, usual activity level, and continued employment after starting dialysis.

PubMed

Kutner, Nancy G; Zhang, Rebecca; Huang, Yijian; Johansen, Kirsten L

2010-11-01

When patients start dialysis, their employment rate declines and disability benefits are an option. With patient sociodemographic and clinical characteristics including disability income status controlled, we investigated the significance of depressed mood and usual activity level as predictors of patients' continued employment after dialysis start. Incident patients from 296 randomly selected dialysis clinics were surveyed in the Comprehensive Dialysis Study (CDS). Participants provided information about employment status, disability income status, education, depressive symptoms measured by the Patient Health Questionnaire-2 (PHQ-2), and usual activity level/energy expenditure measured by the Human Activity Profile. Age, gender, race, insurance, diabetes, inability to ambulate or transfer, chronic obstructive pulmonary disease, cardiovascular conditions, and hemoglobin and serum albumin values at treatment start were obtained from US Renal Data System files. Dialysis modality was defined at time of interview. Among 585 CDS participants who worked in the previous year, 191 (32.6%) continued working after dialysis start. On the basis of the PHQ-2 cutoff score ≥3, 12.1% of patients who remained employed had possible or probable depression, compared with 32.8% of patients who were no longer employed. In adjusted analyses, higher Human Activity Profile scores were associated with increased likelihood of continued employment, and there was a borderline association between lower PHQ-2 scores and continued employment. Screening and management of depressive symptoms and support for increased activity level may facilitate patients' opportunity for continued employment after dialysis start, along with generally improving their overall quality of life.

Use of robotics in colon and rectal surgery.

PubMed

Pucci, Michael J; Beekley, Alec C

2013-03-01

The pace of innovation in the field of surgery continues to accelerate. As new technologies are developed in combination with industry and clinicians, specialized patient care improves. In the field of colon and rectal surgery, robotic systems offer clinicians many alternative ways to care for patients. From having the ability to round remotely to improved visualization and dissection in the operating room, robotic assistance can greatly benefit clinical outcomes. Although the field of robotics in surgery is still in its infancy, many groups are actively investigating technologies that will assist clinicians in caring for their patients. As these technologies evolve, surgeons will continue to find new and innovative ways to utilize the systems for improved patient care and comfort.

Impact of continuous in-home rehabilitation on quality of life and activities of daily living in elderly clients over 1 year.

PubMed

Imanishi, Miyuki; Tomohisa, Hisao; Higaki, Kazuo

2017-11-01

To verify the effect of in-home rehabilitation on quality of life and activities of daily living in elderly clients. In this non-randomized controlled intervention trial, elderly participants were separated into a rehabilitation or a non-rehabilitation group (n = 100 each). The non-rehabilitation group received basic in-home nursing care, including assistance with cooking, cleaning, toileting, meals and medication. The rehabilitation group received a physical treatment program provided by a licensed professional once a week and basic nursing care in the home. For each group, quality of life and activities of daily living were assessed approximately every 3 months over a 1-year period. Quality of life was evaluated using the Philadelphia Geriatric Center Morale Scale, and activities of daily living were evaluated based on the Functional Independence Measure. The rehabilitation group showed statistically significant improvements in both quality of life and activities of daily living. In contrast, the non-rehabilitation group, although showing slight improvement in quality of life at 9 months, showed almost no effects at the other time-points and no significant changes in activities of daily living over the course of the study. The results of the present study suggest that long-term continuous in-home rehabilitation might improve quality of life and activities of daily living in elderly clients. Geriatr Gerontol Int 2017; 17: 1866-1872. © 2017 Japan Geriatrics Society.

Surgical education to improve the quality of patient care: the role of practice-based learning and improvement.

PubMed

Sachdeva, Ajit K

2007-11-01

Health care is going through immense change, and concerns regarding the quality of patient care and patient safety continue to be expressed in many national forums. A variety of stakeholders are demanding greater accountability from the health care profession. Education is key to supporting surgeons' efforts to provide high-quality patient care during these challenging times. Educational programs for surgeons should be founded on principles of continuous professional development (CPD) and practice-based learning and improvement (PBLI). CPD focuses on the specific needs of individual surgeons and involves lifelong learning throughout a surgeon's career. It needs to form the basis of PBLI efforts. PBLI involves a cycle of four steps--identifying areas for improvement, engaging in learning, applying new knowledge and skills to practice, and checking for improvement. Ongoing involvement in PBLI activities to address specific learning needs should positively impact a surgeon's practice and improve outcomes of surgical care.

Collaborative Learning in Physical Education Teachers' Early-Career Professional Development

ERIC Educational Resources Information Center

Keay, Jeanne

2006-01-01

Background/context: Professional development is an important element of professional practice and teachers are expected to engage in activities that not only improve practice but also have a positive impact on pupil learning. Physical educators worldwide have acknowledged the need to improve the continuing education of teachers and have called…

Implementation of quality improvement techniques for management and technical processes in the ACRV project

NASA Technical Reports Server (NTRS)

Raiman, Laura B.

1992-01-01

Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

Implementation of quality improvement techniques for management and technical processes in the ACRV project

NASA Astrophysics Data System (ADS)

Raiman, Laura B.

1992-12-01

Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

Using scientific evidence to improve information practice.

PubMed

Bradley, J; Marshall, J G

1995-09-01

The recent policy statement of the Medical Library Association (MLA) takes the position that scientific evidence is the basis for improving the quality of library and information sciences now and in the future. Research activity is seen as the foundation of an evolving knowledge base for the profession--a knowledge base that will set health sciences librarians apart from others in an increasingly competitive world of information service providers. The statement represents the culmination of many years of activity by association members, during which the role of research in health information practice has been debated. Over a similar time period, the quality movement, with its increasing demand for the collection and use of data, has been growing. Developments such as total quality management (TQM) and continuous quality improvement (CQI) reinforce the centrality of research with its increasing demand for the collection and use of data, has been growing. Developments such as total quality management (TQM) and continuous quality improvement (CQI) reinforce the centrality of research and its relationship to efficient and effective information practice as envisioned in the MLA policy statement.

Finding a balance between "value added" and feeling valued: revising models of care. The human factor of implementing a quality improvement initiative using Lean methodology within the healthcare sector.

PubMed

Deans, Rachel; Wade, Shawna

2011-01-01

Growing demand from clients waiting to access vital services in a healthcare sector under economic constraint, coupled with the pressure for ongoing improvement within a multi-faceted organization, can have a significant impact on the front-line staff, who are essential to the successful implementation of any quality improvement initiative. The Lean methodology is a management system for continuous improvement based on the Toyota Production System; it focuses on two main themes: respect for people and the elimination of waste or non-value-added activities. Within the Lean process, value-added is used to describe any activity that contributes directly to satisfying the needs of the client, and non-value-added refers to any activity that takes time, space or resources but does not contribute directly to satisfying client needs. Through the revision of existing models of service delivery, the authors' organization has made an impact on increasing access to care and has supported successful engagement of staff in the process, while ensuring that the focus remains on the central needs of clients and families accessing services. While the performance metrics continue to exhibit respectable results for this strategic priority, further gains are expected over the next 18-24 months.

42 CFR 460.140 - Additional quality assessment activities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.140 Additional quality...

PDE Occupational Competency Assessment Project--1979. Final Report. Occupational Competency Evaluation Monograph, Number 10. Vocational Technical Education Research Report, Volume 17, Number 23.

ERIC Educational Resources Information Center

Funk, Gerald W.

A project continued activity to improve the occupational competency assessment program for evaluating and certifying vocational education teachers. Development of new testing was continued by Temple University, The Pennsylvania State University, and University of Pittsburgh. Workshops for test developers were conducted to ensure standardization of…

Continuous Blood Pressure Monitoring in Daily Life

NASA Astrophysics Data System (ADS)

Lopez, Guillaume; Shuzo, Masaki; Ushida, Hiroyuki; Hidaka, Keita; Yanagimoto, Shintaro; Imai, Yasushi; Kosaka, Akio; Delaunay, Jean-Jacques; Yamada, Ichiro

Continuous monitoring of blood pressure in daily life could improve early detection of cardiovascular disorders, as well as promoting healthcare. Conventional ambulatory blood pressure monitoring (ABPM) equipment can measure blood pressure at regular intervals for 24 hours, but is limited by long measuring time, low sampling rate, and constrained measuring posture. In this paper, we demonstrate a new method for continuous real-time measurement of blood pressure during daily activities. Our method is based on blood pressure estimation from pulse wave velocity (PWV) calculation, which formula we improved to take into account changes in the inner diameter of blood vessels. Blood pressure estimation results using our new method showed a greater precision of measured data during exercise, and a better accuracy than the conventional PWV method.

Implementation and evaluation of a community-based interprofessional learning activity.

PubMed

Luebbers, Ellen L; Dolansky, Mary A; Vehovec, Anton; Petty, Gayle

2017-01-01

Implementation of large-scale, meaningful interprofessional learning activities for pre-licensure students has significant barriers and requires novel approaches to ensure success. To accomplish this goal, faculty at Case Western Reserve University, Ohio, USA, used the Ottawa Model of Research Use (OMRU) framework to create, improve, and sustain a community-based interprofessional learning activity for large numbers of medical students (N = 177) and nursing students (N = 154). The model guided the process and included identification of context-specific barriers and facilitators, continual monitoring and improvement using data, and evaluation of student learning outcomes as well as programme outcomes. First year Case Western Reserve University medical students and undergraduate nursing students participated in team-structured prevention screening clinics in the Cleveland Metropolitan Public School District. Identification of barriers and facilitators assisted with overcoming logistic and scheduling issues, large class size, differing ages and skill levels of students and creating sustainability. Continual monitoring led to three distinct phases of improvement and resulted in the creation of an authentic team structure, role clarification, and relevance for students. Evaluation of student learning included both qualitative and quantitative methods, resulting in statistically significant findings and qualitative themes of learner outcomes. The OMRU implementation model provided a useful framework for successful implementation resulting in a sustainable interprofessional learning activity.

Overcoming institutional challenges through continuous professionalism improvement: the University of Washington experience.

PubMed

Fryer-Edwards, Kelly; Van Eaton, Erik; Goldstein, Erika A; Kimball, Harry R; Veith, Richard C; Pellegrini, Carlos A; Ramsey, Paul G

2007-11-01

The University of Washington (UW) School of Medicine is in the midst of an emerging ecology of professionalism. This initiative builds on prior work focusing on professionalism at the student level and moves toward the complete integration of a culture of professionalism within the UW medical community of including staff, faculty, residents, and students. The platform for initiating professionalism as institutional culture is the Committee on Continuous Professionalism Improvement, established in November 2006. This article reviews three approaches to organizational development used within and outside medicine and highlights features that are useful for enhancing an institutional culture of professionalism: organizational culture, safety culture, and appreciative inquiry. UW Medicine has defined professional development as a continuous process, built on concrete expectations, using mechanisms to facilitate learning from missteps and highlighting strengths. To this end, the school of medicine is working toward improvements in feedback, evaluation, and reward structures at all levels (student, resident, faculty, and staff) as well as creating opportunities for community dialogues on professionalism issues within the institution. Throughout all the Continuous Professionalism Improvement activities, a two-pronged approach to cultivating a culture of professionalism is taken: celebration of excellence and attention to accountability.

Sustainability of depression care improvements: success of a practice change improvement collaborative.

PubMed

Nease, Donald E; Nutting, Paul A; Graham, Deborah G; Dickinson, W Perry; Gallagher, Kaia M; Jeffcott-Pera, Michelle

2010-01-01

Long-term sustainment of improvements in care continues to challenge primary care practices. During the 2 years after of our Improving Depression Care collaborative, we examined how well practices were sustaining their depression care improvements. Our study design used a qualitative interview follow-up of a modified learning collaborative intervention. We conducted telephone interviews with practice champions from 15 of the original 16 practices. Interviews were conducted during a 3-month period in 2008, and were recorded and professionally transcribed. Data on each of the depression care improvements and the change management strategy emphasized during the learning collaborative were summarized after review of the primary data and a consensus process to resolve differing interpretations. During the period from 15 months to 3 years since our project began, depression screening or case finding was sustained in 14 of 15 practices. Thirteen practices sustained use of the 9-item Patient Health Questionnaire for depression monitoring, and one additional practice initiated it. Seven practices initiated self-management support and 2 of 3 practices sustained it. In contrast, tracking and case management proved difficult to sustain, with only 4 of 8 practices continuing this activity. Diffusion of use of the 9-item Patient Health Questionnaire to other clinicians in the practice was maintained in all but 3 practices and expanded in one practice. Six of the practices continued to use the change management strategy, including all 4 of the practices that sustained tracking. Practices demonstrated long-term sustained improvement in depression care with the exception of tracking and care management, which may be a more challenging innovation to sustain. We hypothesize that sustaining complex depression care innovations may require active management by the practice.

The effectiveness of whole-body-vibration training in improving hamstring flexibility in physically active adults.

PubMed

Houston, Megan N; Hodson, Victoria E; Adams, Kelda K E; Hoch, Johanna M

2015-02-01

Hamstring tightness is common among physically active individuals. In addition to limiting range of motion and increasing the risk of muscle strain, hamstring tightness contributes to a variety of orthopedic conditions. Therefore, clinicians continue to identify effective methods to increase flexibility. Although hamstring tightness is typically treated with common stretching techniques such as static stretching and proprioceptive neuromuscular facilitation, it has been suggested that whole-body-vibration (WBV) training may improve hamstring flexibility. Can WBV training, used in isolation or in combination with common stretching protocols or exercise, improve hamstring flexibility in physically active young adults? Summary of Key Findings: Of the included studies, 4 demonstrated statistically significant improvements in hamstring flexibility in the intervention group, and 1 study found minor improvements over time in the intervention group after treatment. Clinical Bottom Line: There is moderate evidence to support the use of WBV training to improve hamstring flexibility in physically active young adults. There is grade B evidence that WBV training improves hamstring flexibility in physically active adults. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.

Formal and Informal Continuing Education Activities and Athletic Training Professional Practice

PubMed Central

Armstrong, Kirk J.; Weidner, Thomas G.

2010-01-01

Abstract Context: Continuing education (CE) is intended to promote professional growth and, ultimately, to enhance professional practice. Objective: To determine certified athletic trainers' participation in formal (ie, approved for CE credit) and informal (ie, not approved for CE credit) CE activities and the perceived effect these activities have on professional practice with regard to improving knowledge, clinical skills and abilities, attitudes toward patient care, and patient care itself. Design: Cross-sectional study. Setting: Athletic training practice settings. Patients or Other Participants: Of a geographic, stratified random sample of 1000 athletic trainers, 427 (42.7%) completed the survey. Main Outcome Measure(s): The Survey of Formal and Informal Athletic Training Continuing Education Activities was developed and administered electronically. The survey consisted of demographic characteristics and Likert-scale items regarding CE participation and perceived effect of CE on professional practice. Internal consistency of survey items was determined using the Cronbach α (α  =  0.945). Descriptive statistics were computed for all items. An analysis of variance and dependent t tests were calculated to determine differences among respondents' demographic characteristics and their participation in, and perceived effect of, CE activities. The α level was set at .05. Results: Respondents completed more informal CE activities than formal CE activities. Participation in informal CE activities included reading athletic training journals (75.4%), whereas formal CE activities included attending a Board of Certification–approved workshop, seminar, or professional conference not conducted by the National Athletic Trainers' Association or affiliates or committees (75.6%). Informal CE activities were perceived to improve clinical skills or abilities and attitudes toward patient care. Formal CE activities were perceived to enhance knowledge. Conclusions: More respondents completed informal CE activities than formal CE activities. Both formal and informal CE activities were perceived to enhance athletic training professional practice. Informal CE activities should be explored and considered for CE credit. PMID:20446842

Real World Data Driven Evolution of Volvo Cars’ Side Impact Protection Systems and their Effectiveness

PubMed Central

Jakobsson, Lotta; Lindman, Magdalena; Svanberg, Bo; Carlsson, Henrik

2010-01-01

This study analyses the outcome of the continuous improved occupant protection over the last two decades for front seat near side occupants in side impacts based on a real world driven working process. The effectiveness of four generations of improved side impact protection are calculated based on data from Volvo’s statistical accident database of Volvo Cars in Sweden. Generation I includes vehicles with a new structural and interior concept (SIPS). Generation II includes vehicles with structural improvements and a new chest airbag (SIPSbag). Generation III includes vehicles with further improved SIPS and SIPSbag as well as the new concept with a head protecting Inflatable Curtain (IC). Generation IV includes the most recent vehicles with further improvements of all the systems plus advanced sensors and seat belt pretensioner activation. Compared to baseline vehicles, vehicles of generation I reduce MAIS2+ injuries by 54%, generation II by 61% and generation III by 72%. For generation IV effectiveness figures cannot be calculated because of the lack of MAIS2+ injuries. A continuous improved performance is also seen when studying the AIS2+ pelvis, abdomen, chest and head injuries separately. By using the same real world driven working process, future improvements and possibly new passive as well as active safety systems, will be developed with the aim of further improved protection to near side occupants in side impacts. PMID:21050597

Self and Peer Assessments in Active Learning Model to Increase Metacognitive Awareness and Cognitive Abilities

ERIC Educational Resources Information Center

Pantiwati, Yuni; Husamah

2017-01-01

Metacognitive awareness constitutes a part of thinking skills to continuously retain and develop. One of efforts to increase metacognitive awareness is conducting training through lecture integrated in active learning. Self and peer-assessments encourage students to be more responsible for their performance improvement and learning. The population…

5 CFR 960.107 - Authorized activities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 960.107 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS... resources in finance, internal auditing, personnel management, automated data processing applications... educational development of Government employees, improvement of labor-management relations, equal employment...

5 CFR 960.107 - Authorized activities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 960.107 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS... resources in finance, internal auditing, personnel management, automated data processing applications... educational development of Government employees, improvement of labor-management relations, equal employment...

5 CFR 960.107 - Authorized activities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 960.107 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS... resources in finance, internal auditing, personnel management, automated data processing applications... educational development of Government employees, improvement of labor-management relations, equal employment...

Electrochemical tuning of vertically aligned MoS2 nanofilms and its application in improving hydrogen evolution reaction

PubMed Central

Wang, Haotian; Lu, Zhiyi; Xu, Shicheng; Kong, Desheng; Cha, Judy J.; Zheng, Guangyuan; Hsu, Po-Chun; Yan, Kai; Bradshaw, David; Prinz, Fritz B.; Cui, Yi

2013-01-01

The ability to intercalate guest species into the van der Waals gap of 2D layered materials affords the opportunity to engineer the electronic structures for a variety of applications. Here we demonstrate the continuous tuning of layer vertically aligned MoS2 nanofilms through electrochemical intercalation of Li+ ions. By scanning the Li intercalation potential from high to low, we have gained control of multiple important material properties in a continuous manner, including tuning the oxidation state of Mo, the transition of semiconducting 2H to metallic 1T phase, and expanding the van der Waals gap until exfoliation. Using such nanofilms after different degree of Li intercalation, we show the significant improvement of the hydrogen evolution reaction activity. A strong correlation between such tunable material properties and hydrogen evolution reaction activity is established. This work provides an intriguing and effective approach on tuning electronic structures for optimizing the catalytic activity. PMID:24248362

Monitoring how changes in pedagogical practices have improved student interest and performance for an introductory biochemistry course.

PubMed

Karamanos, Yannis; Couturier, Catherine; Boutin, Viviane; Mysiorek, Caroline; Matéos, Aurélie; Berger, Sylvie

2018-04-01

This study describes feedback on the effects of changes introduced in our teaching practices for an introductory biochemistry course in the Life Sciences curriculum. Students on this course have diverse educational qualifications and are taught in large learning groups, creating challenges for the management of individual learning. We used the constructive alignment principle, refining the learning contract and re-drafting the teaching program to introduce active learning and an organization of activities that promotes the participation of all the students and helps their understanding. We also created teaching resources available through the university virtual work environment. Our research aimed to measure the effects of those changes on the students' success. Monitoring of the student performance showed a continuous increase in the percentage of students who passed the course, from 2.13% to 33.5% in 4 years. Analysis of student perceptions highlighted that the teaching methodology was greatly appreciated by the students, whose attendance also improved. The recent introduction of clickers-questions constituted a complementary leverage. The active involvement of the students and better results for summative assessments are altogether a strong motivation for teaching staff to continue to make improvements.

Proceedings: second Lake States forest tree improvement conference

Treesearch

Lake States Forest Experiment Station

1955-01-01

I am firmly convinced that the Lake States Forest Tree Improvement Committee, and similar groups in other regions, can play an important role in encouraging and coordinating research and other activities in forest genetics. As this new field of work continues to expand, which it assuredly will, it will become of increasing importance to maintain close liaison among the...

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

PubMed Central

Ismail, Ahmad; Rahman, Faid

2016-01-01

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

Techniques for active passivation

DOEpatents

Roscioli, Joseph R.; Herndon, Scott C.; Nelson, Jr., David D.

2016-12-20

In one embodiment, active (continuous or intermittent) passivation may be employed to prevent interaction of sticky molecules with interfaces inside of an instrument (e.g., an infrared absorption spectrometer) and thereby improve response time. A passivation species may be continuously or intermittently applied to an inlet of the instrument while a sample gas stream is being applied. The passivation species may have a highly polar functional group that strongly binds to either water or polar groups of the interfaces, and once bound presents a non-polar group to the gas phase in order to prevent further binding of polar molecules. The instrument may be actively used to detect the sticky molecules while the passivation species is being applied.

Use of Robotics in Colon and Rectal Surgery

PubMed Central

Pucci, Michael J.; Beekley, Alec C.

2013-01-01

The pace of innovation in the field of surgery continues to accelerate. As new technologies are developed in combination with industry and clinicians, specialized patient care improves. In the field of colon and rectal surgery, robotic systems offer clinicians many alternative ways to care for patients. From having the ability to round remotely to improved visualization and dissection in the operating room, robotic assistance can greatly benefit clinical outcomes. Although the field of robotics in surgery is still in its infancy, many groups are actively investigating technologies that will assist clinicians in caring for their patients. As these technologies evolve, surgeons will continue to find new and innovative ways to utilize the systems for improved patient care and comfort. PMID:24436647

Nano-antenna in a photoconductive photomixer for highly efficient continuous wave terahertz emission

PubMed Central

Tanoto, H.; Teng, J. H.; Wu, Q. Y.; Sun, M.; Chen, Z. N.; Maier, S. A.; Wang, B.; Chum, C. C.; Si, G. Y.; Danner, A. J.; Chua, S. J.

2013-01-01

We report highly efficient continuous-wave terahertz (THz) photoconductive antenna based photomixer employing nano-gap electrodes in the active region. The tip-to-tip nano-gap electrode structure provides strong THz field enhancement and acts as a nano-antenna to radiate the THz wave generated in the active region of the photomixer. In addition, it provides good impedance matching to the THz planar antenna and exhibits a lower RC time constant, allowing more efficient radiation especially at the higher part of the THz spectrum. As a result, the output intensity of the photomixer with the new nano-gap electrode structure in the active region is two orders of magnitude higher than that of a photomixer with typical interdigitated electrodes. Significant improvement in the THz emission bandwidth was also observed. An efficient continuous wave THz source will greatly benefit compact THz system development for high resolution THz spectroscopy and imaging applications. PMID:24100840

Teacher perceptions and practices regarding school bullying prevention.

PubMed

Dake, Joseph A; Price, James H; Telljohann, Susan K; Funk, Jeanne B

2003-11-01

This study examined a national random sample of teachers regarding their perceptions and practices concerning school bullying prevention activities. A total of 359 of 700 (52.4%) teachers responded. Most (86.3%) teachers had serious talks with both the bully and victim. Less than one-third set aside classroom time to discuss bullying (31.7%) or involved students in creating classroom rules against bullying (31.2%). Most perceived no barriers to implementing these activities. Teachers perceived post-bullying activities as the most effective means of reducing bullying problems, followed by improved student supervision, and by environmental bullying prevention activities. The findings suggest that preprofessional and continuing education are needed to improve teacher knowledge about effective classroom-based bullying prevention activities.

42 CFR 423.150 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement... utilization management programs, quality assurance measures and systems, and medication therapy management... organization (QIO) activities. (f) Compliance deemed on the basis of accreditation. (g) Accreditation...

42 CFR 423.150 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement... utilization management programs, quality assurance measures and systems, and medication therapy management... organization (QIO) activities. (f) Compliance deemed on the basis of accreditation. (g) Accreditation...

42 CFR 423.150 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement... utilization management programs, quality assurance measures and systems, and medication therapy management... organization (QIO) activities. (f) Compliance deemed on the basis of accreditation. (g) Accreditation...

General guidelines for active traffic management deployment : interim report.

DOT National Transportation Integrated Search

2011-08-01

Continued growth in travel in congested freeway corridors and limited public funding for expansion and improvement projects are limiting agencies abilities to provide sufficient roadway capacity in major metropolitan areas. Focusing on trip reliab...

Transportation energy efficiency trends in the 1990s

DOT National Transportation Integrated Search

2003-04-01

In the 1990s : The transportation sector showed little increase : in energy efficiency as transportation activity and : energy use continued to grow. : Passenger travel energy-efficiency levels : improved slightly, mainly due to efficiency ga...

Freeway geometric design for active traffic management in Europe

DOT National Transportation Integrated Search

2011-03-01

Continued growth in travel on congested urban freeway corridors exceeds the ability of agencies to provide sufficient solutions and alternatives based on traditional roadway expansion and improvement projects. Several countries are implementing manag...

Implementing active traffic management strategies in the U.S.

DOT National Transportation Integrated Search

2010-10-01

Limited public funding for roadway expansion and improvement projects, coupled with continued growth in travel along congested urban freeway corridors, creates a pressing need for innovative congestion management approaches. Strategies to address con...

Advancements in the critical care management of status epilepticus.

PubMed

Bauerschmidt, Andrew; Martin, Andrew; Claassen, Jan

2017-04-01

Status epilepticus has a high morbidity and mortality. There are little definitive data to guide management; however, new recent data continue to improve understanding of management options of status epilepticus. This review examines recent advancements regarding the critical care management of status epilepticus. Recent studies support the initial treatment of status epilepticus with early and aggressive benzodiazepine dosing. There remains a lack of prospective randomized controlled trials comparing different treatment regimens. Recent data support further study of intravenous lacosamide as an urgent-control therapy, and ketamine and clobazam for refractory status epilepticus. Recent data support the use of continuous EEG to help guide treatment for all patients with refractory status epilepticus and to better understand epileptic activity that falls on the ictal-interictal continuum. Recent data also improve our understanding of the relationship between periodic epileptic activity and brain injury. Many treatments are available for status epilepticus and there are much new data guiding the use of specific agents. However, there continues to be a lack of prospective data supporting specific regimens, particularly in cases of refractory status epilepticus.

The relevance of the alliance for CME competencies for planning, organizing, and sustaining an interorganizational educational collaborative.

PubMed

Balmer, Jann T; Bellande, Bruce J; Addleton, Robert L; Havens, Carol S

2011-01-01

The heightened demand for accountability, access, and quality performance from health care professionals has resulted in linkages between continuing education (CE), performance improvement (PI), and outcomes. CE health professionals must also expand their skills and abilities to design, implement, and measure CE activities consistent with these new expectations. In addition to administrative and meeting-planning activities, new competencies associated with educational consultation and performance coaching are needed. This article utilizes the Alliance competencies as the framework for discussion of the competencies of CE professionals and applies it to the unique setting of a collaborative. The CS2day initiative serves as an example of the application of these competencies in this environment. The framework of the Alliance competencies can serve as a guide and a tool for self-assessment, work design, and professional development at individual, organization, and systems levels. Continual reassessment of the Alliance competencies for CE in the health professions will be critical to the continued effectiveness of CE that is linked to performance improvement and outcomes for the CE professional and the health care professionals we serve. A collaborative can provide one option for meeting these new expectations for professional development for CE professionals and the creation of effective educational initiatives. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Exercise in the healthy older adult.

PubMed

Karani, R; McLaughlin, M A; Cassel, C K

2001-01-01

Habitual exercise provides numerous health benefits to the older adult. While dynamic aerobic activities increase stamina and lung capacity, isometric or resistance training improves muscle strength and endurance. Long-term benefits of continued exercise include a decreased risk of death from heart disease, enhanced balance and mobility, a decreased risk of diabetes, and an improvement in depressive symptoms. While the hazards of exercise relate predominantly to extremes of intensity and duration, all older adults should consult with a physician before beginning a new activity program. A prescription for exercise should include both aerobic and resistance training components, and frequent follow-up to improve adherence is highly recommended. (c)2001 CVRR, Inc.

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

PubMed

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

2017-02-01

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

Exercise During the Childbearing Year

PubMed Central

Hammer, Roger L.; Perkins, Jan; Parr, Richard

2000-01-01

Many women wish to continue to pursue an active lifestyle during pregnancy, while the pregnancy itself may provide the motivation for other more sedentary women to begin an exercise program for the sake of improved health/fitness. Also, female competitive athletes, upon becoming pregnant, may wish to continue sports performance and require careful monitoring to assure maternal-fetal safety. This review is designed to assist the perinatal educator who is in the position to advise the pregnant patient on the risks and benefits of physical activity during the childbearing year and provide suggestions for developing individualized exercise programs. PMID:17273187

Total Quality Management: Analysis, Evaluation and Implementation Within ACRV Project Teams

NASA Technical Reports Server (NTRS)

Raiman, Laura B.

1991-01-01

Total quality management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The Assured Crew Return Vehicle (ACRV) Project Office was identified as an excellent project in which to demonstrate the applications and benefits of TQM processes. As the ACRV Program moves through its various stages of development, it is vital that effectiveness and efficiency be maintained in order to provide the Space Station Freedom (SSF) crew an affordable, on-time assured return to Earth. A critical factor for the success of the ACRV is attaining the maximum benefit from the resources applied to the program. Through a series of four tutorials on various quality improvement techniques, and numerous one-on-one sessions during the SSF's 10-week term in the project office, results were obtained which are aiding the ACRV Office in implementing a disciplined, ongoing process for generating fundamental decisions and actions that shape and guide the organization. Significant advances were made in improving the processes for two particular groups - the correspondence distribution team and the WATER Test team. Numerous people from across JSC were a part of the various team activities including engineering, man systems, and safety. The work also included significant interaction with the support contractor to the ACRV Project. The results of the improvement activities can be used as models for other organizations desiring to operate under a system of continuous improvement. In particular, they have advanced the ACRV Project Teams further down the path of continuous improvement, in support of a working philosophy of TQM.

Improving the Physical Activity and Outdoor Play Environment of Family Child Care Homes in Nebraska Through Go Nutrition and Physical Activity Self-Assessment for Child Care.

PubMed

Dinkel, Danae; Dev, Dipti; Guo, Yage; Hulse, Emily; Rida, Zainab; Sedani, Ami; Coyle, Brian

2018-05-09

The purpose of this study was to determine if the Go Nutrition and Physical Activity Self-Assessment in Child Care (Go NAP SACC) intervention was effective in improving best practices in the areas of infant and child physical activity and outdoor play and learning in family child care homes (FCCHs) in Nebraska. FCCHs (n = 201) participated in a pre-post evaluation using the Infant and Child Physical Activity and Outdoor Play and Learning assessments from the Go NAP SACC validated measure to assess compliance with best practices. At post, FCCHs demonstrated significant differences in 85% of the Infant and Child Physical Activity items (17 of 20) and 80% of the Outdoor Play and Learning items (12 of 15). Significant differences in best practices between urban and rural FCCH providers were also found. Go NAP SACC appears to be an effective intervention in Nebraska as, after participation in the initiative, providers were improving child care physical activity best practices. Additional research is needed to objectively determine if these changes resulted in objective improvements in children's physical activity levels. Further, efforts are needed to develop and/or identify geographic-specific resources for continued improvement.

Active Learning of Biochemistry Made Easy (for the Teacher)

ERIC Educational Resources Information Center

Bobich, Joseph A.

2008-01-01

This active learning pedagogical technique aims to improve students' learning in a two-semester, upper-division biochemistry course sequence in which the vast majority of students enrolled will continue on to medical or graduate schools. Instead of lecturing, the Instructor moves to the side of the room, thereby becoming "the guide on the side".…

Sustainable MSD prevention: management for continuous improvement between prevention and production. Ergonomic intervention in two assembly line companies.

PubMed

Caroly, S; Coutarel, F; Landry, A; Mary-Cheray, I

2010-07-01

To increase output and meet customers' needs, companies have turned to the development of production management systems: Kaizen, one piece flow, Kanban, etc. The aim of such systems is to accelerate decisions, react to environmental issues and manage various productions. In the main, this type of management system has led to the continuous improvement of production performance. Consequently, such production management systems can have unexpected negative effects on operators' health and safety. Conversely, regulation and control systems focusing on work-related risks have obliged firms to implement health and safety management systems such as OHSAS 18001. The purpose of this type of system, also based on continuous improvement, is to reduce risks, facilitate work-related activities and identify solutions in terms of equipment and tools. However, the prevention actions introduced through health and safety systems often result in other unexpected and unwanted effects on production. This paper shows how companies can improve the way they are run by taking into account both types of management system. Copyright 2010 Elsevier Ltd. All rights reserved.

Best practices and outreach for active traffic management : final report.

DOT National Transportation Integrated Search

2011-12-01

Continued growth in travel on congested freeway corridors and limited public funding for : expansion and improvement projects are limiting agencies abilities to provide sufficient roadway : capacity in major metropolitan areas. Focusing on trip re...

INDIRECT MEASUREMENT OF BIOLOGICAL ACTIVITY TO MONITOR NATURAL ATTENUATION

EPA Science Inventory

The remediation of ground water contamination by natural attenuation, specifically biodegradation, requires continual monitoring. This research is aimed at improving methods for evaluating the long-term performance of Monitored Natural Attenuation (MNA), specifically changes in ...

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

PubMed

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

2011-03-01

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

FY17 Status Report on NEAMS Neutronics Activities

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

Lee, C. H.; Jung, Y. S.; Smith, M. A.

2017-09-30

Under the U.S. DOE NEAMS program, the high-fidelity neutronics code system has been developed to support the multiphysics modeling and simulation capability named SHARP. The neutronics code system includes the high-fidelity neutronics code PROTEUS, the cross section library and preprocessing tools, the multigroup cross section generation code MC2-3, the in-house meshing generation tool, the perturbation and sensitivity analysis code PERSENT, and post-processing tools. The main objectives of the NEAMS neutronics activities in FY17 are to continue development of an advanced nodal solver in PROTEUS for use in nuclear reactor design and analysis projects, implement a simplified sub-channel based thermal-hydraulic (T/H)more » capability into PROTEUS to efficiently compute the thermal feedback, improve the performance of PROTEUS-MOCEX using numerical acceleration and code optimization, improve the cross section generation tools including MC2-3, and continue to perform verification and validation tests for PROTEUS.« less

Continuous enzymatic hydrolysis of lignocellulosic biomass with simultaneous detoxification and enzyme recovery.

PubMed

Gurram, Raghu N; Menkhaus, Todd J

2014-07-01

Recovering hydrolysis enzymes and/or alternative enzyme addition strategies are two potential mechanisms for reducing the cost during the biochemical conversion of lignocellulosic materials into renewable biofuels and biochemicals. Here, we show that enzymatic hydrolysis of acid-pretreated pine wood with continuous and/or fed-batch enzyme addition improved sugar conversion efficiencies by over sixfold. In addition, specific activity of the hydrolysis enzymes (cellulases, hemicellulases, etc.) increased as a result of continuously washing the residual solids with removal of glucose (avoiding the end product inhibition) and other enzymatic inhibitory compounds (e.g., furfural, hydroxymethyl furfural, organic acids, and phenolics). As part of the continuous hydrolysis, anion exchange resin was tested for its dual application of simultaneous enzyme recovery and removal of potential enzymatic and fermentation inhibitors. Amberlite IRA-96 showed favorable adsorption profiles of inhibitors, especially furfural, hydroxymethyl furfural, and acetic acid with low affinity toward sugars. Affinity of hydrolysis enzymes to adsorb onto the resin allowed for up to 92 % of the enzymatic activity to be recovered using a relatively low-molar NaCl wash solution. Integration of an ion exchange column with enzyme recovery into the proposed fed-batch hydrolysis process can improve the overall biorefinery efficiency and can greatly reduce the production costs of lignocellulosic biorenewable products.

Japanese style total quality control: A first hand experience

NASA Astrophysics Data System (ADS)

Cook, S. C.

1991-11-01

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

Extra-analytical quality indicators and laboratory performances.

PubMed

Sciacovelli, Laura; Aita, Ada; Plebani, Mario

2017-07-01

In the last few years much progress has been made in raising the awareness of laboratory medicine professionals about the effectiveness of quality indicators (QIs) in monitoring, and improving upon, performances in the extra-analytical phases of the Total Testing Process (TTP). An effective system for management of QIs includes the implementation of an internal assessment system and participation in inter-laboratory comparison. A well-designed internal assessment system allows the identification of critical activities and their systematic monitoring. Active participation in inter-laboratory comparison provides information on the performance level of one laboratory with respect to that of other participating laboratories. In order to guarantee the use of appropriate QIs and facilitate their implementation, many laboratories have adopted the Model of Quality Indicators (MQI) proposed by Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) of IFCC, since 2008, which is the result of international consensus and continuous experimentation, and updating to meet new, constantly emerging needs. Data from participating laboratories are collected monthly and reports describing the statistical results and evaluating laboratory data, utilizing the Six Sigma metric, issued regularly. Although the results demonstrate that the processes need to be improved upon, overall the comparison with data collected in 2014 shows a general stability of quality levels and that an improvement has been achieved over time for some activities. The continuous monitoring of QI data allows identification all possible improvements, thus highlighting the value of participation in the inter-laboratory program proposed by WG-LEPS. The active participation of numerous laboratories will guarantee an ever more significant State-of-the-Art, promote the reduction of errors and improve quality of the TTP, thus guaranteeing patient safety. Copyright © 2017. Published by Elsevier Inc.

Total knee arthroplasty in motivated patients with knee osteoarthritis and athletic activity approach type goals: a conceptual decision-making model.

PubMed

Nyland, John; Kanouse, Zachary; Krupp, Ryan; Caborn, David; Jakob, Rolie

2011-01-01

Knee osteoarthritis is one of the most common disabling medical conditions. With longer life expectancy the number of total knee arthroplasty (TKA) procedures being performed worldwide is projected to increase dramatically. Patient education, physical activity, bodyweight levels, expectations and goals regarding the ability to continue athletic activity participation are also increasing. For the subset of motivated patients with knee osteoarthritis who have athletic activity approach type goals, early TKA may not be the best knee osteoarthritis treatment option to improve satisfaction, quality of life and outcomes. The purpose of this clinical commentary is to present a conceptual decision-making model designed to improve the knee osteoarthritis treatment intervention outcome for motivated patients with athletic activity approach type goals. The model focuses on improving knee surgeon, patient and rehabilitation clinician dialogue by rank ordering routine activities of daily living and quality of life evoking athletic activities based on knee symptom exacerbation or re-injury risk. This process should help establish realistic patient expectations and goals for a given knee osteoarthritis treatment intervention that will more likely improve self-efficacy, functional independence, satisfaction and outcomes while decreasing the failure risk associated with early TKA.

By Product Synergy Analysis

DTIC Science & Technology

2011-03-24

four phases represent an easy way to implement continuous improvement activities. Figure 3. PDCA Cycle ( Heizer and Render , 2006...Environment: a guide to sustainable product development”, McGraw-Hill, 2nd Edition, 2009. 78 Heizer , Jay and Barry Render (2006), “Principles of

What is your hospitality quotient?

PubMed

DeSilets, Lyn

2015-03-01

In addition to the behind-the-scenes work involved with planning and implementing continuing nursing education activities, there are additional ways we can enhance the learner's experience. This article presents ideas on how to improve your hospitality quotient. Copyright 2015, SLACK Incorporated.

Satellite-tracking and Earth dynamics research programs

NASA Technical Reports Server (NTRS)

1982-01-01

The activities carried out by the Smithsonian Astrophysical Observatory (SAO) are described. The SAO network continued to track LAGEOS at highest priority for polar motion and Earth rotation studies, and for other geophysical investigations, including crustal dynamics, Earth and ocean tides, and the general development of precision orbit determination. The network performed regular tracking of several other retroreflector satellites including GEOS-1, GEOS-3, BE-C, and Starlette for refined determinations of station coordinates and the Earth's gravity field and for studies of solid Earth dynamics. A major program in laser upgrading continued to improve ranging accuracy and data yield. This program includes an increase in pulse repetition rate from 8 ppm to 30 ppm, a reduction in laser pulse width from 6 nsec to 2 to 3 nsec, improvements in the photoreceiver and the electronics to improve daylight ranging, and an analog pulse detection system to improve range noise and accuracy. Data processing hardware and software are discussed.

Activity recognition of assembly tasks using body-worn microphones and accelerometers.

PubMed

Ward, Jamie A; Lukowicz, Paul; Tröster, Gerhard; Starner, Thad E

2006-10-01

In order to provide relevant information to mobile users, such as workers engaging in the manual tasks of maintenance and assembly, a wearable computer requires information about the user's specific activities. This work focuses on the recognition of activities that are characterized by a hand motion and an accompanying sound. Suitable activities can be found in assembly and maintenance work. Here, we provide an initial exploration into the problem domain of continuous activity recognition using on-body sensing. We use a mock "wood workshop" assembly task to ground our investigation. We describe a method for the continuous recognition of activities (sawing, hammering, filing, drilling, grinding, sanding, opening a drawer, tightening a vise, and turning a screwdriver) using microphones and three-axis accelerometers mounted at two positions on the user's arms. Potentially "interesting" activities are segmented from continuous streams of data using an analysis of the sound intensity detected at the two different locations. Activity classification is then performed on these detected segments using linear discriminant analysis (LDA) on the sound channel and hidden Markov models (HMMs) on the acceleration data. Four different methods at classifier fusion are compared for improving these classifications. Using user-dependent training, we obtain continuous average recall and precision rates (for positive activities) of 78 percent and 74 percent, respectively. Using user-independent training (leave-one-out across five users), we obtain recall rates of 66 percent and precision rates of 63 percent. In isolation, these activities were recognized with accuracies of 98 percent, 87 percent, and 95 percent for the user-dependent, user-independent, and user-adapted cases, respectively.

Improving the effect of FDA-mandated drug safety alerts with Internet-based continuing medical education.

PubMed

Kraus, Carl N; Baldwin, Alan T; McAllister, R G

2013-02-01

The US Food and Drug Administration (FDA) requires risk communication as an element of Risk Evaluation and Mitigation Strategies (REMS) to alert and educate healthcare providers about severe toxicities associated with approved drugs. The educational effectiveness of this approach has not been evaluated. To support the communication plan element of the ipilimumab REMS, a Medscape Safe Use Alert (SUA) letter was distributed by Medscape via email and mobile device distribution to clinicians specified in the REMS. This alert contained the FDA-approved Dear Healthcare Provider (DHCP) letter mandated for distribution. A continuing medical education (CME) activity describing ipilimumab toxicities and the appropriate management was simultaneously posted on the website and distributed to Medscape members. Data were collected over a 6-month period regarding the handling of the letter and the responses to pre- and post-test questions for those who participated in the CME activity. Analysis of the answers to the pre- and posttest questions showed that participation in the CME activity resulted in an improvement in correct answer responses of 47%. Our experience shows that there are likely distinct information sources that are utilized by different HCP groups. The ready availability of a brief CME activity was utilized by 24,063 individuals, the majority of whom showed enhanced understanding of ipilimumab toxicity by improvement in post-test scores, educational data that are not available via implementation of standard safety alert communications. These results demonstrate that improvement in understanding of specific drug toxicities is enhanced by a CME intervention.

Impact of Health and Fitness-Related Behavior on Quality of Life

DTIC Science & Technology

1990-12-31

physical activity: running, bicycling, swimming, playing racket sports, continuous walking, performing 7 aerobics, doing calisthenics , weight lifting, and...generally spent in one workout period for each activity (duration). A rate of kilocalories expended per minute was assigned to each activity using the...e.g., protein additives, wheat germ, bran, lecithin). 11. I do things that will improve my health. Traffic Risk 1. I cross busy streets in the middle

Curriculum renewal in child psychiatry.

PubMed

Hanson, M; Tiberius, R; Charach, A; Ulzen, T; Sackin, D; Jain, U; Reiter, S; Shomair, G

1999-11-01

To ensure uniform design and evaluation of a clerkship curriculum for child and adolescent psychiatry teaching common disorders and problems in an efficient manner across 5 teaching sites and to include structures for continuous improvement. The curriculum committee selected for course inclusion disorders and problems of child psychiatry that were commonly encountered by primary care physicians. Instruction methods that encouraged active student learning were selected. Course coordination across sites was encouraged by several methods: involving faculty, adopting a centralized examination format, and aligning teaching methods with examination format. Quantitative and qualitative methods were used to measure students' perceptions of the course's value. These evaluative results were reviewed, and course modifications were implemented and reevaluated. The average adjusted student return rate for course evaluation questionnaires for the 3-year study period was 63%. Clerks' ratings of course learning value demonstrated that the course improved significantly and continually across all sites, according to a Scheffé post-hoc analysis. Analysis of student statements from focus-group transcripts contributed to course modifications, such as the Brief Focused Interview (BFI). Our curriculum in child psychiatry, which focused on common problems and used active learning methods, was viewed as a valuable learning experience by clinical clerks. Curriculum coordination across multiple teaching sites was accomplished by including faculty in the process and by using specific teaching and examination strategies. Structures for continuous course improvement were effective.

Tracking and data system support for the pioneer project. Volume 11 Pioneers 6-9. Extended missions: 1 July 1971 - 1 July 1973

NASA Technical Reports Server (NTRS)

Renzetti, N. A.; Siegmeth, A. J.

1973-01-01

The Tracking and Data System supported the deep space phases of the Pioneer 6, 7, 8, and 9 missions, with two spacecraft in an inward trajectory and two spacecraft in an outward trajectory from the earth in heliocentric orbits. Scientific instruments aboard each of the spacecraft continued to register information relative to interplanetary particles and fields, and radio metric data generated by the network continued to improve our knowledge of the celestial mechanics of the solar system. In addition to network support activity detail, network performance and special support activities are covered.

Global Lightning Activity

NASA Technical Reports Server (NTRS)

Christian, Hugh J.

2004-01-01

Our knowledge of the global distribution of lightning has improved dramatically since the advent of spacebased lightning observations. Of major importance was the 1995 launch of the Optical Transient Detector (OTD), followed in 1997 by the launch of the Lightning Imaging Sensor (LIS). Together, these instruments have generated a continuous eight-year record of global lightning activity. These lightning observations have provided a new global perspective on total lightning activity. For the first time, total lightning activity (cloud-to-ground and intra-cloud) has been observed over large regions with high detection efficiency and accurate geographic location. This has produced new insights into lightning distributions, times of occurrence and variability. It has produced a revised global flash rate estimate (44 flashes per second) and has lead to a new realization of the significance of total lightning activity in severe weather. Accurate flash rate estimates are now available over large areas of the earth (+/- 72 deg. latitude). Ocean-land contrasts as a function of season are clearly reveled, as are orographic effects and seasonal and interannual variability. The space-based observations indicate that air mass thunderstorms, not large storm system dominate global activity. The ability of LIS and OTD to detect total lightning has lead to improved insight into the correlation between lightning and storm development. The relationship between updraft development and lightning activity is now well established and presents an opportunity for providing a new mechanism for remotely monitoring storm development. In this concept, lightning would serve as a surrogate for updraft velocity. It is anticipated that this capability could lead to significantly improved severe weather warning times and reduced false warning rates. This talk will summarize our space-based lightning measurements, will discuss how lightning observations can be used to monitor severe weather, and present a concept for continuous geostationary-based lightning observations.

The effects of fitness on the aging process.

PubMed

Vopat, Bryan G; Klinge, Stephen A; McClure, Philip K; Fadale, Paul D

2014-09-01

Decades of research support the fact that much age-related deterioration is the result of the effects of sedentary lifestyles and the development of medical conditions rather than of aging itself. Elite older athletes, who demonstrate enhanced performance compared with historic cohorts and even some younger peers, are models of this paradigm. Many non-elite middle-aged adults and older adults continue to remain increasingly active throughout middle age and beyond. A continually growing body of basic science and clinical evidence demonstrates how active persons modulate physical decline through training. An updated understanding of how active adults defy age helps orthopaedic surgeons not only manage their patients' performance but also improve their lives. A large segment of sedentary older adults will benefit from counseling that encourages the pursuit of more active and healthier lifestyles. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

Magnetic Earth Ionosphere Resonant Frequencies (MEIRF) project

NASA Technical Reports Server (NTRS)

Spaniol, Craig

1993-01-01

The West Virginia State College Community College Division NASA Magnetic Earth Ionosphere Resonant Frequencies (MEIRF) study is described. During this contract period, the two most significant and professionally rewarding events were the presentation of the research activity at the Sir Isaac Newton Conference in St. Petersburg, Russia, and the second Day of Discovery Conference, focusing on economic recovery in West Virginia. An active antenna concept utilizing a signal feedback principle similar to regenerative receivers used in early radio was studied. The device has potential for ELF research and other commercial applications for improved signal reception. Finally, work continues to progress on the development of a prototype monitoring station. Signal monitoring, data display, and data storage are major areas of activity. In addition, we plan to continue our dissemination of research activity through presentations at seminars and other universities.

[Effects of different application rates of calcium cyanamide on soil microbial biomass and enzyme activity in cucumber continuous cropping].

PubMed

Zhang, Xue-peng; Ning, Tang-yuan; Yang, Yan; Sun, Tao; Zhang, Shu-min; Wang, Bin

2015-10-01

A 2-year field experiment was conducted to study the effects of CaCN2 combined with cucumber straw retention on soil microbial biomass carbon (SMBC) , soil microbial biomass nitrogen (SMBN) and soil enzyme activities under cucumber continuous cropping system. Four treatments were used in this study as follows: CK (null CaCN2), CaCN2-90 (1350 kg CaCN2 . hm-2) CaCN2-60 (900 kg CaCN2 . hm-2), CaCN2-30 (450 kg CaCN2 . hm-2). The results indicated that, compared with the other treatments, CaCN2-90 treatment significantly decreased SMBC in 0-10 cm soil layer at seedling stage, but increased SMBC in 0-20 cm soil layer after early-fruit stage. Compared with CK, CaCN2 increased SMBC in 0-20 cm soil layer at late-fruit stage, and increased SMBN in 0-10 cm soil layer at mid- and late-fruit stages, however there was no significant trend among CaCN2 treatments in the first year (2012), while in the second year (2013) SMBN increased with the increasing CaCN2 amount after mid-fruit stage. CaCN2 increased straw decaying and nutrients releasing, and also increased soil organic matter. Furthermore, the CaCN2-90 could accelerate straw decomposition. Compared with CK, CaCN2 effectively increased soil urease, catalase and polyphenol oxidase activity. The soil urease activity increased while the polyphenol oxidase activity decreased with the increase of CaCN2, and CaCN2-60 could significantly improve catalase activity. Soil organic matter, urease activity and catalase activity had significant positive correlations with SMBC and SMBN. However, polyphenol oxidase activity was negatively correlated to SMBC and SMBN. Our findings indicated that CaCN2 application at 900 kg . hm-2 combined with cucumber straw retention could effectively improve soil environment, alleviating the soil obstacles under the cucumber continuous cropping system.

Crystal and Particle Engineering Strategies for Improving Powder Compression and Flow Properties to Enable Continuous Tablet Manufacturing by Direct Compression.

PubMed

Chattoraj, Sayantan; Sun, Changquan Calvin

2018-04-01

Continuous manufacturing of tablets has many advantages, including batch size flexibility, demand-adaptive scale up or scale down, consistent product quality, small operational foot print, and increased manufacturing efficiency. Simplicity makes direct compression the most suitable process for continuous tablet manufacturing. However, deficiencies in powder flow and compression of active pharmaceutical ingredients (APIs) limit the range of drug loading that can routinely be considered for direct compression. For the widespread adoption of continuous direct compression, effective API engineering strategies to address power flow and compression problems are needed. Appropriate implementation of these strategies would facilitate the design of high-quality robust drug products, as stipulated by the Quality-by-Design framework. Here, several crystal and particle engineering strategies for improving powder flow and compression properties are summarized. The focus is on the underlying materials science, which is the foundation for effective API engineering to enable successful continuous manufacturing by the direct compression process. Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

One for All & All for One

ERIC Educational Resources Information Center

Omotani, Les M.

2010-01-01

The author spent his two superintendencies perfecting a collaborative leadership concept known as "the superintendency." This concept recognized that significant change and positive, continuous improvement required long-term, concentrated attention rather than a few years of frantic activity. While the "superintendency"…

Integrated Vehicle Health Management (IVHM) Activities at Kennedy Space Center

NASA Technical Reports Server (NTRS)

Fox, Jack

2000-01-01

Integrated Vehicle Health Management (IVHM) goals are to develop and integrate the technologies which can provide a continuous, intelligent, and adaptive health state of a vehicle and use this information to improve safety and reduce the costs of operations.

Career ladder program for registered nurses in ambulatory care.

PubMed

Nelson, Joan; Sassaman, Becky; Phillips, Alison

2008-01-01

RN ladder programs are designed to inspire and reward clinical excellence. Kaiser Permanente Colorado's (KPCO) career ladder program emerged as a result of a labor-management partnership. Career ladder point assignments are reflective of the organization's priorities and values. KPCO's career ladder point tool awards RNs for formal and continuing education, professional presentations, organizational experience and experience as an RN, certifications and active professional memberships, leadership activities, research and publications, and nursing-related volunteer work. Participation in the RN career ladder requires that the nurse achieve a self-determined, manager-approved, measurable goal that will improve patient care. Career ladder nurses at KPCO were significantly more involved in leadership and interdisciplinary activities, quality improvement projects, and preceptorship.

Pervasive Computing Technologies to Continuously Assess Alzheimer's Disease Progression and Intervention Efficacy.

PubMed

Lyons, Bayard E; Austin, Daniel; Seelye, Adriana; Petersen, Johanna; Yeargers, Jonathan; Riley, Thomas; Sharma, Nicole; Mattek, Nora; Wild, Katherine; Dodge, Hiroko; Kaye, Jeffrey A

2015-01-01

Traditionally, assessment of functional and cognitive status of individuals with dementia occurs in brief clinic visits during which time clinicians extract a snapshot of recent changes in individuals' health. Conventionally, this is done using various clinical assessment tools applied at the point of care and relies on patients' and caregivers' ability to accurately recall daily activity and trends in personal health. These practices suffer from the infrequency and generally short durations of visits. Since 2004, researchers at the Oregon Center for Aging and Technology (ORCATECH) at the Oregon Health and Science University have been working on developing technologies to transform this model. ORCATECH researchers have developed a system of continuous in-home monitoring using pervasive computing technologies that make it possible to more accurately track activities and behaviors and measure relevant intra-individual changes. We have installed a system of strategically placed sensors in over 480 homes and have been collecting data for up to 8 years. Using this continuous in-home monitoring system, ORCATECH researchers have collected data on multiple behaviors such as gait and mobility, sleep and activity patterns, medication adherence, and computer use. Patterns of intra-individual variation detected in each of these areas are used to predict outcomes such as low mood, loneliness, and cognitive function. These methods have the potential to improve the quality of patient health data and in turn patient care especially related to cognitive decline. Furthermore, the continuous real-world nature of the data may improve the efficiency and ecological validity of clinical intervention studies.

Pervasive Computing Technologies to Continuously Assess Alzheimer’s Disease Progression and Intervention Efficacy

PubMed Central

Lyons, Bayard E.; Austin, Daniel; Seelye, Adriana; Petersen, Johanna; Yeargers, Jonathan; Riley, Thomas; Sharma, Nicole; Mattek, Nora; Wild, Katherine; Dodge, Hiroko; Kaye, Jeffrey A.

2015-01-01

Traditionally, assessment of functional and cognitive status of individuals with dementia occurs in brief clinic visits during which time clinicians extract a snapshot of recent changes in individuals’ health. Conventionally, this is done using various clinical assessment tools applied at the point of care and relies on patients’ and caregivers’ ability to accurately recall daily activity and trends in personal health. These practices suffer from the infrequency and generally short durations of visits. Since 2004, researchers at the Oregon Center for Aging and Technology (ORCATECH) at the Oregon Health and Science University have been working on developing technologies to transform this model. ORCATECH researchers have developed a system of continuous in-home monitoring using pervasive computing technologies that make it possible to more accurately track activities and behaviors and measure relevant intra-individual changes. We have installed a system of strategically placed sensors in over 480 homes and have been collecting data for up to 8 years. Using this continuous in-home monitoring system, ORCATECH researchers have collected data on multiple behaviors such as gait and mobility, sleep and activity patterns, medication adherence, and computer use. Patterns of intra-individual variation detected in each of these areas are used to predict outcomes such as low mood, loneliness, and cognitive function. These methods have the potential to improve the quality of patient health data and in turn patient care especially related to cognitive decline. Furthermore, the continuous real-world nature of the data may improve the efficiency and ecological validity of clinical intervention studies. PMID:26113819

A first continuous 4-aminoantipyrine (4-AAP)-based screening system for directed esterase evolution.

PubMed

Lülsdorf, Nina; Vojcic, Ljubica; Hellmuth, Hendrik; Weber, Thomas T; Mußmann, Nina; Martinez, Ronny; Schwaneberg, Ulrich

2015-06-01

Esterases hydrolyze ester bonds with an often high stereoselectivity as well as regioselectivity and are therefore industrially employed in the synthesis of pharmaceuticals, in food processing, and in laundry detergents. Continuous screening systems based on p-nitrophenyl- (e.g., p-nitrophenyl acetate) or umbelliferyl-esters are commonly used in directed esterase evolution campaigns. Ongoing challenges in directed esterase evolution are screening formats which offer a broad substrate spectrum, especially for complex aromatic substrates. In this report, a novel continuous high throughput screening system for indirect monitoring of esterolytic activity was developed and validated by detection of phenols employing phenyl benzoate as substrate and p-nitrobenzyl esterase (pNBEBL from Bacillus licheniformis) as catalyst. The released phenol directly reacts with 4-aminoantipyrine yielding the red compound 1,5-dimethyl-4-(4-oxo-cyclohexa-2,5-dienylidenamino)-2-phenyl-1,2-dihydro-pyrazol-3-one. In this continuous B. licheniformis esterase activity detection system (cBLE-4AAP), the product formation is followed through an increase in absorbance at 509 nm. The cBLE-4AAP screening system was optimized in 96-well microtiter plate format in respect to standard deviation (5 %), linear detection range (15 to 250 μM), lower detection limit (15 μM), and pH (7.4 to 10.4). The cBLE-4AAP screening system was validated by screening a random epPCR pNBEBL mutagenesis library (2000 clones) for improved esterase activity at elevated temperatures. Finally, the variant T3 (Ser378Pro) was identified which nearly retains its specific activity at room temperature (WT 1036 U/mg and T3 929 U/mg) and shows compared to WT a 4.7-fold improved residual activity after thermal treatment (30 min incubation at 69.4 °C; WT 170 U/mg to T3 804 U/mg).

Impact of Performance Improvement Continuing Medical Education on Cardiometabolic Risk Factor Control: The COSEHC Initiative

PubMed Central

Joyner, JaNae; Moore, Michael A.; Simmons, Debra R.; Forrest, Brian; Yu-Isenberg, Kristina; Piccione, Ron; Caton, Kirt; Lackland, Daniel T.; Ferrario, Carlos M.

2016-01-01

Introduction The Consortium for Southeastern Hypertension Control (COSEHC) implemented a study to assess benefits of a performance improvement continuing medical education (PI CME) activity focused on cardiometabolic risk factor management in primary care patients. Methods Using the plan-do-study-act (PDSA) model as the foundation, this PI CME activity aimed at improving practice gaps by integrating evidence-based clinical interventions, physician-patient education, processes of care, performance metrics, and patient outcomes. The PI CME intervention was implemented in a group of South Carolina physician practices, while a comparable physician practice group served as a control. Performance outcomes at 6 months included changes in patients’ cardiometabolic risk factor values and control rates from baseline. We also compared changes in diabetic, African American, the elderly (> 65 years), and female patient subpopulations and in patients with uncontrolled risk factors at baseline. Results Only women receiving health care by intervention physicians showed a statistical improvement in their cardiometabolic risk factors as evidenced by a −3.0 mg/dL and a −3.5 mg/dL decrease in mean LDL cholesterol and non-HDL cholesterol, respectively, and a −7.0 mg/dL decrease in LDL cholesterol among females with uncontrolled baseline LDL cholesterol values. No other statistical differences were found. Discussion These data demonstrate that our PI CME activity is a useful strategy in assisting physicians to improve their management of cardiometabolic control rates in female patients with abnormal cholesterol control. Other studies that extend across longer PI CME PDSA periods may be needed to demonstrate statistical improvements in overall cardiometabolic treatment goals in men, women, and various subpopulations. PMID:24648361

MEG and fMRI Fusion for Non-Linear Estimation of Neural and BOLD Signal Changes

PubMed Central

Plis, Sergey M.; Calhoun, Vince D.; Weisend, Michael P.; Eichele, Tom; Lane, Terran

2010-01-01

The combined analysis of magnetoencephalography (MEG)/electroencephalography and functional magnetic resonance imaging (fMRI) measurements can lead to improvement in the description of the dynamical and spatial properties of brain activity. In this paper we empirically demonstrate this improvement using simulated and recorded task related MEG and fMRI activity. Neural activity estimates were derived using a dynamic Bayesian network with continuous real valued parameters by means of a sequential Monte Carlo technique. In synthetic data, we show that MEG and fMRI fusion improves estimation of the indirectly observed neural activity and smooths tracking of the blood oxygenation level dependent (BOLD) response. In recordings of task related neural activity the combination of MEG and fMRI produces a result with greater signal-to-noise ratio, that confirms the expectation arising from the nature of the experiment. The highly non-linear model of the BOLD response poses a difficult inference problem for neural activity estimation; computational requirements are also high due to the time and space complexity. We show that joint analysis of the data improves the system's behavior by stabilizing the differential equations system and by requiring fewer computational resources. PMID:21120141

Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians.

PubMed

Thomas, David C; Johnston, Bree; Dunn, Kathel; Sullivan, Gail M; Brett, Belle; Matzko, Marilyn; Levine, Sharon A

2006-10-01

Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners.

Improved Low Temperature Performance of Supercapacitors

NASA Technical Reports Server (NTRS)

Brandon, Erik J.; West, William C.; Smart, Marshall C.; Gnanaraj, Joe

2013-01-01

Low temperature double-layer capacitor operation enabled by: - Base acetonitrile / TEATFB salt formulation - Addition of low melting point formates, esters and cyclic ethers center dot Key electrolyte design factors: - Volume of co-solvent - Concentration of salt center dot Capacity increased through higher capacity electrodes: - Zeolite templated carbons - Asymmetric cell designs center dot Continuing efforts - Improve asymmetric cell performance at low temperature - Cycle life testing Motivation center dot Benchmark performance of commercial cells center dot Approaches for designing low temperature systems - Symmetric cells (activated carbon electrodes) - Symmetric cells (zeolite templated carbon electrodes) - Asymmetric cells (lithium titanate/activated carbon electrodes) center dot Experimental results center dot Summary

Econazole Nitrate Foam 1% Improves the Itch of Tinea Pedis.

PubMed

Fleischer, Alan B; Raymond, Isabelle

2016-09-01

Econazole nitrate topical foam, 1%, is indicated for the treatment of interdigital tinea pedis caused by Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum in patients 12 years of age and older. The symptom of itch or pruritus was evaluated in two randomized, double-blind, parallel-group, vehicle-controlled, multicenter Phase III studies in which econazole foam was compared with foam vehicle in subjects with interdigital tinea pedis. A thin, uniform layer of study treatment was applied once daily to all clinically affected interdigital regions of both feet for four weeks. At baseline, at least 69% of all subjects had moderate to severe itch. Throughout the duration of both studies, numerically econazole foam was numerically superior to vehicle in achieving absence of itch. After the cessation of treatment, from day 29, itching continues to improve until day 43 in the active treatment group, whereas there is no evident continued improvement within the vehicle foam groups. At day 43, in the active treatment groups, 83% in Study 1 and 71% in Study 2 achieved complete absence of itching. Using less stringent criteria, for the econazole nitrate foam arm, achieving no itch or mild itch (0 or 1), in Study 1, 95% and 86.8% in Study 2 achieved this outcome. Tolerability of the products was excellent with few treatment-related adverse events. In summary, econazole foam decreased the burden of itch as early as day 8 in patients with interdigital tinea pedis, and this improvement continued after cessation of treatment.

J Drugs Dermatol. 2016;15(9):1111-1114.

Comparative genome analysis of a thermotolerant Escherichia coli obtained by Genome Replication Engineering Assisted Continuous Evolution (GREACE) and its parent strain provides new understanding of microbial heat tolerance.

PubMed

Luan, Guodong; Bao, Guanhui; Lin, Zhao; Li, Yang; Chen, Zugen; Li, Yin; Cai, Zhen

2015-12-25

Heat tolerance of microbes is of great importance for efficient biorefinery and bioconversion. However, engineering and understanding of microbial heat tolerance are difficult and insufficient because it is a complex physiological trait which probably correlates with all gene functions, genetic regulations, and cellular metabolisms and activities. In this work, a novel strain engineering approach named Genome Replication Engineering Assisted Continuous Evolution (GREACE) was employed to improve the heat tolerance of Escherichia coli. When the E. coli strain carrying a mutator was cultivated under gradually increasing temperature, genome-wide mutations were continuously generated during genome replication and the mutated strains with improved thermotolerance were autonomously selected. A thermotolerant strain HR50 capable of growing at 50°C on LB agar plate was obtained within two months, demonstrating the efficiency of GREACE in improving such a complex physiological trait. To understand the improved heat tolerance, genomes of HR50 and its wildtype strain DH5α were sequenced. Evenly distributed 361 mutations covering all mutation types were found in HR50. Closed material transportations, loose genome conformation, and possibly altered cell wall structure and transcription pattern were the main differences of HR50 compared with DH5α, which were speculated to be responsible for the improved heat tolerance. This work not only expanding our understanding of microbial heat tolerance, but also emphasizing that the in vivo continuous genome mutagenesis method, GREACE, is efficient in improving microbial complex physiological trait. Copyright © 2015 Elsevier B.V. All rights reserved.

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

PubMed

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

2007-07-01

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

The journey

NASA Astrophysics Data System (ADS)

Cohen, Lori A.

1995-12-01

Kodak Optical Products has embarked on a journey that will ultimately lead to manufacturing excellence and total customer satisfaction. With quality as our compass we have already obtained ISO 9001 and Manufacturing Resource Planning (MRP) II certifications. Seeking and attaining these certifications enabled us to understand and enhance fundamentals relative to the operation of our business. This has provided a solid foundation from which we can launch continuous improvement activities. Now we continue our journey to such destinations as 10X reduction in both defects and cycle time, measuring and reducing our cost of poor quality, and upgrading our quality information system. Our presentation will emphasize our 10X improvement process and how it applies to high-volume production of precision plastic optics.

The power of play: Innovations in Getting Active Summit 2011: a science panel proceedings report from the American Heart Association.

PubMed

Lieberman, Debra A; Chamberlin, Barbara; Medina, Ernie; Franklin, Barry A; Sanner, Brigid McHugh; Vafiadis, Dorothea K

2011-05-31

To examine the influence active-play video gaming (also referred to as exergaming, exertainment, and active gaming) might have on improving health-related skills, enhancing self-esteem and self-efficacy, promoting social support, and ultimately motivating positive changes in health behaviors, the American Heart Association convened The Power of Play: Innovations in Getting Active Summit. The summit, as well as a follow-up science panel, was hosted by the American Heart Association and Nintendo of America. The science panel discussed the current state of research on active-play video gaming and its potential to serve as a gateway experience that might motivate players to increase the amount and intensity of physical activity in their daily lives. The panel identified the need for continued research on the gateway concept and on other behavioral health outcomes that could result from active-play video games and considered how these games could potentially affect disparate populations. The summit represented an exciting first step in convening healthcare providers, behavioral researchers, and professionals from the active-play video game industry to discuss the potential health benefits of active-play video games. Research is needed to improve understanding of processes of behavior change with active games. Future games and technologies may be designed with the goal to optimize physical activity participation, increase energy expenditure, and effectively address the abilities and interests of diverse and targeted populations. The summit helped the participants gain an understanding of what is known, identified gaps in current research, and supported a dialogue for continued collaboration.

Macromolecular Structure Database. Final Progress Report

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

Gilliland, Gary L.

2003-09-23

The central activity of the PDB continues to be the collection, archiving and distribution of high quality structural data to the scientific community on a timely basis. In support of these activities NIST has continued its roles in developing the physical archive, in developing data uniformity, in dealing with NMR issues and in the distribution of PDB data through CD-ROMs. The physical archive holdings have been organized, inventoried, and a database has been created to facilitate their use. Data from individual PDB entries have been annotated to produce uniform values improving tremendously the accuracy of results of queries. Working withmore » the NMR community we have established data items specific for NMR that will be included in new entries and facilitate data deposition. The PDB CD-ROM production has continued on a quarterly basis, and new products are being distributed.« less

Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project.

PubMed

Buck, Harleah G; Kolanowski, Ann; Fick, Donna; Baronner, Lawrence

2016-07-01

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project," found on pages 306-313, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until June 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Describe the unique nursing challenges that occur in caring for older adults in rural areas. Discuss the Improving Rural Geriatric Care through Education (iRuGCE) project, including the facilitators and challenges to its implementation. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. Rural elders are the fastest growing segment of the U.S. population, with a projected increase of 32% in the next 20 years. Shortages in geriatric-prepared workers are particularly critical in rural areas. This article describes Improving Rural Geriatric Care through Education (iRuGCE), a feasible, scalable, and collaborative continuing education project. iRuGCE was designed to improve geriatric nursing practice. Project goals were to identify, mentor, and facilitate an RN geriatric site champion in critical access hospitals (CAHs) to complete national certification in gerontological nursing, and to design a continuing education program that met the specific needs of the CAHs via delivery of three continuing education sessions per year. Evaluation of the project is promising. Preliminary results suggest that iRuGCE has a positive effect on nurse-sensitive patient satisfaction scores, such as communication with nurses, responsiveness of hospital staff, pain management, communication about medicine, discharge information, and willingness to recommend the hospital. J Contin Educ Nurs. 2016;47(7):306-313. Copyright 2016, SLACK Incorporated.

Template for success: using a resident-designed sign-out template in the handover of patient care.

PubMed

Clark, Clancy J; Sindell, Sarah L; Koehler, Richard P

2011-01-01

Report our implementation of a standardized handover process in a general surgery residency program. The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System. Nonprofit, tertiary referral teaching hospital. General surgery residents, residency faculty, patient care providers, and hospital administration. After instruction in quality improvement initiatives, a team of general surgery residents designed a sign-out process using an electronic template and standard procedures. The initial implementation phase resulted in 73% compliance. Using resident-driven continuous quality improvement processes, real-time feedback enabled residents to modify and improve this process, eventually attaining 100% compliance and acceptance by residents. The creation of a standardized template and protocol for patient handovers might eliminate communication failures. Encouraging residents to participate in this process can establish the groundwork for successful implementation of a standardized handover process. Integrating a continuous quality-improvement process into such an initiative can promote active participation of busy general surgery residents and lead to successful implementation of standard procedures. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Breaking continuous potato cropping with legumes improves soil microbial communities, enzyme activities and tuber yield

PubMed Central

Qin, Shuhao; Yeboah, Stephen; Cao, Li; Zhang, Junlian; Shi, Shangli; Liu, Yuhui

2017-01-01

This study was conducted to explore the changes in soil microbial populations, enzyme activity, and tuber yield under the rotation sequences of Potato–Common vetch (P–C), Potato–Black medic (P–B) and Potato–Longdong alfalfa (P–L) in a semi–arid area of China. The study also determined the effects of continuous potato cropping (without legumes) on the above mentioned soil properties and yield. The number of bacteria increased significantly (p < 0.05) under P–B rotation by 78%, 85% and 83% in the 2, 4 and 7–year continuous cropping soils, respectively compared to P–C rotation. The highest fungi/bacteria ratio was found in P–C (0.218), followed by P–L (0.184) and then P–B (0.137) rotation over the different cropping years. In the continuous potato cropping soils, the greatest fungi/bacteria ratio was recorded in the 4–year (0.4067) and 7–year (0.4238) cropping soils and these were significantly higher than 1–year (0.3041), 2–year (0.2545) and 3–year (0.3030) cropping soils. Generally, actinomycetes numbers followed the trend P–L>P–C>P–B. The P–L rotation increased aerobic azotobacters in 2–year (by 26% and 18%) and 4–year (40% and 21%) continuous cropping soils compared to P–C and P–B rotation, respectively. Generally, the highest urease and alkaline phosphate activity, respectively, were observed in P–C (55.77 mg g–1) and (27.71 mg g–1), followed by P–B (50.72 mg mg–1) and (25.64 mg g–1) and then P–L (41.61 mg g–1) and (23.26 mg g–1) rotation. Soil urease, alkaline phosphatase and hydrogen peroxidase activities decreased with increasing years of continuous potato cropping. On average, the P–B rotation significantly increased (p <0.05) tuber yield by 19% and 18%, compared to P–C and P–L rotation respectively. P–L rotation also increased potato tuber yield compared to P–C, but the effect was lesser relative to P–B rotation. These results suggest that adopting potato–legume rotation system has the potential to improve soil biology environment, alleviate continuous cropping obstacle and increase potato tuber yield in semi–arid region. PMID:28463981

DICER-ARGONAUTE2 Complex in Continuous Fluorogenic Assays of RNA Interference Enzymes

PubMed Central

Bernard, Mark A.; Wang, Leyu; Tachado, Souvenir D.

2015-01-01

Mechanistic studies of RNA processing in the RNA-Induced Silencing Complex (RISC) have been hindered by lack of methods for continuous monitoring of enzymatic activity. “Quencherless” fluorogenic substrates of RNAi enzymes enable continuous monitoring of enzymatic reactions for detailed kinetics studies. Recombinant RISC enzymes cleave the fluorogenic substrates targeting human thymidylate synthase (TYMS) and hypoxia-inducible factor 1-α subunit (HIF1A). Using fluorogenic dsRNA DICER substrates and fluorogenic siRNA, DICER+ARGONAUTE2 mixtures exhibit synergistic enzymatic activity relative to either enzyme alone, and addition of TRBP does not enhance the apparent activity. Titration of AGO2 and DICER in enzyme assays suggests that AGO2 and DICER form a functional high-affinity complex in equimolar ratio. DICER and DICER+AGO2 exhibit Michaelis-Menten kinetics with DICER substrates. However, AGO2 cannot process the fluorogenic siRNA without DICER enzyme, suggesting that AGO2 cannot self-load siRNA into its active site. The DICER+AGO2 combination processes the fluorogenic siRNA substrate (K m=74 nM) with substrate inhibition kinetics (K i=105 nM), demonstrating experimentally that siRNA binds two different sites that affect Dicing and AGO2-loading reactions in RISC. This result suggests that siRNA (product of DICER) bound in the active site of DICER may undergo direct transfer (as AGO2 substrate) to the active site of AGO2 in the DICER+AGO2 complex. Competitive substrate assays indicate that DICER+AGO2 cleavage of fluorogenic siRNA is specific, since unlabeled siRNA and DICER substrates serve as competing substrates that cause a concentration-dependent decrease in fluorescent rates. Competitive substrate assays of a series of DICER substrates in vitro were correlated with cell-based assays of HIF1A mRNA knockdown (log-log slope=0.29), suggesting that improved DICER substrate designs with 10-fold greater processing by the DICER+AGO2 complex can provide a strong (~2800-fold) improvement in potency for mRNA knockdown. This study lays the foundation of a systematic biochemical approach to optimize nucleic acid-based therapeutics for Dicing and ARGONAUTE2-loading for improving efficacy. PMID:25793518

7 CFR 1212.60 - Programs, plans and projects.

Code of Federal Regulations, 2010 CFR

2010-01-01

... encourage, expand or improve the quality, marketing, and utilization of honey and honey products; (3) Conducting activities that may lead to developing new markets or marketing strategies for honey and honey... Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING...

Why Teach Physical Education History?

ERIC Educational Resources Information Center

Patterson, Jan

2004-01-01

The physical education discipline has had a long development, incorporating concepts learned and appreciated from ancient and modern Olympics, exercise and training, physical activity and sport, and the history of physical education itself. Nevertheless, it continues to evolve as educators improve their instructional methods, medical experts…

Educational Programs That Work. Volume IV.

ERIC Educational Resources Information Center

Far West Lab. for Educational Research and Development, San Francisco, CA.

This catalog is published as one of many mechanisms to stimulate and facilitate continuing communication among the federal, state, intermediate, and local agencies that share responsibility for educational program improvement through nationwide dissemination activities. All the projects cited have undergone close scrutiny by the Joint…

Performance evaluation of the active-flow personal DataRAM PM 2.5 mass monitor (Thermo Anderson pDR-1200) designed for continuous personal exposure measurements

NASA Astrophysics Data System (ADS)

Chakrabarti, Bhabesh; Fine, Philip M.; Delfino, Ralph; Sioutas, Constantinos

The need for continuous personal monitoring for exposure to particulate matter has been demonstrated by recent health studies showing effects of PM exposure on time scales of less than a few hours. Filter-based methods cannot measure this short-term variation of PM levels, which can be quite significant considering human activity patterns. The goal of this study was to evaluate the active-flow personal DataRAM for PM 2.5 (MIE pDR-1200; Thermo Electron Corp., Franklin, MA) designed as a wearable monitor to continuously measure particle exposure. The instrument precision was found to be good (2.1%) and significantly higher than the passive pDR configuration tested previously. A comparison to other proven continuous monitors resulted in good agreement at low relative humidities. Results at higher humidity followed predictable trends and provided a correction scheme that improved the accuracy of pDR readings. The pDR response to particle size also corresponded to previously observed and theoretical errors. The active flow feature of the pDR allows collection of the sampled particles on a back-up filter. The 24-h mass measured on this filter was found to compare very well with a Federal Reference Method for PM 2.5 mass.

A Study on Improving Logistics in a Production Enterprise in the Automotive Domain

NASA Astrophysics Data System (ADS)

Muntean, A.; Inţă, M.; Stroilă, I. A.

2016-11-01

In order to remain on the market and to overcome competition, companies need to develop and implement a strategy of continuous improvement. This is based on customer satisfaction needs, management based on realities and respect for people. In order to meet market requirements global road Faurecia Company uses a system called "Faurecia Excellence System", a system that promotes continuous improvement. FES system controls all activities of Faurecia, from research and development to sales including production and company functions and implements all 114 main procedures. This paper examines the current activity and introduce the new methods to improve manufacturing processes. These new methods are based on some fundamental concepts, namely: a high level of stocks blocks resources and can mask other problems decreasing visibility and communication; product quality is essential and the goods must be produced only when needed using Kanban principle. Additional expenditure with purchased raw materials regarding storage until they are needed, identification and packaging for storage, inventory costs were reduced using a JIT based principle in purchasing.Thus, the paper proposes reorganizing production by reducing the level of stocks using JIT principle and production time. The application made in software Arena refers to simulating the fabrication process to reduce throughput time.

Oxygenated drinking water enhances immune activity in broiler chicks and increases survivability against Salmonella Gallinarum in experimentally infected broiler chicks.

PubMed

Jung, Bock-Gie; Lee, Jin-A; Nam, Kyoung-Woo; Lee, Bong-Joo

2012-03-01

It has been suggested that drinking oxygenated water may improve oxygen availability, which may increase vitality and improving immune activity. The present study evaluated the immune enhancing effects of oxygenated drinking water in broiler chicks and demonstrated the protective efficacy of oxygenated drinking water against Salmonella Gallinarum in experimentally infected broiler chicks. Continuous drinking of oxygenated water markedly increased serum lysozyme activity, peripheral blood mononuclear cell proliferation and the CD4(+)/CD8(+) splenocyte ratio in broiler chicks. In the chicks experimentally infected with S. Gallinarum, oxygenated drinking water alleviated symptoms and increased survival. These findings suggest that oxygenated drinking water enhances immune activity in broiler chicks, and increases survivability against S. Gallinarum in experimentally infected broiler chicks.

Out in the cold: the hypothermic heart response

PubMed Central

Nabeel, Yassar; Ali, Omair

2014-01-01

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

Out in the cold: the hypothermic heart response.

PubMed

Nabeel, Yassar; Ali, Omair

2014-11-18

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

Endurance and sprint benefits of high-intensity and supramaximal interval training.

PubMed

Cicioni-Kolsky, Daniel; Lorenzen, Christian; Williams, Morgan David; Kemp, Justin Guy

2013-01-01

This study examined the effect of two different interval training programs-high-intensity interval training (HIT) and supramaximal interval training (SMIT)-on measures of sprint and endurance performance. Physically active individuals (Females: n=32; age 19.3, s=2.2 years; mass 67.6, s=9.1 kg; stature 172.7, s=6.6 cm. Males: n=23; age 20.0, s=2.7 years; mass 71.3, s=8.3 kg; stature 176.6, s=5.8 cm) completed pre-testing that comprised (1) 3000 m time-trial, (2) 40 m sprint, and (3) repeated sprint ability (RSA-6×40 m sprints, 24 s active recovery) performance. Participants were then matched for average 3000 m running velocity (AV) and randomly assigned to one of three groups: (i) HIT, n=19, 4 min at 100% AV, 4 min passive recovery, 4-6 bouts per session; (ii) SMIT, n=20, 30 s at 130% AV, 150 s passive recovery, 7-12 bouts per session; and (iii) control group, n=16, 30 min continuous running at 75% AV. Groups trained three times per week for six weeks. When time to complete each test were compared among groups: (i) improvements in 3000 m time trial performance were greater following SMIT than continuous running, and (ii) improvements in 40 m sprint and RSA performance were greater following SMIT than HIT and continuous running. In addition, a gender effect was observed for the 3000 m time trial only, where females changed more following the training intervention than males. In summary, for concurrent improvements in endurance, sprint and repeated sprint performance, SMIT provides the greatest benefits for physically active individuals.

Continuous EEG source imaging enhances analysis of EEG-fMRI in focal epilepsy.

PubMed

Vulliemoz, S; Rodionov, R; Carmichael, D W; Thornton, R; Guye, M; Lhatoo, S D; Michel, C M; Duncan, J S; Lemieux, L

2010-02-15

EEG-correlated fMRI (EEG-fMRI) studies can reveal haemodynamic changes associated with Interictal Epileptic Discharges (IED). Methodological improvements are needed to increase sensitivity and specificity for localising the epileptogenic zone. We investigated whether the estimated EEG source activity improved models of the BOLD changes in EEG-fMRI data, compared to conventional < event-related > designs based solely on the visual identification of IED. Ten patients with pharmaco-resistant focal epilepsy underwent EEG-fMRI. EEG Source Imaging (ESI) was performed on intra-fMRI averaged IED to identify the irritative zone. The continuous activity of this estimated IED source (cESI) over the entire recording was used for fMRI analysis (cESI model). The maps of BOLD signal changes explained by cESI were compared to results of the conventional IED-related model. ESI was concordant with non-invasive data in 13/15 different types of IED. The cESI model explained significant additional BOLD variance in regions concordant with video-EEG, structural MRI or, when available, intracranial EEG in 10/15 IED. The cESI model allowed better detection of the BOLD cluster, concordant with intracranial EEG in 4/7 IED, compared to the IED model. In 4 IED types, cESI-related BOLD signal changes were diffuse with a pattern suggestive of contamination of the source signal by artefacts, notably incompletely corrected motion and pulse artefact. In one IED type, there was no significant BOLD change with either model. Continuous EEG source imaging can improve the modelling of BOLD changes related to interictal epileptic activity and this may enhance the localisation of the irritative zone. Copyright 2009 Elsevier Inc. All rights reserved.

Business continuity management in international organisations.

PubMed

Adamou, Christel

2014-01-01

In the area of business continuity management, a preliminary review of the literature reveals extensive knowledge, expertise and experience concerning organisations in the private and public sectors. It is interesting to note, however, that there is little literature about business continuity management in international organisations, although these entities are complex and particularly prone to threats. This apparent absence of literature suggests that business continuity management has not yet hit the agenda of international organisations. In recent years, member states have encouraged senior management to design and implement business continuity strategies to minimise the mishandling of an internal crisis and build organisational resilience, but very few of them have actually been able to design and implement comprehensive business continuity programmes. Based on actual experience working in international organisations, this paper outlines some of the challenges faced by international organisations in developing and implementing business continuity activities and attempts to make suggestions for further improvement.

Strengthening professionals: a chapter-level formative evaluation of the Medical Library Association mentoring initiative.

PubMed

Kwasik, Hanna; Fulda, Pauline O

2006-01-01

The main objective was to determine to what extent the Medical Library Association (MLA) mentoring initiative was implemented in the South Central Chapter of the Medical Library Association (SCC/ MLA) and to identify the needs, improvements, and adjustments in mentoring services for the future to improve the practice of librarianship. The data were collected by administering an anonymous structured survey designed by the authors. The survey was mailed to all 335 chapter members. The authors elicited responses to determine the chapter members' mentoring needs, awareness of available resources, satisfaction with existing services and resources, needs for the future, and suggestions to meet those needs. Of the 335 delivered surveys, 184 were returned, yielding a return rate of 55%. Eighty percent had a mentor or mentors in their careers, and 74% were either very satisfied or satisfied with the relationship. The majority considered having a mentor a critical part of the professional experience. The mentoring activity chosen by respondents as the most important was improvement of job performance through skills development. Over 50% were aware of SCC/MLA's mentoring activities, and less than 50% were aware of MLA's mentoring Website. The rate of response and the wealth of comments provided by respondents document the high level of interest in mentoring by medical librarians in the region. The following mentoring services were equally important to SCC/MLA members and were recommended for improvement or development at the regional level: a formalized mentoring program in the region, Web-based mentoring resources on the SCC/MLA Website, and a continuing education course for mentors. Members are aware of mentoring activities in the region; however, participation levels need to be increased in activities that SCC/MLA and MLA provide. Mentoring continues to evolve as a service in the profession.

Continuous DC-CIK infusions restore CD8+ cellular immunity, physical activity and improve clinical efficacy in advanced cancer patients unresponsive to conventional treatments.

PubMed

Zhao, Yan-Jie; Jiang, Ni; Song, Qing-Kun; Wu, Jiang-Ping; Song, Yu-Guang; Zhang, Hong-Mei; Chen, Feng; Zhou, Lei; Wang, Xiao-Li; Zhou, Xin-Na; Yang, Hua-Bing; Ren, Jun; Lyerly, Herbert Kim

2015-01-01

There are few choices for treatment of advanced cancer patients who do not respond to or tolerate conventional anti-cancer treatments. Therefore this study aimed to deploy the benefits and clinical efficacy of continuous dendritic cell-cytokine induced killer cell infusions in such patients. A total of 381 infusions (from 67 advanced cases recruited) were included in this study. All patients underwent peripheral blood mononuclear cell apheresis for the following cellular therapy and dendritic cells-cytokine induced killer cells were expanded in vitro. Peripheral blood T lymphocyte subsets were quantified through flow cytometry to address the cellular immunity status. Clinical efficacy and physical activities were evaluated by RECIST criteria and Eastern Cooperative Oncology Group scores respectively. Logistic regression model was used to estimate the association between cellular infusions and clinical benefits. An average of 5.7±2.94x10(9) induced cells were infused each time and patients were exposed to 6 infusions. Cellular immunity was improved in that cytotoxic CD8+CD28+T lymphocytes were increased by 74% and suppressive CD8+CD28-T lymphocytes were elevated by 16% (p<0.05). Continuous infusion of dendritic cells-cytokine induced killer cells was associated with improvement of both patient status and cellular immunity. A median of six infusions were capable of reducing risk of progression by 70% (95%CI 0.10-0.91). Every elevation of one ECOG score corresponded to a 3.90-fold higher progression risk (p<0.05) and 1% increase of CD8+CD28- T cell proportion reflecting a 5% higher risk of progression (p<0.05). In advanced cancer patients, continuous dendritic cell-cytokine induced killer cell infusions are capable of recovering cellular immunity, improving patient status and quality of life in those who are unresponsive to conventional cancer treatment.

[Effects of biochar and sheep manure on rhizospheric soil microbial community in continuous ratooning tea orchards].

PubMed

Li, Yan Chun; Li, Zhao Wei; Lin, Wei Wei; Jiang, Yu Hang; Weng, Bo Qi; Lin, Wen Xiong

2018-04-01

Long-term continuous ratooning of tea could lead to serious soil acidification, nutritional imbalance, and the deterioration of the rhizosphere micro-ecological environment. Understanding the effects of biochar and sheep manure on the growth of tea plants and the rhizosphere microbial community structure and function would provide theoretical basis to improve the soil micro-ecological environment of continuous ratooning tea orchards. Biolog technology combined with phospholipid fatty acid (PLFA) approaches were employed to quantify the effects of biochar (40 t·hm -2 ) and sheep manure on the growth of 20 years continuous ratooning tea plants, soil chemical properties, and the soil microbial community structure and function. The results showed that after one year treatment, biochar and sheep manure both improved soil pH and nutrition, and significantly enhanced tea production. Compared with the routine fertilizer application (CK), the biochar and sheep manure treatments significantly increased the carbon metabolic activity (AWCD) and microorganism diversity in the rhizosphere soils, and increased the relative utilization of the carbon sources such as amines, carbohydrates, and polymers. The total PLFA concentrations in the biochar and sheep manure treatments were significantly increased by 20.9% and 47.5% than that in the routine fertilizers application. In addition, sheep manure treatment significantly decreased the saturated/monosaturated fatty acids In conclusion, biochar and sheep manure could alleviate soil acidification, enhance soil nutrition and the growth of tea plants. Both management strategies could increase the soil microbial activity and biomass, enhance the diversity, and improve the microbial community structure, which could be taken as effective measures to regulate the rhizosphere micro-environment of tea plants.

A system of networks and continuing education for physical therapists in rheumatology: a feasibility study

PubMed Central

Verhoef, J.; Oosterveld, F.G.J.; Hoekman, R.; Munneke, M.; Boonman, D.C.G.; Bakker, M.; Otten, W.; Rasker, J.J.; de Vries-vander Zwan, H.M.; Vliet Vlieland, T.P.M.

2004-01-01

Abstract Purpose To evaluate the feasibility of regional physical therapy networks including continuing education in rheumatology. The aim of these networks was to improve care provided by primary care physical therapists by improving specific knowledge, technical and communicative skills and the collaboration with rheumatologists. Methods In two regions in The Netherlands continuing education (CE) programmes, consisting of a 5-day postgraduate training course followed by bimonthly workshops and teaching practices, were organised simultaneously. Network activities included consultations, newsletters and the development of a communication guideline. Endpoint measures included the participation rate, compliance, quality of the CE programme, teaching practices, knowledge, network activities, communication, number of patients treated and patient satisfaction. Results Sixty-three physical therapists out of 193 practices (33%) participated in the project. They all completed the education programmes and were formally registered. All evaluations of the education programmes showed positive scores. Knowledge scores increased significantly directly after the training course and at 18 months. A draft guideline on communication between physical therapists and rheumatologists was developed, and 4 newsletters were distributed. A substantial proportion of physical therapists and rheumatologists reported improved communication at 18 months. The mean number of patients treated by physical therapists participating in the networks increased significantly. Patients' satisfaction scores within the networks were significantly higher than those from outside the networks at 18 months. Conclusions Setting up a system of networks for continuing education for physical therapists regarding the treatment of patients with rheumatic diseases is feasible. Further research will focus on the effectiveness of the system and its implementation on a larger scale. PMID:16773150

Establishing a Framework for Quality

ERIC Educational Resources Information Center

Lehman, Kirby

2006-01-01

The Jenks School District applies a continuous improvement approach that focuses on academics, arts, activities, athletics and attitude, weaving in leadership, professional development, technology and data-based decision making to prepare all learners to be productive, responsible citizens. Since 1998, the Jenks School District has embraced a…

Printed Circuit Board Quality Assurance

NASA Technical Reports Server (NTRS)

Sood, Bhanu

2016-01-01

PCB Assurance Summary: PCB assurance actives are informed by risk in context of the Project. Lessons are being applied across Projects for continuous improvements. Newer component technologies, smaller/high pitch devices: tighter and more demanding PCB designs: Identifying new research areas. New materials, designs, structures and test methods.

At a Glance - Growth of DDGS

USDA-ARS?s Scientific Manuscript database

NCARL is proud of its active partnerships among industry, academic, and extension specialists, and we continue to pursue improved uses and values for distillers grain. We aim to augment both the livestock industry as well as fuel ethanol manufacturers with our research programs. The importance of ...

Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

PubMed

Banerjee, Gourav; Rose, Alison; Briggs, Michelle; Johnson, Mark I

2017-02-24

We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function. 2017 BMJ Publishing Group Ltd.

Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

PubMed Central

Banerjee, Gourav; Rose, Alison; Briggs, Michelle; Johnson, Mark I

2017-01-01

We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function. PMID:28237944

Assessing the impact of a medical librarian on identification of valid and actionable practice gaps for a continuing medical education committee.

PubMed

Bartkowiak, Barbara A; Safford, Lindsey A; Stratman, Erik J

2014-01-01

Identifying educational needs related to professional practice gaps can be a complex process for continuing medical education (CME) committees and for physicians who submit activity applications. Medical librarians possess unique skills that may be useful for identifying practice gaps relevant to CME committees. We assessed this assumption by assessing a medical librarian's contributions to practice gap identification for the Marshfield Clinic's CME Committee. We reviewed all locally relevant, locally actionable practice gaps identified annually by various stakeholders and presented to our CME Committee from 2010 to 2013. Total numbers of practice gaps identified, total categorized as actionable, and numbers of subsequent activities resulting from these gaps were calculated for each year. Medical librarian totals were compared to those of other CME committee stakeholders to determine the relative contribution. The medical librarian identified unique, actionable published practice gaps that directly contributed to CME activity planning. For each study year, contributions by the medical librarian grew, from 0 of 27 actionable gaps validated by CME Committee in 2010 to 49 of 108 (45.4%) in 2013. With the librarian's assistance, the number of valid practice gaps submitted between 2010 and 2013 by stakeholders climbed from 23 for 155 activities (14.8%) to 133 for 157 activities (84.7%). Medical librarians can provide a valuable service to CME committees by identifying valid professional practice gaps that inform decisions about educational activities aimed at improving clinical practice. Medical librarians bring into deliberations unique information, including national health policy priorities, practice gaps found in the literature, and point-of-care search engine statistics. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

The Use of Cyclone Modeling in the Erection of Precast Segmental Aerial Construction.

DTIC Science & Technology

1983-06-01

activity or completion of a work cycle within an activity. Marvin E. Mundel outlines the three methods31 as: 1. CONTINUOUS TIMING In continouous timing...technique described by Mundel and outlined in Chapter II in which actual times are recorded and durations for activities obtained later by suc- cessive...8. 28. Thomas, p. 264. 29. Thomas and Holland, p. 520. 30. Thomas and Holland, p. 521. 31. Marvin E. Mundel , Motion and Time Study, Improving

Best Practices in Supplier Relationship Management and Their Early Implementation in the Air Force Materiel Command

DTIC Science & Technology

2012-01-01

information-sharing and through systematic efforts to develop the supplier. These efforts can be direct involvement activities, such as kaizen events,24 24...Womack and Jones (1996) define kaizen as “Continuous, incremental improvement of an activity to create more value with less muda. Also called point... kaizen and process kaizen .” They define muda as “any activity that consumes resources but creates no value,” i.e., waste. Figure 2.2 Krause and

The experience factory: Can it make you a 5? or what is its relationship to other quality and improvement concepts?

NASA Technical Reports Server (NTRS)

Basili, Victor R.

1992-01-01

The concepts of quality improvements have permeated many businesses. It is clear that the nineties will be the quality era for software and there is a growing need to develop or adapt quality improvement approaches to the software business. Thus we must understand software as an artifact and software as a business. Since the business we are dealing with is software, we must understand the nature of software and software development. The software discipline is evolutionary and experimental; it is a laboratory science. Software is development not production. The technologies of the discipline are human based. There is a lack of models that allow us to reason about the process and the product. All software is not the same; process is a variable, goals are variable, etc. Packaged, reusable, experiences require additional resources in the form of organization, processes, people, etc. There have been a variety of organizational frameworks proposed to improve quality for various businesses. The ones discussed in this presentation include: Plan-Do-Check-Act, a quality improvement process based upon a feedback cycle for optimizing a single process model/production line; the Experience Factory/Quality Improvement Paradigm, continuous improvements through the experimentation, packaging, and reuse of experiences based upon a business's needs; Total Quality Management, a management approach to long term success through customer satisfaction based on the participation of all members of an organization; the SEI capability maturity model, a staged process improvement based upon assessment with regard to a set of key process areas until you reach a level 5 which represents a continuous process improvement; and Lean (software) Development, a principle supporting the concentration of the production on 'value added' activities and the elimination of reduction of 'not value added' activities.

Effects of equine assisted activities on autism spectrum disorder.

PubMed

Lanning, Beth A; Baier, Margaret E Matyastik; Ivey-Hatz, Julie; Krenek, Nancy; Tubbs, Jack D

2014-08-01

Quality of life assessments were used in this study to determine the behavioral changes of children diagnosed with autism spectrum disorder (ASD) who participated in equine assisted activities. Behavioral changes of children with ASD participating in 9 weeks of equines assisted activities (EAA) (N = 10) were compared to behavioral changes of children who participated in a non-equine intervention (N = 8). Parents noted significant improvements in their child's physical, emotional and social functioning following the first 6 weeks of EAA. The children participating in the non-equine program also demonstrated improvement in behavior, but to a lesser degree. The favorable outcome of this study lends support for continuation of programs utilizing EAA in the treatment of children with ASD.

Establishment, Present Condition, and Developmental Direction of the New Korean Healthcare Accreditation System

PubMed Central

Chang, Hoo-Sun

2012-01-01

On July 23rd, 2010 a revised medical law (Article 58) was passed to change existing evaluation system of medical institutions to an accreditation system. The new healthcare accreditation system was introduced to encourage medical institutions to work voluntarily and continuously to improve patient safety and medical service quality. Changes regarding the healthcare accreditation system included the establishment of an accreditation agency, the voluntary participation of medical institutions, accreditation standards centering on the treatment process and patient safety, tracing methodology, and the announcement of comprehensive results concerning accreditation. Despite varying views on the healthcare accreditation system, including some that are critical, it is meaningful that the voluntary nature of the system acknowledges that the medical institutions must be active agents in improving medical service quality. Healthcare quality is not improved instantaneously, but instead gradually through continuous communication within the clinical field. For this accreditation system to be successful, followings are essential: the accreditation agency becomes financially independent and is managed efficiently, the autonomy and regulation surrounding the system are balanced, the professionalism of the system is ensured, and the medical field plays an active role in the operation of the system. PMID:22661873

Feasibility study of the use of a daily electronic mail reminder to improve oral contraceptive compliance.

PubMed

Fox, Michelle C; Creinin, Mitchell D; Murthy, Amitasrigowri S; Harwood, Bryna; Reid, Lynn M

2003-11-01

Women who ingest their oral contraceptive pill (OCP) as part of a daily routine are more likely use their OCPs correctly. This trial examines the feasibility of an electronic-mail (e-mail) reminder system to improve OCP compliance. An e-mail reminder was sent to 50 new OCP users daily for 3 months. Subjects sent an e-mail reply to confirm receipt. OCP compliance was recorded on diaries. Four subjects were discontinued for not checking their e-mail. Active participants missed a median of 18% of the e-mail reminders (range: 0-65%). A follow-up visit was scheduled after completion of three OCP cycles. Of the 40 subjects returning completed diaries, 50% missed no active pills at all and 20% missed at least one in each cycle. Most found the daily e-mail somewhat (65%) or very helpful (19%) for OCP compliance. Of those continuing OCPs, 64% wanted to continue receiving e-mail reminders at the completion of the study. Because inconsistent OCP use is a significant cause of unplanned conception, the use of e-mail to improve OCP compliance has the potential to decrease unintended pregnancies.

Response to belimumab among patients with systemic lupus erythematosus in clinical practice settings: 24-month results from the OBSErve study in the USA

PubMed Central

Collins, C E; Dall'Era, M; Kan, H; Macahilig, C; Molta, C; Koscielny, V; Chang, D J

2016-01-01

Objective To examine disease activity and clinical outcomes, and describe overall patterns of systemic lupus erythematosus (SLE) care in patients who received belimumab in a real-world clinical setting. Methods This observational cohort study was conducted in US clinical practices. Rheumatologists (n=92) identified adults with SLE who had received ≥8 infusions of belimumab plus standard of care (SoC). Physicians assessed disease outcomes at 6-month intervals using patient medical charts, for up to 24 months. The primary outcome was physician-assessed change in SLE disease. Other outcomes included change in steroid use, laboratory tests and healthcare resource utilisation (HCRU). Results Of 501 patients (intent-to-treat population (ITT)), 446 were female, mean age was 43.3 years and 98% had moderate/severe disease activity at baseline (first dose of belimumab). Data for 277 patients who completed 24 months of belimumab treatment were available. Among the ITT, a ≥50% improvement in overall clinical response between baseline and month 6 was reported for 48.7% of patients; continued improvement was seen at all subsequent 6-month intervals relative to the previous timepoint. The percentage of patients with moderate/severe disease also decreased at each timepoint. At baseline, 77.0% of patients received steroids at a mean (SD) prednisone equivalent dose of 19.9 (14.39) mg/day, which decreased to 8.4 (7.35) mg/day at month 6 and 6.1 (9.31) mg/day at month 24. Abnormal laboratory values typically associated with SLE also demonstrated improvements at month 6, which continued through 24 months. HCRU decreased over the duration of the study. Conclusions Patients with SLE who received belimumab plus SoC for up to 24 months demonstrated improvements in disease severity and laboratory values and a reduction in steroid use and HCRU as early as month 6. Improvements continued through 24 months, providing evidence of reduced disease activity among patients taking belimumab in real-world clinical practice. PMID:26835146

How Gender and Reformed Introductory Physics Impacts Student Success in Advanced Physics Courses and Continuation in the Physics Major

ERIC Educational Resources Information Center

Rodriguez, Idaykis; Potvin, Geoff; Kramer, Laird H.

2016-01-01

Active-learning approaches to teaching introductory physics have been found to improve student learning and affective gains on short-term outcomes [S. Freeman et al., "Proc. Natl. Acad. Sci. U.S.A. 111," 8410 (2014)]; however, whether or not the benefits of active learning impact women to the same degree as men has been a point of…

Wearable motion sensors to continuously measure real-world physical activities.

PubMed

Dobkin, Bruce H

2013-12-01

Rehabilitation for sensorimotor impairments aims to improve daily activities, walking, exercise, and motor skills. Monitoring of practice and measuring outcomes, however, is usually restricted to laboratory-based procedures and self-reports. Mobile health devices may reverse these confounders of daily care and research trials. Wearable, wireless motion sensor data, analyzed by activity pattern-recognition algorithms, can describe the type, quantity, and quality of mobility-related activities in the community. Data transmission from the sensors to a cell phone and the Internet enable continuous monitoring. Remote access to laboratory quality data about walking speed, duration and distance, gait asymmetry and smoothness of movements, as well as cycling, exercise, and skills practice, opens new opportunities to engage patients in progressive, personalized therapies with feedback about the performance. Clinical trial designs will be able to include remote verification of the integrity of complex physical interventions and compliance with practice, as well as capture repeated, ecologically sound, ratio scale outcome measures. Given the progressively falling cost of miniaturized wearable gyroscopes, accelerometers, and other physiologic sensors, as well as inexpensive data transmission, sensing systems may become as ubiquitous as cell phones for healthcare. Neurorehabilitation can develop these mobile health platforms for daily care and clinical trials to improve exercise and fitness, skills learning, and physical functioning.

Studies in geophysics: Active tectonics

NASA Technical Reports Server (NTRS)

1986-01-01

Active tectonics is defined within the study as tectonic movements that are expected to occur within a future time span of concern to society. Such movements and their associated hazards include earthquakes, volcanic eruptions, and land subsidence and emergence. The entire range of geology, geophysics, and geodesy is, to some extent, pertinent to this topic. The needs for useful forecasts of tectonic activity, so that actions may be taken to mitigate hazards, call for special attention to ongoing tectonic activity. Further progress in understanding active tectonics depends on continued research. Particularly important is improvement in the accuracy of dating techniques for recent geologic materials.

Continuous, Large-Scale Processing of Seismic Archives for High-Resolution Monitoring of Seismic Activity and Seismogenic Properties

NASA Astrophysics Data System (ADS)

Waldhauser, F.; Schaff, D. P.

2012-12-01

Archives of digital seismic data recorded by seismometer networks around the world have grown tremendously over the last several decades helped by the deployment of seismic stations and their continued operation within the framework of monitoring earthquake activity and verification of the Nuclear Test-Ban Treaty. We show results from our continuing effort in developing efficient waveform cross-correlation and double-difference analysis methods for the large-scale processing of regional and global seismic archives to improve existing earthquake parameter estimates, detect seismic events with magnitudes below current detection thresholds, and improve real-time monitoring procedures. We demonstrate the performance of these algorithms as applied to the 28-year long seismic archive of the Northern California Seismic Network. The tools enable the computation of periodic updates of a high-resolution earthquake catalog of currently over 500,000 earthquakes using simultaneous double-difference inversions, achieving up to three orders of magnitude resolution improvement over existing hypocenter locations. This catalog, together with associated metadata, form the underlying relational database for a real-time double-difference scheme, DDRT, which rapidly computes high-precision correlation times and hypocenter locations of new events with respect to the background archive (http://ddrt.ldeo.columbia.edu). The DDRT system facilitates near-real-time seismicity analysis, including the ability to search at an unprecedented resolution for spatio-temporal changes in seismogenic properties. In areas with continuously recording stations, we show that a detector built around a scaled cross-correlation function can lower the detection threshold by one magnitude unit compared to the STA/LTA based detector employed at the network. This leads to increased event density, which in turn pushes the resolution capability of our location algorithms. On a global scale, we are currently building the computational framework for double-difference processing the combined parametric and waveform archives of the ISC, NEIC, and IRIS with over three million recorded earthquakes worldwide. Since our methods are scalable and run on inexpensive Beowulf clusters, periodic re-analysis of such archives may thus become a routine procedure to continuously improve resolution in existing global earthquake catalogs. Results from subduction zones and aftershock sequences of recent great earthquakes demonstrate the considerable social and economic impact that high-resolution images of active faults, when available in real-time, will have in the prompt evaluation and mitigation of seismic hazards. These results also highlight the need for consistent long-term seismic monitoring and archiving of records.

Accelerating quality improvement within your organization: Applying the Model for Improvement.

PubMed

Crowl, Ashley; Sharma, Anita; Sorge, Lindsay; Sorensen, Todd

2015-01-01

To discuss the fundamentals of the Model for Improvement and how the model can be applied to quality improvement activities associated with medication use, including understanding the three essential questions that guide quality improvement, applying a process for actively testing change within an organization, and measuring the success of these changes on care delivery. PubMed from 1990 through April 2014 using the search terms quality improvement, process improvement, hospitals, and primary care. At the authors' discretion, studies were selected based on their relevance in demonstrating the quality improvement process and tests of change within an organization. Organizations are continuously seeking to enhance quality in patient care services, and much of this work focuses on improving care delivery processes. Yet change in these systems is often slow, which can lead to frustration or apathy among frontline practitioners. Adopting and applying the Model for Improvement as a core strategy for quality improvement efforts can accelerate the process. While the model is frequently well known in hospitals and primary care settings, it is not always familiar to pharmacists. In addition, while some organizations may be familiar with the "plan, do, study, act" (PDSA) cycles-one element of the Model for Improvement-many do not apply it effectively. The goal of the model is to combine a continuous process of small tests of change (PDSA cycles) within an overarching aim with a longitudinal measurement process. This process differs from other forms of improvement work that plan and implement large-scale change over an extended period, followed by months of data collection. In this scenario it may take months or years to determine whether an intervention will have a positive impact. By following the Model for Improvement, frontline practitioners and their organizational leaders quickly identify strategies that make a positive difference and result in a greater degree of success.

Incorporating yoga into an intense physical therapy program in someone with Parkinson's disease: a case report.

PubMed

Moriello, Gabriele; Denio, Christopher; Abraham, Megan; DeFrancesco, Danielle; Townsley, Jill

2013-10-01

The purpose of this case report was to document outcomes following an intense exercise program integrating yoga with physical therapy exercise in a male with Parkinson's disease. The participant performed an intense 1½-hour program (Phase A) incorporating strengthening, balance, agility and yoga exercises twice weekly for 12 weeks. He then completed a new home exercise program developed by the researchers (Phase B) for 12 weeks. His score on the Parkinson's Disease Questionnaire improved 16 points while his score on the High Level Mobility Assessment tool improved 11 points. There were also improvements in muscle length of several lower extremity muscles, in upper and lower extremity muscle strength, in dynamic balance and he continues to work full time 29 months later. There were no improvements in thoracic posture or aerobic power. This intense program was an effective dose of exercise for someone with Parkinson's disease and allowed him to continue to participate in work, leisure, and community activities. Copyright © 2013 Elsevier Ltd. All rights reserved.

Phototherapy for Improvement of Performance and Exercise Recovery: Comparison of 3 Commercially Available Devices.

PubMed

De Marchi, Thiago; Schmitt, Vinicius Mazzochi; Danúbia da Silva Fabro, Carla; da Silva, Larissa Lopes; Sene, Juliane; Tairova, Olga; Salvador, Mirian

2017-05-01

  Recent studies suggest the prophylactic use of low-powered laser/light has ergogenic effects on athletic performance and postactivity recovery. Manufacturers of high-powered lasers/light devices claim that these can produce the same clinical benefits with increased power and decreased irradiation time; however, research with high-powered lasers is lacking.   To evaluate the magnitude of observed phototherapeutic effects with 3 commercially available devices.   Randomized double-blind placebo-controlled study.   Laboratory.   Forty healthy untrained male participants.   Participants were randomized into 4 groups: placebo, high-powered continuous laser/light, low-powered continuous laser/light, or low-powered pulsed laser/light (comprising both lasers and light-emitting diodes). A single dose of 180 J or placebo was applied to the quadriceps.   Maximum voluntary contraction, delayed-onset muscle soreness (DOMS), and creatine kinase (CK) activity from baseline to 96 hours after the eccentric exercise protocol.   Maximum voluntary contraction was maintained in the low-powered pulsed laser/light group compared with placebo and high-powered continuous laser/light groups in all time points (P < .05). Low-powered pulsed laser/light demonstrated less DOMS than all groups at all time points (P < .05). High-powered continuous laser/light did not demonstrate any positive effects on maximum voluntary contraction, CK activity, or DOMS compared with any group at any time point. Creatine kinase activity was decreased in low-powered pulsed laser/light compared with placebo (P < .05) and high-powered continuous laser/light (P < .05) at all time points. High-powered continuous laser/light resulted in increased CK activity compared with placebo from 1 to 24 hours (P < .05).   Low-powered pulsed laser/light demonstrated better results than either low-powered continuous laser/light or high-powered continuous laser/light in all outcome measures when compared with placebo. The increase in CK activity using the high-powered continuous laser/light compared with placebo warrants further research to investigate its effect on other factors related to muscle damage.

Lessons Learned from FIPSE Projects II.

ERIC Educational Resources Information Center

Marcus, Dora; And Others

This monograph describes 30 college and university programs funded by the Fund for the Improvement of Postsecondary Education from 1989 to 1991. Each description includes information on program purpose, project activities, major insights and lessons, project continuation, and available information. The first group of 10 are programs focused on…

Assessment of Barriers to Changing Practice as CME Outcomes

ERIC Educational Resources Information Center

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

2010-01-01

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

75 FR 36373 - Federal Advisory Committee; Advisory Council on Dependents' Education

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-25

... Dependents' Education AGENCY: Department of Defense Education Activity (DoDEA). ACTION: Open meeting notice..., the Department of Defense announces that the Advisory Council on Dependents' Education will meet on... meeting agenda will be the current operational qualities of schools, the continuous improvement processes...

Assessment of Student Professional Outcomes for Continuous Improvement

ERIC Educational Resources Information Center

Keshavarz, Mohsen; Baghdarnia, Mostafa

2013-01-01

This article describes a method for the assessment of professional student outcomes (performance-type outcomes or soft skills). The method is based upon group activities, research on modern electrical engineering topics by individual students, classroom presentations on chosen research topics, final presentations, and technical report writing.…

Putting It All Together: A Minority Transition Program.

ERIC Educational Resources Information Center

Sacramento City Coll., CA.

Sacramento City College (SCC) created a transfer opportunity program to implement joint activities with four-year colleges and high schools, establish an academic skills program for potential minority transfers, improve telecommunications with local four-year institutions, expand its existing junior high school program. and continue its formalized…

At a Glance – Pelleting of DDGS

USDA-ARS?s Scientific Manuscript database

NCARL is proud of its active partnership among industry, academic, and extension specialists, and we continue to pursue improved uses and values for distillers grain. We aim to augment both the livestock industry as well as fuel ethanol manufacturers with our research programs. Pelleting is one wa...

[Seventeen years of haemovigilance in France: assessment and outlook].

PubMed

Carlier, M; Vo Mai, M-P; Fauveau, L; Ounnoughene, N; Sandid, I; Renaudier, P

2011-04-01

Since 1994, the French haemovigilance network has not stopped evolving. Based initially on the reporting of informations and incidents related to recipients, it quickly became interested in the procedures and other activities related to blood component transfusion, in order to improve blood safety. Despite some failures (under reporting, heavy declarative management), the French haemovigilance network is going to continue working on improving blood safety, both at the level of the recipients and the donors, and participate to the global improvement of quality of care. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Lean manufacturing: A better way for enhancement in productivity

NASA Astrophysics Data System (ADS)

Kumar Ahir, Pankaj; Kumar Yadav, Lalit; Singh Chandrawat, Saurabh

2012-03-01

Productivity is the impact of peoples working together. Machines are merely an extended way of collective imagination and energy. Lean Manufacturing is the most used method for continues improvement of business. Organization management philosophy focusing on the reduction of wastage to improve overall customer value. "Lean" operating principles began in manufacturing environments and are known by a variety of synonyms; Lean Manufacturing, Lean Production, Toyota Production System, etc. It is commonly believed that Lean started in Japan "The notable activities in keeping the price of Ford products low is the steady restriction of the production cycle. The longer an article is in the process of manufacture and the more it is moved about, the greater is its ultimate cost." "A systematic approach to identifying and eliminating waste through continuous improvement, flowing the product at the pull of the customer in pursuit of perfection."

Semi-continuous anaerobic co-digestion of thickened waste activated sludge and fat, oil and grease

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

Wan Caixia; Zhou Quancheng; Fu Guiming

2011-08-15

Highlights: > Co-digestion of thickened waste activated sludge (TWAS) with fat, oil and grease (FOG). > Co-digestion of TWAS and FOG at 64% VS increased biogas production by 137%. > FOG addition ratio at 74% of total VS caused inhibition of the anaerobic digestion process. > Micronutrients addition did not significantly improve the biogas production and digestion stabilization. - Abstract: Co-digestion of thickened waste activated sludge (TWAS) and fat, oil and grease (FOG) was conducted semi-continuously under mesophilic conditions. The results showed that daily methane yield at the steady state was 598 L/kg VS{sub added} when TWAS and FOG (64%more » of total VS) were co-digested, which was 137% higher than that obtained from digestion of TWAS alone. The biogas composition was stabilized at a CH{sub 4} and CO{sub 2} content of 66.8% and 29.5%, respectively. Micronutrients added to co-digestion did not improve the biogas production and digestion stabilization. With a higher addition of FOG (74% of total VS), the digester initially failed but was slowly self-recovered; however, the methane yield was only about 50% of a healthy reactor with the same organic loading rate.« less

Using information and communication technology to revitalise continuing professional development for rural health professionals: evidence from a pilot project.

PubMed

Mugisha, J F

2009-01-01

This project revitalised continuing professional development (CPD) among rural health professionals in Uganda, Africa, using information and communication technology (ICT). The project was piloted in 3 rural hospitals where CPD activities were failing to meet demand because activities were not properly coordinated, the meetings were too infrequent, the delivery methods were inappropriate, and the content was highly supply-driven and generally irrelevant to the performance needs of the health workers. The project intervention involved the installation of various ICT equipment including computers, liquid crystal display (LCD) projectors, office copiers, printers, spiral binders and CDs. A number of health workers were also trained in ICT use. Three years later, an evaluation study was conducted using interviews, focus group discussions and document review. The results indicated that there had been a rapid increase in the number of staff attending the CPD sessions, an increased staff mix among participants, improved quality of CPD presentations, increased use of locally produced content, more relevant topics discussed and an increased interest by hospital management in CPD, manifested by commitment of staff training funds. Staff motivation, attitude and responsiveness to clients had also improved as a result of the invigorated CPD activities.

Acute sleep deprivation enhances post-infection sleep and promotes survival during bacterial infection in Drosophila.

PubMed

Kuo, Tzu-Hsing; Williams, Julie A

2014-05-01

Sleep is known to increase as an acute response to infection. However, the function of this behavioral response in host defense is not well understood. To address this problem, we evaluated the effect of acute sleep deprivation on post-infection sleep and immune function in Drosophila. Laboratory. Drosophila melanogaster. Flies were subjected to sleep deprivation before (early DEP) or after (late DEP) bacterial infection. Relative to a non-deprived control, flies subjected to early DEP had enhanced sleep after infection as well as increased bacterial clearance and survival outcome. Flies subjected to late DEP experienced enhanced sleep following the deprivation period, and showed a modest improvement in survival outcome. Continuous DEP (early and late DEP) throughout infection also enhanced sleep later during infection and improved survival. However, improved survival in flies subjected to late or continuous DEP did not occur until after flies had experienced sleep. During infection, both early and late DEP enhanced NFκB transcriptional activity as measured by a luciferase reporter (κB-luc) in living flies. Early DEP also increased NFκB activity prior to infection. Flies that were deficient in expression of either the Relish or Dif NFκB transcription factors showed normal responses to early DEP. However, the effect of early DEP on post-infection sleep and survival was abolished in double mutants, which indicates that Relish and Dif have redundant roles in this process. Acute sleep deprivation elevated NFκB-dependent activity, increased post-infection sleep, and improved survival during bacterial infection.

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

Simpson, L.; Britt, J.; Birkmire, R.

ITN Energy Systems, Inc., and Global Solar Energy, Inc., assisted by NREL's PV Manufacturing R&D program, have continued to advance CIGS production technology by developing trajectory-oriented predictive/control models, fault-tolerance control, control platform development, in-situ sensors, and process improvements. Modeling activities included developing physics-based and empirical models for CIGS and sputter-deposition processing, implementing model-based control, and applying predictive models to the construction of new evaporation sources and for control. Model-based control is enabled by implementing reduced or empirical models into a control platform. Reliability improvement activities include implementing preventive maintenance schedules; detecting failed sensors/equipment and reconfiguring to tinue processing; and systematicmore » development of fault prevention and reconfiguration strategies for the full range of CIGS PV production deposition processes. In-situ sensor development activities have resulted in improved control and indicated the potential for enhanced process status monitoring and control of the deposition processes. Substantial process improvements have been made, including significant improvement in CIGS uniformity, thickness control, efficiency, yield, and throughput. In large measure, these gains have been driven by process optimization, which in turn have been enabled by control and reliability improvements due to this PV Manufacturing R&D program.« less

Removal of Iron and Manganese from Natural Groundwater by Continuous Reactor Using Activated and Natural Mordenite Mineral Adsorption

NASA Astrophysics Data System (ADS)

Zevi, Y.; Dewita, S.; Aghasa, A.; Dwinandha, D.

2018-01-01

Mordenite minerals derived from Sukabumi natural green stone founded in Indonesia was tested in order to remove iron and manganese from natural groundwater. This research used two types of adsorbents which were consisted of physically activated and natural mordenite. Physical activation of the mordenite was carried out by heating at 400-600°C for two hours. Batch system experiments was also conducted as a preliminary experiment. Batch system proved that both activated and natural mordenite minerals were capable of reducing iron and manganese concentration from natural groundwater. Then, continuous experiment was conducted using down-flow system with 45 ml/minute of constant flow rate. The iron & manganese removal efficiency using continuous reactor for physically activated and natural mordenite were 1.38-1.99%/minute & 0.8-1.49%/minute and 2.26%/minute & 1.37-2.26%/minute respectively. In addition, the regeneration treatment using NH4Cl solution managed to improve the removal efficiency of iron & manganese to 1.98%/minute & 1.77-1.90%/minute and 2.25%/minute & 2.02-2.21%/minute on physically activated mordenite and natural mordenite respectively. Subsequently, the activation of the new mordenite was carried out by immersing mordenite in NH4Cl solution. This chemical activation showed 2.42-2.75%/minute & 0.96 - 2.67 %/minute and 2.66 - 2.78 %/minute & 1.34 - 2.32 %/minute of iron & manganese removal efficiency per detention time for chemically activated and natural mordenite respectively.

Elevated cAMP improves signal-to-noise ratio in amphibian rod photoreceptors

PubMed Central

Govardovskii, Victor I.

2017-01-01

The absolute sensitivity of vertebrate retinas is set by a background noise, called dark noise, which originates from several different cell types and is generated by different molecular mechanisms. The major share of dark noise is produced by photoreceptors and consists of two components, discrete and continuous. Discrete noise is generated by spontaneous thermal activations of visual pigment. These events are undistinguishable from real single-photon responses (SPRs) and might be considered an equivalent of the signal. Continuous noise is produced by spontaneous fluctuations of the catalytic activity of the cGMP phosphodiesterase. This masks both SPR and spontaneous SPR-like responses. Circadian rhythms affect photoreceptors, among other systems by periodically increasing intracellular cAMP levels ([cAMP]in), which increases the size and changes the shape of SPRs. Here, we show that forskolin, a tool that increases [cAMP]in, affects the magnitude and frequency spectrum of the continuous and discrete components of dark noise in photoreceptors. By changing both components of rod signaling, the signal and the noise, cAMP is able to increase the photoreceptor signal-to-noise ratio by twofold. We propose that this results in a substantial improvement of signal detection, without compromising noise rejection, at the rod bipolar cell synapse. PMID:28611079

Designing laboratory activities in elementary school oriented to scientific approach for teachers SD-Kreatif Bojonegoro

NASA Astrophysics Data System (ADS)

Dwikoranto; Surasmi, W. A.; Suparto, A.; Tresnaningsih, S.; Sambada, D.; Setyowati, T.; Faqih, A.; Setiani, R.

2018-03-01

Important science lessons are introduced to elementary school students through inquiry. This training is important to do because one key determinant of succesful laboratory activities is teachers. This course aims to enable teachers to design an inquiry-based Laboratory Activity and be able to apply it in the classroom. The training was conducted at SD-Kreatif Bojonegoro by Modeling, Design Laboratory activities and Implementing. The results of Laboratory Activities designed to trace the seven aspects that can support the development of inquiry skills in either category. The teacher's response in this activity is positive. The conclusion of this training can improve the ability of teachers in designing and implementing laboratory activities of Science and then expected to positively affect the frequency of science laboratory activities. Usually teachers use learning by using this Laboratory Activity, it will be affected on the pattern of inquiry behavior to the students as well so that will achieve the expected goals. Teachers are expected to continue for other topics, even for other similarly characterized subjects. This habitation is important so that the teacher's skill in making Laboratory Activity continues to be well honed and useful for the students.

Building a Successful Adult Life: Findings from Youth-Directed Research

ERIC Educational Resources Information Center

Powers, Laurie E.; Garner, Tracee; Valnes, Betsy; Squire, Peter; Turner, Alison; Couture, Todd; Dertinger, Rocky

2007-01-01

Although transition outcomes for youth with disabilities have shown some improvement and transition support practices have been identified, many young people continue to face transition barriers that preclude their full participation in key adult life activities. While research efforts have largely been professionally driven, there is emerging…

USAC Annual Report, 2009

ERIC Educational Resources Information Center

Universal Service Administrative Company, 2009

2009-01-01

This paper presents the activities of the Universal Service Administrative Company (USAC) for 2009. The past year was one of accomplishment for USAC. USAC implemented a host of advances in operations, infrastructure, and outreach in an effort to continue to improve collection and disbursement of the Universal Service Fund (USF) support and to…

ACHP | Federal Emergency Management Agency Historic Preservation Program

Science.gov Websites

developing agreements to improve and expedite Section 106 compliance for disaster recovery activities. The developing the PPA, FEMA conducted outreach to stakeholders, including holding listening sessions with the protocols. In either case, FEMA will continue to be responsible for conducting consultation with Indian

Increases of soil phosphatase and urease activities in potato fields by cropping rotation practices

USDA-ARS?s Scientific Manuscript database

Potato yield in Maine has remained relatively constant for over 50 years. To identify and quantify constraints to potato productivity, we established Status Quo (SQ), Soil Conserving (SC), Soil Improving (SI), Disease Suppressive (DS), and Continuous Potato (PP) cropping systems under both rainfed ...

Current and Projected Government and Commercial Space Activities

DTIC Science & Technology

1975-04-01

satellites. Reimbursable. Figure 1 Space Launches by NASA in 197 5—Continued m mm* m~ammm^m i^» ■^ Mission Improved TIPOS Operational Satellite...costs and development effort. Tiros-N, which will have much more capable sensors than existing low-altitude satellites, also will incorporate a

Physiological Adaptations to Chronic Endurance Exercise Training in Patients with Coronary Artery Disease.

ERIC Educational Resources Information Center

Physician and Sportsmedicine, 1987

1987-01-01

In a roundtable format, five doctors explore the reasons why regular physical activity should continue to play a significant role in the rehabilitation of patients with coronary artery disease. Endurance exercise training improves aerobic capacity, reduces blood pressure, and decreases risk. (Author/MT)

How the Brain Learns: Research, Theory, and Application.

ERIC Educational Resources Information Center

Smilkstein, Rita

2001-01-01

Describes the author's research on learning and brain activity, which involved more than 5,000 students and faculty members. Explores six stages of learning: (1) preparing to learn; (2) starting to learn; (3) consolidation; (4) branching out; (5) gaining fluency; and (6) continued improving. States that merging educational research with…

Optimization of chemical compositions in low-carbon Al-killed enamel steel produced by ultra-fast continuous annealing

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

Dong, Futao, E-mail: dongft@sina.com; Du, Linxiu; Liu, Xianghua

2013-10-15

The influence of Mn,S and B contents on microstructural characteristics, mechanical properties and hydrogen trapping ability of low-carbon Al-killed enamel steel was investigated. The materials were produced and processed in a laboratory and the ultra-fast continuous annealing processing was performed using a continuous annealing simulator. It was found that increasing Mn,S contents in steel can improve its hydrogen trapping ability which is attributed by refined ferrite grains, more dispersed cementite and added MnS inclusions. Nevertheless, it deteriorates mechanical properties of steel sheet. Addition of trace boron results in both good mechanical properties and significantly improved hydrogen trapping ability. The boronmore » combined with nitrogen segregating at grain boundaries, cementite and MnS inclusions, provides higher amount of attractive hydrogen trapping sites and raises the activation energy for hydrogen desorption from them. - Highlights: • We study microstructures and properties in low-carbon Al-killed enamel steel. • Hydrogen diffusion coefficients are measured to reflect fish-scale resistance. • Manganese improves hydrogen trapping ability but decrease deep-drawing ability. • Boron improves both hydrogen trapping ability and deep-drawing ability. • Both excellent mechanical properties and fish-scale resistance can be matched.« less

Learning science as a potential new source of understanding and improvement for continuing education and continuing professional development.

PubMed

Van Hoof, Thomas J; Doyle, Terrence J

2018-01-15

Learning science is an emerging interdisciplinary field that offers educators key insights about what happens in the brain when learning occurs. In addition to explanations about the learning process, which includes memory and involves different parts of the brain, learning science offers effective strategies to inform the planning and implementation of activities and programs in continuing education and continuing professional development. This article provides a brief description of learning, including the three key steps of encoding, consolidation and retrieval. The article also introduces four major learning-science strategies, known as distributed learning, retrieval practice, interleaving, and elaboration, which share the importance of considerable practice. Finally, the article describes how learning science aligns with the general findings from the most recent synthesis of systematic reviews about the effectiveness of continuing medical education.

Advanced dendritic web growth development and development of single-crystal silicon dendritic ribbon and high-efficiency solar cell program

NASA Technical Reports Server (NTRS)

Duncan, C. S.; Seidensticker, R. G.; Mchugh, J. P.; Hopkins, R. H.

1986-01-01

Efforts to demonstrate that the dendritic web technology is ready for commercial use by the end of 1986 continues. A commercial readiness goal involves improvements to crystal growth furnace throughput to demonstrate an area growth rate of greater than 15 sq cm/min while simultaneously growing 10 meters or more of ribbon under conditions of continuous melt replenishment. Continuous means that the silicon melt is being replenished at the same rate that it is being consumed by ribbon growth so that the melt level remains constant. Efforts continue on computer thermal modeling required to define high speed, low stress, continuous growth configurations; the study of convective effects in the molten silicon and growth furnace cover gas; on furnace component modifications; on web quality assessments; and on experimental growth activities.

Global Data Assembly Center (GDAC) Report to the GHRSST Science Team

NASA Technical Reports Server (NTRS)

Armstrong, Edward; Vazquez, Jorge; Bingham, Andy; Gierach, Michelle; Huang, Thomas; Chen, Cynthia; Finch, Chris; Thompson, Charles

2013-01-01

In 2012-2013 the Global Data Assembly Center (GDAC) at NASA's Physical Oceanography Distributed Active Archive Center (PO.DAAC) continued its role as the primary clearinghouse and access node for operational GHRSST data streams, as well as its collaborative role with the NOAA Long Term Stewardship and Reanalysis Facility (LTSRF) for archiving. Our presentation reported on our data management activities and infrastructure improvements since the last science team meeting in 2012.

Infraslow status epilepticus: A new form of subclinical status epilepticus recorded in a child with Sturge-Weber syndrome.

PubMed

Bello-Espinosa, Luis E

2015-08-01

Analysis of infraslow EEG activity (ISA) has shown potential in the evaluation of patients with epilepsy and in the differentiation between focal and generalized epilepsies. Infraslow EEG activity analysis may also provide insights into the pathophysiology of refractory clinical and subclinical status epilepticus. The purpose of this report is to describe a girl with Sturge-Weber syndrome (SWS) who presented with a 96-h refractory encephalopathy and nonischemic hemiparesis and who was identified to have infraslow status epilepticus (ISSE), which successfully resolved after midazolam administration. The continuous EEG recording of a 5-year-old girl with known structural epilepsy due to Sturge-Weber syndrome is presented. The patient presented to the ED with acute confusion, eye deviation, and right hemiparesis similar to two previous admissions. Despite administration of lorazepam, fosphenytoin, phenobarbital, and valproic loads, the patient showed no improvement in the clinical condition after 48 h. The continuous video-EEG monitoring (VEM) showed continuous severe diffuse nonrhythmic asymmetric slowing but no apparent ictal activity on continuous conventional EEG recording settings. As brain CT, CTA, CTV, and complete MRI scans including DWI obtained within 72 h of presentation failed to demonstrate any ischemic changes, analysis of the EEG infraslow (ISA) activity was undertaken using LFF: 0.01 Hz and HFF: of 0.1 Hz, respectively. Continuous subclinical unilateral rhythmic ictal ISA was identified. This was only evident on the left hemisphere which correlated with the structural changes due to SWS. A trial of continuous 120 to 240 μg/kg/h of IV midazolam resulted in immediate resolution of the contralateral hemiparesis and encephalopathy. Continuous prolonged rhythmic ictal infraslow activity (ISA) can cause super-refractory subclinical focal status epilepticus. This has not been previously reported, and we propose that this be called infraslow status epilepticus (ISSE). Infraslow EEG activity analysis should be performed in all patients with unexplained subclinical status epilepticus. This article is part of a Special Issue entitled "Status Epilepticus". Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Health Care Improvement and Continuing Interprofessional Education: Continuing Interprofessional Development to Improve Patient Outcomes

ERIC Educational Resources Information Center

Wilcock, Peter M.; Janes, Gillian; Chambers, Alison

2009-01-01

Health care improvement and continuing professional education must be better understood if we are to promote continuous service improvement through interprofessional learning in the workplace. We propose that situating interprofessional working, interprofessional learning, work-based learning, and service improvement within a framework of social…

Active Commuting: Workplace Health Promotion for Improved Employee Well-Being and Organizational Behavior

PubMed Central

Page, Nadine C.; Nilsson, Viktor O.

2017-01-01

Objective: This paper describes a behavior change intervention that encourages active commuting using electrically assisted bikes (e-bikes) for health promotion in the workplace. This paper presents the preliminary findings of the intervention’s impact on improving employee well-being and organizational behavior, as an indicator of potential business success. Method: Employees of a UK-based organization participated in a workplace travel behavior change intervention and used e-bikes as an active commuting mode; this was a change to their usual passive commuting behavior. The purpose of the intervention was to develop employee well-being and organizational behavior for improved business success. We explored the personal benefits and organizational co-benefits of active commuting and compared these to a travel-as-usual group of employees who did not change their behavior and continued taking non-active commutes. Results: Employees who changed their behavior to active commuting reported more positive affect, better physical health and more productive organizational behavior outcomes compared with passive commuters. In addition, there was an interactive effect of commuting mode and commuting distance: a more frequent active commute was positively associated with more productive organizational behavior and stronger overall positive employee well-being whereas a longer passive commute was associated with poorer well-being, although there was no impact on organizational behavior. Conclusion: This research provides emerging evidence of the value of an innovative workplace health promotion initiative focused on active commuting in protecting and improving employee well-being and organizational behavior for stronger business performance. It considers the significant opportunities for organizations pursuing improved workforce well-being, both in terms of employee health, and for improved organizational behavior and business success. PMID:28119640

Active Commuting: Workplace Health Promotion for Improved Employee Well-Being and Organizational Behavior.

PubMed

Page, Nadine C; Nilsson, Viktor O

2016-01-01

Objective: This paper describes a behavior change intervention that encourages active commuting using electrically assisted bikes (e-bikes) for health promotion in the workplace. This paper presents the preliminary findings of the intervention's impact on improving employee well-being and organizational behavior, as an indicator of potential business success. Method: Employees of a UK-based organization participated in a workplace travel behavior change intervention and used e-bikes as an active commuting mode; this was a change to their usual passive commuting behavior. The purpose of the intervention was to develop employee well-being and organizational behavior for improved business success. We explored the personal benefits and organizational co-benefits of active commuting and compared these to a travel-as-usual group of employees who did not change their behavior and continued taking non-active commutes. Results: Employees who changed their behavior to active commuting reported more positive affect, better physical health and more productive organizational behavior outcomes compared with passive commuters. In addition, there was an interactive effect of commuting mode and commuting distance: a more frequent active commute was positively associated with more productive organizational behavior and stronger overall positive employee well-being whereas a longer passive commute was associated with poorer well-being, although there was no impact on organizational behavior. Conclusion: This research provides emerging evidence of the value of an innovative workplace health promotion initiative focused on active commuting in protecting and improving employee well-being and organizational behavior for stronger business performance. It considers the significant opportunities for organizations pursuing improved workforce well-being, both in terms of employee health, and for improved organizational behavior and business success.

Treatment of Sleep Disordered Breathing Reverses Low Fetal Activity Levels in Preeclampsia

PubMed Central

Blyton, Diane M.; Skilton, Michael R.; Edwards, Natalie; Hennessy, Annemarie; Celermajer, David S.; Sullivan, Colin E.

2013-01-01

Study Objectives: Preeclampsia affects 5% to 7% of pregnancies, is strongly associated with low birth weight and fetal death, and is accompanied by sleep disordered breathing. We hypothesized that sleep disordered breathing may link preeclampsia with reduced fetal movements (a marker of fetal health), and that treatment of sleep disordered breathing might improve fetal activity during sleep. Design, Setting, and Participants: First, a method of fetal movement recording was validated against ultrasound in 20 normal third trimester pregnancies. Second, fetal movement was measured overnight with concurrent polysomnography in 20 patients with preeclampsia and 20 control subjects during third trimester. Third, simultaneous polysomnography and fetal monitoring was done in 10 additional patients with preeclampsia during a control night and during a night of nasal CPAP. Intervention: Overnight continuous positive airway pressure. Measurements and Results: Women with preeclampsia had inspiratory flow limitation and an increased number of oxygen desaturations during sleep (P = 0.008), particularly during REM sleep. Preeclampsia was associated with reduced total fetal movements overnight (319 [SD 32]) versus controls (689 [SD 160], P < 0.0001) and a change in fetal movement patterns. The number of fetal hiccups was also substantially reduced in preeclampsia subjects (P < 0.0001). Continuous positive airway pressure treatment increased the number of fetal movements and hiccups (P < 0.0001 and P = 0.0002, respectively). Conclusions: The effectiveness of continuous positive airway pressure in improving fetal movements suggests a pathogenetic role for sleep disordered breathing in the reduced fetal activity and possibly in the poorer fetal outcomes associated with preeclampsia. Citation: Blyton DM; Skilton MR; Edwards N; Hennessy A; Celermajer DS; Sullivan CE. Treatment of sleep disordered breathing reverses low fetal activity levels in preeclampsia. SLEEP 2013;36(1):15–21. PMID:23288967

Continuous Dropout.

PubMed

Shen, Xu; Tian, Xinmei; Liu, Tongliang; Xu, Fang; Tao, Dacheng

2017-10-03

Dropout has been proven to be an effective algorithm for training robust deep networks because of its ability to prevent overfitting by avoiding the co-adaptation of feature detectors. Current explanations of dropout include bagging, naive Bayes, regularization, and sex in evolution. According to the activation patterns of neurons in the human brain, when faced with different situations, the firing rates of neurons are random and continuous, not binary as current dropout does. Inspired by this phenomenon, we extend the traditional binary dropout to continuous dropout. On the one hand, continuous dropout is considerably closer to the activation characteristics of neurons in the human brain than traditional binary dropout. On the other hand, we demonstrate that continuous dropout has the property of avoiding the co-adaptation of feature detectors, which suggests that we can extract more independent feature detectors for model averaging in the test stage. We introduce the proposed continuous dropout to a feedforward neural network and comprehensively compare it with binary dropout, adaptive dropout, and DropConnect on Modified National Institute of Standards and Technology, Canadian Institute for Advanced Research-10, Street View House Numbers, NORB, and ImageNet large scale visual recognition competition-12. Thorough experiments demonstrate that our method performs better in preventing the co-adaptation of feature detectors and improves test performance.

Monitoring activity patterns and trends of older adults.

PubMed

Virone, G; Sixsmith, A

2008-01-01

This paper presents a pattern mining model developed for the continuous monitoring of high level activities and home-based behaviors for functional and cognitive status assessment with ambient assisted living systems such as in the EU-funded SOPRANO project. Motivating older people to engage in regular physical exercise is a key task of SOPRANO to improve health status and executive functions. A case study has been elaborated through software simulations to show how physical everyday life activity such as walking or sitting could be assessed and controlled for a better health lifestyle using the model.

Self-efficacy, physical activity, and aerobic fitness in middle school children: examination of a pedometer intervention program.

PubMed

Manley, Dana; Cowan, Patricia; Graff, Carolyn; Perlow, Michael; Rice, Pamela; Richey, Phyllis; Sanchez, Zoila

2014-01-01

Physical activity in children has been associated with a number of health benefits. Unfortunately, physical inactivity continues to increase. The purpose of this study was to examine the relationships among self-efficacy levels, physical activity, aerobic fitness, and body composition (relative body mass index [RBMI]) and to determine whether a school-based pedometer intervention program would improve those variables. The sample consisted of 116 rural 11- to 13-year-old students. Weakly positive correlations between self-efficacy, physical activity, and aerobic fitness and weakly correlated inverse relationships between self-efficacy, physical activity, aerobic fitness and RBMI were found. There was no statistical significance between the intervention and control group when analyzing outcome variables. These findings suggest that those with optimal RBMI levels have higher self-efficacy, physical activity and aerobic fitness levels. Although not statistically significant, the intervention group had greater improvements in mean self-efficacy scores, aerobic fitness levels, and RBMI. © 2014.

Interval Running Training Improves Cognitive Flexibility and Aerobic Power of Young Healthy Adults.

PubMed

Venckunas, Tomas; Snieckus, Audrius; Trinkunas, Eugenijus; Baranauskiene, Neringa; Solianik, Rima; Juodsnukis, Antanas; Streckis, Vytautas; Kamandulis, Sigitas

2016-08-01

Venckunas, T, Snieckus, A, Trinkunas, E, Baranauskiene, N, Solianik, R, Juodsnukis, A, Streckis, V, and Kamandulis, S. Interval running training improves cognitive flexibility and aerobic power of young healthy adults. J Strength Cond Res 30(8): 2114-2121, 2016-The benefits of regular physical exercise may well extend beyond the reduction of chronic diseases risk and augmentation of working capacity, to many other aspects of human well-being, including improved cognitive functioning. Although the effects of moderate intensity continuous training on cognitive performance are relatively well studied, the benefits of interval training have not been investigated in this respect so far. The aim of the current study was to assess whether 7 weeks of interval running training is effective at improving both aerobic fitness and cognitive performance. For this purpose, 8 young dinghy sailors (6 boys and 2 girls) completed the interval running program with 200 m and 2,000 m running performance, cycling maximal oxygen uptake, and cognitive function was measured before and after the intervention. The control group consisted of healthy age-matched subjects (8 boys and 2 girls) who continued their active lifestyle and were tested in the same way as the experimental group, but did not complete any regular training. In the experimental group, 200 m and 2,000 m running performance and cycling maximal oxygen uptake increased together with improved results on cognitive flexibility tasks. No changes in the results of short-term and working memory tasks were observed in the experimental group, and no changes in any of the measured indices were evident in the controls. In conclusion, 7 weeks of interval running training improved running performance and cycling aerobic power, and were sufficient to improve the ability to adjust behavior to changing demands in young active individuals.

[Audit and feedback, and continuous quality improvement strategies to improve the quality of care for type 2 diabetes: a systematic review of literature].

PubMed

Vecchi, Simona; Agabiti, Nera; Mitrova, Susanna; Cacciani, Laura; Amato, Laura; Davoli, Marina; Bargagli, Anna Maria

2016-01-01

we analysed evidence on effective interventions to improve the quality of care and management in patients with diabetes type 2. This review focuses particularly on audit and feedback intervention, targeted to healthcare providers, and continuous quality improvement (CQI) involving health professionals and health care systems, respectively. we searched The Cochrane Library, PubMed, and EMBASE (search period: January 2005-December 2015) to identify systematic reviews (SR) and randomized controlled trials (RCTs) considering patients' outcomes and process measures as quality indicators in diabetes care. Selection of studies and data extraction were carried out independently by two reviewers. Methodological quality of individual studies was assessed using the checklist «Assessment of methodological quality of systematic review» (AMSTAR) and the Cochrane's tool, respectively. We produced summaries of results for each study design. the search process resulted in 810 citations. One SR and 7 RCTs that compared any intervention in which audit and feedback and CQI was a component vs. other interventions were selected. The SR found that audit and feedback activity was associated with improvements of glycaemic (mean difference: 0.26; 95%CI 0.08;0.44) and cholesterol control (mean difference: 0.03; 95%CI -0.04;0.10). CQI interventions were not associated with an improvement of quality of diabetes care. The RCTs considered in this review compared a broad range of interventions including feedback as unique activity or as part of more complex strategies. The methodological quality was generally poor in all the included trials. the available evidence suggests that audit and feedback and CQI improve quality of care in diabetic patients, although the effect is small and heterogeneous among process and outcomes indicators.

Greater impact of acute high-intensity interval exercise on post-exercise executive function compared to moderate-intensity continuous exercise.

PubMed

Tsukamoto, Hayato; Suga, Tadashi; Takenaka, Saki; Tanaka, Daichi; Takeuchi, Tatsuya; Hamaoka, Takafumi; Isaka, Tadao; Hashimoto, Takeshi

2016-03-01

Aerobic moderate-intensity continuous exercise (MCE) can improve executive function (EF) acutely, potentially through the activation of both physiological and psychological factors. Recently, high-intensity interval exercise (HIIE) has been reported to be more beneficial for physical adaptation than MCE. Factors for EF improvement can potentially be more enhanced by HIIE than by MCE; but the effects of HIIE on EF remain unknown. Therefore, we aimed to examine to what extent HIIE impacts post-exercise EF immediately after exercise and during post-exercise recovery, compared with traditional MCE. Twelve healthy male subjects performed cycle ergometer exercise based on either HIIE or MCE protocols in a randomized and counterbalanced order. The HIIE protocol consisted of four 4-min bouts at 90% of peak VO2 with 3-min active recovery at 60% of peak VO2. A volume-matched MCE protocol was applied at 60% of peak VO2. To evaluate EF, a color-words Stroop task was performed pre- and post-exercise. Improvement in EF immediately after exercise was the same for the HIIE and MCE protocols. However, the improvement of EF by HIIE was sustained during 30 min of post-exercise recovery, during which MCE returned to the pre-exercise level. The EF response in the post-exercise recovery was associated with changes in physiological and psychological responses. The present findings showed that HIIE and MCE were capable of improving EF. Moreover, HIIE could prolong improvement in EF during post-exercise recovery. For the first time, we suggest that HIIE may be more effective strategy than MCE for improving EF. Copyright © 2015 Elsevier Inc. All rights reserved.

The use of data for process and quality improvement in long term care and home care: a systematic review of the literature.

PubMed

Sales, Anne E; Bostrom, Anne-Marie; Bucknall, Tracey; Draper, Kellie; Fraser, Kimberly; Schalm, Corinne; Warren, Sharon

2012-02-01

Standardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data. To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes? Searches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention. After reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education intervention. The most frequently cited issues contributing to unsuccessful quality improvement interventions were lack of staff, high staff turnover, and limited time available to train staff in ways that would improve client care. Innovative strategies and supporting research are required to determine how to intervene successfully to improve quality in these settings characterized by low staffing levels and predominantly nonprofessional staff. Research on how to effectively enable practitioners to use data to improve quality of care, and ultimately quality of life, needs to be a priority. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Alteration of histological gastritis after cure of Helicobacter pylori infection.

PubMed

Hojo, M; Miwa, H; Ohkusa, T; Ohkura, R; Kurosawa, A; Sato, N

2002-11-01

It is still disputed whether gastric atrophy or intestinal metaplasia improves after the cure of Helicobacter pylori infection. To clarify the histological changes after the cure of H. pylori infection through a literature survey. Fifty-one selected reports from 1066 relevant articles were reviewed. The extracted data were pooled according to histological parameters of gastritis based on the (updated) Sydney system. Activity improved more rapidly than inflammation. Eleven of 25 reports described significant improvement of atrophy. Atrophy was not improved in one of four studies with a large sample size (> 100 samples) and in two of five studies with a long follow-up period (> 12 months), suggesting that disagreement between the studies was not totally due to sample size or follow-up period. Methodological flaws, such as patient selection, and statistical analysis based on the assumption that atrophy improves continuously and generally in all patients might be responsible for the inconsistent results. Four of 28 studies described significant improvement of intestinal metaplasia [corrected]. Activity and inflammation were improved after the cure of H. pylori infection. Atrophy did not improve generally among all patients, but improved in certain patients. Improvement of intestinal metaplasia was difficult to analyse due to methodological problems including statistical power.

Aging and the segmentation of narrative film.

PubMed

Kurby, Christopher A; Asiala, Lillian K E; Mills, Steven R

2014-01-01

The perception of event structure in continuous activity is important for everyday comprehension. Although the segmentation of experience into events is a normal concomitant of perceptual processing, previous research has shown age differences in the ability to perceive structure in naturalistic activity, such as a movie of someone washing a car. However, past research has also shown that older adults have a preserved ability to comprehend events in narrative text, which suggests that narrative may improve the event processing of older adults. This study tested whether there are age differences in event segmentation at the intersection of continuous activity and narrative: narrative film. Younger and older adults watched and segmented a narrative film, The Red Balloon, into coarse and fine events. Changes in situational features, such as changes in characters, goals, and objects predicted segmentation. Analyses revealed little age-difference in segmentation behavior. This suggests the possibility that narrative structure supports event understanding for older adults.

The road to NHDPlus — Advancements in digital stream networks and associated catchments

USGS Publications Warehouse

Moore, Richard B.; Dewald, Thomas A.

2016-01-01

A progression of advancements in Geographic Information Systems techniques for hydrologic network and associated catchment delineation has led to the production of the National Hydrography Dataset Plus (NHDPlus). NHDPlus is a digital stream network for hydrologic modeling with catchments and a suite of related geospatial data. Digital stream networks with associated catchments provide a geospatial framework for linking and integrating water-related data. Advancements in the development of NHDPlus are expected to continue to improve the capabilities of this national geospatial hydrologic framework. NHDPlus is built upon the medium-resolution NHD and, like NHD, was developed by the U.S. Environmental Protection Agency and U.S. Geological Survey to support the estimation of streamflow and stream velocity used in fate-and-transport modeling. Catchments included with NHDPlus were created by integrating vector information from the NHD and from the Watershed Boundary Dataset with the gridded land surface elevation as represented by the National Elevation Dataset. NHDPlus is an actively used and continually improved dataset. Users recognize the importance of a reliable stream network and associated catchments. The NHDPlus spatial features and associated data tables will continue to be improved to support regional water quality and streamflow models and other user-defined applications.

Probabilistic Reasoning for Plan Robustness

NASA Technical Reports Server (NTRS)

Schaffer, Steve R.; Clement, Bradley J.; Chien, Steve A.

2005-01-01

A planning system must reason about the uncertainty of continuous variables in order to accurately project the possible system state over time. A method is devised for directly reasoning about the uncertainty in continuous activity duration and resource usage for planning problems. By representing random variables as parametric distributions, computing projected system state can be simplified in some cases. Common approximation and novel methods are compared for over-constrained and lightly constrained domains. The system compares a few common approximation methods for an iterative repair planner. Results show improvements in robustness over the conventional non-probabilistic representation by reducing the number of constraint violations witnessed by execution. The improvement is more significant for larger problems and problems with higher resource subscription levels but diminishes as the system is allowed to accept higher risk levels.

New modalities of brain stimulation for stroke rehabilitation

PubMed Central

Lucas, T. H.; Carey, J. R.; Fetz, E. E.

2014-01-01

Stroke is a leading cause of disability, and the number of stroke survivors continues to rise. Traditional neurorehabilitation strategies aimed at restoring function to weakened limbs provide only modest benefit. New brain stimulation techniques designed to augment traditional neurorehabilitation hold promise for reducing the burden of stroke-related disability. Investigators discovered that repetitive transcranial magnetic stimulation (rTMS), trans-cranial direct current stimulation (tDCS), and epidural cortical stimulation (ECS) can enhance neural plasticity in the motor cortex post-stroke. Improved outcomes may be obtained with activity-dependent stimulation, in which brain stimulation is contingent on neural or muscular activity during normal behavior. We review the evidence for improved motor function in stroke patients treated with rTMS, tDCS, and ECS and discuss the mediating physiological mechanisms. We compare these techniques to activity-dependent stimulation, discuss the advantages of this newer strategy for stroke rehabilitation, and suggest future applications for activity-dependent brain stimulation. PMID:23192336

Teaching nursing concepts through an online discussion board.

PubMed

Hudson, Kandi Ann

2014-09-01

Barriers to course content engagement and student learning in nursing education abound. Some of these barriers include content overload, classroom time constraints, and large student numbers. One way to overcome these issues is the implementation of active learning strategies in the classroom. Despite the positive learning outcomes associated with active learning strategies described in the education literature, traditional passive learning strategies continue to be used by nurse educators in the classroom. This article details the results of a pilot study using an active teaching strategy—an online discussion board—which was designed to improve the learning engagement of beginning nursing students enrolled in their first face-to-face nursing course. The results of the semester-long pilot study indicated a favorable student response to the active teaching strategy and improved overall success in the course by the students who participated fully in the online discussions.

Operation of Terahertz Quantum-cascade Lasers at 164 K in Pulsed Mode and at 117 K in Continuous-wave Mode

NASA Technical Reports Server (NTRS)

Williams, Benjamin S.; Kumar, Sushil; Hu, Qing; Reno, John L.

2005-01-01

We report the demonstration of a terahertz quantum-cascade laser that operates up to 164 K in pulsed mode and 117 K in continuous-wave mod e at approximately 3.0 THz. The active region was based on a resonant -phonon depopulation scheme and a metal-metal waveguide was used for modal confinement. Copper to copper thermocompression wafer bonding w as used to fabricate the waveguide, which displayed improved thermal properties compared to a previous indium-gold bonding method.

Effects of Interrupting Children's Sedentary Behaviors With Activity on Metabolic Function: A Randomized Trial.

PubMed

Belcher, Britni R; Berrigan, David; Papachristopoulou, Alexia; Brady, Sheila M; Bernstein, Shanna B; Brychta, Robert J; Hattenbach, Jacob D; Tigner, Ira L; Courville, Amber B; Drinkard, Bart E; Smith, Kevin P; Rosing, Douglas R; Wolters, Pamela L; Chen, Kong Y; Yanovski, Jack A

2015-10-01

Limited data suggest that interrupting sedentary behaviors with activity improves metabolic parameters in adults. We tested whether interrupting sitting with short, moderate-intensity walking bouts improved glucose tolerance in children. Participants underwent two experimental conditions in random order on different days: continuous sitting for 3 hours or sitting interrupted by walking (3 min of moderate-intensity walking every 30 min). Insulin, C-peptide, glucose, and free fatty acids were measured every 30 minutes for 3 hours during an oral glucose tolerance test. Area under the curve (AUC) was calculated from hormone and substrate measurements. Children were given a buffet meal after each condition. The study was conducted at the National Institutes of Health Hatfield Clinical Research Center. Twenty-eight normal-weight 7-11 year olds participated. Patterns of substrate/hormone secretion and AUC, as well as energy intake, were examined by experimental condition. Interrupting sitting resulted in a 32% lower insulin AUC (P < .001), 17% lower C-peptide AUC (P < .001), and 7% lower glucose AUC (P = .018) vs continuous sitting. Mixed model results indicated that insulin (P = .036) and free fatty acid concentrations (P = .009) were significantly lower in the interrupted vs the continuous sitting condition. Lunchtime buffet meal energy intake did not significantly differ between the conditions (975 ± 387 vs 963 ± 309 kcal; P = .85). Interrupting sedentary time with brief moderate-intensity walking improved short-term metabolic function in non-overweight children without increasing subsequent energy intake. These findings suggest that interrupting sedentary behavior may be a promising prevention strategy for reducing cardiometabolic risk in children.

[Peer training for patients with diabetes mellitus 2. A quantitative and qualitative evaluation in the Basque Country and Andalusia].

PubMed

Danet, Alina; Prieto Rodríguez, María Ángeles; Gamboa Moreno, Estibaliz; Ochoa de Retana Garcia, Lourdes; March Cerdà, Joan Carles

2016-10-01

To evaluate a peer training strategy for patients with type2 diabetes mellitus, developed in two training programmes in the Basque Country and Andalusia. Quantitative pre- and post-intervention and qualitative evaluation, developed between 2012 and 2014. The Basque Country and Andalusia. A total of 409 patients and trainer-patients, participating in self-management peer training programmes. Intentional sample of 44 patients for the qualitative study. Bivariate analysis and net gains for common variables used in questionnaires in the Basque Country and Andalusia: self-reported health, daily activities, physical activity, use of health services, and self-management. Content analysis of 8 focus groups with patients and trainer-patients, including: coding, categorisation, and triangulation of results. Peer training has a positive impact on physical activity, the use of health services, and self-management, with some gender differences. The peer-training strategy is considered positive, as it strengthens the patient-health provider relationship, generates group support and self-confidence, and improves the emotional management. Patients identify two areas of potential improvement: access and continuity of training strategies, and more support and recognition from health providers and institutions. The positive impact on health and quality of life that this patient peer-training provides, requires the collaboration of health professionals and institutions, which should improve the access, continuity and adaptation to patient needs and expectations. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Application of lean six sigma to waste minimization in cigarette paper industry

NASA Astrophysics Data System (ADS)

Syahputri, K.; Sari, R. M.; Anizar; Tarigan, I. R.; Siregar, I.

2018-02-01

The cigarette paper industry is one of the industry that is always experiencing increasing demand from consumers. Consumer expectations for the products produced also increased both in terms of quality and quantity. The company continuously improves the quality of its products by trying to minimize nonconformity, waste and improve the efficiency of the whole production process of the company. In this cigarette industry, there is a disability whose value is above the company’s defect tolerance that is 10% of the production amount per month. Another problem also occurs in the production time is too long due to the many activities that are not value added (non value added activities) on the production floor. To overcome this problem, it is necessary to improve the production process of cigarette paper and minimize production time by reducing non value added activities. Repairs done with Lean Six Sigma. Lean Six Sigma is a combination of Lean and Six Sigma concept with DMAIC method (Define, Measure, Analyze, Improve, Control). With this Lean approach, obtained total production time of 1479.13 minutes proposal with cycle efficiency process increased by 12.64%.

Oxygenated drinking water enhances immune activity in pigs and increases immune responses of pigs during Salmonella typhimurium infection.

PubMed

Jung, Bock-Gie; Lee, Jin-A; Lee, Bong-Joo

2012-12-01

It has been considered that drinking oxygenated water improves oxygen availability, which may increase vitality and improve immune functions. The present study evaluated the effects of oxygenated drinking water on immune function in pigs. Continuous drinking of oxygenated water markedly increased peripheral blood mononuclear cell proliferation, interleukin-1β expression level and the CD4(+):CD8(+) cell ratio in pigs. During Salmonella Typhimurium infection, total leukocytes and relative cytokines expression levels were significantly increased in pigs consuming oxygenated water compared with pigs consuming tap water. These findings suggest that oxygenated drinking water enhances immune activity in pigs and increases immune responses of pigs during S. Typhimurium Infection.

Current management of wound healing.

PubMed

Gottrup, F; Karlsmark, T

2009-06-01

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

ERMHAN: A Context-Aware Service Platform to Support Continuous Care Networks for Home-Based Assistance

PubMed Central

Paganelli, Federica; Spinicci, Emilio; Giuli, Dino

2008-01-01

Continuous care models for chronic diseases pose several technology-oriented challenges for home-based continuous care, where assistance services rely on a close collaboration among different stakeholders such as health operators, patient relatives, and social community members. Here we describe Emilia Romagna Mobile Health Assistance Network (ERMHAN) a multichannel context-aware service platform designed to support care networks in cooperating and sharing information with the goal of improving patient quality of life. In order to meet extensibility and flexibility requirements, this platform has been developed through ontology-based context-aware computing and a service oriented approach. We also provide some preliminary results of performance analysis and user survey activity. PMID:18695739

Expectations and perceptions of primary healthcare professionals regarding their own continuous education in Catalonia (Spain): a qualitative study.

PubMed

Mundet-Tuduri, Xavier; Crespo, Ramon; Fernandez-Coll, Ma Luisa; Saumell, Montserrat; Millan-Mata, Flor; Cardona, Àngels; Codern-Bové, Núria

2017-11-15

The planning and execution of continuous education in an organization that provides health services is a complex process. The objectives, learning sequences, and implementation strategies should all be oriented to improving the health of the population. The aim of this study was to analyse the expectations and perceptions of continuous educations by primary healthcare professionals (physicians and nurses) and identify aspects that hinder or encourage the process. A qualitative study with 5 focus groups made up of 25 primary healthcare professionals from the Catalan Health Institute, Barcelona (Catalonia, Spain). The focus groups were audio-recorded and the results transcribed. The analysis involved: a) Reading of the data looking for meanings b) Coding of the data by themes and extracting categories c) Reviewing and refining codes and categories d) Reconstruction of the data providing an explanatory framework for the meanings e) Discussion about the interpretations of the findings and f) Discussed with relevant professionals from PHC (physicians and nurses)"Data regarding thematic content were analyzed with the support of Atlasti 5.1 software. The health needs of the population were often at the core of the learning processes but the participants' views did not always spontaneously refer to improvements in these issues. Common themes that could hinder learning and where identified, including contextual aspects such as work constraints (timetables, places being covered during training) and funding policies. New learning strategies to improve the effectiveness of continuous education were proposed such as the exchange of knowledge, the activation of personal commitment to change, and the improvement of organizational aspects. The primary healthcare professionals in our study viewed continuous education as a professional necessity and would like to translate the knowledge acquired to improving the health of the population. Nevertheless, professional, structural, and organizational issues impede the process.

Communicating quality improvement through a hospital newsletter.

PubMed

Tietz, A; Tabor, R

1995-01-01

Healthcare organizations across the United States are embracing the tenets of continuous quality improvement. The challenge is to disseminate information about this quality activity throughout the organization. A monthly newsletter serves two vital purposes: to share the improvements and to generate more enthusiasm and participation by staff members. This article gives practical suggestions for promoting a monthly newsletter. Preparation of an informative newsletter requires a significant investment of time and effort. However, the positive results of providing facilitywide communications can make it worth the effort. The current availability of relatively inexpensive desktop publishing computer software programs has made the process much easier.

Improvement of red pepper yield and soil environment by summer catch aquatic crops in greenhouses

NASA Astrophysics Data System (ADS)

Du, X. F.; Wang, L. Z.; Peng, J.; Wang, G. L.; Guo, X. S.; Wen, T. G.; Gu, D. L.; Wang, W. Z.; Wu, C. W.

2016-08-01

To investigate effects of the rotation of summer catch crops on remediation retrogressed soils in continuous cropping, a field experiment was conducted. Rice, water spinach, or cress were selected as summer catch crops; bare fallow during summer fallow was used as the control group. Results showed that aquatic crops grown in summer fallow period could effectively reduce soil bulk density and pH, facilitate soil nutrient release, and improve soil physical and chemical properties compared with those grown in fallow period. Paddy-upland rotation could improve soil microbial members and increase bacterial and actinomycete populations; by contrast, paddy-upland rotation could reduce fungal populations and enhance bacterium-to-fungus ratio. Paddy-upland rotation could also actively promote activities of soil enzymes, such as urease, phosphatase, invertase, and catalase. The proposed paddy-upland rotation significantly affected the growth of red pepper; the yield and quality of the grown red pepper were enhanced. Summer catch crops, such as rice, water spinach, and cress significantly increased pepper yield in the following growing season by 15.4%, 10.2% and 14.0%, respectively, compared with those grown in fallow treatment. Therefore, the proposed paddy-upland crop rotation could be a useful method to alleviate continuous cropping problems involved in cultivating red pepper in greenhouses.

Corporate Repair Philosophy and Measuring for Continuous Improvement at Philadelphia Naval Shipyard

DTIC Science & Technology

1992-09-01

processes and products of Improvement Program (NIIP) vegan a series Wavy depot-level activities, of discussions which centered on the development of a...alteration project have been made at the and workforce. Prior to entering the shipyard. These changes and their effect planning stages fortheUSS...the in CKO at 80% is slightly less for CV-64 "rippling effects " of a DSR submittal when compared to CV-63 at its 80% point such as work stoppage

Human Factors Tools for Improving Simulation Activities in Continuing Medical Education

ERIC Educational Resources Information Center

Seagull, F. Jacob

2012-01-01

Human factors (HF) is a discipline often drawn upon when there is a need to train people to perform complex, high-stakes tasks and effectively assess their performance. Complex tasks often present unique challenges for training and assessment. HF has developed specialized techniques that have been effective in overcoming several of these…

Diabetes Care as an Active Learning Model of Postgraduate Education and Training for Pharmaceutical Care.

ERIC Educational Resources Information Center

Koda-Kimble, Mary Anne; Batz, Forrest R.

1994-01-01

In a University of California continuing pharmacy education course in diabetes care, practicing pharmacists lived as patients with diabetes for two days and role-played in small groups. One year later, participants reported making changes in their diabetes care-related practice, suggesting its effectiveness in improving practitioners' skill…

Building a Critically Reflective Practice: Relating Brookfield's Four Lenses to Inservice Teachers' Experiences

ERIC Educational Resources Information Center

Nager, Laura Helen

2017-01-01

Educators are a special group of professional practitioners. They are often characterized as self-directed, lifelong learners who routinely implement some level of reflection to improve instruction. Dewey referred to these reflective practitioners as professionals who, in an effort to continually develop their practice, actively consider multiple…

Motivational and Adaptational Factors of Successful Women Engineers

ERIC Educational Resources Information Center

Bornsen, Susan Edith

2012-01-01

It is no surprise that there is a shortage of women engineers. The reasons for the shortage have been researched and discussed in myriad papers, and suggestions for improvement continue to evolve. However, there are few studies that have specifically identified the positive aspects that attract women to engineering and keep them actively engaged…

The Relevance of the Alliance for CME Competencies for Planning, Organizing, and Sustaining an Interorganizational Educational Collaborative

ERIC Educational Resources Information Center

Balmer, Jann T.; Bellande, Bruce J.; Addleton, Robert L.; Havens, Carol S.

2011-01-01

The heightened demand for accountability, access, and quality performance from health care professionals has resulted in linkages between continuing education (CE), performance improvement (PI), and outcomes. CE health professionals must also expand their skills and abilities to design, implement, and measure CE activities consistent with these…

Directory of Nature Centers and Related Environmental Education Facilities. Third Revision.

ERIC Educational Resources Information Center

National Audubon Society, New York, NY.

This directory is part of a continuing effort to identify facilities actively involved in environmental education. Designed as a guide for the casual visitor as well as the professional person, it aims to stimulate interest in nature centers, improve communication among facilities, and encourage development of new and better ones. This third…

Software measurement guidebook

NASA Technical Reports Server (NTRS)

Bassman, Mitchell J.; Mcgarry, Frank; Pajerski, Rose

1994-01-01

This software Measurement Guidebook presents information on the purpose and importance of measurement. It discusses the specific procedures and activities of a measurement program and the roles of the people involved. The guidebook also clarifies the roles that measurement can and must play in the goal of continual, sustained improvement for all software production and maintenance efforts.

Proceedings of the NCTM Research Catalyst Conference

ERIC Educational Resources Information Center

Lester, Frank K., Jr., Ed.; Ferrini-Mundy, Joan, Ed.

2004-01-01

In 1999-2000, the National Council of Teachers of Mathematics (NCTM) Board of Directors established the Standards Impact Research Group (SIRG) in response to the continuing need for a clearer understanding of the role of standards in the improvement of mathematics education. SIRG has undertaken a number of activities in support of its objectives,…

Balancing Risk? First Year Performing Arts Students' Experience of a Community Arts Event

ERIC Educational Resources Information Center

Hains-Wesson, Rachael; Campbell, Angela

2014-01-01

This study examines participants' responses to first year students' street performances as a non-placement work-integrated learning (WIL) activity over a two year period. The purpose of the study was to determine: (1) community perception, (2) continuous improvement, and (3) future needs. Data was collected through surveying participants'…

Productive Use of Collaborative Time. Research into Practice

ERIC Educational Resources Information Center

Williamson, Ronald

2012-01-01

Many schools have embraced the idea of professional learning communities (PLC's). While the term is used to describe many types of collaborative activities, PLC's are most successful when they focus intently on improving student learning. In these communities of learners there is a shared commitment to continually learn and act on that learning in…

The effect of various parameters of large scale radio propagation models on improving performance mobile communications

NASA Astrophysics Data System (ADS)

Pinem, M.; Fauzi, R.

2018-02-01

One technique for ensuring continuity of wireless communication services and keeping a smooth transition on mobile communication networks is the soft handover technique. In the Soft Handover (SHO) technique the inclusion and reduction of Base Station from the set of active sets is determined by initiation triggers. One of the initiation triggers is based on the strong reception signal. In this paper we observed the influence of parameters of large-scale radio propagation models to improve the performance of mobile communications. The observation parameters for characterizing the performance of the specified mobile system are Drop Call, Radio Link Degradation Rate and Average Size of Active Set (AS). The simulated results show that the increase in altitude of Base Station (BS) Antenna and Mobile Station (MS) Antenna contributes to the improvement of signal power reception level so as to improve Radio Link quality and increase the average size of Active Set and reduce the average Drop Call rate. It was also found that Hata’s propagation model contributed significantly to improvements in system performance parameters compared to Okumura’s propagation model and Lee’s propagation model.

Effects of Person-Centered Physical Therapy on Fatigue-Related Variables in Persons With Rheumatoid Arthritis: A Randomized Controlled Trial.

PubMed

Feldthusen, Caroline; Dean, Elizabeth; Forsblad-d'Elia, Helena; Mannerkorpi, Kaisa

2016-01-01

To examine effects of person-centered physical therapy on fatigue and related variables in persons with rheumatoid arthritis (RA). Randomized controlled trial. Hospital outpatient rheumatology clinic. Persons with RA aged 20 to 65 years (N=70): intervention group (n=36) and reference group (n=34). The 12-week intervention, with 6-month follow-up, focused on partnership between participant and physical therapist and tailored health-enhancing physical activity and balancing life activities. The reference group continued with regular activities; both groups received usual health care. Primary outcome was general fatigue (visual analog scale). Secondary outcomes included multidimensional fatigue (Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire) and fatigue-related variables (ie, disease, health, function). At posttest, general fatigue improved more in the intervention group than the reference group (P=.042). Improvement in median general fatigue reached minimal clinically important differences between and within groups at posttest and follow-up. Improvement was also observed for anxiety (P=.0099), and trends toward improvements were observed for most multidimensional aspects of fatigue (P=.023-.048), leg strength/endurance (P=.024), and physical activity (P=.023). Compared with the reference group at follow-up, the intervention group improvement was observed for leg strength/endurance (P=.001), and the trends toward improvements persisted for physical (P=.041) and living-related (P=.031) aspects of fatigue, physical activity (P=.019), anxiety (P=.015), self-rated health (P=.010), and self-efficacy (P=.046). Person-centered physical therapy focused on health-enhancing physical activity and balancing life activities showed significant benefits on fatigue in persons with RA. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Addressing Core Competencies Through Hospital Quality Improvement Activities: Attitudes and Engagement

PubMed Central

Lipstein, Ellen A; Kronman, Matthew P; Richmond, Camilla; White, Kristin Nyweide; Shugerman, Richard P; McPhillips, Heather A

2011-01-01

Background Hospital quality improvement initiatives are becoming increasingly common. Little is known about the influence of these initiatives on resident learning and attitudes. Our objective was to assess whether training in a hospital committed to involving residents in hospital-initiated, continuous quality improvement (CQI), and to participation in such activities, would influence residents' attitudes toward CQI and engagement in the hospital community. Methods We surveyed Seattle Children's Hospital pediatric residents, from residency graduation years 2002–2009. We included questions about participation in quality improvement activities during residency and measures of attitude toward CQI and of workplace engagement. We used descriptive statistics to assess trends in resident participation in hospital CQI activities, attitudes toward CQI and workplace engagement. Results The overall response rate was 84% (162 of 194). Among graduated residents, there was a significant trend toward increased participation in CQI activities (P  =  .03). We found no difference in attitude toward CQI between those who had and those who had not participated in such activities nor between residents who began training before and those who began after the hospital formally committed to CQI. Sixty-three percent of residents (25 of 40) who participated in CQI activities were engaged in the hospital community compared with 53% (57 of 107) who did not participate in CQI activities (P  =  .21). Conclusions Training in a hospital committed to involving residents in CQI was associated with a high rate of participation in CQI activities. Although such training and participation in CQI were not associated with resident attitudes toward CQI or hospital engagement, it may allow residents to learn skills for practice-based learning and improvement and systems-based practice. PMID:22942955

The short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture.

PubMed

Sator-Katzenschlager, Sabine M; Scharbert, Gisela; Kozek-Langenecker, Sibylle A; Szeles, Jozef C; Finster, Gabriele; Schiesser, Andreas W; Heinze, Georg; Kress, Hans Georg

2004-05-01

Acupuncture is an established adjuvant analgesic modality for the treatment of chronic pain. Electrical stimulation of acupuncture points is considered to increase acupuncture analgesia. In this prospective, randomized, double-blind, controlled study we tested the hypothesis that auricular electroacupuncture (EA) relieves pain more effectively than conventional manual auricular acupuncture (CO) in chronic low back pain patients with insufficient pain relief (visual analogue scale [VAS] > or = 5) treated with standardized analgesic therapy. Disposable acupuncture needles were inserted in the auricular acupuncture points 29, 40, and 55 of the dominant side and connected to a newly developed battery-powered miniaturized stimulator worn behind the ear. Patients were randomized into group EA (n = 31) with continuous low-frequency auricular EA (1 Hz biphasic constant current of 2 mA) and group CO (n = 30) without electrical stimulation (sham-electroacupuncture). Treatment was performed once weekly for 6 wk, and in each group needles were withdrawn 48 h after insertion. During the study period and a 3-mo follow-up, patients were asked to complete the McGill questionnaire. Psychological well being, activity level, quality of sleep, and pain intensity were assessed by means of VAS; moreover, analgesic drug consumption was documented. Pain relief was significantly better in group EA during the study and the follow-up period as compared with group CO. Similarly, psychological well-being, activity, and sleep were significantly improved in group EA versus group CO, the consumption of analgesic rescue medication was less, and more patients returned to full-time employment. Neuropathic pain in particular improved in patients treated with EA. There were no adverse side effects. These results are the first to demonstrate that continuous EA stimulation of auricular acupuncture points improves the treatment of chronic low back pain in an outpatient population. Continuous electrical stimulation of auricular acupuncture points using the new point stimulation device P-stim significantly decreases pain intensity and improves psychological well-being, activity, and sleep in chronic low back pain patients.

Acute Sleep Deprivation Enhances Post-Infection Sleep and Promotes Survival during Bacterial Infection in Drosophila

PubMed Central

Kuo, Tzu-Hsing; Williams, Julie A.

2014-01-01

Study Objectives: Sleep is known to increase as an acute response to infection. However, the function of this behavioral response in host defense is not well understood. To address this problem, we evaluated the effect of acute sleep deprivation on post-infection sleep and immune function in Drosophila. Setting: Laboratory. Participants: Drosophila melanogaster. Methods and Results: Flies were subjected to sleep deprivation before (early DEP) or after (late DEP) bacterial infection. Relative to a non-deprived control, flies subjected to early DEP had enhanced sleep after infection as well as increased bacterial clearance and survival outcome. Flies subjected to late DEP experienced enhanced sleep following the deprivation period, and showed a modest improvement in survival outcome. Continuous DEP (early and late DEP) throughout infection also enhanced sleep later during infection and improved survival. However, improved survival in flies subjected to late or continuous DEP did not occur until after flies had experienced sleep. During infection, both early and late DEP enhanced NFκB transcriptional activity as measured by a luciferase reporter (κB-luc) in living flies. Early DEP also increased NFκB activity prior to infection. Flies that were deficient in expression of either the Relish or Dif NFκB transcription factors showed normal responses to early DEP. However, the effect of early DEP on post-infection sleep and survival was abolished in double mutants, which indicates that Relish and Dif have redundant roles in this process. Conclusions: Acute sleep deprivation elevated NFκB-dependent activity, increased post-infection sleep, and improved survival during bacterial infection. Citation: Kuo TH, Williams JA. Acute sleep deprivation enhances post-infection sleep and promotes survival during bacterial infection in Drosophila. SLEEP 2014;37(5):859-869. PMID:24790264

Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures.

PubMed

Sapir, Tamar; Moreo, Kathleen; Carter, Jeffrey D; Greene, Laurence; Patel, Barry; Higgins, Peter D R

2016-07-01

Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists. We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities. Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively. At baseline, randomly selected charts of patients with moderate-to-severe ulcerative colitis were retrospectively reviewed for the gastroenterologists' performance of 8 PQRS IBD measures and 4 NQS-related measures. The intervention group participated in a series of accredited continuing medical education (CME) activities focusing on QI. Follow-up chart reviews were conducted 6 months after the CME activities. Independent t tests were conducted to compare between-group differences in baseline-to-follow-up rates of documented compliance with each measure. The analysis included 299 baseline charts and 300 follow-up charts. The intervention group had significantly greater magnitudes of improvement than the control group for the following measures: assessment of IBD type, location, and activity (+14 %, p = 0.009); influenza vaccination (+13 %, p = 0.025); pneumococcal vaccination (+20 %, p = 0.003); testing for latent tuberculosis before anti-TNF-α therapy (+10 %, p = 0.028); assessment of hepatitis B virus status before anti-TNF-α therapy (+9 %, p = 0.010); assessment of side effects (+17 %, p = 0.048), and counseling patients about cancer risks (+13 %, p = 0.013). QI-focused CME improves community-based gastroenterologists' compliance with IBD quality measures and measures aligned with NQS priorities.

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care

PubMed Central

Percival, Nikki; O’Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

PubMed

Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.

Production of egg white protein hydrolysates with improved antioxidant capacity in a continuous enzymatic membrane reactor: optimization of operating parameters by statistical design.

PubMed

Jakovetić Tanasković, Sonja; Luković, Nevena; Grbavčić, Sanja; Stefanović, Andrea; Jovanović, Jelena; Bugarski, Branko; Knežević-Jugović, Zorica

2018-01-01

This study focuses on the influence of operating conditions on Alcalase-catalyzed egg white protein hydrolysis performed in a continuously stirred tank reactor coupled with ultrafiltration module (10 kDa). The permeate flow rate did not significantly affect the degree of hydrolysis (DH), but a significant increase in process productivity was apparent above flow rate of 1.9 cm 3 min -1 . By contrast, an increase in enzyme/substrate ( E / S ) ratio provided an increase in DH, but a negative correlation was observed between E / S ratio and productivity. The relationship between operating conditions and antioxidant properties of the hydrolysates, measured by three methods, was studied using Box-Behnken experimental design and response surface methodology. The statistical analysis showed that each variable (impeller speed, E / S ratio, and permeate flow rate) had a significant effect on the antioxidant capacity of all tested systems. Nevertheless, obtained response functions revealed that antioxidative activity measured by DPPH, ABTS and FRAP methods were affected differently by the same operating conditions. High impeller speeds and low permeate flow rates favor ABTS while high impeller speeds and high permeate flow rates had a positive effect on the DPPH scavenging activity. On the other hand, the best results obtained with FRAP method were achieved under moderate operating conditions. The integration of the reaction and ultrafiltration membrane separation in a continuous manner appears to be a right approach to improve and intensify the enzymatic process, enabling the production of peptides with desired antioxidant activity.

Motivational characteristics and resistance training in older adults: a randomized controlled trial and 1-year follow-up.

PubMed

Kekäläinen, Tiia; Kokko, Katja; Tammelin, Tuija; Sipilä, Sarianna; Walker, Simon

2018-06-07

The aim of this study was to investigate the effects of a nine-month supervised resistance training intervention on motivational and volitional characteristics related to exercise, and whether the absolute level and/or intervention-induced change in these characteristics predict self-directed continuation of resistance training one year after the intervention. Community-dwelling older adults aged 65-75, who did not fulfill physical activity recommendations, were randomized into resistance training intervention groups: training once- (n=26), twice- (n=27), three-times-a-week (n=28) or non-training control group (n=25). Training groups participated in supervised resistance training for nine months: during months 1-3 all groups trained twice-a-week and then with allocated frequencies during months 4-9. Exercise-related motivation, self-efficacy and planning were measured with questionnaires at baseline, month-3 and month-9. The continuance of resistance training was determined by interviews six and twelve months after the end of the intervention. The intervention improved action and coping planning as well as intrinsic motivation (group×time p<.05). During one-year follow-up, 54% of participants did not continue self-directed regular resistance training, 22% continued regular resistance training once-a-week and 24% twice-a-week. Increases in exercise self-efficacy and intrinsic motivation related to training during the intervention predicted continuation of resistance training twice-a-week. Resistance training improved exercise-related motivational and volitional characteristics in older adults. These improvements were linked to continuing resistance training one year after the supervised intervention. The role of these characteristics should be taken into account when promoting long-term resistance training participation among older adults. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Recent improvements in monitoring Hawaiian volcanoes with webcams and thermal cameras

NASA Astrophysics Data System (ADS)

Patrick, M. R.; Orr, T. R.; Antolik, L.; Lee, R.; Kamibayashi, K.

2012-12-01

Webcams have become essential tools for continuous observation of ongoing volcanic activity. The use of both visual webcams and Web-connected thermal cameras has increased dramatically at the Hawaiian Volcano Observatory over the past five years, improving our monitoring capability and understanding of both Kilauea's summit eruption, which began in 2008, and the east rift zone eruption, which began in 1983. The recent bolstering of the webcam network builds upon the three sub-megapixel webcams that were in place five years ago. First, several additional fixed visual webcam systems have been installed, using multi-megapixel low-light cameras. Second, several continuously operating thermal cameras have been deployed, providing a new view of activity, easier detection of active flows, and often "seeing" through fume that completely obscures views from visual webcams. Third, a new type of "mobile" webcam - using cellular modem telemetry and capable of rapid deployment - has allowed us to respond quickly to changes in eruptive activity. Fourth, development of automated analysis and alerting scripts provide real-time products that aid in quantitative interpretation of incoming images. Finally, improvements in the archiving and Web-based display of images allow efficient review of current and recent images by observatory staff. Examples from Kilauea's summit and lava flow field provide more detail on the improvements. A thermal camera situated at Kilauea's summit has tracked the changes in the active lava lake in Halema`uma`u Crater since late 2010. Automated measurements from these images using Matlab scripts are now providing real-time quantitative data on lava level and, in some cases, lava crust velocity. Lava level essentially follows summit tilt over short time scales, in which near-daily cycles of deflation and inflation correspond with about ten meters of lava level drop and rise, respectively. The data also show that the long-term Halema`uma`u lava level tracked by the thermal cameras also correlates with the pressure state of the summit magma reservoir over months based on deformation data. Comparing the summit lava level with that in Pu`u `O`o crater, about 20 km distant on the east rift zone, reveals a clear correlation that reaffirms the hydraulic connection from summit to rift zone. Elsewhere on Kilauea, mobile webcams deployed on the coastal plain have improved the tracking of active breakouts from the east rift zone eruption site - a critical hazard zone given that four homes, mostly in the Kalapana area, have been destroyed by lava flows in the last three years. Each morning an automated Matlab script detects incandescent areas in overnight images and, using the known image geometry, determines the azimuth to active flows. The results of this eruptive "breakout locator" are emailed to observatory staff each morning and provide a quantitative constraint on breakout locations and hazard potential that serves as a valuable addition to routine field mapping. These examples show the utility of webcams and thermal cameras for monitoring volcanic activity, and they reinforce the importance of continued development of equipment as well as real-time processing and analysis tools.

Golimumab in patients with active rheumatoid arthritis who have previous experience with tumour necrosis factor inhibitors: results of a long-term extension of the randomised, double-blind, placebo-controlled GO-AFTER study through week 160

PubMed Central

Smolen, Josef S; Kay, Jonathan; Landewé, Robert B M; Matteson, Eric L; Gaylis, Norman; Wollenhaupt, Jurgen; Murphy, Frederick T; Zhou, Yiying; Hsia, Elizabeth C; Doyle, Mittie K

2012-01-01

Objective The aim of this study was to assess long-term golimumab therapy in patients with rheumatoid arthritis (RA) who discontinued previous tumour necrosis factor alpha (TNFα) inhibitor(s) for any reason. Methods Results through week 24 of this multicentre, randomised, double-blind, placebo-controlled study of active RA (≥4 tender, ≥4 swollen joints) were previously reported. Patients received placebo (Group 1), 50 mg golimumab (Group 2) or 100 mg golimumab (Group 3) subcutaneous injections every 4 weeks. Patients from Groups 1 and 2 with <20% improvement in tender/swollen joints at week 16 early escaped to golimumab 50 mg and 100 mg, respectively. At week 24, Group 1 patients crossed over to golimumab 50 mg, Group 2 continued golimumab 50/100 mg per escape status and Group 3 maintained dosing. Data through week 160 are reported. Results 459 of the 461 randomised patients were treated; 236/459 (51%) continued treatment through week 160. From week 24 to week 100, ACR20 (≥20% improvement in American College of Rheumatology criteria) response and ≥0.25 unit HAQ (Health Assessment Questionnaire) improvement were sustained in 70–73% and 75–81% of responding patients, respectively. Overall at week 160, 63%, 67% and 57% of patients achieved ACR20 response and 59%, 65% and 64% had HAQ improvement ≥0.25 unit in Groups 1, 2 and 3, respectively. Adjusted for follow-up duration, adverse event incidences (95% CI) per 100 patient-years among patients treated with golimumab 50 mg and 100 mg were 4.70 (2.63 to 7.75) and 8.07 (6.02 to 10.58) for serious infection, 0.95 (0.20 to 2.77) and 2.04 (1.09 to 3.49) for malignancy and 0.00 (0.00 to 0.94) and 0.62 (0.17 to 1.59) for death, respectively. Conclusion In patients with active RA who discontinued previous TNF-antagonist treatment, golimumab 50 and 100 mg injections every 4 weeks yielded sustained improvements in signs/symptoms and physical function in ∼57–67% of patients who continued treatment. Golimumab safety was consistent with other anti-TNF agents, although definitive conclusions regarding long-term safety require further monitoring. PMID:22459542

Continuous monitoring of Hawaiian volcanoes with thermal cameras

USGS Publications Warehouse

Patrick, Matthew R.; Orr, Tim R.; Antolik, Loren; Lee, Robert Lopaka; Kamibayashi, Kevan P.

2014-01-01

Continuously operating thermal cameras are becoming more common around the world for volcano monitoring, and offer distinct advantages over conventional visual webcams for observing volcanic activity. Thermal cameras can sometimes “see” through volcanic fume that obscures views to visual webcams and the naked eye, and often provide a much clearer view of the extent of high temperature areas and activity levels. We describe a thermal camera network recently installed by the Hawaiian Volcano Observatory to monitor Kīlauea’s summit and east rift zone eruptions (at Halema‘uma‘u and Pu‘u ‘Ō‘ō craters, respectively) and to keep watch on Mauna Loa’s summit caldera. The cameras are long-wave, temperature-calibrated models protected in custom enclosures, and often positioned on crater rims close to active vents. Images are transmitted back to the observatory in real-time, and numerous Matlab scripts manage the data and provide automated analyses and alarms. The cameras have greatly improved HVO’s observations of surface eruptive activity, which includes highly dynamic lava lake activity at Halema‘uma‘u, major disruptions to Pu‘u ‘Ō‘ō crater and several fissure eruptions.

Progress toward poliomyelitis eradication - Nigeria, January 2012-September 2013.

PubMed

2013-12-13

Transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Pakistan, and Nigeria, and since 2003, Nigeria has been a reservoir for WPV reintroduction to 25 polio-free countries. In 2012, the Nigerian government activated an emergency operations center and implemented a national emergency action plan to eradicate polio. The 2013 revision of this plan prioritized 1) improving quality of supplemental immunization activities (SIAs), 2) implementing strategies to reach underserved populations, 3) adopting special approaches in security-compromised areas, 4) improving outbreak response, 5) enhancing routine immunization and activities implemented between SIAs, and 6) strengthening surveillance. This report summarizes polio eradication activities in Nigeria during January 2012-September 2013 and updates previous reports. During January-September 2013, 49 polio cases were reported from 26 local government areas (LGAs) in nine states in Nigeria, compared with 101 cases reported from 70 LGAs in 13 states during the same period in 2012. For all of 2012, a total of 122 cases were reported. No WPV type 3 (WPV3) cases have been reported since November 2012. For the first time ever, in 2013, no polio cases of any type have been detected in the northwest of Nigeria; however, transmission continues in Kano and states in the northeast. Despite considerable progress, 24 LGAs in 2012 and seven LGAs in 2013 reported two or more cases; WPV continues to circulate in eight LGAs that had cases in 2012. Efforts to interrupt transmission remain impeded by insecurity, anti-polio-vaccine sentiment, and chronically poor SIA implementation in selected areas. Improvement of SIA quality and effective outbreak response will be needed to interrupt WPV transmission in 2014.

Creating State Accountability Systems That Help Schools Improve

ERIC Educational Resources Information Center

Elgart, Mark A.

2016-01-01

Organizational leaders from nearly every sector have been using continuous improvement models and improvement science for years to improve products, services, and processes. Though continuous improvement processes are not new in education, they are relatively new in the state policy arena. In a continuous improvement system, educators use data,…

Educating Nurses in the United States about Pressure Injuries.

PubMed

Ayello, Elizabeth A; Zulkowski, Karen; Capezuti, Elizabeth; Jicman, Wendy Harris; Sibbald, R Gary

2017-02-01

To provide information about the current state of educating nurses about wound care and pressure injuries with recommendations for the future. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Discuss the importance of pressure injury education and wound care for nurses and identify the current state of nursing education on the subject. 2. Identify strategies that can be used to put improved wound care and pressure injury education into practice. Wound care nursing requires knowledge and skill to operationalize clinical guidelines. Recent surveys and studies have revealed gaps in nurses' knowledge of wound care and pressure injuries and their desire for more education, both in their undergraduate programs and throughout their careers. Data from baccalaureate programs in the United States can pinpoint areas for improvement in nursing curriculum content. Lifelong learning about wound care and pressure injuries starts with undergraduate nursing education but continues through the novice-to-expert Benner categories that are facilitated by continuing professional development. This article introduces a pressure injury competency skills checklist and educational strategies based on Adult Learning principles to support knowledge acquisition (in school) and translation (into clinical settings). The responsibility for lifelong learning is part of every nurse's professional practice.

Benefits of exercise in old age.

PubMed

Gorman, K M; Posner, J D

1988-02-01

Although exercise capacity declines with age, the decline appears to be slight when measured in healthy, physically active subjects. There is growing evidence that exercise has a positive influence on increasing healthy function and decreasing the impact of diseases common in the elderly. While the dose-response relationship between physical activity and health benefits continues to be studied, there is some evidence that even low- and moderate-intensity exercise programs in older people result in tangible improvements in many physical and psychologic parameters.

Lithospheric Models of the Middle East to Improve Seismic Source Parameter Determination/Event Location Accuracy

DTIC Science & Technology

2012-09-01

State Award Nos. DE-AC52-07NA27344/24.2.3.2 and DOS_SIAA-11-AVC/NMA-1 ABSTRACT The Middle East is a tectonically complex and seismically...active region. The ability to accurately locate earthquakes and other seismic events in this region is complicated by tectonics , the uneven...and seismic source parameters show that this activity comes from tectonic events. This work is informed by continuous or event-based regional

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

PubMed Central

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

2014-01-01

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

Little shop of errors: an innovative simulation patient safety workshop for community health care professionals.

PubMed

Tupper, Judith B; Pearson, Karen B; Meinersmann, Krista M; Dvorak, Jean

2013-06-01

Continuing education for health care workers is an important mechanism for maintaining patient safety and high-quality health care. Interdisciplinary continuing education that incorporates simulation can be an effective teaching strategy for improving patient safety. Health care professionals who attended a recent Patient Safety Academy had the opportunity to experience firsthand a simulated situation that included many potential patient safety errors. This high-fidelity activity combined the best practice components of a simulation and a collaborative experience that promoted interdisciplinary communication and learning. Participants were challenged to see, learn, and experience "ah-ha" moments of insight as a basis for error reduction and quality improvement. This innovative interdisciplinary educational training method can be offered in place of traditional lecture or online instruction in any facility, hospital, nursing home, or community care setting. Copyright 2013, SLACK Incorporated.

A Community-Based Exergaming Physical Activity Program Improves Readiness-to-Change and Self-Efficacy Among Rural-Residing Older Adults.

PubMed

Sowle, Ashleigh J; Francis, Sarah L; Margrett, Jennifer A; Shelley, Mack C; Franke, Warren D

2017-07-01

Rural-residing older adults (OA) are not meeting physical activity (PA) recommendations, such that identifying methods of increasing PA among OA remains an ongoing challenge. This study evaluated the effect of a community-based exergaming program on PA readiness-to-change and self-efficacy among rural-residing OA (n = 265). There was a significant (p = .008) increase in readiness-to-change classification from PRE to POST. Significant increases in self-efficacy, or confidence in their ability to be physically active for a prescribed period of time, were detected for 35 (p = .011) and 40 min (p = .035) of continuous PA. PA self-efficacy change for 35 min of continuous PA (F [3,137] = 3.973, p = .010) and 40 min of continuous PA (F [3,137) = 2.893, p = .038) were influenced by the interaction between PRE self-reported health and PRE PA readiness-to-change levels. Results suggest that an exergaming-themed PA intervention is effective at increasing PA participation and self-efficacy for PA among rural-residing OA.

Using Continuous Quality Improvement (CQI) to Sustain Success in Faculty Development for Online Teaching

ERIC Educational Resources Information Center

Kerrick, Sharon A.; Miller, Karen Hughes; Ziegler, Craig

2015-01-01

This article shares the curriculum and evaluation findings over four years for a faculty development program aimed at increasing skills in designing and teaching online courses. The University of Louisville's "Delphi U" is a four-day retreat style program covering 17 modules, each of which includes an exercise or activity. Over the four…

Can the Tools of Activity Theory Help Us in Advancing Understanding and Organisational Change in Undergraduate Medical Education?

ERIC Educational Resources Information Center

Reid, Anne-Marie; Ledger, Alison; Kilminster, Sue; Fuller, Richard

2015-01-01

Continued changes to healthcare delivery in the UK, and an increasing focus on patient safety and quality improvement, require a radical rethink on how we enable graduates to begin work in challenging, complex environments. Professional regulatory bodies now require undergraduate medical schools to implement an "assistantship" period in…

42 CFR 3.102 - Process and requirements for initial and continued listing of PSOs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... improve patient safety and the quality of health care delivery. (B) The PSO must have appropriately... patient safety reporting system to which health care providers (other than members of the entity's... activities, defined in § 3.20. With respect to paragraphs (5) and (6) in the definition of patient safety...

42 CFR 3.102 - Process and requirements for initial and continued listing of PSOs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... improve patient safety and the quality of health care delivery. (B) The PSO must have appropriately... patient safety reporting system to which health care providers (other than members of the entity's... activities, defined in § 3.20. With respect to paragraphs (5) and (6) in the definition of patient safety...

42 CFR 3.102 - Process and requirements for initial and continued listing of PSOs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... improve patient safety and the quality of health care delivery. (B) The PSO must have appropriately... patient safety reporting system to which health care providers (other than members of the entity's... activities, defined in § 3.20. With respect to paragraphs (5) and (6) in the definition of patient safety...

34 CFR 304.31 - Requirements for obtaining an exception or deferral to performance or repayment under an agreement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION SERVICE OBLIGATIONS UNDER SPECIAL EDUCATION-PERSONNEL DEVELOPMENT TO IMPROVE SERVICES AND RESULTS... institution of higher education; (2) Is serving on active duty as a member of the armed services of the United...

34 CFR 304.31 - Requirements for obtaining an exception or deferral to performance or repayment under an agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION SERVICE OBLIGATIONS UNDER SPECIAL EDUCATION-PERSONNEL DEVELOPMENT TO IMPROVE SERVICES AND RESULTS... institution of higher education; (2) Is serving on active duty as a member of the armed services of the United...

Plan-Do-Check-Act and the Management of Institutional Research. AIR 1992 Annual Forum Paper.

ERIC Educational Resources Information Center

McLaughlin, Gerald W.; Snyder, Julie K.

This paper describes the application of a Total Quality Management strategy called Plan-Do-Check-Act (PDCA) to the projects and activities of an institutional research office at the Virginia Polytechnic Institute and State University. PDCA is a cycle designed to facilitate incremental continual improvement through change. The specific steps are…

Teenagers: fertility control behavior and attitudes before and after abortion, childbearing or negative pregnancy test.

PubMed

Evans, J R; Selstad, G; Welcher, W H

1976-01-01

Following abortion or delivery, teenagers' knowledge and use of effective contraception improved markedly; but those who had negative pregnancy tests continued to take risks--and to get pregnant--subsequently. Most sexually active teenagers were poorly educated on the facts of reproduction, and began to have intercourse before seeking contraception.

Loans, Logins, and Lasting the Course: Academic Library Use and Student Retention

ERIC Educational Resources Information Center

Haddow, Gaby; Joseph, Jayanthi

2010-01-01

Activities and services that improve student engagement and retention in the higher education sector are important not only to individual students' success but also to university planning and funding. This paper reports on a study carried out to explore whether use of the library by new university students is associated with continued enrolment.…

Program Review: A Tool for Continuous Improvement of Academic Programs. AIR Professional File. Number 105, Fall 2007

ERIC Educational Resources Information Center

Pitter, Gita Wijesinghe

2007-01-01

Program reviews became widely used as quality assurance activities in the United States beginning in the 1970s. Since then, they have evolved as an essential component in demonstrating institutional effectiveness to accrediting bodies. The paper discusses various approaches to reviews with a focus on a recently reengineered institutional program…

Overt Naming fMRI Pre- and Post- TMS: Two Nonfluent Aphasia Patients, with and without Improved Naming Post- TMS

PubMed Central

Martin, Paula I; Naeser, Margaret A.; Ho, Michael; Doron, Karl W.; Kurland, Jacquie; Kaplan, Jerome; Wang, Yunyan; Nicholas, Marjorie; Baker, Errol H.; Alonso, Miguel; Fregni, Felipe; Pascual-Leone, Alvaro

2009-01-01

Two chronic, nonfluent aphasia patients participated in overt naming fMRI scans, pre- and post- a series of repetitive transcranial magnetic stimulation (rTMS) treatments as part of a TMS study to improve naming. Each patient received ten, 1-Hz rTMS treatments to suppress a part of R pars triangularis. P1 was a ‘good responder’ with improved naming and phrase length; P2 was a ‘poor responder’ without improved naming. Pre- TMS (10 yr. poststroke), P1 had significant activation in R and L sensorimotor cortex, R IFG, and in both L and R SMA during overt naming fMRI (28% pictures named. At 3 mo. post- TMS (42% named), P1 showed continued activation in R and L sensorimotor cortex, R IFG, and in R and L SMA. At 16 mo. post- TMS (58% named), he also showed significant activation in R and L sensorimotor cortex mouth and R IFG. He now showed a significant increase in activation in the L SMA compared to pre- TMS and at 3 mo. post- TMS (p<.02; p<.05, respectively). At 16 mo. there was also greater activation in L than R SMA (p<.08). At 46 mo. post- TMS (42% named), this new LH pattern of activation continued. He improved on the Boston Naming Test from 11 pictures named pre- TMS, to scores ranging from 14-18 pictures, post- TMS (2 mo. to 43 mo. post- TMS). His longest phrase length (Cookie Theft picture) improved from 3 words pre- TMS, to 5-6 words post- TMS. Pre- TMS (1.5 yr. poststroke), P2 had significant activation in R IFG (3% pictures named). At 3 and 6 mo. post- TMS, there was no longer significant activation in R IFG, but significant activation was present in R sensorimotor cortex. On all three fMRI scans, P2 had significant activation in both the L and R SMA. There was no new, lasting perilesional LH activation across sessions for this patient. Over time, there was little or no change in his activation. His naming remained only at 1-2 pictures during all three fMRI scans. His BNT score and longest phrase length remained at 1 word, post- TMS. Lesion site may play a role in each patient’s fMRI activation pattern and response to TMS treatment. P2, the poor responder, had an atypical frontal lesion in the L motor and premotor cortex that extended high, near brain vertex, with deep white matter lesion near L SMA. P2 also had frontal lesion in the posterior middle frontal gyrus, an area important for naming (Duffau et al., 2003); P1 did not. Additionally, P2 had lesion inferior and posterior to Wernicke’s area, in parts of BA 21 and 37, whereas P1 did not. The fMRI data of our patient who had good response following TMS support the notion that restoration of the LH language network is linked in part, to better recovery of naming and phrase length in nonfluent aphasia. PMID:19695692

Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS.

PubMed

Martin, Paula I; Naeser, Margaret A; Ho, Michael; Doron, Karl W; Kurland, Jacquie; Kaplan, Jerome; Wang, Yunyan; Nicholas, Marjorie; Baker, Errol H; Alonso, Miguel; Fregni, Felipe; Pascual-Leone, Alvaro

2009-10-01

Two chronic, nonfluent aphasia patients participated in overt naming fMRI scans, pre- and post-a series of repetitive transcranial magnetic stimulation (rTMS) treatments as part of a TMS study to improve naming. Each patient received 10, 1-Hz rTMS treatments to suppress a part of R pars triangularis. P1 was a 'good responder' with improved naming and phrase length; P2 was a 'poor responder' without improved naming. Pre-TMS (10 years poststroke), P1 had significant activation in R and L sensorimotor cortex, R IFG, and in both L and R SMA during overt naming fMRI (28% pictures named). At 3 mo. post-TMS (42% named), P1 showed continued activation in R and L sensorimotor cortex, R IFG, and in R and L SMA. At 16 mo. post-TMS (58% named), he also showed significant activation in R and L sensorimotor cortex mouth and R IFG. He now showed a significant increase in activation in the L SMA compared to pre-TMS and at 3 mo. post-TMS (p < .02; p < .05, respectively). At 16 mo. there was also greater activation in L than R SMA (p < .08). At 46 mo. post-TMS (42% named), this new LH pattern of activation continued. He improved on the Boston Naming Test from 11 pictures named pre-TMS, to scores ranging from 14 to 18 pictures, post-TMS (2-43 mo. post-TMS). His longest phrase length (Cookie Theft picture) improved from three words pre-TMS, to 5-6 words post-TMS. Pre-TMS (1.5 years poststroke), P2 had significant activation in R IFG (3% pictures named). At 3 and 6 mo. post-TMS, there was no longer significant activation in R IFG, but significant activation was present in R sensorimotor cortex. On all three fMRI scans, P2 had significant activation in both the L and R SMA. There was no new, lasting perilesional LH activation across sessions for this patient. Over time, there was little or no change in his activation. His naming remained only at 1-2 pictures during all three fMRI scans. His BNT score and longest phrase length remained at one word, post-TMS. Lesion site may play a role in each patient's fMRI activation pattern and response to TMS treatment. P2, the poor responder, had an atypical frontal lesion in the L motor and premotor cortex that extended high, near brain vertex, with deep white matter lesion near L SMA. P2 also had frontal lesion in the posterior middle frontal gyrus, an area important for naming (Duffau et al., 2003); P1 did not. Additionally, P2 had lesion inferior and posterior to Wernicke's area, in parts of BA 21 and 37, whereas P1 did not. The fMRI data of our patient who had good response following TMS support the notion that restoration of the LH language network is linked in part, to better recovery of naming and phrase length in nonfluent aphasia.

Health benefits of dancing activity among Korean middle-aged women.

PubMed

Kim, Min Jeong; Lee, Chul Won

2016-01-01

The purpose of this study was to understand the health benefits of line dancing activity in Korean middle-aged women. This study explored how Korean middle-aged women perceive health benefits through lived experiences of line dancing in their leisure time. Three themes emerged related to health benefits: (1) psychological benefit, (2) physical benefit, and (3) social benefit. This finding suggested that serious leisure experience aids health enhancements in the lives of Korean middle-aged women. This study also discusses the research implication that continuous participation in leisure activity is necessary for health improvement in Korean middle-aged women.

Health benefits of dancing activity among Korean middle-aged women

PubMed Central

Kim, Min Jeong; Lee, Chul Won

2016-01-01

The purpose of this study was to understand the health benefits of line dancing activity in Korean middle-aged women. This study explored how Korean middle-aged women perceive health benefits through lived experiences of line dancing in their leisure time. Three themes emerged related to health benefits: (1) psychological benefit, (2) physical benefit, and (3) social benefit. This finding suggested that serious leisure experience aids health enhancements in the lives of Korean middle-aged women. This study also discusses the research implication that continuous participation in leisure activity is necessary for health improvement in Korean middle-aged women. PMID:27389818

The multiparameter station at Galeras Volcano (Colombia): concept and realization

NASA Astrophysics Data System (ADS)

Seidl, Dieter; Hellweg, Margaret; Calvache, Marta; Gomez, Diego; Ortega, Adriana; Torres, Roberto; Böker, Franz; Buttkus, Burkhard; Faber, Eckhard; Greinwald, Siegfried

2003-07-01

Volcanoes are complex systems, in which the interaction of many different physical and chemical factors and processes contribute to changes in activity. In the past 40 years, our ability to observe and quantify short-term changes in a volcano's activity has improved due to the installation of seismometers and tiltmeters and the continuous records they provide. However, due to instrumental limitations, the observations have mainly been used phenomenologically, to draw inferences about possible changes on the basis of previous experience. Since 1995, the Bundesanstalt für Geowissenschaften und Rohstoffe (BGR) and the Instituto de Investigación e Información Geocientífica, Minero-Ambiental y Nuclear (INGEOMINAS) have been working to develop and deploy a multiparameter (MP) station on Galeras Volcano, Colombia. This station is designed to concurrently measure various geophysical and geochemical parameters. It includes three broadband seismometers at the crater rim, as well as a more remotely located, broadband seismic reference. At other locations in the crater or on the rim, electromagnetic probes, an infrasound sensor and a weather station are operating. The data from these sensors are digitized at each site with 24-bit digitizers and transmitted by spread-spectrum radio, via repeater when necessary, to the Observatorio Vulcanológico y Sismológico (OVP) in the city of Pasto. There they are received and displayed on a networked personal computer and recorded continuously. The data flow into the routine analysis procedures of the OVP and the continuous data are archived on CD. In addition to the other sensors, a system of specially developed sensors continuously monitors the chemistry and physics of the gases at fumaroles on the active cone. The data from this system are also transmitted in realtime to OVP and recorded. The continuous recordings of the MP station are supplemented by regular thermographic measurements of the surface temperature in the crater using an infrared camera. Joint analysis and interpretation of the data streams from the many sensors of the MP station will improve our understanding of the physical processes occurring in Galeras Volcano.

Implementing evidence-based continuous quality improvement strategies in an urban Aboriginal Community Controlled Health Service in South East Queensland: a best practice implementation pilot.

PubMed

Hogg, Sandra; Roe, Yvette; Mills, Richard

2017-01-01

The Institute for Urban Indigenous Health believes that continuous quality improvement (CQI) contributes to the delivery of high-quality care, thereby improving health outcomes for Aboriginal and Torres Strait Islander people. The opening of a new health service in 2015 provided an opportunity to implement best practice CQI strategies and apply them to a regional influenza vaccination campaign. The aim of this project was to implement an evidence-based CQI process within one Aboriginal Community Controlled Health Service in South East Queensland and use staff engagement as a measure of success. A CQI tool was selected from the Joanna Briggs Institute Practical Application of Clinical Evidence System (PACES) to be implemented in the study site. The study site was a newly established Aboriginal and Torres Strait Islander Community Controlled Health Service located in the northern suburbs of Brisbane. This project used the evidence-based information collected in PACES to develop a set of questions related to known variables resulting in proven CQI uptake. A pre implementation clinical audit, education and self-directed learning, using the Plan Do Study Act framework, included a total of seven staff and was conducted in April 2015. A post implementation audit was conducted in July 2015. There were a total of 11 pre- and post-survey respondents which included representation from most of the clinical team and medical administration. The results of the pre implementation audit identified a number of possible areas to improve engagement with the CQI process including staff training and support, understanding CQI and its impacts on individual work areas, understanding clinical data extraction, clinical indicator benchmarking, strong internal leadership and having an external data extractor. There were improvements to all audit criteria in the post-survey, for example, knowledge regarding the importance of CQI activity, attendance at education and training sessions on CQI, active involvement with CQI activity and a multidisciplinary team approach to problem solving within the CQI process. The study found that the implementation of regular, formally organized CQI strategies does have an immediate impact on clinical practice, in this case, by increasing staff awareness regarding the uptake of influenza vaccination against regional targets. The Plan Do Study Act cycle is an efficient tool to record and monitor the change and to guide discussions. For the CQI process to be effective, continued education and training on data interpretation is pivotal to improve staff confidence to engage in regular data discussions, and this should be incorporated into all future CQI sessions.

English Language Support for Engineering Students and Professors

NASA Astrophysics Data System (ADS)

Teshigawara, Mihoko

The University of Tokushima Graduate School of Advanced Technology and Science has launched the International Affiliated Double-Degree Program. In this program students pursue double degrees in engineering at the graduate level organized between the Graduate School and one of its 11 overseas partner institutions. Since the Graduate School is committed to offering content lectures in English, the faculty members involved need a good command of English. Future outgoing students also have to improve their English (and the local language spoken at the partner institution) to conduct academic activities at the partner institution successfully. This paper describes the author‧s continuing efforts toward the provision and improvement of English language support for engineering students and instructors, touching on similar activities elsewhere.

Advancement of Optical Component Control for an Imaging Fabry-Perot Interferometer

NASA Technical Reports Server (NTRS)

Larar, Allen M.; Cook, William B.; Flood, Michael A.; Campbell, Joel F.; Boyer, Charles M.

2009-01-01

Risk mitigation activities associated with a prototype imaging Fabry-Perot Interferometer (FPI) system are continuing at the NASA Langley Research Center. The system concept and technology center about enabling and improving future space-based atmospheric composition missions, with a current focus on observing tropospheric ozone around 9.6 micron, while having applicability toward measurement in different spectral regions and other applications. Recent activities have focused on improving an optical element control subsystem to enable precise and accurate positioning and control of etalon plates; this is needed to provide high system spectral fidelity critical for enabling the required ability to spectrally-resolve atmospheric line structure. The latest results pertaining to methodology enhancements, system implementation, and laboratory characterization testing will be reported

Quality Improvement in Skilled Nursing Facilities for Residents With Alzheimer's Disease.

PubMed

Farlow, Martin R; Borson, Soo; Connor, Stephen R; Grossberg, George T; Mittelman, Mary S

2016-03-01

This report describes a quality improvement continuing medical education activity designed to enhance the recognition and treatment of residents with Alzheimer's disease (AD) or other dementias in skilled-nursing facilities (SNFs). Charts were compared in 6 areas prior to and following (stages A and C) a live, faculty-led workshop (stage B). Four SNFs completed stages A (n = 67 residents) and B, and 3 SNFs completed stage C (n = 52 residents). All charts came from residents with AD or a diagnosis of dementia or dementia-like symptoms. The SNFs had >95% baseline performance in both the frequency of cognitive assessments and documented medication reviews. The percentage of residents who received a quality-of-life assessment and those who had a mental health care plan in place represent areas for improvement. As part of this activity, a toolkit was developed to help guide facilities and clinicians in instituting care improvements for residents with AD/dementia. © The Author(s) 2015.

Improvements in Concentration, Working Memory, and Sustained Attention Following Consumption of a Natural Citicoline-Caffeine Beverage

PubMed Central

Bruce, Steven E.; Werner, Kimberly B.; Preston, Brittany F.; Baker, Laurie M.

2015-01-01

The present study examined the neurocognitive and electrophysiological effects of a citicoline-caffeine-based beverage in 60 healthy adult participants enrolled in a randomized, double-blind, placebo-controlled trial. Measures of electrical brain activity using electroencephalogram (EEG) and neuropsychological measures examining attention, concentration, and reaction time were administered. Compared to placebo, participants receiving the citicoline-caffeine beverage exhibited significantly faster maze learning times and reaction times on a continuous performance test, fewer errors in a Go No-Go task, and better accuracy on a measure of information processing speed. EEG results examining P450 event related potentials (ERP) revealed that participants receiving the citicoline-caffeine beverage exhibited higher P450 amplitudes than controls, suggesting an increase in sustained attention. Overall, these findings suggest that the beverage significantly improved sustained attention, cognitive effort, and reaction times in healthy adults. Evidence of improved P450 amplitude indicates a general improvement in the ability to accommodate new and relevant information within working memory and overall enhanced brain activation. PMID:25046515

Spatiotemporal neuromodulation therapies engaging muscle synergies improve motor control after spinal cord injury

PubMed Central

Wenger, Nikolaus; Moraud, Eduardo Martin; Gandar, Jerome; Musienko, Pavel; Capogrosso, Marco; Baud, Laetitia; Le Goff, Camille G.; Barraud, Quentin; Pavlova, Natalia; Dominici, Nadia; Minev, Ivan R.; Asboth, Leonie; Hirsch, Arthur; Duis, Simone; Kreider, Julie; Mortera, Andrea; Haverbeck, Oliver; Kraus, Silvio; Schmitz, Felix; DiGiovanna, Jack; van den Brand, Rubia; Bloch, Jocelyne; Detemple, Peter; Lacour, Stéphanie P.; Bézard, Erwan; Micera, Silvestro; Courtine, Grégoire

2016-01-01

Electrical neuromodulation of lumbar segments improves motor control after spinal cord injury in animal models and humans. However, the physiological principles underlying the effect of this intervention remain poorly understood, which has limited this therapeutic approach to continuous stimulation applied to restricted spinal cord locations. Here, we developed novel stimulation protocols that reproduce the natural dynamics of motoneuron activation during locomotion. For this, we computed the spatiotemporal activation pattern of muscle synergies during locomotion in healthy rats. Computer simulations identified optimal electrode locations to target each synergy through the recruitment of proprioceptive feedback circuits. This framework steered the design of spatially selective spinal implants and real–time control software that modulate extensor versus flexor synergies with precise temporal resolution. Spatiotemporal neuromodulation therapies improved gait quality, weight–bearing capacities, endurance and skilled locomotion in multiple rodent models of spinal cord injury. These new concepts are directly translatable to strategies to improve motor control in humans. PMID:26779815

Measuring impact of JAMA Dermatology Practice Gaps section on training in US dermatology residency programs.

PubMed

Britton, Kristina M; Stratman, Erik J

2013-07-01

JAMA Dermatology Practice Gaps commentaries are intended to aid in the interpretation of the literature to make it more practical and applicable to daily patient care. Practice Gaps commentaries have had an impact on physician clinical practice and dermatology residency curricula. To assess the impact of JAMA Dermatology Practice Gaps commentaries on dermatology residency training programs in the United States, including journal club discussions and local quality improvement activities. A web-based questionnaire of 17 questions was sent via e-mail to US dermatology residency program directors (PDs) in February 2012. Program director report of incorporating Practice Gaps themes and discussions into resident journal club activities, clinical practice, quality improvement activities, or research projects in the residency programs, as a result of a Practice Gaps commentary. Of the 114 surveys distributed to US dermatology residency PDs, 48 were completed (42% response rate). Sixty percent of PDs reported familiarity with the Practice Gaps section of JAMA Dermatology, and 56% discuss these commentaries during resident journal club activities. Quality improvement and research projects have been initiated as a result of Practice Gaps commentaries. Practice Gaps commentaries are discussed during most dermatology residency journal club activities. Practice Gaps have had an impact on physician practice and dermatology residency curricula and can serve as a tool for enhanced continuing medical education and quality improvement initiatives.

What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review.

PubMed

Rotter, Thomas; Plishka, Christopher; Lawal, Adegboyega; Harrison, Liz; Sari, Nazmi; Goodridge, Donna; Flynn, Rachel; Chan, James; Fiander, Michelle; Poksinska, Bonnie; Willoughby, Keith; Kinsman, Leigh

2018-01-01

Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.

Apparatus having reduced background for measuring radiation activity in aerosol particles

DOEpatents

Rodgers, John C.; McFarland, Andrew R.; Oritz, Carlos A.; Marlow, William H.

1992-01-01

Apparatus having reduced background for measuring radiation activity in aerosol particles. A continuous air monitoring sampler is described for use in detecting the presence of alpha-emitting aerosol particles. An inlet fractionating screen has been demonstrated to remove about 95% of freshly formed radon progeny from the aerosol sample, and approximately 33% of partially aged progeny. Addition of an electrical condenser and a modified dichotomous virtual impactor are expected to produce considerable improvement in these numbers, the goal being to enrich the transuranic (TRU) fraction of the aerosols. This offers the possibility of improving the signal-to-noise ratio for the detected alpha-particle energy spectrum in the region of interest for detecting TRU materials associated with aerosols, thereby enhancing the performance of background-compensation algorithms for improving the quality of alarm signals intended to warn personnel of potentially harmful quantities of TRU materials in the ambient air.

Test Activities in the Langley Transonic Dynamics Tunnel and a Summary of Recent Facility Improvements

NASA Technical Reports Server (NTRS)

Cole, Stanley R.; Johnson, R. Keith; Piatak, David J.; Florance, Jennifer P.; Rivera, Jose A., Jr.

2003-01-01

The Langley Transonic Dynamics Tunnel (TDT) has provided a unique capability for aeroelastic testing for over forty years. The facility has a rich history of significant contributions to the design of many United States commercial transports, military aircraft, launch vehicles, and spacecraft. The facility has many features that contribute to its uniqueness for aeroelasticity testing, perhaps the most important feature being the use of a heavy gas test medium to achieve higher test densities compared to testing in air. Higher test medium densities substantially improve model-building requirements and therefore simplify the fabrication process for building aeroelastically scaled wind tunnel models. This paper describes TDT capabilities that make it particularly suited for aeroelasticity testing. The paper also discusses the nature of recent test activities in the TDT, including summaries of several specific tests. Finally, the paper documents recent facility improvement projects and the continuous statistical quality assessment effort for the TDT.

Research Activities for the DORIS Contribution to the Next International Terrestrial Reference Frame

NASA Technical Reports Server (NTRS)

Soudarin, L.; Moreaux, G.; Lemoine, F.; Willis, P.; Stepanek, P.; Otten, M.; Govind, R.; Kuzin, S.; Ferrage, P.

2012-01-01

For the preparation of ITRF2008, the IDS processed data from 1993 to 2008, including data from TOPEX/Poseidon, the SPOT satellites and Envisat in the weekly solutions. Since the development of ITRF2008, the IDS has been engaged in a number of efforts to try and improve the reference frame solutions. These efforts include (i) assessing the contribution of the new DORIS satellites, Jason-2 and Cryosat2 (2008-2011), (ii) individually analyzing the DORIS satellite contributions to geocenter and scale, and (iii) improving orbit dynamics (atmospheric loading effects, satellite surface force modeling. . . ). We report on the preliminary results from these research activities, review the status of the IDS combination which is now routinely generated from the contributions of the IDS analysis centers, and discuss the prospects for continued improvement in the DORIS contribution to the next international reference frame.

The evaluation of a strength and balance exercise program for falls prevention in community primary care.

PubMed

Hawley-Hague, Helen; Roden, Amy; Abbott, Jo

2017-08-01

We aimed to evaluate a strength and balance program delivered in the community. There is little evidence of implementation of evidence-based exercise in practice. The program was a step-down model, designed to encourage long-term exercise in community classes. The program consisted of a fully funded referral only evidence-based 12-week strength and balance (Community Otago) class, followed by an evidence-based continuous open-access community strength and balance class (Active Always). The program was offered to patients: 1) after formal falls rehabilitation (falls and fracture service); 2) after falls rehabilitation in intermediate care; and 3) referred by a GP who were not eligible for rehabilitation (preventative measure). Outcome evaluation used descriptive statistics to report changes in function, confidence in balance, hospital attendance/admission for falls/fractures and transition to community classes. Focus groups established participant experience/satisfaction. Seventy-nine participants were included, aged 56-96, and 53 (67%) were women. About 63.3% of patients transitioned to Active Always classes, demonstrating improvement in maintenance. Follow-up scores from baseline attendance at falls and fracture service to 12-weeks follow-up (24 weeks) in Community Otago showed the majority of patients improved their function (Timed up and Go), confidence (ConfBal) and lowered their falls risk (Tinetti). Follow-up of participants from Community Otago baseline to the end of 12-weeks showed improvement in function and confidence, but only a third of participants lowered their falls risk. Focus groups data suggest that continuity of delivery, the role of the instructor, health professional, and social and physical outcomes were essential for maintenance. A supportive environment can be created which encourages older adults' continued participation in group-based strength and balance, helping the delivery of evidence-based practice.

Aquarius Radiometer Status

NASA Technical Reports Server (NTRS)

Le Vine, D. M.; Piepmeier, J. R.; Dinnat, E. P.; de Matthaeis, P.; Utku, C.; Abraham, S.; Lagerloef, G.S.E.; Meissner, T.; Wentz, F.

2014-01-01

Aquarius was launched on June 10, 2011 as part of the Aquarius/SAC-D observatory and the instrument has been operating continuously since being turned on in August of the same year. The initial map of sea surface salinity was released one month later (September) and the quality of the retrieval has continuously improved since then. The Aquarius radiometers include several special features such as measurement of the third Stokes parameter, fast sampling, and careful thermal control, and a combined passive/active instrument. Aquarius is working well and in addition to helping measure salinity, the radiometer special features are generating new results.

Building and Maintaining Organizational Infrastructure to Attain Clinical Excellence.

PubMed

Lebak, Kelly; Lane, Jason; Taus, Richard; Kim, Hansol; Stecker, Michael S; Hall, Michael; Lane-Fall, Meghan B; Weiss, Mark S

2017-12-01

Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non-operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. For anesthesiologists, this training must begin during residency. The training should be supplemented with continuing education in this field for providers who find themselves working in the NORA space. As NORA continues to grow, robust NORA-specific quality assurance and improvement programs will empower anesthesiologists with the tools they need to best care for these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Acoustic (loudspeaker) facial EMG monitoring: II. Use of evoked EMG activity during acoustic neuroma resection.

PubMed

Prass, R L; Kinney, S E; Hardy, R W; Hahn, J F; Lüders, H

1987-12-01

Facial electromyographic (EMG) activity was continuously monitored via loudspeaker during eleven translabyrinthine and nine suboccipital consecutive unselected acoustic neuroma resections. Ipsilateral facial EMG activity was synchronously recorded on the audio channels of operative videotapes, which were retrospectively reviewed in order to allow detailed evaluation of the potential benefit of various acoustic EMG patterns in the performance of specific aspects of acoustic neuroma resection. The use of evoked facial EMG activity was classified and described. Direct local mechanical (surgical) stimulation and direct electrical stimulation were of benefit in the localization and/or delineation of the facial nerve contour. Burst and train acoustic patterns of EMG activity appeared to indicate surgical trauma to the facial nerve that would not have been appreciated otherwise. Early results of postoperative facial function of monitored patients are presented, and the possible value of burst and train acoustic EMG activity patterns in the intraoperative assessment of facial nerve function is discussed. Acoustic facial EMG monitoring appears to provide a potentially powerful surgical tool for delineation of the facial nerve contour, the ongoing use of which may lead to continued improvement in facial nerve function preservation through modification of dissection strategy.

Regular activity breaks combined with physical activity improve postprandial plasma triglyceride, nonesterified fatty acid, and insulin responses in healthy, normal weight adults: A randomized crossover trial.

PubMed

Homer, Ashleigh R; Fenemor, Stephen P; Perry, Tracy L; Rehrer, Nancy J; Cameron, Claire M; Skeaff, C Murray; Peddie, Meredith C

Compared with prolonged sitting, regular activity breaks immediately lower postprandial glucose and insulin, but not triglyceride responses. Postprandial triglycerides can be lowered by physical activity but the effect is often delayed by ∼12 to 24 hours. The objective of the study was to determine whether regular activity breaks affect postprandial triglyceride response in a delayed manner similar to physical activity. In a randomized crossover trial, 36 adults (body mass index 23.9 kg/m 2 [standard deviation 3.9]) completed four 2-day interventions: (1) prolonged sitting (SIT); (2) prolonged sitting with 30 minutes of continuous walking (60% VO 2max ), at the end of Day 1 (SIT + PA D1 ); (3) Sitting with 2 minutes of walking (60% VO 2max ) every 30 minutes (RAB); (4) A combination of the continuous walking and regular activity breaks in 2 and 3 above (RAB + PA D1 ). Postprandial plasma triglyceride, nonesterified fatty acids, glucose, and insulin responses were measured in venous blood over 5 hours on Day 2. Compared with SIT, both RAB (difference: -43.61 mg/dL·5 hours; 95% confidence interval [CI] -83.66 to -2.67; P = .035) and RAB + PA D1 (-65.86 mg/dL·5 hours; 95% CI -112.14 to -19.58; P = .005) attenuated triglyceride total area under the curve (tAUC). RAB + PA D1 produced the greatest reductions in insulin tAUC (-23%; 95% CI -12% to -31%; P < .001), whereas RAB resulted in the largest increase in nonesterified fatty acids (tAUC, 10.08 mg/dL·5 hours; 95% CI 5.60-14.84; P < .001). There was no effect on glucose tAUC (P = .290). Postprandial triglyceride response is attenuated by regular activity breaks, when measured ∼24 hours after breaks begin. Combining regular activity breaks with 30 minutes of continuous walking further improves insulinemic and lipidemic responses. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Developing a pain management program through continuous improvement strategies.

PubMed

Woodward, Dora

2005-01-01

Pain affects more than one third of cancer patients in the early stages of their disease, dramatically rising above 70% in the advanced stages. Numerous studies have been conducted in the pursuit of cancer pain relief, yet the prevalence of pain persists. This article focuses on a pain management program, developed by a performance improvement team, which addressed the inadequacies of current pain management. Performance improvement activities are described through the process of assessment, planning, implementation, and evaluation of the pain management program. This pain management program is uniquely derived from a unit core value that all staff is responsible and accountable for pain management.

Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals.

PubMed

Boyce, John M

2016-01-01

Experts agree that careful cleaning and disinfection of environmental surfaces are essential elements of effective infection prevention programs. However, traditional manual cleaning and disinfection practices in hospitals are often suboptimal. This is often due in part to a variety of personnel issues that many Environmental Services departments encounter. Failure to follow manufacturer's recommendations for disinfectant use and lack of antimicrobial activity of some disinfectants against healthcare-associated pathogens may also affect the efficacy of disinfection practices. Improved hydrogen peroxide-based liquid surface disinfectants and a combination product containing peracetic acid and hydrogen peroxide are effective alternatives to disinfectants currently in widespread use, and electrolyzed water (hypochlorous acid) and cold atmospheric pressure plasma show potential for use in hospitals. Creating "self-disinfecting" surfaces by coating medical equipment with metals such as copper or silver, or applying liquid compounds that have persistent antimicrobial activity surfaces are additional strategies that require further investigation. Newer "no-touch" (automated) decontamination technologies include aerosol and vaporized hydrogen peroxide, mobile devices that emit continuous ultraviolet (UV-C) light, a pulsed-xenon UV light system, and use of high-intensity narrow-spectrum (405 nm) light. These "no-touch" technologies have been shown to reduce bacterial contamination of surfaces. A micro-condensation hydrogen peroxide system has been associated in multiple studies with reductions in healthcare-associated colonization or infection, while there is more limited evidence of infection reduction by the pulsed-xenon system. A recently completed prospective, randomized controlled trial of continuous UV-C light should help determine the extent to which this technology can reduce healthcare-associated colonization and infections. In conclusion, continued efforts to improve traditional manual disinfection of surfaces are needed. In addition, Environmental Services departments should consider the use of newer disinfectants and no-touch decontamination technologies to improve disinfection of surfaces in healthcare.

Perceptuo-motor compatibility governs multisensory integration in bimanual coordination dynamics.

PubMed

Zelic, Gregory; Mottet, Denis; Lagarde, Julien

2016-02-01

The brain has the remarkable ability to bind together inputs from different sensory origin into a coherent percept. Behavioral benefits can result from such ability, e.g., a person typically responds faster and more accurately to cross-modal stimuli than to unimodal stimuli. To date, it is, however, largely unknown whether such multisensory benefits, shown for discrete reactive behaviors, generalize to the continuous coordination of movements. The present study addressed multisensory integration from the perspective of bimanual coordination dynamics, where the perceptual activity no longer triggers a single response but continuously guides the motor action. The task consisted in coordinating anti-symmetrically the continuous flexion-extension of the index fingers, while synchronizing with an external pacer. Three different configurations of metronome were tested, for which we examined whether a cross-modal pacing (audio-tactile beats) improved the stability of the coordination in comparison with unimodal pacing condition (auditory or tactile beats). We found a more stable bimanual coordination for cross-modal pacing, but only when the metronome configuration directly matched the anti-symmetric coordination pattern. We conclude that multisensory integration can benefit the continuous coordination of movements; however, this is constrained by whether the perceptual and motor activities match in space and time.

Bike, walk, and wheel: a way of life in Columbia, Missouri, revisited.

PubMed

Sayers, Stephen P; LeMaster, Joseph W; Thomas, Ian M; Petroski, Gregory F; Ge, Bin

2012-11-01

In 2003, Columbia MO was the recipient of a Robert Wood Johnson Foundation (RWJF) Active Living by Design (ALbD) grant to foster active living in the community through behavioral (social marketing, education) and environmental change (improved street design standards, sidewalks around schools, activity-friendly infrastructure) strategies. To examine the extent to which the ALbD intervention was associated with increased active living in children and adults community-wide. Seasonal pedestrian and bicyclist counts were performed quarterly in January, April, July, and October at four intersections in downtown Columbia from 2007 to 2009. Pedestrian counts increased significantly during July 2009 and October 2009 compared to 2007 and 2008, whereas cyclist counts increased significantly during only July 2009 compared to 2007 and 2008. The ALbD intervention in Columbia was associated with modest increases in active living in the community, and continued evaluation of these behavior patterns is warranted. The combination of multiple strategies (social marketing, local programming, and infrastructure changes) may be a critical factor in improving active living in communities. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Stellar Mass Function of Active and Quiescent Galaxies via the Continuity Equation

NASA Astrophysics Data System (ADS)

Lapi, A.; Mancuso, C.; Bressan, A.; Danese, L.

2017-09-01

The continuity equation is developed for the stellar mass content of galaxies and exploited to derive the stellar mass function of active and quiescent galaxies over the redshift range z˜ 0{--}8. The continuity equation requires two specific inputs gauged from observations: (I) the star formation rate functions determined on the basis of the latest UV+far-IR/submillimeter/radio measurements and (II) average star formation histories for individual galaxies, with different prescriptions for disks and spheroids. The continuity equation also includes a source term taking into account (dry) mergers, based on recent numerical simulations and consistent with observations. The stellar mass function derived from the continuity equation is coupled with the halo mass function and with the SFR functions to derive the star formation efficiency and the main sequence of star-forming galaxies via the abundance-matching technique. A remarkable agreement of the resulting stellar mass functions for active and quiescent galaxies of the galaxy main sequence, and of the star formation efficiency with current observations is found; the comparison with data also allows the characteristic timescales for star formation and quiescence of massive galaxies, the star formation history of their progenitors, and the amount of stellar mass added by in situ star formation versus that contributed by external merger events to be robustly constrained. The continuity equation is shown to yield quantitative outcomes that detailed physical models must comply with, that can provide a basis for improving the (subgrid) physical recipes implemented in theoretical approaches and numerical simulations, and that can offer a benchmark for forecasts on future observations with multiband coverage, as will become routinely achievable in the era of JWST.

Trunk Exercises Improve Gait Symmetry in Parkinson Disease: A Blind Phase II Randomized Controlled Trial.

PubMed

Hubble, Ryan P; Naughton, Geraldine; Silburn, Peter A; Cole, Michael H

2018-03-01

Deficits in step-to-step symmetry and trunk muscle activations have been linked to falls in Parkinson disease. Given such symptoms are poorly managed with anti-parkinsonian medications, alternate therapies are needed. This blind phase II randomized controlled trial sought to establish whether exercise can improve step-to-step symmetry in Parkinson disease. Twenty-four Parkinson disease patients with a falls history completed baseline assessments of symptom severity, balance confidence, mobility, and quality of life. Step-to-step symmetry was assessed by deriving harmonic ratios from three-dimensional accelerations collected for the head and trunk. Patients were randomly assigned to either 12 wks of exercise and falls prevention education or falls prevention education only. Both groups repeated the baseline tests 12 and 24 wks after the initial assessment. The Australian and New Zealand Clinical Trials Registry number is ACTRN12613001175763. At 12 wks, the exercise group had statistically significant and clinically relevant improvements in anterior-posterior step-to-step trunk symmetry. In contrast, the education group recorded statistically significant and clinically meaningful reductions in medial-lateral and vertical step-to-step trunk symmetry at 12 wks. Given that step-to-step symmetry improved for the exercise group and declined for the education group after intervention, active interventions seem more suited to increasing independence and quality of life for people with Parkinson disease. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to do the following: (1) Describe the effect deficits in trunk muscle function have on gait in individuals with Parkinson disease; (2) Identify the benefits of targeted trunk exercises on step-to-step symmetry; and (3) Discuss the benefits of improving step-to-step symmetry in individuals with Parkinson disease. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The June 2009 Perspective on Canadian IYA2009 Activities

NASA Astrophysics Data System (ADS)

Hesser, James E.; Bartlett, C.; Breland, K.; Hay, K.; Lane, D.; Lacasse, R.; Lemay, D.; Langill, P.; Percy, J.; Welch, D. L.; Woodsworth, A.

2009-05-01

IYA effort in Canada is almost entirely a volunteer one relying heavily upon generous donations of time and effort by hundreds of people. Here we analyze accomplishments to date, and we describe activities to come in the remaining seven months of 2009 and well beyond. Accomplishments include provisions of hundreds of diverse opportunities for many thousands to experience their personal moment of astronomical discovery (their `Galileo Moment') a new planetarium show being presented at four major science centres; original works of music and performance that showcase astronomy in a captivating way for children and adults; an animated video narrated in English, French or Mi'kmaq of an Aboriginal story relating the seasons with circumpolar motions of stars; new educational and outreach materials aimed primarily at youth that are distributed freely at IYA events; theatre events; image exhibits; improved science education materials linked closely to curriculum requirements; and many more. In the months to come, all of the above will continue, but opportunities for new activities and partnerships continue to arise, e.g., Canada's Parks Day (18 July) emphasizes IYA, as do numerous cross-cultural events. We provide examples of the activities planned and/or being pursued for the latter portion of 2009 and beyond. These include issuance of a commemorative coin; delivery of a number of new education materials; prototyping of specific programs with Canadian Aboriginal communities in many provinces with the goal of creating multi-year partnerships to improve educational opportunities in their communities; and many more.

"The mirror" and "the village": a new method for teaching practice-based learning and improvement and systems-based practice.

PubMed

Ziegelstein, Roy C; Fiebach, Nicholas H

2004-01-01

Practice-based learning and improvement (PBLI) and systems-based practice (SBP) may be conceptually difficult for both residents and faculty. Methods for introducing these concepts are needed if PBLI and SBP are to be incorporated into education and practice. In 2001, PBLI and SBP were introduced at Johns Hopkins Bayview Medical Center in Baltimore, Maryland, using the metaphors "the mirror" and "the village." PBLI was likened to residents' holding up a mirror to document, assess, and improve their practice. Specific tools for residents (e.g., weekly morbidity and mortality morning reports, continuity clinic chart self-audits, and resident learning portfolios) became the mirrors. SBP was introduced through specific training activities (e.g., multidisciplinary patient care rounds, nursing evaluations, and quality assessment-systems improvement exercises) using the metaphor of the village made famous by Hillary Clinton in the phrase: "It takes a village to raise a child." Residents completed a questionnaire in which they rated these initiatives' impact on their training. The majority of residents who participated in specific activities agreed that quality assessment-systems improvement exercises (92.9%), multidisciplinary rounds (92.1%), morbidity and mortality morning reports (86.8%), clinic chart self-audits (76.4%), and nursing evaluations (52.8%) helped to improve their proficiency in specific aspects of PBLI and SBP. Residents' retrospective self-assessments of their PBLI abilities demonstrated significant improvement after the introduction of specific training activities. PBLI and SBP can be introduced effectively in residency training by incorporating specific activities that use the metaphors of the mirror and the village.

Carbohydrate administration during a day of sustained aerobic activity improves vigilance, as assessed by a novel ambulatory monitoring device, and mood.

PubMed

Lieberman, Harris R; Falco, Christina M; Slade, Steven S

2002-07-01

The brain requires a continuous supply of glucose to function adequately. During aerobic exercise, peripheral glucose requirements increase and carbohydrate supplementation improves physical performance. The brain's utilization of glucose also increases during aerobic exercise. However, the effects of energy supplementation on cognitive function during sustained aerobic exercise are not well characterized. The effects of energy supplementation, as liquid carbohydrate, on cognitive function during sustained aerobic activity were examined. A double-blind, placebo-controlled, between-subjects design was used. Young, healthy men (n = 143) were randomly assigned to 1 of 3 treatment groups. The groups received either a 6% (by vol) carbohydrate (35.1 kJ/kg), 12% (by vol) carbohydrate (70.2 kJ/kg), or placebo beverage in 6 isovolumic doses, and all groups consumed 2 meals (3200 kJ). Over the 10-h study, the subjects performed physically demanding tasks, including a 19.3-km road march and two 4.8-km runs, interspersed with rest and other activities. Wrist-worn vigilance monitors, which emitted auditory stimuli (20/h) to which the subjects responded as rapidly as possible, and a standardized self-report mood questionnaire were used to assess cognitive function. Vigilance consistently improved with supplemental carbohydrates in a dose-related manner; the 12% carbohydrate group performed the best and the placebo group the worst (P < 0.001). Mood-questionnaire results corroborated the results from the monitors; the subjects who received carbohydrates reported less confusion (P = 0.040) and greater vigor (P = 0.025) than did those who received the placebo. Supplemental carbohydrate beverages enhance vigilance and mood during sustained physical activity and interspersed rest. In addition, ambulatory monitoring devices can continuously assess the effects of nutritional factors on cognition as individuals conduct their daily activities or participate in experiments.

Association of weight loss with improved disease activity in patients with rheumatoid arthritis: A retrospective analysis using electronic medical record data

PubMed Central

Kreps, David J.; Halperin, Florencia; Desai, Sonali P.; Zhang, Zhi Z.; Losina, Elena; Olson, Amber T.; Karlson, Elizabeth W.; Bermas, Bonnie L.; Sparks, Jeffrey A.

2018-01-01

Objective To evaluate the association between weight loss and rheumatoid arthritis (RA) disease activity. Methods We conducted a retrospective cohort study of RA patients seen at routine clinic visits at an academic medical center, 2012–2015. We included patients who had ≥2 clinical disease activity index (CDAI) measures. We identified visits during follow-up where the maximum and minimum weights occurred and defined weight change and CDAI change as the differences of these measures at these visits. We defined disease activity improvement as CDAI decrease of ≥5 and clinically relevant weight loss as ≥5 kg. We performed logistic regression analyses to establish the association between improved disease activity and weight loss and baseline BMI category (≥25 kg/m2 or <25 kg/m2). We built linear regression models to investigate the association between continuous weight loss and CDAI change among patients who were overweight/obese at baseline and who lost weight during follow-up. Results We analyzed data from 174 RA patients with a median follow-up of 1.9 years (IQR 1.3–2.4); 117 (67%) were overweight/obese at baseline, and 53 (31%) lost ≥5 kg during follow-up. Patients who were overweight/obese and lost ≥5 kg had three-fold increased odds of disease activity improvement compared to those who did not (OR 3.03, 95%CI 1.18–7.83). Among those who were overweight/obese at baseline, each kilogram weight loss was associated with CDAI improvement of 1.15 (95%CI 0.42–1.88). Our study was limited by using clinical data from a single center without fixed intervals for assessments. Conclusion Clinically relevant weight loss (≥5 kg) was associated with improved RA disease activity in the routine clinical setting. Further studies are needed for replication and to evaluate the effect of prospective weight loss interventions on RA disease activity. PMID:29606976

Improvement and Neuroplasticity after Combined Rehabilitation to Forced Grasping

PubMed Central

Ogata, Atsuko; Kawahira, Kazumi; Shimodozono, Megumi

2017-01-01

The grasp reflex is a distressing symptom but the need to treat or suppress it has rarely been discussed in the literature. We report the case of a 17-year-old man who had suffered cerebral infarction of the right putamen and temporal lobe 10 years previously. Forced grasping of the hemiparetic left upper limb was improved after a unique combined treatment. Botulinum toxin type A (BTX-A) was first injected into the left biceps, wrist flexor muscles, and finger flexor muscles. Forced grasping was reduced along with spasticity of the upper limb. In addition, repetitive facilitative exercise and object-related training were performed under low-amplitude continuous neuromuscular electrical stimulation. Since this 2-week treatment improved upper limb function, we compared brain activities, as measured by near-infrared spectroscopy during finger pinching, before and after the combined treatment. Brain activities in the ipsilesional sensorimotor cortex (SMC) and medial frontal cortex (MFC) during pinching under electrical stimulation after treatment were greater than those before. The results suggest that training under electrical stimulation after BTX-A treatment may modulate the activities of the ipsilesional SMC and MFC and lead to functional improvement of the affected upper limb with forced grasping. PMID:28265475

A Hierarchical structure of key performance indicators for operation management and continuous improvement in production systems

PubMed Central

Kang, Ningxuan; Zhao, Cong; Li, Jingshan; Horst, John A.

2018-01-01

Key performance indicators (KPIs) are critical for manufacturing operation management and continuous improvement (CI). In modern manufacturing systems, KPIs are defined as a set of metrics to reflect operation performance, such as efficiency, throughput, availability, from productivity, quality and maintenance perspectives. Through continuous monitoring and measurement of KPIs, meaningful quantification and identification of different aspects of operation activities can be obtained, which enable and direct CI efforts. A set of 34 KPIs has been introduced in ISO 22400. However, the KPIs in a manufacturing system are not independent, and they may have intrinsic mutual relationships. The goal of this paper is to introduce a multi-level structure for identification and analysis of KPIs and their intrinsic relationships in production systems. Specifically, through such a hierarchical structure, we define and layer KPIs into levels of basic KPIs, comprehensive KPIs and their supporting metrics, and use it to investigate the relationships and dependencies between KPIs. Such a study can provide a useful tool for manufacturing engineers and managers to measure and utilize KPIs for CI. PMID:29398722

An EMG-based system for continuous monitoring of clinical efficacy of Parkinson's disease treatments.

PubMed

Askari, Sina; Zhang, Mo; Won, Deborah S

2010-01-01

Current methods for assessing the efficacy of treatments for Parkinson's disease (PD) rely on physician rated scores. These methods pose three major shortcomings: 1) the subjectivity of the assessments, 2) the lack of precision on the rating scale (6 discrete levels), and 3) the inability to assess symptoms except under very specific conditions and/or for very specific tasks. To address these shortcomings, a portable system was developed to continuously monitor Parkinsonian symptoms with quantitative measures based on electrical signals from muscle activity (EMG). Here, we present the system design and the implementation of methods for system validation. This system was designed to provide continuous measures of tremor, rigidity, and bradykinesia which are related to the neurophysiological source without the need for multiple bulky experimental apparatuses, thus allowing more precise, quantitative indicators of the symptoms which can be measured during practical daily living tasks. This measurement system has the potential to improve the diagnosis of PD as well as the evaluation of PD treatments, which is an important step in the path to improving PD treatments.

A Hierarchical structure of key performance indicators for operation management and continuous improvement in production systems.

PubMed

Kang, Ningxuan; Zhao, Cong; Li, Jingshan; Horst, John A

2016-01-01

Key performance indicators (KPIs) are critical for manufacturing operation management and continuous improvement (CI). In modern manufacturing systems, KPIs are defined as a set of metrics to reflect operation performance, such as efficiency, throughput, availability, from productivity, quality and maintenance perspectives. Through continuous monitoring and measurement of KPIs, meaningful quantification and identification of different aspects of operation activities can be obtained, which enable and direct CI efforts. A set of 34 KPIs has been introduced in ISO 22400. However, the KPIs in a manufacturing system are not independent, and they may have intrinsic mutual relationships. The goal of this paper is to introduce a multi-level structure for identification and analysis of KPIs and their intrinsic relationships in production systems. Specifically, through such a hierarchical structure, we define and layer KPIs into levels of basic KPIs, comprehensive KPIs and their supporting metrics, and use it to investigate the relationships and dependencies between KPIs. Such a study can provide a useful tool for manufacturing engineers and managers to measure and utilize KPIs for CI.

Nursing unit leaders' influence on the long-term sustainability of evidence-based practice improvements.

PubMed

Fleiszer, Andrea R; Semenic, Sonia E; Ritchie, Judith A; Richer, Marie-Claire; Denis, Jean-Louis

2016-04-01

To describe how actions of nursing unit leaders influenced the long-term sustainability of a best practice guidelines (BPG) program on inpatient units. Several factors influence the initial implementation of evidence-based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term. A qualitative descriptive case study included 39 in-depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation. Higher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability-promoting environments characterized by teamwork and accountability. Unit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long-term sustainability of BPG-based practice improvements. As part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities. © 2015 John Wiley & Sons Ltd.

Sustained functional improvement by hepatocyte growth factor-like small molecule BB3 after focal cerebral ischemia in rats and mice

PubMed Central

Chaparro, Rafael E; Izutsu, Miwa; Sasaki, Toshihiro; Sheng, Huaxin; Zheng, Yi; Sadeghian, Homa; Qin, Tao; von Bornstadt, Daniel; Herisson, Fanny; Duan, Bin; Li, Jing-Song; Jiang, Kai; Pearlstein, Molly; Pearlstein, Robert D; Smith, David E; Goldberg, Itzhak D; Ayata, Cenk; Warner, David S

2015-01-01

Hepatocyte growth factor (HGF), efficacious in preclinical models of acute central nervous system injury, is burdened by administration of full-length proteins. A multiinstitutional consortium investigated the efficacy of BB3, a small molecule with HGF-like activity that crosses the blood–brain barrier in rodent focal ischemic stroke using Stroke Therapy Academic Industry Roundtable (STAIR) and Good Laboratory Practice guidelines. In rats, BB3, begun 6 hours after temporary middle cerebral artery occlusion (tMCAO) reperfusion, or permanent middle cerebral artery occlusion (pMCAO) onset, and continued for 14 days consistently improved long-term neurologic function independent of sex, age, or laboratory. BB3 had little effect on cerebral infarct size and no effect on blood pressure. BB3 increased HGF receptor c-Met phosphorylation and synaptophysin expression in penumbral tissue consistent with a neurorestorative mechanism from HGF-like activity. In mouse tMCAO, BB3 starting 10 minutes after reperfusion and continued for 14 days improved neurologic function that persisted for 8 weeks in some, but not all measures. Study in animals with comorbidities and those exposed to common stroke drugs are the next steps to complete preclinical assessment. These data, generated in independent, masked, and rigorously controlled settings, are the first to suggest that the HGF pathway can potentially be harnessed by BB3 for neurologic benefit after ischemic stroke. PMID:25712497

The ReACH Collaborative--improving quality home care.

PubMed

Boyce, Patricia Simino; Pace, Karen B; Lauder, Bonnie; Solomon, Debra A

2007-08-01

Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71). In summary, home health care is a significant and growing sector of the health care system that provides care to millions of vulnerable patients. There seems little doubt that home health agencies want to focus on quality of care issues and provide optimal care to home-based patients. Furthermore, there is a growing awareness of the value for adapting innovative, effective models for improving the culture of home care practice. This awareness stems from the notion that some agencies see quality improvement activities as a way for them to distinguish themselves not only to regulators and customers, but also to meet the cultural and transformational needs to remain viable in a constantly evolving and competitive health care industry.

Progress Toward Poliomyelitis Eradication--Afghanistan, January 2014‒August 2015.

PubMed

Mbaeyi, Chukwuma; Saatcioglu, Akif; Tangermann, Rudolf H; Hadler, Stephen; Ehrhardt, Derek

2015-10-23

Despite recent progress toward global polio eradication, endemic transmission of wild poliovirus (WPV) continues to be reported in Afghanistan and Pakistan. The Afghanistan program must overcome many challenges to remain on track toward achieving the objectives set in the 2013–2018 strategic plan of the Global Polio Eradication Initiative (GPEI). Cross-border transmission of WPV type 1 (WPV1) continues to occur among children traveling to and from Pakistan. The country's routine immunization system remains weak and unable to reach recommended benchmarks in most regions; hence, the national Polio Eradication Initiative (PEI) relies mainly on providing children aged <5 years with oral poliovirus vaccine (OPV), administered during supplementary immunization activities (SIAs). Because of ongoing conflict and insecurity, some children continue to be missed during SIAs in areas not under government control; however, the majority of missed children live in accessible areas and are often unreached because of a failure to plan, implement, and supervise SIAs efficiently. This report describes polio eradication activities and progress in Afghanistan during January 2014‒August 2015 and updates previous reports. During 2014, a total of 28 WPV1 cases were reported in Afghanistan, compared with 14 cases in 2013; nine cases were reported during January‒August 2015, the same number as during the same period in 2014. To eliminate poliovirus transmission in Afghanistan, emergency operations centers (EOCs) need to be established at the national level and in critical regions without delay to improve overall coordination and oversight of polio eradication activities. The recently revised National Emergency Action Plan for polio eradication needs to be fully implemented, including detailed microplanning and enhanced monitoring and supervision of SIAs, as well as improved cross-border coordination with Pakistan.

The long-term benefits of a multi-component exercise intervention to balance and mobility in healthy older adults.

PubMed

Bird, M; Hill, K D; Ball, M; Hetherington, S; Williams, A D

2011-01-01

We examined the long-term effects of a multi-component exercise program on balance, mobility and exercise behavior. The benefits of a community-based resistance and flexibility exercise intervention in a group of healthy older (60-75 years) individuals were recorded 12 months after completion of the randomized control intervention. Differences between those participants who continued to exercise and those who discontinued were investigated. Significant improvements from baseline in sit to stand (p<0.001), timed up and go (p=0.001), and sway (p<0.001) remained at follow up in the exercise intervention group, with a control group unchanged. Participants who continued exercising had significantly greater improvements in strength immediately after the intervention, compared to those who discontinued (p=0.004). Those who continued regular resistance training performed better in the step test at 12-month follow up (p=0.009) and believed that the program was of more benefit to their physical activity (p<0.001) than those who discontinued exercising. Benefits to balance and mobility persist 1 year after participation in a multi-component exercise program, due in part to some continuing participation in resistance training. Motivation to continue resistance training may be related real and perceived benefits attained from the intervention as well as the environmental context of the intervention. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Intestinal alkaline phosphatase to treat necrotizing enterocolitis.

PubMed

Biesterveld, Ben E; Koehler, Shannon M; Heinzerling, Nathan P; Rentea, Rebecca M; Fredrich, Katherine; Welak, Scott R; Gourlay, David M

2015-06-15

Intestinal alkaline phosphatase (IAP) activity is decreased in necrotizing enterocolitis (NEC), and IAP supplementation prevents NEC development. It is not known if IAP given after NEC onset can reverse the course of the disease. We hypothesized that enteral IAP given after NEC induction would not reverse intestinal injury. NEC was induced in Sprague-Dawley pups by delivery preterm followed by formula feedings with lipopolysaccharide (LPS) and hypoxia exposure and continued up to 4 d. IAP was added to feeds on day 2 until being sacrificed on day 4. NEC severity was scored based on hematoxylin and eosin-stained terminal ileum sections, and AP activity was measured using a colorimetric assay. IAP and interleukin-6 expression were measured using real time polymerase chain reaction. NEC pups' alkaline phosphatase (AP) activity was decreased to 0.18 U/mg compared with controls of 0.57 U/mg (P < 0.01). Discontinuation of LPS and hypoxia after 2 d increased AP activity to 0.36 U/mg (P < 0.01). IAP supplementation in matched groups did not impact total AP activity or expression. Discontinuing LPS and hypoxia after NEC onset improved intestinal injury scores to 1.14 compared with continued stressors, score 2.25 (P < 0.01). IAP supplementation decreased interleukin-6 expression two-fold (P < 0.05), though did not reverse NEC intestinal damage (P = 0.5). This is the first work to demonstrate that removing the source of NEC improves intestinal damage and increases AP activity. When used as a rescue treatment, IAP decreased intestinal inflammation though did not impact injury making it likely that IAP is best used preventatively to those neonates at risk. Copyright © 2015 Elsevier Inc. All rights reserved.

Improving maternal care with a continuous quality improvement strategy: a report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network.

PubMed

Bennett, Ian M; Coco, Andrew; Anderson, Janice; Horst, Michael; Gambler, Angela S; Barr, Wendy Brooks; Ratcliffe, Stephen

2009-01-01

Maternal medical care (prenatal and postpartum) involves a set of clinical interventions addressing risk factors associated with important maternal and infant outcomes. Programs to increase the rate of delivery of these interventions in clinical practice have not been widely implemented. A practice-based research network focused on developing continuous quality improvement (CQI) processes for maternal care among 10 family medicine residency training sites in the northeastern United States (the IMPLICIT Network) from January 2003 through September 2007. Documented delivery of 5 standard maternal care interventions was assessed before and after initiating a program to increase their frequency. Proportion chart analyses were conducted comparing the period before and after implementation of the CQI interventions. Data were available for 3936 pregnancies during the course of the study period. Results varied across the clinical interventions. Significant improvement in care processes was seen for 3 screening activities: (1) prenatal depression symptomatology (by 15 weeks' gestation); (2) screening for smoking at 30 weeks' gestation; (3) and postpartum contraception planning. Screening for smoking by 15 weeks' gestation and testing for asymptomatic bacteriuria were already conducted >90% of the time during the baseline period and did not increase significantly after initiating the CQI program. Screening for postpartum depression symptomatology was recorded in 50% to 60% of women before the CQI program and did not increase significantly. A practice-based research network of family medicine residency practices focused on CQI outcomes was successful in increasing the delivery of some maternal care interventions.

Experimental investigation of active rib stitch knitted architecture for flow control applications

NASA Astrophysics Data System (ADS)

Abel, Julianna M.; Mane, Poorna; Pascoe, Benjamin; Luntz, Jonathan; Brei, Diann

2010-04-01

Actively manipulating flow characteristics around the wing can enhance the high-lift capability and reduce drag; thereby, increasing fuel economy, improving maneuverability and operation over diverse flight conditions which enables longer, more varied missions. Active knits, a novel class of cellular structural smart material actuator architectures created by continuous, interlocked loops of stranded active material, produce distributed actuation that can actively manipulate the local surface of the aircraft wing to improve flow characteristics. Rib stitch active knits actuate normal to the surface, producing span-wise discrete periodic arrays that can withstand aerodynamic forces while supplying the necessary displacement for flow control. This paper presents a preliminary experimental investigation of the pressuredisplacement actuation performance capabilities of a rib stitch active knit based upon shape memory alloy (SMA) wire. SMA rib stitch prototypes in both individual form and in stacked and nestled architectures were experimentally tested for their quasi-static load-displacement characteristics, verifying the parallel and series relationships of the architectural configurations. The various configurations tested demonstrated the potential of active knits to generate the required level of distributed surface displacements while under aerodynamic level loads for various forms of flow control.

The Volunteering-in-Place (VIP) Program: Providing meaningful volunteer activity to residents in assisted living with mild cognitive impairment.

PubMed

Klinedinst, N Jennifer; Resnick, Barbara

2016-01-01

The Volunteering-in-Place (VIP) Program was developed to provide individualized meaningful volunteer activities matched to interests and capabilities for older adults with MCI in assisted living. The purposes of this single-site pre-test/post-test pilot study were to (1) establish feasibility of the VIP Program based on treatment fidelity (design, treatment, delivery, enactment); and (2) evaluate preliminary efficacy via improvement in psychological health (depressive symptoms, usefulness, purpose, resilience, and life satisfaction) and decreased sedentary activity (survey and Fitbit) at 3 and 6 months. Ten residents participated. The majority was white, female and educated, and on average 88 years old. The VIP Program was feasible and most participants continued to volunteer at 6 months. There were non-significant improvements in depressive symptoms, usefulness, purpose, resilience and recreational physical activity. The results of this study provide support for the feasibility of the VIP Program. Further study is necessary to examine efficacy. Copyright © 2016 Elsevier Inc. All rights reserved.

Comfort-oriented vehicle suspension design with skyhook inerter configuration

NASA Astrophysics Data System (ADS)

Hu, Yinlong; Chen, Michael Z. Q.; Sun, Yonghui

2017-09-01

This paper is concerned with the comfort-oriented vehicle suspension design problem by using a skyhook inerter configuration. The rationale of the skyhook inerter is to use a grounded inerter to virtually increase the sprung mass of a vehicle, as it is analytically demonstrated that increasing the sprung mass can always improve the ride comfort performance. Semi-active means to realize the skyhook inerter configuration are investigated by using semi-active inerters. Three control laws, that is the on-off control, the anti-chatter on-off control, and the continuous control, are proposed for the semi-active inerter to approximate the skyhook inerter. Numerical simulations are performed to demonstrate the effectiveness and performances of these control laws. It is shown that the semi-active realizations of the skyhook inerter by using the proposed control laws can achieve over 10% improvement compared with the traditional strut, and similar performances are obtained for these control laws, with slight differences with respect to different static stiffnesses of the suspension system.

Communication Problems for Patients Hospitalized with Chest Pain

PubMed Central

Simon, Steven R.; Lee, Thomas H.; Goldman, Lee; McDonough, Allison L.; Pearson, Steven D.

1998-01-01

In many settings, primary care physicians have begun to delegate inpatient care to hospitalists, but the impact of this change on patients' hospital experience is unknown. To determine the effect on physician-patient communication of having the regular outpatient physician (continuity physician) continue involvement in hospital care, we surveyed 1,059 consecutive patients hospitalized with chest pain. Patients whose continuity physicians remained involved in their hospital care were less likely to report communication problems regarding tests (20% vs 31%, p = .03), activity after discharge (42% vs 51%, p = .02), and health habits (31% vs 38%, p = .07). In a setting without a designated hospitalist system, communication problems were less frequent among patients whose continuity physicians were involved in their hospital care. New models of inpatient care delivery can maintain patient satisfaction but to do so must focus attention on improving physician-patient communication. PMID:9844081

Kids on the Move: Afterschool Programs Promoting Healthy Eating and Physical Activity. America After 3PM Special Report

ERIC Educational Resources Information Center

Afterschool Alliance, 2015

2015-01-01

Afterschool programs have continued to grow in sophistication, increase their offerings and improve quality. As the role of afterschool programs has evolved from primarily providing a safe and supervised environment to a resource that provides a host of supports for their students, programs have become valuable partners in helping students reach…

The Transfer of Training at Macro Level in Least Developed Countries: A Case Study of the "Brain-Drain" in Eritrea

ERIC Educational Resources Information Center

Tessema, Mussie T.; Winrow, Brian P.; Teclezion, Mussie M.

2012-01-01

Over the past four decades, governments in the least developed countries (LDCs--a categorization adopted by the United Nations) have been attempting to improve the skills and knowledge of their public servants by providing local and international training programs. Despite these training activities, however, many LDCs continue to experience acute…

A Bridge Too Far: The Decline in Shared Science Activities during Primary-Secondary Transition

ERIC Educational Resources Information Center

Galton, Maurice

2016-01-01

This article reviews the use of "bridging units" in science to improve curriculum continuity during transition from primary to secondary school. Based on research evidence collected over several decades, it suggests that the use of these units rose to a peak around the time of the millennium, but that in recent years few schools have…

Measuring Work-Based Learning for Continuous Improvement. Connecting the Classroom to Careers: The State's Role in Work-Based Learning

ERIC Educational Resources Information Center

Advance CTE: State Leaders Connecting Learning to Work, 2016

2016-01-01

Work-based learning provides a continuum of activities--from career exploration and job shadowing to internships and apprenticeships--that help students develop technical and professional skills in an authentic work environment. While many work-based learning programs are designed and operated at the local level, several states have begun building…

Integrating On-Line Technology into Teaching Activities to Enhance Student and Teacher Learning in a New Zealand Primary School

ERIC Educational Resources Information Center

Baskerville, Delia

2012-01-01

Continuing emphasis given to computer technology resourcing in schools presents potential for web-based initiatives which focus on quality arts teaching and learning, as ways to improve arts outcomes for all students. An arts e-learning collaborative research project between specialist on-line teacher/researchers and generalist primary teachers…

Continuous intra-articular infusion anesthesia for pain control after total knee arthroplasty: study protocol for a randomized controlled trial.

PubMed

Guo, Da; Cao, Xue-Wei; Liu, Jin-Wen; Ouyang, Wen-Wei; Pan, Jian-Ke; Liu, Jun

2014-06-23

Postoperative pain control after total knee arthroplasty (TKA) remains a great challenge. The management of pain in the immediate postoperative period is one of the most critical aspects to allow speedier rehabilitation and reduce the risk of postoperative complications. Recently, periarticular infiltration anesthesia has become popular, but the outcome is controversial. Some studies have shown transient effects, "rebound pain", or no effectiveness in pain control. Continuous intra-articular infusion technique has been introduced to improve these transient effects, but more clinical studies are needed. Furthermore, the potential risk of early periprosthetic joint infection is causing concerning. We plan to compare continuous intra-articular infusion anesthesia with epidural infusion anesthesia after TKA to assess the effectiveness of this technique in reducing pain, in improving postoperative function, and to look at the evidence for risk of early infection. This trial is a randomized, controlled study. Patients (n = 214) will be randomized into two groups: to receive continuous intra-articular infusion anesthesia (group C); and epidural infusion anesthesia (group E). For the first 3 postoperative days, pain at rest, active range of motion (A-ROM), rescue analgesia and side effects will be recorded. At 3-month and 6-month follow-up, A-ROM, C-reactive protein, erythrocyte sedimentation rate, and synovial fluid cell count and culture will be analyzed. The results from this study will provide clinical evidence on the efficacy of a continuous intra-articular infusion technique in reducing pain, postoperative functional improvement and safety. It will be the first randomized controlled trial to investigate infection risk with local anesthesia after TKA. ClinicalTrials.gov identifier: ChiCTR-TRC-13003999.

AMOLED (active matrix OLED) functionality and usable lifetime at temperature

NASA Astrophysics Data System (ADS)

Fellowes, David A.; Wood, Michael V.; Prache, Olivier; Jones, Susan

2005-05-01

Active Matrix Organic Light Emitting Diode (AMOLED) displays are known to exhibit high levels of performance, and these levels of performance have continually been improved over time with new materials and electronics design. eMagin Corporation developed a manually adjustable temperature compensation circuit with brightness control to allow for excellent performance over a wide temperature range. Night Vision and Electronic Sensors Directorate (US Army) tested the performance and survivability of a number of AMOLED displays in a temperature chamber over a range from -55°C to +85°C. Although device performance of AMOLEDs has always been its strong suit, the issue of usable display lifetimes for military applications continues to be an area of discussion and research. eMagin has made improvements in OLED materials and worked towards the development of a better understanding of usable lifetime for operation in a military system. NVESD ran luminance degradation tests of AMOLED panels at 50°C and at ambient to characterize the lifetime of AMOLED devices. The result is a better understanding of the applicability of AMOLEDs in military systems: where good fits are made, and where further development is needed.

Towards a wearable sensor system for continuous occupational cold stress assessment

PubMed Central

AUSTAD, Hanne; WIGGEN, Øystein; FÆREVIK, Hilde; SEEBERG, Trine M.

2018-01-01

This study investigated the usefulness of continuous sensor data for improving occupational cold stress assessment. Eleven volunteer male subjects completed a 90–120-min protocol in cold environments, consisting of rest, moderate and hard work. Biomedical data were measured using a smart jacket with integrated temperature, humidity and activity sensors, in addition to a custom-made sensor belt worn around the chest. Other relevant sensor data were measured using commercially available sensors. The study aimed to improve decision support for workers in cold climates, by taking advantage of the information provided by data from the rapidly growing market of wearable sensors. Important findings were that the subjective thermal sensation did not correspond to the measured absolute skin temperature and that large differences were observed in both metabolic energy production and skin temperatures under identical exposure conditions. Temperature, humidity, activity and heart rate were found to be relevant parameters for cold stress assessment, and the locations of the sensors in the prototype jacket were adequate. The study reveals the need for cold stress assessment and indicates that a generalised approached is not sufficient to assess the stress on an individual level. PMID:29353859

Continuous quality improvement for continuity of care.

PubMed

Kibbe, D C; Bentz, E; McLaughlin, C P

1993-03-01

Continuous quality improvement (CQI) techniques have been used most frequently in hospital operations such as pharmaceutical ordering, patient admitting, and billing of insurers, and less often to analyze and improve processes that are close to the clinical interaction of physicians and their patients. This paper describes a project in which CQI was implemented in a family practice setting to improve continuity of care. A CQI study team was assembled in response to patients' complaints about not being able to see their regular physician providers when they wanted. Following CQI methods, the performance of the practice in terms of provider continuity was measured. Two "customer" groups were surveyed: physician faculty members were surveyed to assess their attitudes about continuity, and patients were surveyed about their preferences for provider continuity and convenience factors. Process improvements were selected in the critical pathways that influence provider continuity. One year after implementation of selected process improvements, repeat chart audit showed that provider continuity levels had improved from .45 to .74, a 64% increase from 1 year earlier. The project's main accomplishment was to establish the practicality of using CQI methods in a primary care setting to identify a quality issue of value to both providers and patients, in this case, continuity of provider care, and to identify processes that linked the performance of health care delivery procedures with patient expectations.

A tailored educational intervention improves doctor's performance in managing depression: a randomized controlled trial.

PubMed

Shirazi, Mandana; Lonka, Kirsti; Parikh, Sagar V; Ristner, Gunilla; Alaeddini, Farshid; Sadeghi, Majid; Wahlstrom, Rolf

2013-02-01

To assess the effects of a tailored and activating educational intervention, based on a three-stage modified Prochaska model of readiness-to-change, on the performance of general physicians in primary care (GPs) regarding management of depressive disorders. Parallel group, randomized control trial. Primary hypothesis was that performance would improve by 20 percentage units in the intervention arm. The setting was primary care in southern Tehran. The participants were 192 GPs stratified on stage of readiness-to-change, sex, age and work experience. The intervention was a 2-day interactive workshop for a small group of GPs' at a higher stage of readiness-to-change ('intention') and a 2-day interactive large group meeting for those with lower propensity to change ('attitude') at the pre-assessment. GPs in the control arm participated in a standard educational programme on the same topic. The main outcome measures were validated tools to assess GPs' performance by unannounced standardized patients, regarding diagnosis and treatment of depressive disorders. The assessments were made 2 months before and 2 months after the intervention. GPs in the intervention arm significantly improved their overall mean scores for performance regarding both diagnosis, with an intervention effect of 14 percentage units (P = 0.007), and treatment and referral, with an intervention effect of 20 percentage units (P < 0.0001). The largest improvement after the intervention appeared in the small group: 30 percentage units for diagnosis (P = 0.027) and 29 percentage units for treatment and referral (P < 0.0001). Activating learning methods, tailored according to the participants' readiness to change, improved clinical performance of GPs in continuing medical education and can be recommended for continuing professional development. © 2011 Blackwell Publishing Ltd.

Collaborative action research: implementation of cooperative learning.

PubMed

Smith-Stoner, Marilyn; Molle, Mary E

2010-06-01

Nurse educators must continually improve their teaching skills through innovation. However, research about the process used by faculty members to transform their teaching methods is limited. This collaborative study uses classroom action research to describe, analyze, and address problems encountered in implementing cooperative learning in two undergraduate nursing courses. After four rounds of action and reflection, the following themes emerged: students did not understand the need for structured cooperative learning; classroom structure and seating arrangement influenced the effectiveness of activities; highly structured activities engaged the students; and short, targeted activities that involved novel content were most effective. These findings indicate that designing specific activities to prepare students for class is critical to cooperative learning. Copyright 2010, SLACK Incorporated.

High intensity interval and moderate continuous cycle training in a physical education programme improves health-related fitness in young females.

PubMed

Mazurek, K; Zmijewski, P; Krawczyk, K; Czajkowska, A; Kęska, A; Kapuściński, P; Mazurek, T

2016-06-01

The aim of the study was to investigate the effects of eight weeks of regular physical education classes supplemented with high intensity interval cycle exercise (HIIE) or continuous cycle exercises of moderate intensity (CME). Forty-eight collegiate females exercising in two regular physical education classes per week were randomly assigned to two programmes (HIIE; n = 24 or CME; n = 24) of additional (one session of 63 minutes per week) physical activity for 8 weeks. Participants performed HIIE comprising 2 series of 6x10 s sprinting with maximal pedalling cadence and active recovery pedalling with intensity 65%-75% HRmax or performed CME corresponding to 65%-75% HRmax. Before and after the 8-week programmes, anthropometric data and aero- and anaerobic capacity were measured. Two-way ANOVA revealed a significant time main effect for VO2max (p < 0.001), similar improvements being found in both groups (+12% in HIIE and +11% in CME), despite body mass not changing significantly (p = 0.59; +0.4% in HIIE and -0.1% in CME). A significant main time effect was found for relative fat mass (FM) and fat-free mass (FFM) (p < 0.001 and p < 0.001, respectively). A group x time interaction effect was found for relative FM and FFM (p = 0.018 and p = 0.018); a greater reduction in FM and greater increase in FFM were noted in the CME than the HIIE group. Improvements in anaerobic power were observed in both groups (p < 0.001), but it was greater in the HIIE group (interaction effect, p = 0.022). Weight loss is not mandatory for exercise-induced effects on improving aerobic and anaerobic capacity in collegiate females. Eight weeks of regular physical education classes supplemented with CME sessions are more effective in improving body composition than physical education classes supplemented with HIIE sessions. In contrast to earlier, smaller trials, similar improvements in aerobic capacity were observed following physical activity with additional HIIE or CME sessions.

ActivityAware: An App for Real-Time Daily Activity Level Monitoring on the Amulet Wrist-Worn Device.

PubMed

Boateng, George; Batsis, John A; Halter, Ryan; Kotz, David

2017-03-01

Physical activity helps reduce the risk of cardiovascular disease, hypertension and obesity. The ability to monitor a person's daily activity level can inform self-management of physical activity and related interventions. For older adults with obesity, the importance of regular, physical activity is critical to reduce the risk of long-term disability. In this work, we present ActivityAware , an application on the Amulet wrist-worn device that measures daily activity levels (sedentary, moderate and vigorous) of individuals, continuously and in real-time. The app implements an activity-level detection model, continuously collects acceleration data on the Amulet, classifies the current activity level, updates the day's accumulated time spent at that activity level, logs the data for later analysis, and displays the results on the screen. We developed an activity-level detection model using a Support Vector Machine (SVM). We trained our classifiers using data from a user study, where subjects performed the following physical activities: sit, stand, lay down, walk and run. With 10-fold cross validation and leave-one-subject-out (LOSO) cross validation, we obtained preliminary results that suggest accuracies up to 98%, for n=14 subjects. Testing the ActivityAware app revealed a projected battery life of up to 4 weeks before needing to recharge. The results are promising, indicating that the app may be used for activity-level monitoring, and eventually for the development of interventions that could improve the health of individuals.

Transferring learning to practice with e-learning--experiences in continuing education in the field of ambient assisted living.

PubMed

Illiger, Kristin; Egbert, Nicole; Krückeberg, Jörn; Stiller, Gerald; Kupka, Thomas; Hübner, Ursula; Behrends, Marianne

2014-01-01

The article describes an analysis of the use of e-learning to improve the learning transfer to practice in continuing education. Therefore an e-learning offer has been developed as a part between two attendance periods of a training course in the field of Ambient Assisted Living (AAL). All participants of the course were free to use the e-learning offer. After the end of the e-learning part we compared the e-learning users to the other participants. Using an online questionnaire we explored if there are differences in the activities in the field AAL after the training course. The results show that e-learning is beneficial especially for communication processes. Due to the fact that the possibility to talk about the learning content is an essential factor for the learning transfer, e-learning can improve the learning success.

Case study evaluating Just-In-Time Teaching and Peer Instruction using clickers in a quantum mechanics course

NASA Astrophysics Data System (ADS)

Sayer, Ryan; Marshman, Emily; Singh, Chandralekha

2016-12-01

Just-in-Time Teaching (JiTT) is an instructional strategy involving feedback from students on prelecture activities in order to design in-class activities to build on the continuing feedback from students. We investigate the effectiveness of a JiTT approach, which included in-class concept tests using clickers in an upper-division quantum mechanics course. We analyze student performance on prelecture reading quizzes, in-class clicker questions answered individually, and clicker questions answered after group discussion, and compare those performances with open-ended retention quizzes administered after all instructional activities on the same concepts. In general, compared to the reading quizzes, student performance improved when individual clicker questions were posed after lectures that focused on student difficulties found via electronic feedback. The performance on the clicker questions after group discussion following individual clicker question responses also showed improvement. We discuss some possible reasons for the improved performance at various stages, e.g., from prelecture reading quizzes to postlecture clicker questions, and from individual to group clicker questions.

[Role of physical activity in the prevention of osteoporosis].

PubMed

Siegrist, Monika

2008-07-01

In recent years, osteoporosis has become a leading cause of morbidity and mortality in elderly women. Research has demonstrated that the prevention of osteoporosis and osteoporosis-related fractures may best be achieved by initiating sound health behaviors early in life and continuing them throughout life. Evidence suggests that osteoporosis is easier to prevent than to treat. In fact, healthy early life practices, including the adequate consumption of most nutrients, calcium in particular, and regular physical activity, contribute to greater bone mineral mass and optimal peak bone mass. Bone is living tissue that responds to exercise by becoming stronger. Two types of exercises are important for building and maintaining bone mass and density: Weight-bearing exercises, in which bones and muscles work against gravity and resistance training that use muscular strength to improve muscle mass and strengthen bone. Exercise can also improve gait, balance, coordination, proprioception, reaction time, and muscle strength, even in very old and frail elderly people. Overall, the evidence strongly suggests that regular physical activity, especially started in childhood and adolescence, is a cheap and safe way of both improving bone strength and reducing the risk to fall.

A translational platform for prototyping closed-loop neuromodulation systems

PubMed Central

Afshar, Pedram; Khambhati, Ankit; Stanslaski, Scott; Carlson, David; Jensen, Randy; Linde, Dave; Dani, Siddharth; Lazarewicz, Maciej; Cong, Peng; Giftakis, Jon; Stypulkowski, Paul; Denison, Tim

2013-01-01

While modulating neural activity through stimulation is an effective treatment for neurological diseases such as Parkinson's disease and essential tremor, an opportunity for improving neuromodulation therapy remains in automatically adjusting therapy to continuously optimize patient outcomes. Practical issues associated with achieving this include the paucity of human data related to disease states, poorly validated estimators of patient state, and unknown dynamic mappings of optimal stimulation parameters based on estimated states. To overcome these challenges, we present an investigational platform including: an implanted sensing and stimulation device to collect data and run automated closed-loop algorithms; an external tool to prototype classifier and control-policy algorithms; and real-time telemetry to update the implanted device firmware and monitor its state. The prototyping system was demonstrated in a chronic large animal model studying hippocampal dynamics. We used the platform to find biomarkers of the observed states and transfer functions of different stimulation amplitudes. Data showed that moderate levels of stimulation suppress hippocampal beta activity, while high levels of stimulation produce seizure-like after-discharge activity. The biomarker and transfer function observations were mapped into classifier and control-policy algorithms, which were downloaded to the implanted device to continuously titrate stimulation amplitude for the desired network effect. The platform is designed to be a flexible prototyping tool and could be used to develop improved mechanistic models and automated closed-loop systems for a variety of neurological disorders. PMID:23346048

Effect of bright light at night on core temperature, subjective alertness and performance as a function of exposure time.

PubMed

Foret, J; Daurat, A; Tirilly, G

1998-01-01

This simulated night shift study measured the effects of moderate bright light (a 4-hour pulse starting at 2000 or 0400) during the exposure night and subsequent night (dim light). Eight young males remained confined with little physical activity to a laboratory in groups of 4. After a night of reference, they were active for 24 hours; then after a morning recovery sleep, they were active again for 16 hours. Continuously measured rectal temperature proved to be immediately sensitive to 4 hours of bright light, particularly when given at the end of the night. Self-assessed alertness and also performance on a task with a high requirement for short-term memory were improved by the exposure to bright light. During the subsequent night the subjects were exposed only to dim light. Core temperature, subjective alertness and performance continued to show a time course depending on the preceding bright light exposure. Probably because evening exposure to bright light and morning sleep both had a phase-delaying effect, the effects on the circadian pacemaker were more pronounced. Thus, for practical applications in long night shifts, bright light can be considered to improve mood and alertness immediately but the possibility of modifying the circadian "clock" during subsequent nights should be taken into consideration, in particular after exposure to bright light in the evening.

A translational platform for prototyping closed-loop neuromodulation systems.

PubMed

Afshar, Pedram; Khambhati, Ankit; Stanslaski, Scott; Carlson, David; Jensen, Randy; Linde, Dave; Dani, Siddharth; Lazarewicz, Maciej; Cong, Peng; Giftakis, Jon; Stypulkowski, Paul; Denison, Tim

2012-01-01

While modulating neural activity through stimulation is an effective treatment for neurological diseases such as Parkinson's disease and essential tremor, an opportunity for improving neuromodulation therapy remains in automatically adjusting therapy to continuously optimize patient outcomes. Practical issues associated with achieving this include the paucity of human data related to disease states, poorly validated estimators of patient state, and unknown dynamic mappings of optimal stimulation parameters based on estimated states. To overcome these challenges, we present an investigational platform including: an implanted sensing and stimulation device to collect data and run automated closed-loop algorithms; an external tool to prototype classifier and control-policy algorithms; and real-time telemetry to update the implanted device firmware and monitor its state. The prototyping system was demonstrated in a chronic large animal model studying hippocampal dynamics. We used the platform to find biomarkers of the observed states and transfer functions of different stimulation amplitudes. Data showed that moderate levels of stimulation suppress hippocampal beta activity, while high levels of stimulation produce seizure-like after-discharge activity. The biomarker and transfer function observations were mapped into classifier and control-policy algorithms, which were downloaded to the implanted device to continuously titrate stimulation amplitude for the desired network effect. The platform is designed to be a flexible prototyping tool and could be used to develop improved mechanistic models and automated closed-loop systems for a variety of neurological disorders.

Continuous Improvement in Education. Advancing Teaching--Improving Learning. White Paper

ERIC Educational Resources Information Center

Park, Sandra; Hironaka, Stephanie; Carver, Penny; Nordstrum, Lee

2013-01-01

In recent years, "continuous improvement" has become a popular catchphrase in the field of education. However, while continuous improvement has become commonplace and well-documented in other industries, such as healthcare and manufacturing, little is known about how this work has manifested itself in education. This white paper attempts…

Continuous wave power scaling in high power broad area quantum cascade lasers

NASA Astrophysics Data System (ADS)

Suttinger, M.; Leshin, J.; Go, R.; Figueiredo, P.; Shu, H.; Lyakh, A.

2018-02-01

Experimental and model results for high power broad area quantum cascade lasers are presented. Continuous wave power scaling from 1.62 W to 2.34 W has been experimentally demonstrated for 3.15 mm-long, high reflection-coated 5.6 μm quantum cascade lasers with 15 stage active region for active region width increased from 10 μm to 20 μm. A semi-empirical model for broad area devices operating in continuous wave mode is presented. The model uses measured pulsed transparency current, injection efficiency, waveguide losses, and differential gain as input parameters. It also takes into account active region self-heating and sub-linearity of pulsed power vs current laser characteristic. The model predicts that an 11% improvement in maximum CW power and increased wall plug efficiency can be achieved from 3.15 mm x 25 μm devices with 21 stages of the same design but half doping in the active region. For a 16-stage design with a reduced stage thickness of 300Å, pulsed roll-over current density of 6 kA/cm2 , and InGaAs waveguide layers; optical power increase of 41% is projected. Finally, the model projects that power level can be increased to 4.5 W from 3.15 mm × 31 μm devices with the baseline configuration with T0 increased from 140 K for the present design to 250 K.

The Business Change Initiative: A Novel Approach to Improved Cost and Schedule Management

NASA Technical Reports Server (NTRS)

Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param

2016-01-01

Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.

[Clinical effects of nasal glucocorticoid on amelioration of nasal obstruction in patients with persistent non-allergic rhinitis].

PubMed

Sail, Giyab A; Zuo, Ke-jun; Xu, Geng

2009-09-01

To observe the efficacy of nasal glucocorticoid continuously used for 12 weeks on nasal obstruction in patients with persistent non-allergic rhinitis (PNAR). The changes of nasal obstruction, nasal resistance, nasal mucous membrane and quality of life in 47 patients with PNAR were observed. The efficacy of nasal glucocorticoid (Mometasone Furoate Nasal Spray, MFNS 200 microg/day) on patients with PNAR was evaluated. The results of nasal glucocorticoid (MFNS) continuously used for 12 weeks demonstrated: (1) After treatment, the nasal obstruction, nasal discharge, nasal obstruction related dizziness, headache, hyposmia, daily life activity, whole body fatigue, mental status were significantly improved (P < 0.05). (2) Nasal resistance showed significant amelioration (pre-treatment = 0.28 +/- 0.10, post- treatment = 0.16 +/- 0.05; F = 91.471, P < 0.05). (3) SF-36 questionnaire revealed that role physical, bodily pain, general health, role emotional had significant amelioration (P < 0.01). (4) SNOT-20 questionnaire revealed that the defatigation, impaired concentration, pinch the nose, nasal discharging into the throat, sleep quality had significant amelioration (P < 0.01). (5) Continued treatment for 12 weeks was better than 4 weeks, continued treatment had good effect. The study shows that nasal glucocorticoid improved the nasal obstruction, nasal resistance, nasal mucous membrane and quality of life in patients with PNAR.

Steady-state entanglement activation in optomechanical cavities

NASA Astrophysics Data System (ADS)

Farace, Alessandro; Ciccarello, Francesco; Fazio, Rosario; Giovannetti, Vittorio

2014-02-01

Quantum discord, and related indicators, are raising a relentless interest as a novel paradigm of nonclassical correlations beyond entanglement. Here, we discover a discord-activated mechanism yielding steady-state entanglement production in a realistic continuous-variable setup. This comprises two coupled optomechanical cavities, where the optical modes (OMs) communicate through a fiber. We first use a simplified model to highlight the creation of steady-state discord between the OMs. We show next that such discord improves the level of stationary optomechanical entanglement attainable in the system, making it more robust against temperature and thermal noise.

Research on Intelligent Synthesis Environments

NASA Technical Reports Server (NTRS)

Noor, Ahmed K.; Lobeck, William E.

2002-01-01

Four research activities related to Intelligent Synthesis Environment (ISE) have been performed under this grant. The four activities are: 1) non-deterministic approaches that incorporate technologies such as intelligent software agents, visual simulations and other ISE technologies; 2) virtual labs that leverage modeling, simulation and information technologies to create an immersive, highly interactive virtual environment tailored to the needs of researchers and learners; 3) advanced learning modules that incorporate advanced instructional, user interface and intelligent agent technologies; and 4) assessment and continuous improvement of engineering team effectiveness in distributed collaborative environments.

An Innovative and Successful Simulation Day.

PubMed

Bowling, Ann M; Eismann, Michelle

This article discusses the development of a creative and innovative plan to incorporate independent activities, including skill reviews and scenarios, into a single eight-hour day, using small student groups to enhance the learning process for pediatric nursing students. The simulation day consists of skills activities and pediatric simulation scenarios using the human patient simulator. Using small student groups in simulation captures the students' attention and enhances motivation to learn. The simulation day is a work in progress; appropriate changes are continually being made to improve the simulation experience for students.

Research on Intelligent Synthesis Environments

NASA Astrophysics Data System (ADS)

Noor, Ahmed K.; Loftin, R. Bowen

2002-12-01

Four research activities related to Intelligent Synthesis Environment (ISE) have been performed under this grant. The four activities are: 1) non-deterministic approaches that incorporate technologies such as intelligent software agents, visual simulations and other ISE technologies; 2) virtual labs that leverage modeling, simulation and information technologies to create an immersive, highly interactive virtual environment tailored to the needs of researchers and learners; 3) advanced learning modules that incorporate advanced instructional, user interface and intelligent agent technologies; and 4) assessment and continuous improvement of engineering team effectiveness in distributed collaborative environments.

Educating nurses about research ethics and practices with a self-directed practice-based learning program.

PubMed

Cibulka, Nancy J

2011-11-01

Learner-driven and practice-based education programs are recommended for integration of learning. A continuing education program on research ethics was introduced to five nurses in an ambulatory care setting at a Magnet® hospital, using a commercially available web-based course followed by a research practicum. The seasoned nurses reported little previous education in this area. Working with a nurse researcher, three nurses participated in a research project for improving clinic care delivery. The success of the continuing education program was determined by knowledge acquisition, satisfaction with learning activities, and perceived confidence in research participation. This continuing education program was effective in providing for knowledge and skill development in research ethics. The integrative learning format was well received. Copyright 2011, SLACK Incorporated.

Living well: an intervention to improve self-management of medical illness for individuals with serious mental illness.

PubMed

Goldberg, Richard W; Dickerson, Faith; Lucksted, Alicia; Brown, Clayton H; Weber, Elyssa; Tenhula, Wendy N; Kreyenbuhl, Julie; Dixon, Lisa B

2013-01-01

Individuals with serious mental illness have elevated rates of comorbid chronic general medical conditions and may benefit from interventions designed to support illness self-management. This study examined the effectiveness of a modified version of the Chronic Disease Self-Management Program called Living Well for individuals with serious mental illness. A total of 63 mental health consumers with serious mental illness and at least one concurrent chronic general medical condition were randomly assigned to receive the 13-session peer-cofacilitated Living Well intervention or usual care. Participants were evaluated on attitudinal, behavioral, and functional outcomes at baseline, at the end of the intervention, and at a two-month follow-up. Living Well participants showed significant postintervention improvements across a range of attitudinal (self-efficacy and patient activation), behavioral (illness self-management techniques), and functional (physical and emotional well-being and general health functioning) outcomes. Although attenuation of effect was observed for most outcomes at two months postintervention, evidence was found of continued improvement in general self-management behaviors (use of action planning, brainstorming, and problem-solving). Continued advantage was found for the Living Well group in other areas, such as health-related locus of control and reports of healthy eating and physical activity. Receipt of Living Well was associated with a notable decrease in use of the emergency room for medical care, although the between-group difference was not statistically significant. Living Well shows promise in helping mental health consumers more effectively manage chronic general medical conditions and experience improved functioning and well-being.

Approaches to chronic disease management for asthma and chronic obstructive pulmonary disease: strategies through the continuum of care

PubMed Central

Millard, Mark W.

2010-01-01

Investigator-initiated research in both asthma and chronic obstructive pulmonary disease conducted at the Baylor Martha Foster Lung Care Center has sought to improve management throughout the continuum of respiratory care using a multidisciplinary approach. Respiratory care therapists employed in the primary care setting were shown to improve the quality of asthma care: rescue inhaler use decreased by 75% and respiratory symptom score decreased by 49% in patients who were seen by this midlevel specialty provider. In addition to similar results in a geriatric population, patients' diagnosis was changed in 48% of cases and treatment was changed in 76% of cases after the intervention. For pulmonary rehabilitation, an activity of daily living assessment form was created, and rehabilitation—whether traditional or water-based—was shown to improve patients' ability to perform activities of daily living and improve quality of life scores. The Rules of Two®, developed by Baylor University Medical Center at Dallas to simplify understanding of good asthma control, continues to be taught, and patient education has also been offered through asthma summer camps for children. Finally, a multidisciplinary team worked to develop a protocol for treatment of asthma patients in the emergency department and, through this effort, was able to reduce length of stay from an average of 278 minutes to an average of 168 minutes. These efforts aim to overcome the gap between recommended care and actual practice, so that patients benefit from evidence-based medicine and continuing refinements to diagnosis and treatment. PMID:20671816

Application of gamma irradiation for aging control and improvement of shelf-life of kimchi, korean salted and fermented vegetables

NASA Astrophysics Data System (ADS)

Song, Hyun-Pa; Kim, Dong-Ho; Yook, Hong-Sun; Kim, Kyung-Soo; Kwon, Joong-Ho; Byun, Myung-Woo

2004-09-01

This study was carried out to evaluate the application of food irradiation as a method for extending shelf life of Kimchi. Gamma irradiation up to 10 kGy in the early stage of Kimchi fermentation had a dose-dependent effect on the inactivation of fermentative microbes, lowering the lactate dehydrogenase (LDH) activity and delaying acidification. Although gamma irradiation on the mid-fermentation stage of Kimchi inactivated the fermentative microbes effectively, LDH activity remained high and acidification continued. Kimchi irradiated at 10 kGy had lower scores in acceptability than those of control, 2.5 and 5 kGy irradiated. Therefore, gamma irradiation upto 5 kGy in the early fermentation stage is recommended for aging control and the improvement of shelf life of Kimchi.

Estimation of the outer-sphere contribution to the activation volume for electron exchange reactions using the mean spherical approximation

NASA Astrophysics Data System (ADS)

Takagi, Hideo D.; Swaddle, Thomas W.

1996-01-01

The outer-sphere contribution to the volume of activation of homogeneous electron exchange reactions is estimated for selected solvents on the basis of the mean spherical approximation (MSA), and the calculated values are compared with those estimated by the Strank-Hush-Marcus (SHM) theory and with activation volumes obtained experimentally for the electron exchange reaction between tris(hexafluoroacetylacetonato)ruthenium(III) and -(II) in acetone, acetonitrile, methanol and chloroform. The MSA treatment, which recognizes the molecular nature of the solvent, does not improve significantly upon the continuous-dielectric SHM theory, which represents the experimental data adequately for the more polar solvents.

Participation of National Medical Associations in quality improvement activities - International comparison and the Israeli case

PubMed Central

2014-01-01

Background Many countries have devoted considerable efforts in an attempt to improve the performance of their health care systems. National Medical Associations (NMAs), along with other stakeholders, play a part in the promotion of such activities. The purpose of this paper is to explore the nature and level of participation of NMAs in activities of quality improvement in medicine, with a specific emphasis on Israel. Methods The authors conducted a survey among NMAs around the world inquiring as to their involvement in three central aspects of quality improvement: clinical guidelines, quality measurement and continuing medical education (CME). In addition, they conducted a review of the literature in order to gather more information and complete the data collected in the survey. The findings were processed and analyzed comparatively. Results Most of the NMAs surveyed participate in quality improvement activities at least to some extent. NMAs' main involvement is in the regulation of CME and they are involved to a much lesser extent in the preparation of clinical guidelines and in quality measurement. In Israel, the Israeli Medical Association (IMA) has a dominant role in both the preparation of clinical guidelines and the regulation of CME credits. Discussion It is possible that the expertise maintained by the profession, coupled with the organizational power of the NMA as a union, is viewed as beneficial for regulating educational activities in medicine such as CME. Conversely, the issuing of clinical guidelines is usually regarded as a typical scientific activity, and therefore often rests in the hands of professional medical societies. Quality measurement is regarded as a distinctive administrative tool and is usually found in the province of governments. Based on the typology that we introduced in our previous paper, we discovered that the extent of NMAs’ involvement in quality improvement coincides with the mode of governance of the health care system. Conclusions The nature and level of participation of NMAs in activities of quality improvement varies widely. Collaboration of NMAs in this field with other stakeholders is not uncommon, and may contribute to the further development of quality improvement in medicine. PMID:24808940

Effect of solids retention time and temperature on waste activated sludge hydrolysis and short-chain fatty acids accumulation under alkaline conditions in continuous-flow reactors.

PubMed

Feng, Leiyu; Wang, Hua; Chen, Yinguang; Wang, Qin

2009-01-01

The effects of solids retention time (SRT) and temperature on waste activated sludge (WAS) hydrolysis and short-chain fatty acids (SCFAs) accumulation were investigated in a series of continuous-flow reactors at pH 10. The experimental results showed that the increase of either SRT or temperature benefited the hydrolysis of WAS and the production of SCFAs. The changes in SRT gave also impact on the percentage of acetic and propionic acids in the fermentative SCFAs, but little influence on that of the slightly long-chain SCFAs, such as n-butyric, iso-butyric, n-valeric and iso-valeric acids. Compared with the control (pH unadjusted) experiment, at SRT of 12d and temperature of 20 degrees C the concentration of SCFAs produced at pH 10 increased from 261.2 to 933.5mg COD/L, and the propionic acid percentage improved from 11.7 to 16.0%. It can be concluded from this investigation that the efficient continuous production of SCFAs at pH 10 is feasible.

Idaho National Laboratory Integrated Safety Management System FY 2013 Effectiveness Review and Declaration Report

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

Hunt, Farren

2013-12-01

Idaho National Laboratory (INL) performed an Annual Effectiveness Review of the Integrated Safety Management System (ISMS), per 48 Code of Federal Regulations (CFR) 970.5223 1, “Integration of Environment, Safety and Health into Work Planning and Execution.” The annual review assessed Integrated Safety Management (ISM) effectiveness, provided feedback to maintain system integrity, and identified target areas for focused improvements and assessments for Fiscal Year (FY) 2014. Results of the FY 2013 annual effectiveness review demonstrate that the INL’s ISMS program is “Effective” and continually improving and shows signs of being significantly strengthened. Although there have been unacceptable serious events in themore » past, there has also been significant attention, dedication, and resources focused on improvement, lessons learned and future prevention. BEA’s strategy of focusing on these improvements includes extensive action and improvement plans that include PLN 4030, “INL Sustained Operational Improvement Plan, PLN 4058, “MFC Strategic Excellence Plan,” PLN 4141, “ATR Sustained Excellence Plan,” and PLN 4145, “Radiological Control Road to Excellence,” and the development of LWP 20000, “Conduct of Research.” As a result of these action plans, coupled with other assurance activities and metrics, significant improvement in operational performance, organizational competence, management oversight and a reduction in the number of operational events is being realized. In short, the realization of the fifth core function of ISMS (feedback and continuous improvement) and the associated benefits are apparent.« less

Support for school-based obesity prevention efforts: attitudes among administrators at nationally representative samples of US elementary schools.

PubMed

Turner, Lindsey; Slater, Sandy J; Chaloupka, Frank J

2013-08-01

With the continued threat of childhood obesity, many public health intervention efforts focus on school settings. The current study sought to document administrator attitudes regarding obesity and interest in improving relevant school practices (i.e., nutrition and physical activity) in elementary schools. Mail-back surveys were used to gather data from public and private elementary schools during the 2006-2007, 2007-2008, 2008-2009, and 2010-2011 school years. In each year, a different set of items pertaining to administrator attitudes was included. Numbers of responding schools annually ranged from 259 to 336 private schools, and from 578 to 748 public schools. The vast majority of elementary school administrators (>90%) agreed that schools can play a role in addressing childhood obesity, physical education improves a variety of academic outcomes, and they were interested in improving practices at their school. Concern about childhood obesity and perceiving that schools can play a role in addressing obesity were both associated with more interest in improving school practices. However, only one-third of administrators agreed that parents were interested in participating in improving nutrition and physical activity practices, suggesting opportunities for efforts to improve collaboration. Administrators are generally very supportive of school-based efforts to improve nutrition and physical activity practices and see the value in doing so. Given the amount of time children spend in school, schools are an essential venue for efforts to address childhood obesity.

Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes.

PubMed

Melzer, Katarina; Schutz, Yves; Boulvain, Michel; Kayser, Bengt

2010-06-01

Regular physical activity is associated with improved physiological, metabolic and psychological parameters, and with reduced risk of morbidity and mortality. Current recommendations aimed at improving the health and well-being of nonpregnant subjects advise that an accumulation of > or =30 minutes of moderate physical activity should occur on most, if not all, days of the week. Regardless of the specific physiological changes induced by pregnancy, which are primarily developed to meet the increased metabolic demands of mother and fetus, pregnant women benefit from regular physical activity the same way as nonpregnant subjects. Changes in submaximal oxygen uptake (VO(2)) during pregnancy depend on the type of exercise performed. During maternal rest or submaximal weight-bearing exercise (e.g. walking, stepping, treadmill exercise), absolute maternal VO(2) is significantly increased compared with the nonpregnant state. The magnitude of change is approximately proportional to maternal weight gain. When pregnant women perform submaximal weight-supported exercise on land (e.g. level cycling), the findings are contradictory. Some studies reported significantly increased absolute VO(2), while many others reported unchanged or only slightly increased absolute VO(2) compared with the nonpregnant state. The latter findings may be explained by the fact that the metabolic demand of cycle exercise is largely independent of the maternal body mass, resulting in no absolute VO(2) alteration. Few studies that directly measured changes in maternal maximal VO(2) (VO(2max)) showed no difference in the absolute VO(2max) between pregnant and nonpregnant subjects in cycling, swimming or weight-bearing exercise. Efficiency of work during exercise appears to be unchanged during pregnancy in non-weight-bearing exercise. During weight-bearing exercise, the work efficiency was shown to be improved in athletic women who continue exercising and those who stop exercising during pregnancy. When adjusted for weight gain, the increased efficiency is maintained throughout the pregnancy, with the improvement being greater in exercising women. Regular physical activity has been proven to result in marked benefits for mother and fetus. Maternal benefits include improved cardiovascular function, limited pregnancy weight gain, decreased musculoskeletal discomfort, reduced incidence of muscle cramps and lower limb oedema, mood stability, attenuation of gestational diabetes mellitus and gestational hypertension. Fetal benefits include decreased fat mass, improved stress tolerance, and advanced neurobehavioural maturation. In addition, few studies that have directly examined the effects of physical activity on labour and delivery indicate that, for women with normal pregnancies, physical activity is accompanied with shorter labour and decreased incidence of operative delivery. However, a substantial proportion of women stop exercising after they discover they are pregnant, and only few begin participating in exercise activities during pregnancy. The adoption or continuation of a sedentary lifestyle during pregnancy may contribute to the development of certain disorders such as hypertension, maternal and childhood obesity, gestational diabetes, dyspnoea, and pre-eclampsia. In view of the global epidemic of sedentary behaviour and obesity-related pathology, prenatal physical activity was shown to be useful for the prevention and treatment of these conditions. Further studies with larger sample sizes are required to confirm the association between physical activity and outcomes of labour and delivery.

Improved naming after TMS treatments in a chronic, global aphasia patient — case report

PubMed Central

NAESER, MARGARET A.; MARTIN, PAULA I; NICHOLAS, MARJORIE; BAKER, ERROL H.; SEEKINS, HEIDI; HELM-ESTABROOKS, NANCY; CAYER-MEADE, CAROL; KOBAYASHI, MASAHITO; THEORET, HUGO; FREGNI, FELIPE; TORMOS, JOSE MARIA; KURLAND, JACQUIE; DORON, KARL W.; PASCUAL-LEONE, ALVARO

2005-01-01

We report improved ability to name pictures at 2 and 8 months after repetitive transcranial magnetic stimulation (rTMS) treatments to the pars triangularis portion of right Broca’s homologue in a 57 year-old woman with severe nonfluent/global aphasia (6.5 years post left basal ganglia bleed, subcortical lesion). TMS was applied at 1 Hz, 20 minutes a day, 10 days, over a two-week period. She received no speech therapy during the study. One year after her TMS treatments, she entered speech therapy with continued improvement. TMS may have modulated activity in the remaining left and right hemisphere neural network for naming. PMID:16006338

Partnership for Continuous Improvement

NASA Technical Reports Server (NTRS)

1990-01-01

The proceedings are presented of the sixth annual conference on quality control between NASA and its contractors. The emphasis is placed on a commitment to quality and excellence that guarantees mission success. A forum is provided for representatives from government, industry, and academia to exchange ideas and experiences, encouraging total quality performance that results in high quality products and services. Key points are highlighted from the presentations and activities are described that have resulted in a broad range of improvements in products and services from government, industry, and academia. Long term commitment to quality is an essential requirement that ensures future success. That commitment reinterates the dedication to excellence in space exploration and to national quality and productivity improvement.

The improved physical activity index for measuring physical activity in EPIC Germany.

PubMed

Wientzek, Angelika; Vigl, Matthäus; Steindorf, Karen; Brühmann, Boris; Bergmann, Manuela M; Harttig, Ulrich; Katzke, Verena; Kaaks, Rudolf; Boeing, Heiner

2014-01-01

In the European Investigation into Cancer and Nutrition study (EPIC), physical activity (PA) has been indexed as a cross-tabulation between PA at work and recreational activity. As the proportion of non-working participants increases, other categorization strategies are needed. Therefore, our aim was to develop a valid PA index for this population, which will also be able to express PA continuously. In the German EPIC centers Potsdam and Heidelberg, a clustered sample of 3,766 participants was re-invited to the study center. 1,615 participants agreed to participate and 1,344 participants were finally included in this study. PA was measured by questionnaires on defined activities and a 7-day combined heart rate and acceleration sensor. In a training sample of 433 participants, the Improved Physical Activity Index (IPAI) was developed. Its performance was evaluated in a validation sample of 911 participants and compared with the Cambridge Index and the Total PA Index. The IPAI consists of items covering five areas including PA at work, sport, cycling, television viewing, and computer use. The correlations of the IPAI with accelerometer counts in the training and validation sample ranged r = 0.40-0.43 and with physical activity energy expenditure (PAEE) r = 0.33-0.40 and were higher than for the Cambridge Index and the Total PA Index previously applied in EPIC. In non-working participants the IPAI showed higher correlations than the Cambridge Index and the Total PA Index, with r = 0.34 for accelerometer counts and r = 0.29 for PAEE. In conclusion, we developed a valid physical activity index which is able to express PA continuously as well as to categorize participants according to their PA level. In populations with increasing rates of non-working people the performance of the IPAI is better than the established indices used in EPIC.

The Improved Physical Activity Index for Measuring Physical Activity in EPIC Germany

PubMed Central

Wientzek, Angelika; Vigl, Matthäus; Steindorf, Karen; Brühmann, Boris; Bergmann, Manuela M.; Harttig, Ulrich; Katzke, Verena; Kaaks, Rudolf; Boeing, Heiner

2014-01-01

In the European Investigation into Cancer and Nutrition study (EPIC), physical activity (PA) has been indexed as a cross-tabulation between PA at work and recreational activity. As the proportion of non-working participants increases, other categorization strategies are needed. Therefore, our aim was to develop a valid PA index for this population, which will also be able to express PA continuously. In the German EPIC centers Potsdam and Heidelberg, a clustered sample of 3,766 participants was re-invited to the study center. 1,615 participants agreed to participate and 1,344 participants were finally included in this study. PA was measured by questionnaires on defined activities and a 7-day combined heart rate and acceleration sensor. In a training sample of 433 participants, the Improved Physical Activity Index (IPAI) was developed. Its performance was evaluated in a validation sample of 911 participants and compared with the Cambridge Index and the Total PA Index. The IPAI consists of items covering five areas including PA at work, sport, cycling, television viewing, and computer use. The correlations of the IPAI with accelerometer counts in the training and validation sample ranged r = 0.40–0.43 and with physical activity energy expenditure (PAEE) r = 0.33–0.40 and were higher than for the Cambridge Index and the Total PA Index previously applied in EPIC. In non-working participants the IPAI showed higher correlations than the Cambridge Index and the Total PA Index, with r = 0.34 for accelerometer counts and r = 0.29 for PAEE. In conclusion, we developed a valid physical activity index which is able to express PA continuously as well as to categorize participants according to their PA level. In populations with increasing rates of non-working people the performance of the IPAI is better than the established indices used in EPIC. PMID:24642812

Update on petroleum exploration activities in the Philippines

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

Salcedo, B.H.C.; Bausa, G.J.G.; Ocampo. I.U.

1996-01-01

The first significant event in Philippine Petroleum exploration dates back to 1896 with the drilling of Toledo-1 in Cebu by Smith Bell. From the 1950's to the 1970's, widespread exploration activities were carried out but it was only eighty years after the first oil drilling in 1896 that oil was finally discovered in commercial quantity in Northwest Palawan. This could be attributed to the fact that serious exploration for petroleum was made with the enactment of Presidential Decree No. 87, better known as the [open quotes]Oil Exploration and Development Act of 1972[close quotes], which takes into effect the current Servicemore » Contract System. Amendments to P.D. No. 87 is underway to further improve its incentive package and make it more attractive to explorationists. Petroleum exploration in the Philippines continues to be an energetic industry even if the players are not always rewarded with finds. Frontier areas have become attractive for exploration in view of the continuing research studies resulting to increased database thereat. While Northwest Palawan continues to be the hub of action, frontier areas as well as the more risky deepwater acreages still generate interests, if one wishes to be an active player in a growing energy-hungry economy.« less

Update on petroleum exploration activities in the Philippines

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

Salcedo, B.H.C.; Bausa, G.J.G.; Ocampo. I.U.

1996-12-31

The first significant event in Philippine Petroleum exploration dates back to 1896 with the drilling of Toledo-1 in Cebu by Smith & Bell. From the 1950`s to the 1970`s, widespread exploration activities were carried out but it was only eighty years after the first oil drilling in 1896 that oil was finally discovered in commercial quantity in Northwest Palawan. This could be attributed to the fact that serious exploration for petroleum was made with the enactment of Presidential Decree No. 87, better known as the {open_quotes}Oil Exploration and Development Act of 1972{close_quotes}, which takes into effect the current Service Contractmore » System. Amendments to P.D. No. 87 is underway to further improve its incentive package and make it more attractive to explorationists. Petroleum exploration in the Philippines continues to be an energetic industry even if the players are not always rewarded with finds. Frontier areas have become attractive for exploration in view of the continuing research studies resulting to increased database thereat. While Northwest Palawan continues to be the hub of action, frontier areas as well as the more risky deepwater acreages still generate interests, if one wishes to be an active player in a growing energy-hungry economy.« less

The impact of experience on undergraduate preregistration student nurses' responses to patients in pain: a 2-year qualitative longitudinal study.

PubMed

Mackintosh-Franklin, Carolyn

2014-03-01

The management of pain is consistently reported as a problematic area of practice, with limited evidence of improvements in the past 30 years. This study explores the impact of experience on student nurses' responses to patients in pain. Sixteen volunteers from a cohort of undergraduate student nurses in the U.K. participated in a qualitative longitudinal study that used two semistructured interviews 18 months apart. Interview transcripts were analyzed with the use of thematic content analysis for each individual interview stage and then additionally to identify relationships between each stage. Participants revealed an initial lack of interest in nearly all aspects of pain. At the second stage of interviews, some participants expressed increasing discernment and empathy toward patients in pain, although some continued to have minimal interest. Findings suggest that an active interest in pain is essential so that individuals can react critically to assumptions of the clinical culture they are exposed to. Further research is needed to identify how an active interest can by developed among those students for whom experience has little positive impact. Without active interest, apathy, aversion to change, and continued poor pain management practices are likely to continue. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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

PubMed

Azuma, Koichiro; Matsumoto, Hideo

2017-06-25

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

Heart failure.

PubMed

Metra, Marco; Teerlink, John R

2017-10-28

Heart failure is common in adults, accounting for substantial morbidity and mortality worldwide. Its prevalence is increasing because of ageing of the population and improved treatment of acute cardiovascular events, despite the efficacy of many therapies for patients with heart failure with reduced ejection fraction, such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β blockers, and mineralocorticoid receptor antagonists, and advanced device therapies. Combined angiotensin receptor blocker neprilysin inhibitors (ARNIs) have been associated with improvements in hospital admissions and mortality from heart failure compared with enalapril, and guidelines now recommend substitution of ACE inhibitors or ARBs with ARNIs in appropriate patients. Improved safety of left ventricular assist devices means that these are becoming more commonly used in patients with severe symptoms. Antidiabetic therapies might further improve outcomes in patients with heart failure. New drugs with novel mechanisms of action, such as cardiac myosin activators, are under investigation for patients with heart failure with reduced left ventricular ejection fraction. Heart failure with preserved ejection fraction is a heterogeneous disorder that remains incompletely understood and will continue to increase in prevalence with the ageing population. Although some data suggest that spironolactone might improve outcomes in these patients, no therapy has conclusively shown a significant effect. Hopefully, future studies will address these unmet needs for patients with heart failure. Admissions for acute heart failure continue to increase but, to date, no new therapies have improved clinical outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

High-intensity interval running is perceived to be more enjoyable than moderate-intensity continuous exercise: implications for exercise adherence.

PubMed

Bartlett, Jonathan D; Close, Graeme L; MacLaren, Don P M; Gregson, Warren; Drust, Barry; Morton, James P

2011-03-01

The aim of this study was to objectively quantify ratings of perceived enjoyment using the Physical Activity Enjoyment Scale following high-intensity interval running versus moderate-intensity continuous running. Eight recreationally active men performed two running protocols consisting of high-intensity interval running (6 × 3 min at 90% VO(2max) interspersed with 6 × 3 min active recovery at 50% VO(2max) with a 7-min warm-up and cool down at 70% VO(2max)) or 50 min moderate-intensity continuous running at 70% VO(2max). Ratings of perceived enjoyment after exercise were higher (P < 0.05) following interval running compared with continuous running (88 ± 6 vs. 61 ± 12) despite higher (P < 0.05) ratings of perceived exertion (14 ± 1 vs. 13 ± 1). There was no difference (P < 0.05) in average heart rate (88 ± 3 vs. 87 ± 3% maximum heart rate), average VO(2) (71 ± 6 vs. 73 ± 4%VO(2max)), total VO(2) (162 ± 16 vs. 166 ± 27 L) or energy expenditure (811 ± 83 vs. 832 ± 136 kcal) between protocols. The greater enjoyment associated with high-intensity interval running may be relevant for improving exercise adherence, since running is a low-cost exercise intervention requiring no exercise equipment and similar relative exercise intensities have previously induced health benefits in patient populations.

Production of D-lactic acid in a continuous membrane integrated fermentation reactor by genetically modified Saccharomyces cerevisiae: enhancement in D-lactic acid carbon yield.

PubMed

Mimitsuka, Takashi; Sawai, Kenji; Kobayashi, Koji; Tsukada, Takeshi; Takeuchi, Norihiro; Yamada, Katsushige; Ogino, Hiroyasu; Yonehara, Tetsu

2015-01-01

Poly d-lactic acid is an important polymer because it improves the thermostability of poly l-lactic acid by stereo complex formation. To demonstrate potency of continuous fermentation using a membrane-integrated fermentation reactor (MFR) system, continuous fermentation using genetically modified Saccharomyces cerevisiae which produces d-lactic acid was performed at the low pH and microaerobic conditions. d-Lactic acid continuous fermentation using the MFR system by genetically modified yeast increased production rate by 11-fold compared with batch fermentation. In addition, the carbon yield of d-lactic acid in continuous fermentation was improved to 74.6 ± 2.3% compared to 39.0 ± 1.7% with batch fermentation. This dramatic improvement in carbon yield could not be explained by a reduction in carbon consumption to form cells compared to batch fermentation. Further detailed analysis at batch fermentation revealed that the carbon yield increased to 76.8% at late stationary phase. S. cerevisiae, which exhibits the Crabtree-positive effect, demonstrated significant changes in metabolic activities at low sugar concentrations (Rossignol et al., Yeast, 20, 1369-1385, 2003). Moreover, lactate-producing S. cerevisiae requires ATP supplied not only from the glycolytic pathway but also from the TCA cycle (van Maris et al., Appl. Environ. Microbiol., 70, 2898-2905, 2004). Our finding was revealed that continuous fermentation, which can maintain the conditions of both a low sugar concentration and air supply, results in Crabtree-positive and lactate-producing S. cerevisiae for suitable conditions of d-lactic acid production with respect to redox balance and ATP generation because of releasing the yeast from the Crabtree effect. Copyright © 2014 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

A framework for the continual improvement of behavioral healthcare. Part II--Policy for leadership.

PubMed

Redelheim, P S; Pomeroy, L H; Batalden, P

1994-01-01

In the first part of this article, published in the November/December 1993 issue of Behavioral Healthcare Tomorrow, the authors presented a framework for understanding the process of continuous quality improvement in the behavioral healthcare setting. Four elements of continual improvement were identified: underlying knowledge, policy for leadership, tools and methods, and daily work applications. They showed how traditional professional knowledge of one's subject, discipline and values must be augmented by improvement knowledge--which quality improvement guru W. Edwards Deming calls "the system of profound knowledge." In Part II, they focus on the second element of continual improvement, the importance of organizational leadership.

Superior Effects of High-Intensity Interval Training Compared to Conventional Therapy on Cardiovascular and Psychological Aspects in Myocardial Infarction

PubMed Central

2018-01-01

Objective To evaluate the effect of high-intensity interval training (HIIT) on psychological symptoms, activity states, and cardiovascular functions in patients with myocardial infarction (MI) of low and moderate risk stratification. Methods This prospective study randomly allocated 44 patients with MI to 18 sessions of HIIT or conventional moderate-intensity continuous training (MICT). Outcome measures were assessed at baseline and after 18 sessions. Results Post-exercise cardiovascular and functional states, maximal oxygen uptake (VO2max), metabolic equivalents (METs), 6-Minute Walking Test (6MWT), and Korean Activity Scale/Index (KASI) scores were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. In particular, VO2max was significantly (p<0.005) improved in the HIIT group (7.58 mL/kg/min) compared to that in the MICT group (2.42 mL/kg/min). In addition, post-exercise psychological states (i.e., scores of Fatigue Severity Scale [FSS] and depression items of the Hospital Anxiety and Depression Scale [HADS_D]) were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. HADS-D was improved by 1.89 in the HIIT group compared to decrement of 0.47 in the MICT group. FSS was improved by 6.38 in the HIIT group compared to decrement of 0.77 in the MICT group (p<0.005). Conclusion This study demonstrates that HIIT can improve cardiac function, psychological, and activity states in low and moderate risk MI patients. Compared to conventional MICT, HIIT can improve cardiovascular functions, activity states, depression, and fatigue more effectively. PMID:29560335

Superior Effects of High-Intensity Interval Training Compared to Conventional Therapy on Cardiovascular and Psychological Aspects in Myocardial Infarction.

PubMed

Choi, Ha-Yoon; Han, Hee-Jun; Choi, Ji-Won; Jung, Han-Young; Joa, Kyung-Lim

2018-02-01

To evaluate the effect of high-intensity interval training (HIIT) on psychological symptoms, activity states, and cardiovascular functions in patients with myocardial infarction (MI) of low and moderate risk stratification. This prospective study randomly allocated 44 patients with MI to 18 sessions of HIIT or conventional moderate-intensity continuous training (MICT). Outcome measures were assessed at baseline and after 18 sessions. Post-exercise cardiovascular and functional states, maximal oxygen uptake (VO 2max ), metabolic equivalents (METs), 6-Minute Walking Test (6MWT), and Korean Activity Scale/Index (KASI) scores were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. In particular, VO 2max was significantly (p<0.005) improved in the HIIT group (7.58 mL/kg/min) compared to that in the MICT group (2.42 mL/kg/min). In addition, post-exercise psychological states (i.e., scores of Fatigue Severity Scale [FSS] and depression items of the Hospital Anxiety and Depression Scale [HADS_D]) were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. HADS-D was improved by 1.89 in the HIIT group compared to decrement of 0.47 in the MICT group. FSS was improved by 6.38 in the HIIT group compared to decrement of 0.77 in the MICT group (p<0.005). This study demonstrates that HIIT can improve cardiac function, psychological, and activity states in low and moderate risk MI patients. Compared to conventional MICT, HIIT can improve cardiovascular functions, activity states, depression, and fatigue more effectively.

Continuous theta-burst stimulation may improve visuospatial neglect via modulating the attention network: a randomized controlled study.

PubMed

Fu, Wei; Cao, Lei; Zhang, Yanming; Huo, Su; Du, JuBao; Zhu, Lin; Song, Weiqun

2017-05-01

Visuospatial neglect (VSN) is devastating and common after stroke, and is thought to involve functional disturbance of the attention network. Non-invasive theta-burst stimulation (TBS) may help restore the normal function of attention network, therefore facilitating recovery from VSN. This study investigated the effects of continuous TBS on resting-state functional connectivity (RSFC) in the attention network, and behavioral performances of patients with VSN after stroke. Twelve patients were randomly assigned to receive 10-day cTBS of the left posterior parietal cortex delivered at 80% (the cTBS group), or 40% (the active control group) of the resting motor threshold. Both groups received daily visual scanning training and motor function treatment. Resting-state functional MRI (fMRI) and behavioral tests including line bisection test and star cancelation test were conducted at baseline and after the treatment. At baseline, the two groups showed comparable results in the resting-state fMRI experiments and behavioral tests. After treatment, the cTBS group showed lower functional connectivity between right temporoparietal junction (TPJ) and right anterior insula, and between right superior temporal sulcus and right anterior insula, as compared with the active control group; both groups showed improvement in the behavioral tests, with the cTBS group showing larger changes from baseline than the active control group. cTBS of the left posterior parietal cortex in patients with VSN may induce changes in inter-regional RSFC in the right ventral attention network. These changes may be associated with improved recovery of behavioral deficits after behavioral training. The TPJ and superior temporal sulcus may play crucial roles in recovery from VSN.

[Opinion of the primary care veterinarians of Andalusia concerning the management of their professional practice].

PubMed

Conti Cuesta, F; Baena Parejo, M I; Pinzón Pulido, S A

1999-01-01

This study describes the opinion of the veterinarians in Andalusia regarding the organization and management of their professional practice and pinpoints solutions to the problems found for the purpose of providing planning and management aspects in view of the reforms undertaken in the Andalusian Health Service Strategy Plan. Descriptive opinion poll employing a questionnaire filled out by each individual among all of the Primary Care (PC) veterinarians in Andalusia (including those who have been currently employed who possess at least one year's experience, except substitutes). A description was provided of their personal traits, their opinion of the management-related factors involved in their professional practice. A description was also provided of the suggestions for improving the problems found to exist. Over 70% said they were aware of the objectives, although only the coordinators found them to be clearly motivating the practice. Their opinion was that the indicators of activity neither include any quality-related criteria nor afford the possibility of evaluating the activity they are carrying out. They believed that the contributions from other members of the multidisciplinary team improve their work and are in favor of continuing their involvement therein. They were satisfied with doing their work (the coordinators to a greater degree). They found the productivity pay to be too low and not useful as regards providing them with any incentive. They were not satisfied with the training with which they are provided and thought that what they are offered is far less than their other colleagues in the health care field. Most were of the opinion that they should remain under the authority of the Andalusian Health Service. This group prefers to continue working for the same organization, but improving the following management aspects: training offer, practice incentives and activity indicators.

Positron Emission Tomography Imaging Reveals Auditory and Frontal Cortical Regions Involved with Speech Perception and Loudness Adaptation.

PubMed

Berding, Georg; Wilke, Florian; Rode, Thilo; Haense, Cathleen; Joseph, Gert; Meyer, Geerd J; Mamach, Martin; Lenarz, Minoo; Geworski, Lilli; Bengel, Frank M; Lenarz, Thomas; Lim, Hubert H

2015-01-01

Considerable progress has been made in the treatment of hearing loss with auditory implants. However, there are still many implanted patients that experience hearing deficiencies, such as limited speech understanding or vanishing perception with continuous stimulation (i.e., abnormal loudness adaptation). The present study aims to identify specific patterns of cerebral cortex activity involved with such deficiencies. We performed O-15-water positron emission tomography (PET) in patients implanted with electrodes within the cochlea, brainstem, or midbrain to investigate the pattern of cortical activation in response to speech or continuous multi-tone stimuli directly inputted into the implant processor that then delivered electrical patterns through those electrodes. Statistical parametric mapping was performed on a single subject basis. Better speech understanding was correlated with a larger extent of bilateral auditory cortex activation. In contrast to speech, the continuous multi-tone stimulus elicited mainly unilateral auditory cortical activity in which greater loudness adaptation corresponded to weaker activation and even deactivation. Interestingly, greater loudness adaptation was correlated with stronger activity within the ventral prefrontal cortex, which could be up-regulated to suppress the irrelevant or aberrant signals into the auditory cortex. The ability to detect these specific cortical patterns and differences across patients and stimuli demonstrates the potential for using PET to diagnose auditory function or dysfunction in implant patients, which in turn could guide the development of appropriate stimulation strategies for improving hearing rehabilitation. Beyond hearing restoration, our study also reveals a potential role of the frontal cortex in suppressing irrelevant or aberrant activity within the auditory cortex, and thus may be relevant for understanding and treating tinnitus.

Positron Emission Tomography Imaging Reveals Auditory and Frontal Cortical Regions Involved with Speech Perception and Loudness Adaptation

PubMed Central

Berding, Georg; Wilke, Florian; Rode, Thilo; Haense, Cathleen; Joseph, Gert; Meyer, Geerd J.; Mamach, Martin; Lenarz, Minoo; Geworski, Lilli; Bengel, Frank M.; Lenarz, Thomas; Lim, Hubert H.

2015-01-01

Considerable progress has been made in the treatment of hearing loss with auditory implants. However, there are still many implanted patients that experience hearing deficiencies, such as limited speech understanding or vanishing perception with continuous stimulation (i.e., abnormal loudness adaptation). The present study aims to identify specific patterns of cerebral cortex activity involved with such deficiencies. We performed O-15-water positron emission tomography (PET) in patients implanted with electrodes within the cochlea, brainstem, or midbrain to investigate the pattern of cortical activation in response to speech or continuous multi-tone stimuli directly inputted into the implant processor that then delivered electrical patterns through those electrodes. Statistical parametric mapping was performed on a single subject basis. Better speech understanding was correlated with a larger extent of bilateral auditory cortex activation. In contrast to speech, the continuous multi-tone stimulus elicited mainly unilateral auditory cortical activity in which greater loudness adaptation corresponded to weaker activation and even deactivation. Interestingly, greater loudness adaptation was correlated with stronger activity within the ventral prefrontal cortex, which could be up-regulated to suppress the irrelevant or aberrant signals into the auditory cortex. The ability to detect these specific cortical patterns and differences across patients and stimuli demonstrates the potential for using PET to diagnose auditory function or dysfunction in implant patients, which in turn could guide the development of appropriate stimulation strategies for improving hearing rehabilitation. Beyond hearing restoration, our study also reveals a potential role of the frontal cortex in suppressing irrelevant or aberrant activity within the auditory cortex, and thus may be relevant for understanding and treating tinnitus. PMID:26046763

Continual improvement plan

NASA Technical Reports Server (NTRS)

1994-01-01

NASA's approach to continual improvement (CI) is a systems-oriented, agency-wide approach that builds on the past accomplishments of NASA Headquarters and its field installations and helps achieve NASA's vision, mission, and values. The NASA of the future will fully use the principles of continual improvement in every aspect of its operations. This NASA CI plan defines a systematic approach and a model for continual improvement throughout NASA, stressing systems integration and optimization. It demonstrates NASA's constancy of purpose for improvement - a consistent vision of NASA as a worldwide leader in top-quality science, technology, and management practices. The CI plan provides the rationale, structures, methods, and steps, and it defines NASA's short term (1-year) objectives for improvement. The CI plan presents the deployment strategies necessary for cascading the goals and objectives throughout the agency. It also provides guidance on implementing continual improvement with participation from top leadership and all levels of employees.

Pharmaceutical spray drying: solid-dose process technology platform for the 21st century.

PubMed

Snyder, Herman E

2012-07-01

Requirement for precise control of solid-dosage particle properties created with a scalable process technology are continuing to expand in the pharmaceutical industry. Alternate methods of drug delivery, limited active drug substance solubility and the need to improve drug product stability under room-temperature conditions are some of the pharmaceutical applications that can benefit from spray-drying technology. Used widely for decades in other industries with production rates up to several tons per hour, pharmaceutical uses for spray drying are expanding beyond excipient production and solvent removal from crystalline material. Creation of active pharmaceutical-ingredient particles with combinations of unique target properties are now more common. This review of spray-drying technology fundamentals provides a brief perspective on the internal process 'mechanics', which combine with both the liquid and solid properties of a formulation to enable high-throughput, continuous manufacturing of precision powder properties.

Outlook for space

NASA Technical Reports Server (NTRS)

1976-01-01

Future space activities within the context of national needs were examined, and directions that the United States should take in the civilian use and exploration of space for the time period from 1980 to 2000 were identified. It was decided that the following activities should be pursued: (1) those related to the continuing struggle to improve the quality of life (food production and distribution, new energy sources, etc., (2) those meeting the need for intellectual challenge, for exploration, and for the knowledge by which man can better understand the universe and his relationship to it, (3) those related to research and development in areas applicable to future space systems and missions. A continuing emphasis should be placed on orienting the space program to the physical needs of mankind, to the quest of the mind and spirit, to the vitality of the nation and to the relationship between this nation and other nations of the world.

Scale models: A proven cost-effective tool for outage planning

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

Lee, R.; Segroves, R.

1995-03-01

As generation costs for operating nuclear stations have risen, more nuclear utilities have initiated efforts to improve cost effectiveness. Nuclear plant owners are also being challenged with lower radiation exposure limits and new revised radiation protection related regulations (10 CFR 20), which places further stress on their budgets. As source term reduction activities continue to lower radiation fields, reducing the amount of time spent in radiation fields becomes one of the most cost-effective ways of reducing radiation exposure. An effective approach for minimizing time spent in radiation areas is to use a physical scale model for worker orientation planning andmore » monitoring maintenance, modifications, and outage activities. To meet the challenge of continued reduction in the annual cumulative radiation exposures, new cost-effective tools are required. One field-tested and proven tool is the physical scale model.« less

Processing activities for STS-91 continue in OPF Bay 2

NASA Technical Reports Server (NTRS)

1998-01-01

Processing activities for STS-91 continue in Orbiter Processing Facility Bay 2. Two Get Away Special (GAS) canisters are shown after their installation into Discovery's payload bay. The GAS payload G-765, in the canister on the left, is sponsored by the Canadian Space Agency and managed by C-CORE/Memorial University of Newfoundland. It is a study to understand the transport of fluids in porous media as it pertains to improving methods for enhanced oil recovery. The GAS canister on the right houses the Space Experiment Module (SEM-05), part of an educational initiative of NASA's Shuttle Small Payloads Project. STS-91 is scheduled to launch aboard the Space Shuttle Discovery for the ninth and final docking with the Russian Space Station Mir from KSC's Launch Pad 39A on June 2 with a launch window opening around 6:04 p.m. EDT.

Implementing a resource management program for accreditation process at the medical laboratory.

PubMed

Yenice, Sedef

2009-03-01

To plan for and provide adequate resources to meet the mission and goals of a medical laboratory in compliance with the requirements for laboratory accreditation by Joint Commission International. The related policies and procedures were developed based on standard requirements for resource management. Competency assessment provided continuing education and performance feedback to laboratory employees. Laboratory areas were designed for the efficient and safe performance of laboratory work. A physical environment was built up where hazards were controlled and personnel activities were managed to reduce the risk of injuries. An Employees Occupational Safety and Health Program (EOSHP) was developed to address all types of hazardous materials and wastes. Guidelines were defined to verify that the methods would produce accurate and reliable results. An active resource management program will be an effective way of assuring that systems are in control and continuous improvement is in progress.

Measuring a hospital's ability to improve.

PubMed

Meurer, Steven J; Counte, Michael A; Rubio, Doris M; Arrington, Barbara

2004-01-01

The aim of this study was to test whether a recently developed measure of Continuous Quality Improvement (CQI) implementation can provide health care researchers and administrators with a tool to assist in understanding and with developing an appropriate structure for improvement efforts in hospitals. Two hundred respondents from 40 Missouri hospitals completed a 28-item survey addressing 8 domains of CQI. Overall, hospital scores showed low implementation of a structure that supports improvement efforts. All survey domains showed acceptable psychometric results. Leadership proved to be the most important domain of CQI because it differentiated well between all levels of the scale. Because of its ease of administration and analysis, and its reliability, validity, and level differentiation results, the researchers recommend the widespread use of this tool to understand and develop a hospital's organizational structure to support improvement activities.

New Approaches to the New Normal: Recapping 2012 Higher Education Legislative Activity in the West. Policy Insights

ERIC Educational Resources Information Center

Krueger, Carl

2012-01-01

While tax revenues in many Western states have improved since FY 2011, the 2012 legislative sessions still experienced what has become the familiar round of funding cuts to higher education, coupled with tuition increases for students. The good news is that the cuts and increases weren't as severe as in previous years, despite continued aversion…

Positioning hospitals for improved access to capital.

PubMed

Ponton, Kevin T; Sandrick, Karen M

2002-11-01

Hospitals need to actively position themselves in the next 18 to 24 months to ensure continued access to financing. Hospitals need to shift their focus from investment income to operations. Hospitals should recognize the importance of balance-sheet liquidity to institutional investors. Not-for-profit hospitals should focus on both sides of the balance sheet. Healthcare executives need to develop effective leadership and investor-relations skills.

Partnership with the customer

NASA Astrophysics Data System (ADS)

Trachta, Gregory S.

This discussion will recount some historical observations about establishing partnerships with the customer. It suggests that such partnerships are established as the natural evolutionary product of a continuous improvement culture. Those are warm, ethereal terms about a topic that some people think already suffers from an excess of hot air. We will focus on some real-world activities and workplace artifacts to show there are substantive concepts behind the TQM buzzwords.

Is the Unfolding of the Group Discussion Off-Pattern? Improving Coordination Support in Educational Forums Using Mobile Devices

ERIC Educational Resources Information Center

Gerosa, Marco Aurelio; Filippo, Denise; Pimentel, Mariano; Fuks, Hugo; Lucena, Carlos J. P.

2010-01-01

A forum is a valuable tool to foster reflection in an in-depth discussion; however, it forces the course mediator to continually pay close attention in order to coordinate learners' activities. Moreover, monitoring a forum is time consuming given that it is impossible to know in advance when new messages are going to be posted. Additionally, a…

Defence Capability Plan 2006-2016

DTIC Science & Technology

2006-06-14

and supply chain management ; and • developing strategies focussing on critical industry capabilities and Defence’s ability to manage supply and... managers undertake pre-approval study activity and prepare the necessary departmental documentation. More formal industry solicitation would continue...Defence Management Systems Improvement Less than $10m JP 2085 Phase 1B Explosive Ordnance Warstock $150m to $200m JP 2090 Phase 1B Combined Information

Partnership with the customer

NASA Technical Reports Server (NTRS)

Trachta, Gregory S.

1992-01-01

This discussion will recount some historical observations about establishing partnerships with the customer. It suggests that such partnerships are established as the natural evolutionary product of a continuous improvement culture. Those are warm, ethereal terms about a topic that some people think already suffers from an excess of hot air. We will focus on some real-world activities and workplace artifacts to show there are substantive concepts behind the TQM buzzwords.

Defense Logistics: DOD Has Addressed Most Reporting Requirements and Continues to Refine Its Asset Visibility Strategy

DTIC Science & Technology

2015-12-01

Development, Test, and Evaluation RFID Radio Frequency Identification SEP Supporting Execution Plan Strategy Strategy to Improve Asset...migration of active Radio Frequency Identification ( RFID )19 from a proprietary communication standard protocol to an international standard to...technologies enabling hands-off processing of materiel deploying through the Defense Transportation System. Materiel marked with RFID tags may be remotely

PBL on Line: A Proposal for the Organization, Part-Time Monitoring and Assessment of PBL Group Activities

ERIC Educational Resources Information Center

Marti, Enric; Gil, Debora; Gurguí, Antoni; Hernández-Sabaté, Aura; Rocarías, Jaume; Poveda, Ferran

2015-01-01

This report presents the organisation of PBL (Project Based Learning) for a subject included in the IT engineering degree course. It is the result of 10 years of experience of the implantation and continuous improvement of the PBL class structure. The latest innovations include the experience of part-time monitoring with PBL groups using the Open…

A New Two-Step Approach for Hands-On Teaching of Gene Technology: Effects on Students' Activities during Experimentation in an Outreach Gene Technology Lab

ERIC Educational Resources Information Center

Scharfenberg, Franz-Josef; Bogner, Franz X.

2011-01-01

Emphasis on improving higher level biology education continues. A new two-step approach to the experimental phases within an outreach gene technology lab, derived from cognitive load theory, is presented. We compared our approach using a quasi-experimental design with the conventional one-step mode. The difference consisted of additional focused…

Boxing training for patients with Parkinson disease: a case series.

PubMed

Combs, Stephanie A; Diehl, M Dyer; Staples, William H; Conn, Lindsay; Davis, Kendra; Lewis, Nicole; Schaneman, Katie

2011-01-01

A nontraditional form of exercise recently applied for patients with Parkinson disease (PD) is boxing training. The primary purpose of this case series is to describe the effects of disease severity and duration of boxing training (short term and long term) on changes in balance, mobility, and quality of life for patients with mild or moderate to severe PD. The feasibility and safety of the boxing training program also were assessed. Six patients with idiopathic PD attended 24 to 36 boxing training sessions for 12 weeks, with the option of continuing the training for an additional 24 weeks (a seventh patient attended sessions for only 4 weeks). The 90-minute sessions included boxing drills and traditional stretching, strengthening, and endurance exercises. Outcomes were tested at the baseline and after 12, 24, and 36 weeks of boxing sessions (12-, 24-, and 36-week tests). The outcome measures were the Functional Reach Test, Berg Balance Scale, Activities-specific Balance Confidence Scale, Timed "Up & Go" Test, Six-Minute Walk Test, gait speed, cadence, stride length, step width, activities of daily living and motor examination subscales of the Unified Parkinson Disease Rating Scale, and Parkinson Disease Quality of Life Scale. Six patients completed all phases of the case series, showed improvements on at least 5 of the 12 outcome measures over the baseline at the 12-week test, and showed continued improvements at the 24- and 36-week tests. Patients with mild PD typically showed improvements earlier than those with moderate to severe PD. Despite the progressive nature of PD, the patients in this case series showed short-term and long-term improvements in balance, gait, activities of daily living, and quality of life after the boxing training program. A longer duration of training was necessary for patients with moderate to severe PD to show maximal training outcomes. The boxing training program was feasible and safe for these patients with PD.

Perspectives: The Continuous Improvement Trap

ERIC Educational Resources Information Center

Arnold, David L.

2011-01-01

Accrediting agencies, legislators, pundits, and even higher educational professionals have become enamored with applying the language of continuous improvement to learning outcomes. The Southern Association of Colleges and Schools Commission on Colleges specifically uses the term "continuing improvement" in Core Standard 2.5, one of its…

Setting priorities for EU healthcare workforce IT skills competence improvement.

PubMed

Li, Sisi; Bamidis, Panagiotis D; Konstantinidis, Stathis Th; Traver, Vicente; Car, Josip; Zary, Nabil

2017-04-01

A major challenge for healthcare quality improvement is the lack of IT skills and knowledge of healthcare workforce, as well as their ambivalent attitudes toward IT. This article identifies and prioritizes actions needed to improve the IT skills of healthcare workforce across the EU. A total of 46 experts, representing different fields of expertise in healthcare and geolocations, systematically listed and scored actions that would improve IT skills among healthcare workforce. The Child Health and Nutrition Research Initiative methodology was used for research priority-setting. The participants evaluated the actions using the following criteria: feasibility, effectiveness, deliverability, and maximum impact on IT skills improvement. The leading priority actions were related to appropriate training, integrating eHealth in curricula, involving healthcare workforce in the eHealth solution development, improving awareness of eHealth, and learning arrangement. As the different professionals' needs are prioritized, healthcare workforce should be actively and continuously included in the development of eHealth solutions.

The Royal College experience and plans for the maintenance of certification program.

PubMed

Campbell, Craig M; Parboosingh, John

2013-01-01

The Royal College of Physicians and Surgeons of Canada, in 2001, implemented a mandatory maintenance of certification (MOC) program that is required for fellows to maintain membership and fellowship. Participation in the MOC program is one of the recognized pathways approved by provincial medical regulatory authorities in Canada by which specialists can demonstrate their commitment to continued competent performance in practice. This article traces the historical beginnings of the MOC program, highlighting the educational foundation and scientific evidence that influenced its philosophy, goals, and strategic priorities. The MOC program has evolved into a complex system of continuing professional development to facilitate and enable a "cultural shift'' in how we conceptualize and support the continuing professional development (CPD) of specialists. The MOC program is an educational strategy that supports a learning culture where specialists are able to design, implement and document their accomplishments from multiple learning activities to build evidence-informed practices. In the future, the MOC Program must evolve from assisting fellows to use effective educational resources "for credit" to enable fellows, leveraging a competency-based CPD model, to demonstrate their capacity to continuously improve practice. This will require innovative methods to capture learning and practice improvements in real time, integrate learning during the delivery of health care, expand automation of reporting strategies, and facilitate new sociocultural methods of emergent learning and practice change. Collectively, these directions will require a research agenda that will generate evidence for how transformative cultural change in continuing professional education of the profession can be realized. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Hand Robotic Therapy in Children with Hemiparesis: A Pilot Study.

PubMed

Bishop, Lauri; Gordon, Andrew M; Kim, Heakyung

2017-01-01

The aim of this study was to understand the impact of training with a hand robotic device on hand paresis and function in a population of children with hemiparesis. Twelve children with hemiparesis (mean age, 9 [SD, 3.64] years) completed participation in this prospective, experimental, pilot study. Participants underwent clinical assessments at baseline and again 6 weeks later with instructions to not initiate new therapies. After these assessments, participants received 6 weeks of training with a hand robotic device, consisting of 1-hour sessions, 3 times weekly. Assessments were repeated on completion of training. Results showed significant improvements after training on the Assisting Hand Assessment (mean difference, 2.0 Assisting Hand Assessment units; P = 0.011) and on the upper-extremity component of the Fugl-Meyer scale (raw score mean difference, 4.334; P = 0.001). No significant improvements between pretest and posttest were noted on the Jebsen-Taylor Test of Hand Function, the Quality of Upper Extremity Skills Test, or the Pediatric Evaluation of Disability Inventory after intervention. Total active mobility of digits and grip strength also failed to demonstrate significant changes after training. Participants tolerated training with the hand robotic device, and significant improvements in bimanual hand use, as well as impairment-based scales, were noted. Improvements were carried over into bimanual skills during play. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand key components of neuroplasticity; (2) Discuss the benefits of robotic therapy in the recovery of hand function in pediatric patients with hemiplegia; and (3) Appropriately incorporate robotic therapy into the treatment plan of pediatric patients with hemiplegia. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Continuous microwave pasteurization of a vegetable smoothie improves its physical quality and hinders detrimental enzyme activity.

PubMed

Arjmandi, Mitra; Otón, Mariano; Artés, Francisco; Artés-Hernández, Francisco; Gómez, Perla A; Aguayo, Encarna

2017-01-01

The effect of a pasteurization treatment at 90 ± 2 ℃ for 35 s provided by continuous microwave under different doses (low power/long time and high power/short time) or conventional pasteurization on the quality of orange-colored smoothies and their changes throughout 45 days of storage at 5 ℃ was investigated. A better color retention of the microwave pasteurization- treated smoothie using high power/short time than in conventionally processed sample was evidenced by the stability of the hue angle. The continuous microwave heating increased the viscosity of the smoothie more than the conventional pasteurization in comparison with non-treated samples. Lower residual enzyme activities from peroxidase, pectin methylesterase and polygalacturonase were obtained under microwave heating, specifically due to the use of higher power/shorter time. For this kind of smoothie, polygalacturonase was the more thermo-resistant enzyme and could be used as an indicator of pasteurization efficiency. The use of a continuous semi-industrial microwave using higher power and shorter time, such as 1600 W/206 s and 3600 W/93 s, resulted in better quality smoothies and greater enzyme reduction than conventional thermal treatment. © The Author(s) 2016.

Opening wedge and anatomic-specific plates in foot and ankle applications.

PubMed

Kluesner, Andrew J; Morris, Jason B

2011-08-01

As surgeons continually push to improve techniques and outcomes, anatomic-specific and procedure-specific fixation options are becoming increasingly available. The unique size, shape, and function of the foot provide an ideal framework for the use of anatomic-specific plates. These distinctive plate characteristics range from anatomic contouring and screw placements to incorporated step-offs and wedges. By optimizing support, compression, and stabilization, patients may return to weight bearing and activity sooner, improving outcomes. This article discusses anatomic-specific plates and their use in forefoot and rearfoot surgical procedures. Copyright © 2011 Elsevier Inc. All rights reserved.

Mechanisms of deterioration of nutrients. [freeze drying methods for space flight food

NASA Technical Reports Server (NTRS)

Karel, M.; Flink, J. M.

1974-01-01

Methods are reported by which freeze dried foods of improved quality will be produced. The applicability of theories of flavor retention has been demonstrated for a number of food polymers, both proteins and polysacchardies. Studies on the formation of structures during freeze drying have been continued for emulsified systems. Deterioration of organoleptic quality of freeze dried foods due to high temperature heating has been evaluated and improved procedures developed. The influence of water activity and high temperature on retention of model flavor materials and browning deterioration has been evaluated for model systems and food materials.

A Geographic Information Science (GISc) Approach to Characterizing Spatiotemporal Patterns of Terrorist Incidents in Iraq, 2004-2009

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

Medina, Richard M; Siebeneck, Laura K.; Hepner, George F.

2011-01-01

As terrorism on all scales continues, it is necessary to improve understanding of terrorist and insurgent activities. This article takes a Geographic Information Systems (GIS) approach to advance the understanding of spatial, social, political, and cultural triggers that influence terrorism incidents. Spatial, temporal, and spatiotemporal patterns of terrorist attacks are examined to improve knowledge about terrorist systems of training, planning, and actions. The results of this study aim to provide a foundation for understanding attack patterns and tactics in emerging havens as well as inform the creation and implementation of various counterterrorism measures.

Shared visions: Partnership of Rockwell International and NASA Cost Effectiveness Enhancements (CEE) for the space shuttle system integration program

NASA Technical Reports Server (NTRS)

Bejmuk, Bohdan I.; Williams, Larry

1992-01-01

As a result of limited resources and tight fiscal constraints over the past several years, the defense and aerospace industries have experienced a downturn in business activity. The impact of fewer contracts being awarded has placed a greater emphasis for effectiveness and efficiency on industry contractors. It is clear that a reallocation of resources is required for America to continue to lead the world in space and technology. The key to technological and economic survival is the transforming of existing programs, such as the Space Shuttle Program, into more cost efficient programs so as to divert the savings to other NASA programs. The partnership between Rockwell International and NASA and their joint improvement efforts that resulted in significant streamlining and cost reduction measures to Rockwell International Space System Division's work on the Space Shuttle System Integration Contract is described. This work was a result of an established Cost Effectiveness Enhancement (CEE) Team formed initially in Fiscal Year 1991, and more recently expanded to a larger scale CEE Initiative in 1992. By working closely with the customer in agreeing to contract content, obtaining management endorsement and commitment, and involving the employees in total quality management (TQM) and continuous improvement 'teams,' the initial annual cost reduction target was exceeded significantly. The CEE Initiative helped reduce the cost of the Shuttle Systems Integration contract while establishing a stronger program based upon customer needs, teamwork, quality enhancements, and cost effectiveness. This was accomplished by systematically analyzing, challenging, and changing the established processes, practices, and systems. This examination, in nature, was work intensive due to the depth and breadth of the activity. The CEE Initiative has provided opportunities to make a difference in the way Rockwell and NASA work together - to update the methods and processes of the organizations. The future success of NASA space programs and Rockwell hinges upon the ability to adopt new, more efficient and effective work processes. Efficiency, proficiency, cost effectiveness, and teamwork are a necessity for economic survival. Continuous improvement initiatives like the CEE are, and will continue to be, vehicles by which the road can be traveled with a vision to the future.

Calf Muscle Performance Deficits Remain 7 Years After an Achilles Tendon Rupture.

PubMed

Brorsson, Annelie; Grävare Silbernagel, Karin; Olsson, Nicklas; Nilsson Helander, Katarina

2018-02-01

Optimizing calf muscle performance seems to play an important role in minimizing impairments and symptoms after an Achilles tendon rupture (ATR). The literature lacks long-term follow-up studies after ATR that describe calf muscle performance over time. The primary aim was to evaluate calf muscle performance and patient-reported outcomes at a mean of 7 years after ATR in patients included in a prospective, randomized controlled trial. A secondary aim was to evaluate whether improvement in calf muscle performance continued after the 2-year follow-up. Cohort study; Level of evidence, 2. Sixty-six subjects (13 women, 53 men) with a mean age of 50 years (SD, 8.5 years) were evaluated at a mean of 7 years (SD, 1 year) years after their ATR. Thirty-four subjects had surgical treatment and 32 had nonsurgical treatment. Patient-reported outcomes were evaluated with Achilles tendon Total Rupture Score (ATRS) and Physical Activity Scale (PAS). Calf muscle performance was evaluated with single-leg standing heel-rise test, concentric strength power heel-rise test, and single-legged hop for distance. Limb Symmetry Index (LSI = injured side/healthy side × 100) was calculated for side-to-side differences. Seven years after ATR, the injured side showed decreased values in all calf muscle performance tests ( P < .001-.012). Significant improvement in calf muscle performance did not continue after the 2-year follow-up. Heel-rise height increased significantly ( P = .002) between the 1-year (10.8 cm) and the 7-year (11.5 cm) follow-up assessments. The median ATRS was 96 (of a possible score of 100) and the median PAS was 4 (of a possible score of 6), indicating minor patient-reported symptoms and fairly high physical activity. No significant differences were found in calf muscle performance or patient-reported outcomes between the treatment groups except for the LSI for heel-rise repetitions. Continued deficits in calf muscle endurance and strength remained 7 years after ATR. No continued improvement in calf muscle performance occurred after the 2-year follow-up except for heel-rise height.

Shared visions: Partnership of Rockwell International and NASA Cost Effectiveness Enhancements (CEE) for the space shuttle system integration program

NASA Astrophysics Data System (ADS)

Bejmuk, Bohdan I.; Williams, Larry

As a result of limited resources and tight fiscal constraints over the past several years, the defense and aerospace industries have experienced a downturn in business activity. The impact of fewer contracts being awarded has placed a greater emphasis for effectiveness and efficiency on industry contractors. It is clear that a reallocation of resources is required for America to continue to lead the world in space and technology. The key to technological and economic survival is the transforming of existing programs, such as the Space Shuttle Program, into more cost efficient programs so as to divert the savings to other NASA programs. The partnership between Rockwell International and NASA and their joint improvement efforts that resulted in significant streamlining and cost reduction measures to Rockwell International Space System Division's work on the Space Shuttle System Integration Contract is described. This work was a result of an established Cost Effectiveness Enhancement (CEE) Team formed initially in Fiscal Year 1991, and more recently expanded to a larger scale CEE Initiative in 1992. By working closely with the customer in agreeing to contract content, obtaining management endorsement and commitment, and involving the employees in total quality management (TQM) and continuous improvement 'teams,' the initial annual cost reduction target was exceeded significantly. The CEE Initiative helped reduce the cost of the Shuttle Systems Integration contract while establishing a stronger program based upon customer needs, teamwork, quality enhancements, and cost effectiveness. This was accomplished by systematically analyzing, challenging, and changing the established processes, practices, and systems. This examination, in nature, was work intensive due to the depth and breadth of the activity. The CEE Initiative has provided opportunities to make a difference in the way Rockwell and NASA work together - to update the methods and processes of the organizations. The future success of NASA space programs and Rockwell hinges upon the ability to adopt new, more efficient and effective work processes. Efficiency, proficiency, cost effectiveness, and teamwork are a necessity for economic survival. Continuous improvement initiatives like the CEE are, and will continue to be, vehicles by which the road can be traveled with a vision to the future.

Continuity of care for elderly patients with diabetes mellitus, hypertension, asthma, and chronic obstructive pulmonary disease in Korea.

PubMed

Hong, Jae Seok; Kang, Hee Chung; Kim, Jaiyong

2010-09-01

We sought to assess continuity of care for elderly patients in Korea and to examine any association between continuity of care and health outcomes (hospitalization, emergency department visits, health care costs). This was a retrospective cohort study using the Korea National Health Insurance Claims Database. Elderly people, 65-84 yr of age, who were first diagnosed with diabetes mellitus (n=268,220), hypertension (n=858,927), asthma (n=129,550), or chronic obstructive pulmonary disease (COPD, n=131,512) in 2002 were followed up for four years, until 2006. The mean of the Continuity of Care Index was 0.735 for hypertension, 0.709 for diabetes mellitus, 0.700 for COPD, and 0.663 for asthma. As continuity of care increased, in all four diseases, the risks of hospitalization and emergency department visits decreased, as did health care costs. In the Korean health care system, elderly patients with greater continuity of care with health care providers had lower risks of hospital and emergency department use and lower health care costs. In conclusion, policy makers need to develop and try actively the program to improve the continuity of care in elderly patients with chronic diseases.

Improving the Discipline of Cost Estimation and Analysis

NASA Technical Reports Server (NTRS)

Piland, William M.; Pine, David J.; Wilson, Delano M.

2000-01-01

The need to improve the quality and accuracy of cost estimates of proposed new aerospace systems has been widely recognized. The industry has done the best job of maintaining related capability with improvements in estimation methods and giving appropriate priority to the hiring and training of qualified analysts. Some parts of Government, and National Aeronautics and Space Administration (NASA) in particular, continue to need major improvements in this area. Recently, NASA recognized that its cost estimation and analysis capabilities had eroded to the point that the ability to provide timely, reliable estimates was impacting the confidence in planning man), program activities. As a result, this year the Agency established a lead role for cost estimation and analysis. The Independent Program Assessment Office located at the Langley Research Center was given this responsibility.

Global Lightning Activity

NASA Technical Reports Server (NTRS)

Christian, Hugh

2003-01-01

Our knowledge of the global distribution of lightning has improved dramatically since the 1995 launch of the Optical Transient Detector (OTD) followed in 1997 by the launch of the Lightning Imaging Sensor (LIS). Together, these instruments have generated a continuous seven-year record of global lightning activity. These lightning observations have provided a new global perspective on total lightning activity. For the first time, total lightning activity (CG and IC) has been observed over large regions with high detection efficiencies and accurate geographic location. This has produced new insights into lightning distributions, times of occurrence and variability. It has produced a revised global flash rate estimate (46 flashes per second) and has lead to a new realization of the significance of total lightning activity in severe weather. Accurate flash rate estimates are now available for large areas of the earth (+/- 72deg latitude) Ocean-land contrasts as a function of season are clearly revealed, as are orographic effects and seasonal and interannual variability. The data set indicates that air mass thunderstorms, not large storm systems dominate global activity. The ability of LIS and OTD to detect total lightning has lead to improved insight into the correlation between lightning and storm development. The relationship between updraft development and lightning activity is now well established and presents an opportunity for providing a new mechanism for remotely monitoring storm development. In this concept, lightning would serve as a surrogate for updraft velocity. It is anticipated hat this capability could lead to significantly improved severe weather warning times and reduced false warning rates.

Process improvement to enhance existing stroke team activity toward more timely thrombolytic treatment.

PubMed

Cho, Han-Jin; Lee, Kyung Yul; Nam, Hyo Suk; Kim, Young Dae; Song, Tae-Jin; Jung, Yo Han; Choi, Hye-Yeon; Heo, Ji Hoe

2014-10-01

Process improvement (PI) is an approach for enhancing the existing quality improvement process by making changes while keeping the existing process. We have shown that implementation of a stroke code program using a computerized physician order entry system is effective in reducing the in-hospital time delay to thrombolysis in acute stroke patients. We investigated whether implementation of this PI could further reduce the time delays by continuous improvement of the existing process. After determining a key indicator [time interval from emergency department (ED) arrival to intravenous (IV) thrombolysis] and conducting data analysis, the target time from ED arrival to IV thrombolysis in acute stroke patients was set at 40 min. The key indicator was monitored continuously at a weekly stroke conference. The possible reasons for the delay were determined in cases for which IV thrombolysis was not administered within the target time and, where possible, the problems were corrected. The time intervals from ED arrival to the various evaluation steps and treatment before and after implementation of the PI were compared. The median time interval from ED arrival to IV thrombolysis in acute stroke patients was significantly reduced after implementation of the PI (from 63.5 to 45 min, p=0.001). The variation in the time interval was also reduced. A reduction in the evaluation time intervals was achieved after the PI [from 23 to 17 min for computed tomography scanning (p=0.003) and from 35 to 29 min for complete blood counts (p=0.006)]. PI is effective for continuous improvement of the existing process by reducing the time delays between ED arrival and IV thrombolysis in acute stroke patients.

Improvement of activated sludge dewaterability by humus soil induced bioflocculation.

PubMed

Choi, Young-Gyun; Kim, Seong-Hong; Kim, Hee-Jun; Kim, Gyu Dong; Chung, Tai-Hak

2004-01-01

Effects of humus soil particles on the dewaterability of activated sludge were investigated. Cations leaching increased proportionally with the dosage of humus soil, and the leaching was not significant after 2 h. Divalent cations, Ca2+ and Mg2+, leaching from the humus soil played an important role in improving dewaterability of the biological sludge. On the contrary, dewaterability was not affected or slightly deteriorated by the monovalent cations, K+ and Na+ leached from the humus soil. Improvement in dewaterability of the sludge by addition of humus soil was higher than that of equivalent cations mixture. It seemed that the decrease of supracolloidal bio-particles (1 to 100 microm in diameter) resulted in diminishing of the blinding effect on cake and filter medium. SRF (specific resistance to filtration) of the humus soil added sludge varied in parallel with the M/D (monovalent to divalent cation) ratio, and the M/D ratio could be utilized as a useful tool for evaluation of the sludge dewatering characteristics. Long-term effects of humus soil on the improvement of activated sludge dewaterability were clearly identified by continuous operation results of a bench-scale MLE (Modified Ludzack Ettinger) system combined with a humus soil contactor. On the other hand, dewaterability of the control sludge was only slightly improved by a decrease in M/D ratio of the wastewater influent.

High Accuracy Human Activity Recognition Based on Sparse Locality Preserving Projections.

PubMed

Zhu, Xiangbin; Qiu, Huiling

2016-01-01

Human activity recognition(HAR) from the temporal streams of sensory data has been applied to many fields, such as healthcare services, intelligent environments and cyber security. However, the classification accuracy of most existed methods is not enough in some applications, especially for healthcare services. In order to improving accuracy, it is necessary to develop a novel method which will take full account of the intrinsic sequential characteristics for time-series sensory data. Moreover, each human activity may has correlated feature relationship at different levels. Therefore, in this paper, we propose a three-stage continuous hidden Markov model (TSCHMM) approach to recognize human activities. The proposed method contains coarse, fine and accurate classification. The feature reduction is an important step in classification processing. In this paper, sparse locality preserving projections (SpLPP) is exploited to determine the optimal feature subsets for accurate classification of the stationary-activity data. It can extract more discriminative activities features from the sensor data compared with locality preserving projections. Furthermore, all of the gyro-based features are used for accurate classification of the moving data. Compared with other methods, our method uses significantly less number of features, and the over-all accuracy has been obviously improved.

High Accuracy Human Activity Recognition Based on Sparse Locality Preserving Projections

PubMed Central

2016-01-01

Human activity recognition(HAR) from the temporal streams of sensory data has been applied to many fields, such as healthcare services, intelligent environments and cyber security. However, the classification accuracy of most existed methods is not enough in some applications, especially for healthcare services. In order to improving accuracy, it is necessary to develop a novel method which will take full account of the intrinsic sequential characteristics for time-series sensory data. Moreover, each human activity may has correlated feature relationship at different levels. Therefore, in this paper, we propose a three-stage continuous hidden Markov model (TSCHMM) approach to recognize human activities. The proposed method contains coarse, fine and accurate classification. The feature reduction is an important step in classification processing. In this paper, sparse locality preserving projections (SpLPP) is exploited to determine the optimal feature subsets for accurate classification of the stationary-activity data. It can extract more discriminative activities features from the sensor data compared with locality preserving projections. Furthermore, all of the gyro-based features are used for accurate classification of the moving data. Compared with other methods, our method uses significantly less number of features, and the over-all accuracy has been obviously improved. PMID:27893761

Introducing a new semi-active engine mount using force controlled variable stiffness

NASA Astrophysics Data System (ADS)

Azadi, Mojtaba; Behzadipour, Saeed; Faulkner, Gary

2013-05-01

This work introduces a new concept in designing semi-active engine mounts. Engine mounts are under continuous development to provide better and more cost-effective engine vibration control. Passive engine mounts do not provide satisfactory solution. Available semi-active and active mounts provide better solutions but they are more complex and expensive. The variable stiffness engine mount (VSEM) is a semi-active engine mount with a simple ON-OFF control strategy. However, unlike available semi-active engine mounts that work based on damping change, the VSEM works based on the static stiffness change by using a new fast response force controlled variable spring. The VSEM is an improved version of the vibration mount introduced by the authors in their previous work. The results showed significant performance improvements over a passive rubber mount. The VSEM also provides better vibration control than a hydromount at idle speed. Low hysteresis and the ability to be modelled by a linear model in low-frequency are the advantages of the VSEM over the vibration isolator introduced earlier and available hydromounts. These specifications facilitate the use of VSEM in the automotive industry, however, further evaluation and developments are needed for this purpose.

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

PubMed

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

2017-08-01

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

Expeditionary Force Health Protection for Global Health Engagement: Lessons Learned from Continuing Promise 2017.

PubMed

Johnson, Lucas A; Lennon, Robert P

2018-05-01

Global health engagement (GHE) is an important priority for the Military Health Service as such activities strengthen the health capabilities of partner nations and improve interoperability. By their very nature, GHE activities are predominantly conducted in low-resource areas with limited infrastructure and substantial humanitarian need. The Department of Defense is evaluating leaner, flexible force packages to accomplish GHE missions and better prepare uniformed medical providers to provide care in austere environments. Observations made during the execution of Continuing Promise 2017, a recurring civil-military humanitarian operation conducted in Central and South America, are offered herein. Descriptions of relevant force health protection (FHP) threats experienced by mission personnel and mitigation measures successfully employed to prevent illness are provided. Relevant Department of Defense instructions are reviewed and risk mitigation strategies are compared with published standards and expert recommendations. In addition to well-described sanitation, hygiene, and infectious disease challenges that traditionally accompany military field activities, providing health care services to host nation populations in low-resource settings generates unique FHP vulnerabilities. Public health expertise leveraged throughout the planning and execution of GHE activities is instrumental for successfully identifying and mitigating the numerous FHP risks present. Experiences from Continuing Promise 2017 demonstrate the expeditionary public health practitioner's role as a force multiplier has never been more relevant. A variety of public health countermeasures are available to successfully mitigate FHP threats experienced during GHE events. The public health lessons learned from Continuing Promise 2017 assist mission planners, commanders, and health care providers ensure that GHE participants remain healthy enough to accomplish the mission and meet America's commitments to partner nations.

Ultralow Dose of Naloxone as an Adjuvant to Intrathecal Morphine Infusion Improves Perceived Quality of Sleep but Fails to Alter Persistent Pain

PubMed Central

Lundborg, Christopher; Bjersing, Jan; Dahm, Peter; Hansson, Elisabeth; Biber, Björn

2015-01-01

Introduction: This randomized, cross-over, double-blind, controlled study of continuous intrathecal morphine administration in patients with severe, long-term pain addresses whether the supplementation of low doses of naloxone in this setting is associated with beneficial clinical effects. Methods: All of the study subjects (n=11) provided informed consent and were recruited from a subset of patients who were already undergoing long-term treatment with continuous intrathecal morphine because of difficult-to-treat pain. The patients were (in a randomized order) also given intrathecal naloxone (40 ng/24 h or 400 ng/24 h). As control, the patients’ ordinary dose of morphine without any additions was used. The pain (Numeric Rating Scale, NRS) during activity, perceived quality of sleep, level of activity, and quality of life as well as the levels of several proinflammatory and anti-inflammatory cytokines in the blood were assessed. The prestudy pain (NRS during activity) in the study group ranged from 3 to 10. Results: A total of 64% of the subjects reported improved quality of sleep during treatment with naloxone at a dose of 40 ng per 24 hours as compared with 9% with sham treatment (P=0.024). Although not statistically significant, pain was reduced by 2 NRS steps or more during supplemental treatment with naloxone in 36% of subjects when using the 40 ng per 24 hours dose and in 18% of the subjects when using naloxone 400 ng per 24 hours dose. The corresponding percentage among patients receiving unaltered treatment was 27%. Conclusions: To conclude, the addition of an ultralow dose of intrathecal naloxone (40 ng/24 h) to intrathecal morphine infusion in patients with severe, persistent pain improved perceived quality of sleep. We were not able to show any statistically significant effects of naloxone on pain relief, level of activity, or quality of life. PMID:25629634

Treatment of heparin-induced thrombocytopenia with drotrecogin alfa (activated).

PubMed

Rubeiz, George J; Marrone, Christopher M; Leclerc, Jacques R

2006-03-01

A patient was administered drotrecogin alfa (activated) in addition to the standard of care for presumed severe sepsis and circulatory shock. Heparin-induced thrombocytopenia (HIT) and hepatic and splenic thromboses complicated her clinical course. Because drotrecogin alfa (activated) treatment is associated with improvement in thrombotic manifestations and thrombocytopenia, it was continued as the sole antithrombotic agent after the HIT became apparent. This approach was chosen despite the patient's severe hepatic and renal dysfunction, which made the use of direct thrombin inhibitors unfavorable. She survived with a reasonable outcome and salvage of her limbs. Although this case suggests a potential role of drotrecogin alfa (activated) in the management of HIT, systematic evaluation of its efficacy in this situation is warranted.

Improved rotation-activity-age relations in Sun-like stars

NASA Astrophysics Data System (ADS)

Meléndez, Jorge; dos Santos, Leonardo A.; Freitas, Fabrício C.

2017-10-01

The evolution of rotational velocity and magnetic activity with age follows approximately a t -1/2 relation, the famous Skumanich law. Using a large sample of about 80 solar twins with precise ages, we show departures from this law. We found a steep drop in rotational velocity and activity in the first 2-3 Gyr and afterwards there seems to be a shallow decrease. Our inferred rotational periods suggest that the Sun will continue to slow down, validating thus the use of gyrochronology beyond solar age. The Sun displays normal rotational velocity and activity when compared to solar twins of solar age. We also show that stars with exceedingly high stellar activity for their age are spectroscopic binaries that also exhibit enhanced rotational velocities and chemical signatures of mass transfer.

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

PubMed

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

2017-07-01

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

Proceedings of the AMCP Partnership Forum: Breaking the Link Between Pain Management and Opioid Use Disorder.

PubMed

2015-12-01

Prescription drug misuse and abuse, especially with opioid analgesics, is the fastest growing drug problem in the United States. Addressing this public health crisis demands the coordinated efforts and actions of all stakeholders to establish a process of improving patient care and decreasing misuse and abuse. On September 9, 2014, the Academy of Managed Care Pharmacy (AMCP) convened a meeting of multiple stakeholders to recommend activities and programs that AMCP can promote to improve pain management, prevent opioid use disorder (OUD), and improve medication-assisted treatment outcomes. The speakers and panelists recommended that efforts to improve pain management outcomes and reduce the potential for OUD should rely on demonstrated evidence and best practices. It was recommended that AMCP promote a more holistic and evidence-based approach to pain management and OUD treatment that actively engages the patient in the decision-making process and includes care coordination with medical, pharmacy, behavioral, and mental health aspects of organizations, all of which is seamlessly supported by a technology infrastructure. To accomplish this, it was recommended that AMCP work to collaborate with organizations representing these stakeholders. Additionally, it was recommended that AMCP conduct continuing pharmacy education programs, develop a best practices toolkit on pain management, and actively promote quality standards for OUD prevention and treatment.

Protracted development of executive and mnemonic brain systems underlying working memory in adolescence: A longitudinal fMRI study.

PubMed

Simmonds, Daniel J; Hallquist, Michael N; Luna, Beatriz

2017-08-15

Working memory (WM), the ability to hold information on-line to guide planned behavior, improves through adolescence in parallel with continued maturation of critical brain systems supporting cognitive control. Initial developmental neuroimaging studies with one or two timepoints have provided important though varied results limiting our understanding of which and how neural systems change during this transition into mature WM. In this study, we leverage functional magnetic resonance imaging (fMRI) longitudinal data spanning up to 9 years in 129 normally developing individuals to identify which systems demonstrate growth changes that accompany improvements in WM performance. We used a memory guided saccade task that allowed us to probe encoding, pure maintenance, and retrieval neural processes of WM. Consistent with prior research, we found that WM performance continued to improve into the early 20's. fMRI region of interest (ROI) analyses revealed developmental (1) increases in sensorimotor-related (encoding/retrieval) activity in visual cortex from childhood through early adulthood that were associated with WM accuracy and (2) decreases in sustained (maintenance) activity in executive regions from childhood through mid-adolescence that were associated with response latency in childhood and early adolescence. Together these results provide compelling evidence that underlying the maturation of WM is a transition from reliance on executive systems to specialized regions related to the domain of mnemonic requirements of the task leading to optimal performance. Copyright © 2017. Published by Elsevier Inc.

Quadriceps strength and weight acceptance strategies continue to improve two years after anterior cruciate ligament reconstruction

PubMed Central

Roewer, Ben D.; Di Stasi, Stephanie L.; Snyder-Mackler, Lynn

2011-01-01

The anterior cruciate ligament (ACL) is the most commonly-injured knee ligament during sporting activities. After injury, most individuals experience episodes of the knee giving way during daily activities (non-copers). Non-copers demonstrate asymmetrical quadriceps strength and movement patterns which could have long-term deleterious effects on the integrity of the knee joint. The purpose of this study was to determine if non-copers resolve their strength and movement asymmetries within two years after surgery. 26 non-copers were recruited to undergo pre-operative quadriceps strength testing and 3-dimensional gait analysis. Subjects underwent surgery to reconstruct the ligament followed by physical therapy focused on restoring normal range of motion, quadriceps strength, and function. Subjects returned for quadriceps strength testing and gait analysis six months and two years after surgery. Acutely after injury, quadriceps strength was asymmetric between limbs, but resolved six months after surgery. Asymmetric knee angles, knee moments, and knee and hip power profiles were also observed acutely after injury and persisted six months after surgery despite subjects achieving symmetrical quadriceps strength. Two years after surgery, quadriceps strength in the involved limb continued to improve and most kinematic and kinetic asymmetries resolved. These findings suggest that adequate quadriceps strength does not immediately resolve gait asymmetries in non-copers. They also suggest that non-copers have the capacity to improve their quadriceps strength and gait symmetry long after ACL reconstruction. PMID:21592482

Guidelines for Risk-Based Changeover of Biopharma Multi-Product Facilities.

PubMed

Lynch, Rob; Barabani, David; Bellorado, Kathy; Canisius, Peter; Heathcote, Doug; Johnson, Alan; Wyman, Ned; Parry, Derek Willison

2018-01-01

In multi-product biopharma facilities, the protection from product contamination due to the manufacture of multiple products simultaneously is paramount to assure product quality. To that end, the use of traditional changeover methods (elastomer change-out, full sampling, etc.) have been widely used within the industry and have been accepted by regulatory agencies. However, with the endorsement of Quality Risk Management (1), the use of risk-based approaches may be applied to assess and continuously improve established changeover processes. All processes, including changeover, can be improved with investment (money/resources), parallel activities, equipment design improvements, and standardization. However, processes can also be improved by eliminating waste. For product changeover, waste is any activity not needed for the new process or that does not provide added assurance of the quality of the subsequent product. The application of a risk-based approach to changeover aligns with the principles of Quality Risk Management. Through the use of risk assessments, the appropriate changeover controls can be identified and controlled to assure product quality is maintained. Likewise, the use of risk assessments and risk-based approaches may be used to improve operational efficiency, reduce waste, and permit concurrent manufacturing of products. © PDA, Inc. 2018.

Do Medicaid incentive payments boost quality? Florida's direct care staffing adjustment program.

PubMed

Hyer, Kathryn; Thomas, Kali S; Johnson, Christopher E; Harman, Jeffrey S; Weech-Maldonado, Robert

2013-01-01

Beginning in April 2000 and continuing for 21 months, Florida's legislature allocated $31.6 million (annualized) to nursing homes through a Medicaid direct care staffing adjustment. Florida's legislature paid the highest incentives to nursing homes with the lowest staffing levels and the greatest percentage of Medicaid residents--the bottom tier of quality. Using Donabedian's structure-process-outcomes framework, this study tracks changes in staffing, wages, process of care, and outcomes. The incentive payments increased staffing and wages in nursing home processes (decreased restraint use and feeding tubes) for the facilities receiving the largest amount of money but had no change on pressure sores or decline in activities of daily living. The group receiving the lowest incentives payment (those highest staffed at baseline) saw significant improvement in two quality measures: pressure sores and decline in activities of daily living. All providers receiving more resources improved on deficiency scores, suggesting more Medicaid spending improves quality of care regardless of total incentive payments.

Using an electronic activity monitor system as an intervention modality: A systematic review.

PubMed

Lewis, Zakkoyya H; Lyons, Elizabeth J; Jarvis, Jessica M; Baillargeon, Jacques

2015-06-24

Obesity is a growing global health concern that may lead to cardiovascular disease, type II diabetes, and cancer. Several systematic reviews have shown that technology is successful in combating obesity through increased physical activity, but there is no known review on interventions that use an electronic activity monitor system (EAMS). EAMSs are defined as a wearable device that objectively measures lifestyle physical activity and can provide feedback, beyond the display of basic activity count information, via the monitor display or through a partnering application to elicit continual self-monitoring of activity behavior. These devices improve upon standard pedometers because they have the ability to provide visual feedback on activity progression, verbal encouragement, and social comparison. This systematic review aimed to synthesize the efficacy and feasibility results of EAMSs within published physical activity interventions. Electronic databases and journal references were searched for relevant articles. Data sources included CINAHL, Cochrane CENTRAL, Medline Ovid, PsycINFO, and clinicaltrials.gov. Out of the 1,574 retrieved, 11 articles met the inclusion criteria. These articles were reviewed for quality and content based on a risk of bias tool and intervention components. Most articles were determined to be of medium quality while two were of low quality, and one of high quality. Significant pre-post improvements in the EAMS group were found in five of nine studies for physical activity and in four of five studies for weight. One found a significant increase in physical activity and two studies found significant weight loss in the intervention group compared with the comparator group. The EAMS interventions appear to be feasible with most studies reporting continual wear of the device during waking hours and a higher retention rate of participants in the EAMS groups. These studies provide preliminary evidence suggesting that EAMS can increase physical activity and decrease weight significantly, but their efficacy compared to other interventions has not yet been demonstrated. More high-quality randomized controlled trials are needed to evaluate the overall effect of EAMS, examine which EAMS features are most effective, and determine which populations are most receptive to an EAMS.

Continuous contact with females in estrus throughout the year enhances testicular activity and improves seminal traits of male goats.

PubMed

Giriboni, Julia; Lacuesta, Lorena; Ungerfeld, Rodolfo

2017-01-01

The "female effect" consists in the stimulation of males' reproductive activity by different signals emitted by females. This stimulation leads to endocrine and behavioral changes that may modify the seasonal pattern of male ruminants. The aims of this experiment were (1) to describe the local reproductive seasonal pattern of Gabon bucks and (2) to determine if continuous chemical, auditory, and visual contact with does in estrus enhances bucks' testicular activity and improves seminal traits throughout the year and modify their seasonal pattern. We used 16 adult Gabon bucks assigned to two experimental groups: nine bucks remained continuously isolated from females (isolated bucks, group IB) and seven bucks were in continuous chemical, auditory, and visual contact through a fence line with does in estrus (stimulated bucks, group SB). During 13 months, scrotal circumference and testosterone concentration were measured weekly and testicular echogenicity was measured every 2 weeks. Also, sperm motility mass and percentage of abnormal spermatozoa were determined, and sperm concentration and total number of motile spermatozoa were calculated every 2 weeks. Testicular echogenicity was greater in IB than that in SB bucks (P < 0.0001), but there were no differences in scrotal circumference. Overall, testosterone concentration was greater in IB than that in SB bucks (P = 0.04), but from late winter to mid-summer, when testosterone concentration presented basal concentrations, SB bucks had greater values than IB bucks (P = 0.004). Sperm concentration (P = 0.05) and sperm mass motility (P = 0.01) were greater in SB than that in IB bucks, and the total number of progressive motile spermatozoa tended to be greater in SB than in that IB bucks (P = 0.1). The percentage of abnormal spermatozoa was lower in SB than in IB bucks in several time points (P < 0.0001). Testicular and seminal traits were better from the end of the spring until mid-autumn. We concluded that does in estrus stimulated bucks' testicular activity, including better seminal quality and a greater increase of testicular fluid content than bucks isolated from females. However, the general seasonal pattern was not modified by stimulation with does in estrus. Copyright © 2016 Elsevier Inc. All rights reserved.

A computerized resolution of scheduling conflicts.

PubMed

Bolinger, R E; McFarlane, M J

1989-01-01

Residency training programs in Internal Medicine require resident attendance in a continuity clinic. This inevitably engenders conflicts between scheduling in the ambulatory clinic and the required teaching activities of the in-patient services. Some of the conflicts can be resolved by allowing the in-patient service directors to indicate preferred plans for their residents to attend in the continuity clinic. With this plan, scheduling becomes quite complicated. A computer program is presented with coordinates these service requests with ambulatory clinic scheduling. As a result, a given resident may have his/her clinic day changed on different rotations. The program automatically arbitrates conflicts and publishes the attendance dates for the entire academic year. This information is supplied to the appointment desk so that patients can be scheduled accordingly. This system has resulted in a 74% continuity rate and improved satisfaction by both residents and staff.

New Service Excellence Model for eHealth and AAL Solutions - A Framework for Continuous New Service Development.

PubMed

Kriegel, Johannes; Reckwitz, Luise; Auinger, Klemens; Tuttle-Weidinger, Linda; Schmitt-Rüth, Stephanie; Kränzl-Nagl, Renate

2017-01-01

The development of eHealth and AAL (Ambient Assisted Living) services with the aim to reduce the complexity of living environments for the elderly often does not lead to the desired results on the market. The design of an eHealth/AAL specific framework for continuous New Service Development is presented in this paper. Our research addresses this challenge with a new Service Excellence Model (SEM) and outlines the benefits of this specific approach. The research is based on the data of the DALIA project (Assistant for DAily LIfe Activities at Home) and the PenAAL project (Performance Measurement Index for AAL solutions), parts of which the projects were the classification of relevant business dimensions and the development of a related scoring tool for continuous benchmarking and improvement.

[Internet-based continuing medical education: as effective as live continuing medical education].

PubMed

Maisonneuve, Hervé; Chabot, Olivier

2009-10-01

E-learning consists in using new multimedia and Internet technologies to improve the quality of learning activities by facilitating access to resources and services, as well as exchanges and remote collaboration. The Internet is used for adult education in most professional domains, but its use for continuing medical education is less developed. Advantages are observed for teachers (e.g., permanent updating, interactive links, illustrations, archiving, and collective intelligence) and for the learners (e.g., accessibility, autonomy, flexibility, and adaptable pace). Research and meta-analyses have shown that e-CME is as effective as live events for immediate and retained learning. English-language educational medical websites that grant CME credits are numerous; few such French-language sites can currently grant credits. Accreditation of websites for CME, in its infancy in Europe, is common in North America.

Nurses' attitudes toward continuing formal education: a comparison by level of education and geography.

PubMed

Altmann, Tanya K

2012-01-01

The education of nurses has an influence on patient safety and outcomes, the nursing shortage, the faculty shortage, and nurses' attitudes and actions. This article reports on a dissertation study designed to examine the attitudes of nurses, initially registered with an associate degree or diploma in nursing, toward continuing formal education. Actively licensed registered nurses in the eastern and western United States (n=535) participated. The main finding of this study was that, although nurses held positive attitudes overall, attitudes ranked barely above neutral. The findings suggest that work needs to be done to improve nurses' attitudes toward continuing formal education and research needs to be undertaken to understand what would entice nurses back to school. Implications for nursing practice and education are discussed along with suggestions for future research.

Combined motor disturbances following severe traumatic brain injury: an integrative long-term treatment approach.

PubMed

Keren, O; Reznik, J; Groswasser, Z

2001-07-01

Patients surviving severe traumatic brain injury (TBI) often suffer from residual impairments in motor control, communication skills, cognition and social behaviour. These distinctly hamper their capability to return to their 'pre-trauma' activity. Comprehensive and integrated rehabilitation programmes initiate, during the acute phase, a prolonged treatment process which starts at the most sophisticated medical systems. There is no clear end point for the treatment of these patients, since the recovery process and the rehabilitation activity may continue for years, even after patients return home to live with their families. The inherent inability to make a firm early prediction regarding outcome of patients and the late appearance of additional symptoms stress the need for a comprehensive close long-term follow-up. The following presentation concerns the description of the treatment strategy and long-term improvement of a 22-year-old male who suffered from very severe TBI. On admission to the emergency room, he was in the decerebrated position and his Glasgow Coma Scale (GCS) was at the lowest (3). The focus of this presentation is on the recovery of motor function. The initial motor disabilities included weakness in all four limbs, in particular left hemiplegia, and right hemiparesis with severe bilateral ataxic elements and a marked tremor of the right arm. Range of motion was limited in hips, and he suffered from stiff trunk and neck. Goals of physiotherapy were directed towards improving range of motion (ROM) and active movement. Casting, use of orthoses, biofeedback, hydrotherapy, hippotherapy, medication and nerve blocks for reducing spasticity were timely applied during the process. The motor improvement in this very severe TBI patient who is now over 3 years post-injury still continues and has a functional meaning. He has succeeded in being able to stand up by himself from a chair and is able to walk unaided and without orthoses for very short distances--up to five steps. He is able to drink soup without assistance and play a few notes on the piano. Marked cognitive improvement occurred as well. It is concluded that motor improvement may be evident over long periods of time and various timely interventions may assist in the process.

Continuous Enhancement of Science Teachers' Knowledge and Skills through Scientific Lecturing.

PubMed

Azevedo, Maria-Manuel; Duarte, Sofia

2018-01-01

Due to their importance in transmitting knowledge, teachers can play a crucial role in students' scientific literacy acquisition and motivation to respond to ongoing and future economic and societal challenges. However, to conduct this task effectively, teachers need to continuously improve their knowledge, and for that, a periodic update is mandatory for actualization of scientific knowledge and skills. This work is based on the outcomes of an educational study implemented with science teachers from Portuguese Basic and Secondary schools. We evaluated the effectiveness of a training activity consisting of lectures covering environmental and health sciences conducted by scientists/academic teachers. The outcomes of this educational study were evaluated using a survey with several questions about environmental and health scientific topics. Responses to the survey were analyzed before and after the implementation of the scientific lectures. Our results showed that Basic and Secondary schools teachers' knowledge was greatly improved after the lectures. The teachers under training felt that these scientific lectures have positively impacted their current knowledge and awareness on several up-to-date scientific topics, as well as their teaching methods. This study emphasizes the importance of continuing teacher education concerning knowledge and awareness about health and environmental education.

Pacific Northwest Aquatic Monitoring Partnership 2017 Annual Report

USGS Publications Warehouse

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

2018-01-01

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

Longitudinal Growth Curves of Brain Function Underlying Inhibitory Control through Adolescence

PubMed Central

Foran, William; Velanova, Katerina; Luna, Beatriz

2013-01-01

Neuroimaging studies suggest that developmental improvements in inhibitory control are primarily supported by changes in prefrontal executive function. However, studies are contradictory with respect to how activation in prefrontal regions changes with age, and they have yet to analyze longitudinal data using growth curve modeling, which allows characterization of dynamic processes of developmental change, individual differences in growth trajectories, and variables that predict any interindividual variability in trajectories. In this study, we present growth curves modeled from longitudinal fMRI data collected over 302 visits (across ages 9 to 26 years) from 123 human participants. Brain regions within circuits known to support motor response control, executive control, and error processing (i.e., aspects of inhibitory control) were investigated. Findings revealed distinct developmental trajectories for regions within each circuit and indicated that a hierarchical pattern of maturation of brain activation supports the gradual emergence of adult-like inhibitory control. Mean growth curves of activation in motor response control regions revealed no changes with age, although interindividual variability decreased with development, indicating equifinality with maturity. Activation in certain executive control regions decreased with age until adolescence, and variability was stable across development. Error-processing activation in the dorsal anterior cingulate cortex showed continued increases into adulthood and no significant interindividual variability across development, and was uniquely associated with task performance. These findings provide evidence that continued maturation of error-processing abilities supports the protracted development of inhibitory control over adolescence, while motor response control regions provide early-maturing foundational capacities and suggest that some executive control regions may buttress immature networks as error processing continues to mature. PMID:24227721

Neural control of computer cursor velocity by decoding motor cortical spiking activity in humans with tetraplegia*

PubMed Central

Kim, Sung-Phil; Simeral, John D; Hochberg, Leigh R; Donoghue, John P; Black, Michael J

2010-01-01

Computer-mediated connections between human motor cortical neurons and assistive devices promise to improve or restore lost function in people with paralysis. Recently, a pilot clinical study of an intracortical neural interface system demonstrated that a tetraplegic human was able to obtain continuous two-dimensional control of a computer cursor using neural activity recorded from his motor cortex. This control, however, was not sufficiently accurate for reliable use in many common computer control tasks. Here, we studied several central design choices for such a system including the kinematic representation for cursor movement, the decoding method that translates neuronal ensemble spiking activity into a control signal and the cursor control task used during training for optimizing the parameters of the decoding method. In two tetraplegic participants, we found that controlling a cursor's velocity resulted in more accurate closed-loop control than controlling its position directly and that cursor velocity control was achieved more rapidly than position control. Control quality was further improved over conventional linear filters by using a probabilistic method, the Kalman filter, to decode human motor cortical activity. Performance assessment based on standard metrics used for the evaluation of a wide range of pointing devices demonstrated significantly improved cursor control with velocity rather than position decoding. PMID:19015583

Continuous Improvement in the Industrial and Management Systems Engineering Programme at Kuwait University

ERIC Educational Resources Information Center

Aldowaisan, Tariq; Allahverdi, Ali

2016-01-01

This paper describes the process employed by the Industrial and Management Systems Engineering programme at Kuwait University to continuously improve the programme. Using a continuous improvement framework, the paper demonstrates how various qualitative and quantitative analyses methods, such as hypothesis testing and control charts, have been…

Chemical Education Research: Improving Chemistry Learning

NASA Astrophysics Data System (ADS)

Dudley Herron, J.; Nurrenbern, Susan C.

1999-10-01

Chemical education research is the systematic investigation of learning grounded in a theoretical foundation that focuses on understanding and improving learning of chemistry. This article reviews many activities, changes, and accomplishments that have taken place in this area of scholarly activity despite its relatively recent emergence as a research area. The article describes how the two predominant broad perspectives of learning, behaviorism and constructivism, have shaped and influenced chemical education research design, analysis, and interpretation during the 1900s. Selected research studies illustrate the range of research design strategies and results that have contributed to an increased understanding of learning in chemistry. The article also provides a perspective of current and continuing challenges that researchers in this area face as they strive to bridge the gap between chemistry and education - disciplines with differing theoretical bases and research paradigms.

Physical activity intervention effects on perceived stress in working mothers: the role of self-efficacy.

PubMed

Mailey, Emily L; McAuley, Edward

2014-01-01

Working mothers often report elevated stress, and efforts to improve their coping resources are needed to buffer the detrimental effects of stress on health. This study examined the impact of changes in physical activity, self-efficacy, and self-regulation across the course of a brief intervention on subsequent levels of stress in working mothers. Participants (N = 141) were randomly assigned to an intervention or control condition (2:1 ratio). The intervention was conducted in Illinois between March 2011 and January 2012 and consisted of two group-mediated workshop sessions with content based on social cognitive theory. Participants completed measures of physical activity, self-efficacy, self-regulation, and perceived stress at baseline, immediately postintervention, and 6-month follow-up. Stress levels declined across the 6-month period in both groups. Changes in stress were negatively associated with changes in self-efficacy and self-regulation among intervention participants only. Regression analyses revealed the intervention elicited short-term increases in physical activity, self-efficacy, and self-regulation, but only changes in self-efficacy predicted perceived stress at 6-month follow-up. These results suggest that enhancing self-efficacy is likely to improve working mothers' perceived capabilities to cope with stressors in their lives. Future interventions should continue to focus on increasing self-efficacy to promote improvements in physical activity and psychological well-being in this population.

Effect of electrical stimulation therapy on upper extremity functional recovery and cerebral cortical changes in patients with chronic hemiplegia.

PubMed

Sasaki, Kana; Matsunaga, Toshiki; Tomite, Takenori; Yoshikawa, Takayuki; Shimada, Yoichi

2012-04-01

Hemiplegia is a common sequel of stroke and assisted living care is needed in many cases. The purpose of this study was to evaluate the effect of using surface electrode stimulation device in rehabilitation, in terms of functional improvement in upper limb and the changes in brain activation related to central nervous system reconstruction. Five patients with chronic hemiplegia received electrical stimulation therapy using the orthosis-type surface electrode stimulation device for 12 weeks. Training time was 30 min/day for the first weeks, and increased 30 min/day in every 4 weeks. Upper limb outcome measures included Brunnstrom stage, range of motion, Fugl-Meyer assessment and manual function test. Brain activation was measured using functional MRI. After therapy with therapeutic electrical stimulation (TES) for 12 weeks upper limb function improved in all cases. The results of brain activation showed two patterns. In the first, the stimulation produced an activity in the bilateral somatosensory cortices (SMC), which was seen to continue over time. The second, activation was bilateral and extensive before stimulation, but localized to the SMC after intervention. Treatment with TES using an orthosis-type electrode stimulation device improves upper limb function in chronic hemiplegia patients. The present findings suggest that there are not only efferent but also afferent effects that may promote central nervous system remodeling.

Segmentation and Recognition of Continuous Human Activity

DTIC Science & Technology

2001-01-01

This paper presents a methodology for automatic segmentation and recognition of continuous human activity . We segment a continuous human activity into...commencement or termination. We use single action sequences for the training data set. The test sequences, on the other hand, are continuous sequences of human ... activity that consist of three or more actions in succession. The system has been tested on continuous activity sequences containing actions such as

Long-term outcome and prognostic factors of juvenile dermatomyositis: a multinational, multicenter study of 490 patients.

PubMed

Ravelli, Angelo; Trail, Lucia; Ferrari, Cristina; Ruperto, Nicolino; Pistorio, Angela; Pilkington, Clarissa; Maillard, Susan; Oliveira, Sheila K; Sztajnbok, Flavio; Cuttica, Ruben; Beltramelli, Matilde; Corona, Fabrizia; Katsicas, Maria Martha; Russo, Ricardo; Ferriani, Virginia; Burgos-Vargas, Ruben; Magni-Manzoni, Silvia; Solis-Valleoj, Eunice; Bandeira, Marcia; Zulian, Francesco; Baca, Vicente; Cortis, Elisabetta; Falcini, Fernanda; Alessio, Maria; Alpigiani, Maria Giannina; Gerloni, Valeria; Saad-Magalhaes, Claudia; Podda, Rosanna; Silva, Clovis A; Lepore, Loredana; Felici, Enrico; Rossi, Federica; Sala, Elena; Martini, Alberto

2010-01-15

To investigate the long-term outcome and prognostic factors of juvenile dermatomyositis (DM) through a multinational, multicenter study. Patients consisted of inception cohorts seen between 1980 and 2004 in 27 centers in Europe and Latin America. Predictor variables were sex, continent, ethnicity, onset year, onset age, onset type, onset manifestations, course type, disease duration, and active disease duration. Outcomes were muscle strength/endurance, continued disease activity, cumulative damage, muscle damage, cutaneous damage, calcinosis, lipodystrophy, physical function, and health-related quality of life (HRQOL). A total of 490 patients with a mean disease duration of 7.7 years were included. At the cross-sectional visit, 41.2-52.8% of patients, depending on the instrument used, had reduced muscle strength/endurance, but less than 10% had severe impairment. Persistently active disease was recorded in 41.2-60.5% of the patients, depending on the activity measure used. Sixty-nine percent of the patients had cumulative damage. The frequency of calcinosis and lipodystrophy was 23.6% and 9.7%, respectively. A total of 40.7% of the patients had decreased functional ability, but only 6.5% had major impairment. Only a small fraction had decreased HRQOL. A chronic course, either polycyclic or continuous, consistently predicted a poorer outcome. Mortality rate was 3.1%. This study confirms the marked improvement in functional outcome of juvenile DM when compared with earlier literature. However, many patients had continued disease activity and cumulative damage at followup. A chronic course was the strongest predictor of poor prognosis. These findings highlight the need for treatment strategies that enable a better control of disease activity over time and the reduction of nonreversible damage.

[Blood transfusion and supply chain management safety].

PubMed

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

2015-02-01

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

Using activity-based learning approach to enhance the quality of instruction in civil engineering in Indonesian universities

NASA Astrophysics Data System (ADS)

Priyono, Wena, Made; Rahardjo, Boedi

2017-09-01

Experts and practitioners agree that the quality of higher education in Indonesia needs to be improved significantly and continuously. The low quality of university graduates is caused by many factors, one of which is the poor quality of learning. Today's instruction process tends to place great emphasis only on delivering knowledge. To avoid the pitfalls of such instruction, e.g. passive learning, thus Civil Engineering students should be given more opportunities to interact with others and actively participate in the learning process. Based on a number of theoretical and empirical studies, one appropriate strategy to overcome the aforementioned problem is by developing and implementing activity-based learning approach.

The assembly and use of continuous flow systems for chemical synthesis.

PubMed

Britton, Joshua; Jamison, Timothy F

2017-11-01

The adoption of and opportunities in continuous flow synthesis ('flow chemistry') have increased significantly over the past several years. Continuous flow systems provide improved reaction safety and accelerated reaction kinetics, and have synthesised several active pharmaceutical ingredients in automated reconfigurable systems. Although continuous flow platforms are commercially available, systems constructed 'in-lab' provide researchers with a flexible, versatile, and cost-effective alternative. Herein, we describe the assembly and use of a modular continuous flow apparatus from readily available and affordable parts in as little as 30 min. Once assembled, the synthesis of a sulfonamide by reacting 4-chlorobenzenesulfonyl chloride with dibenzylamine in a single reactor coil with an in-line quench is presented. This example reaction offers the opportunity to learn several important skills including reactor construction, charging of a back-pressure regulator, assembly of stainless-steel syringes, assembly of a continuous flow system with multiple junctions, and yield determination. From our extensive experience of single-step and multistep continuous flow synthesis, we also describe solutions to commonly encountered technical problems such as precipitation of solids ('clogging') and reactor failure. Following this protocol, a nonspecialist can assemble a continuous flow system from reactor coils, syringes, pumps, in-line liquid-liquid separators, drying columns, back-pressure regulators, static mixers, and packed-bed reactors.

Maintenance of Certification: Perceptions and Attitudes of Neurosurgeons.

PubMed

Babu, Maya A; Liau, Linda M; Connolly, E Sander; Meyer, Fredric B

2018-02-09

Assuring clinical competence throughout the career of a neurosurgeon is of paramount importance for patient safety. We present the first comprehensive survey of all neurosurgeons board certified through the American Board of Neurological Surgery (ABNS) to evaluate perceptions of Maintenance of Certification (MOC). We administered a validated, online, confidential survey to 4899 neurosurgeons (2435 ABNS diplomates participating in MOC, 1440 diplomates certified prior to 1999 [time-unlimited certificates], and 1024 retired diplomates). We received 1449 responses overall (30% response rate). Our study found that most respondents believe that neurosurgeons should be required to participate in continuing professional improvement following initial board certification (75%). Most believe that specialty boards, working in conjunction with specialty societies, should require diplomates to participate in programs meant to promote continuous professional development (73%). The majority of respondents (76%) believed that self-assessment tests constituted a meaningful professional development activity, in addition to periodic case log reviews (33%) or quality improvement projects (32.6%). A plurality of respondents (44%) do not feel that the MOC process as currently structured provides them with value. There were no differences between those who were "grandfathered" and those who actively participate in MOC and no differences between those in private practice versus those in academics. The ABNS is cognizant of diplomate concerns and is actively developing new MOC paradigms to ensure that the process achieves both the goals of meeting the public interest and assuring that the quality of American neurosurgery remains exemplary. Copyright © 2018 by the Congress of Neurological Surgeons.

Profiling health-care accreditation organizations: an international survey.

PubMed

Shaw, Charles D; Braithwaite, Jeffrey; Moldovan, Max; Nicklin, Wendy; Grgic, Ileana; Fortune, Triona; Whittaker, Stuart

2013-07-01

To describe global patterns among health-care accreditation organizations (AOs) and to identify determinants of sustainability and opportunities for improvement. Web-based questionnaire survey. Organizations offering accreditation services nationally or internationally to health-care provider institutions or networks at primary, secondary or tertiary level in 2010. s) External relationships, scope and activity public information. Forty-four AOs submitted data, compared with 33 in a survey 10 years earlier. Of the 30 AOs that reported survey activity in 2000 and 2010, 16 are still active and stable or growing. New and old programmes are increasingly linked to public funding and regulation. While the number of health-care AOs continues to grow, many fail to thrive. Successful organizations tend to complement mechanisms of regulation, health-care funding or governmental commitment to quality and health-care improvement that offer a supportive environment. Principal challenges include unstable business (e.g. limited market, low uptake) and unstable politics. Many organizations make only limited information available to patients and the public about standards, procedures or results.

Biomimetic Sniffing Improves the Detection Performance of a 3D Printed Nose of a Dog and a Commercial Trace Vapor Detector

NASA Astrophysics Data System (ADS)

Staymates, Matthew E.; Maccrehan, William A.; Staymates, Jessica L.; Kunz, Roderick R.; Mendum, Thomas; Ong, Ta-Hsuan; Geurtsen, Geoffrey; Gillen, Greg J.; Craven, Brent A.

2016-12-01

Unlike current chemical trace detection technology, dogs actively sniff to acquire an odor sample. Flow visualization experiments with an anatomically-similar 3D printed dog’s nose revealed the external aerodynamics during canine sniffing, where ventral-laterally expired air jets entrain odorant-laden air toward the nose, thereby extending the “aerodynamic reach” for inspiration of otherwise inaccessible odors. Chemical sampling and detection experiments quantified two modes of operation with the artificial nose-active sniffing and continuous inspiration-and demonstrated an increase in odorant detection by a factor of up to 18 for active sniffing. A 16-fold improvement in detection was demonstrated with a commercially-available explosives detector by applying this bio-inspired design principle and making the device “sniff” like a dog. These lessons learned from the dog may benefit the next-generation of vapor samplers for explosives, narcotics, pathogens, or even cancer, and could inform future bio-inspired designs for optimized sampling of odor plumes.

Biomimetic Sniffing Improves the Detection Performance of a 3D Printed Nose of a Dog and a Commercial Trace Vapor Detector

PubMed Central

Staymates, Matthew E.; MacCrehan, William A.; Staymates, Jessica L.; Kunz, Roderick R.; Mendum, Thomas; Ong, Ta-Hsuan; Geurtsen, Geoffrey; Gillen, Greg J.; Craven, Brent A.

2016-01-01

Unlike current chemical trace detection technology, dogs actively sniff to acquire an odor sample. Flow visualization experiments with an anatomically-similar 3D printed dog’s nose revealed the external aerodynamics during canine sniffing, where ventral-laterally expired air jets entrain odorant-laden air toward the nose, thereby extending the “aerodynamic reach” for inspiration of otherwise inaccessible odors. Chemical sampling and detection experiments quantified two modes of operation with the artificial nose-active sniffing and continuous inspiration-and demonstrated an increase in odorant detection by a factor of up to 18 for active sniffing. A 16-fold improvement in detection was demonstrated with a commercially-available explosives detector by applying this bio-inspired design principle and making the device “sniff” like a dog. These lessons learned from the dog may benefit the next-generation of vapor samplers for explosives, narcotics, pathogens, or even cancer, and could inform future bio-inspired designs for optimized sampling of odor plumes. PMID:27906156

Performance analysis of the GR712RC dual-core LEON3FT SPARC V8 processor in an asymmetric multi-processing environment

NASA Astrophysics Data System (ADS)

Giusi, Giovanni; Liu, Scige J.; Galli, Emanuele; Di Giorgio, Anna M.; Farina, Maria; Vertolli, Nello; Di Lellis, Andrea M.

2016-07-01

In this paper we present the results of a series of performance tests carried out on a prototype board mounting the Cobham Gaisler GR712RC Dual Core LEON3FT processor. The aim was the characterization of the performances of the dual core processor when used for executing a highly demanding lossless compression task, acting on data segments continuously copied from the static memory to the processor RAM. The selection of the compression activity to evaluate the performances was driven by the possibility of a comparison with previously executed tests on the Cobham/Aeroflex Gaisler UT699 LEON3FT SPARC™ V8. The results of the test activity have shown a factor 1.6 of improvement with respect to the previous tests, which can easily be improved by adopting a faster onboard board clock, and provided indications on the best size of the data chunks to be used in the compression activity.

AIM - Agile Instrumented Monitoring for Improving User Experience of Participation in HealthIT Development.

PubMed

Pitkänen, Janne; Nieminen, Marko

2017-01-01

Participation of healthcare professionals in information technology development has emerged as an important challenge. As end-users, the professionals are willing to participate in the development activities, but their experiences on the current methods of participation remain mostly negative. There is lack of applicable methods for meeting the needs of agile development approach and scaling up to the largest implementation projects, while maintaining the interest of the professional users to participate in development activities and keeping up their ability to continue working in a productive manner. In this paper, we describe the Agile Instrumented Monitoring as a methodology, based on the methods of instrumented usability evaluation, for improving user experience in HealthIT development. The contribution of the proposed methodology is analyzed in relation to activities of whole iteration cycle and chosen usability evaluation methods, while the user experience of participation is addressed regarding healthcare professionals. Prospective weak and strong market tests for AIM are discussed in the conclusions for future work.

Exploring Parents' Perceptions and How Physiotherapy Supports Transition from Rehabilitation to School for Youth with an ABI.

PubMed

Lee, Tracy; Norton, Andrea; Hayes, Sue; Adamson, Keith; Schwellnus, Heidi; Evans, Cathy

2017-11-01

To explore parents' perceptions of their youth's transition from rehabilitation to school following an Acquired Brain Injury (ABI) and how physiotherapy influenced the youth's participation and physical function during the transition. The study utilized phenomenological qualitative methodology using semi-structured interviews with 11 parents of youth 10 to 18 years of age recruited from one pediatric rehabilitation hospital in Ontario. Each interview was audiotaped, transcribed verbatim, and thematically analyzed. Parents valued physiotherapy and highlighted potential areas of improved service delivery to promote participation in an active lifestyle during this transition. In addition to being parents, they had to assume new roles and responsibilities in order to motivate their youth to continue with therapy and physical activity and had to facilitate their participation in school, recreational and social activities. For youth following an ABI, the transition back to school is complex and strategies should be supportive and responsive. Implications for physiotherapists include improved collaboration with community partners to motivate youth and promote physical activity; engage youth with their peers early in the rehabilitation process; and ongoing support for parents.

Continuous quality improvement in the ambulatory endoscopy center.

PubMed

Johanson, John F

2002-04-01

What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit of improvement. Second, learning must be viewed as a process. A quality improvement plan that is successful in one setting may not be as favorable in another situation. Clinicians must be able to focus on their individual situations and adapt what others have implemented to their own practice. Third, the most important aspect of the quality improvement is the implementation step. It matters little if elegant studies of endoscopic complications or patient satisfaction are completed if the information is not used to improve the delivery of health care to every single patient. The delivery of medical care continues to evolve. Resources are becoming increasingly scarce and the progressive rise of health care expenditures suggests a need for control. In this zeal for cost constraint, quality must not be sacrificed. This new-found attention to quality must be extended to the level of the individual practitioner to ensure that individual patients' interests are protected and the best possible care is delivered regardless of the economic implications. As providers of health care, endoscopists need to take an active role in these efforts both in understanding and implementing the techniques of quality assessment into their practices. If physicians are not actively involved in data collection and measurement to improve the quality and value of their own work, someone else will undoubtedly assume this role.

Content Integrity, Conflict of Interest, and Commercial Support: Defining and Operationalizing the Terms.

PubMed

Dickerson, Pam; Chappell, Kathy

2015-01-01

One of the hallmarks of quality continuing education developed using accreditation criteria is content integrity. Components of content integrity include identifying, resolving, and disclosing conflict of interest; ensuring content is based on the best available evidence; managing commercial support (if applicable); and presenting the educational activity free of promotion or bias. This article explores content integrity, conflict of interest, and commercial support. Understanding and being able to operationalize these concepts will enable providers to offer high-quality educational activities that promote the professional development of nurses and/or improve the quality of patient care.

System engineering for image and video systems

NASA Astrophysics Data System (ADS)

Talbot, Raymond J., Jr.

1997-02-01

The National Law Enforcement and Corrections Technology Centers (NLECTC) support public law enforcement agencies with technology development, evaluation, planning, architecture, and implementation. The NLECTC Western Region has a particular emphasis on surveillance and imaging issues. Among its activities, working with government and industry, NLECTC-WR produces 'Guides to Best Practices and Acquisition Methodologies' that facilitate government organizations in making better informed purchasing and operational decisions. This presentation includes specific examples from current activities. Through these systematic procedures, it is possible to design solutions optimally matched to the desired outcomes and provide a process for continuous improvement and greater public awareness of success.

Cardiovascular health behavior and health factor changes (1988-2008) and projections to 2020: results from the National Health and Nutrition Examination Surveys.

PubMed

Huffman, Mark D; Capewell, Simon; Ning, Hongyan; Shay, Christina M; Ford, Earl S; Lloyd-Jones, Donald M

2012-05-29

The American Heart Association's 2020 Strategic Impact Goals target a 20% relative improvement in overall cardiovascular health with the use of 4 health behavior (smoking, diet, physical activity, body mass) and 3 health factor (plasma glucose, cholesterol, blood pressure) metrics. We sought to define current trends and forward projections to 2020 in cardiovascular health. We included 35 059 cardiovascular disease-free adults (aged ≥20 years) from the National Health and Nutrition Examination Survey 1988-1994 and subsequent 2-year cycles during 1999-2008. We calculated population prevalence of poor, intermediate, and ideal health behaviors and factors and also computed a composite, individual-level Cardiovascular Health Score for all 7 metrics (poor=0 points; intermediate=1 point; ideal=2 points; total range, 0-14 points). Prevalence of current and former smoking, hypercholesterolemia, and hypertension declined, whereas prevalence of obesity and dysglycemia increased through 2008. Physical activity levels and low diet quality scores changed minimally. Projections to 2020 suggest that obesity and impaired fasting glucose/diabetes mellitus could increase to affect 43% and 77% of US men and 42% and 53% of US women, respectively. Overall, population-level cardiovascular health is projected to improve by 6% overall by 2020 if current trends continue. Individual-level Cardiovascular Health Score projections to 2020 (men=7.4 [95% confidence interval, 5.7-9.1]; women=8.8 [95% confidence interval, 7.6-9.9]) fall well below the level needed to achieve a 20% improvement (men=9.4; women=10.1). The American Heart Association 2020 target of improving cardiovascular health by 20% by 2020 will not be reached if current trends continue.

Cardiovascular Health Behavior and Health Factor Changes (1988 –2008) and Projections to 2020

PubMed Central

Huffman, Mark D.; Capewell, Simon; Ning, Hongyan; Shay, Christina M.; Ford, Earl S.; Lloyd-Jones, Donald M.

2014-01-01

Background The American Heart Association’s 2020 Strategic Impact Goals target a 20% relative improvement in overall cardiovascular health with the use of 4 health behavior (smoking, diet, physical activity, body mass) and 3 health factor (plasma glucose, cholesterol, blood pressure) metrics. We sought to define current trends and forward projections to 2020 in cardiovascular health. Methods and Results We included 35 059 cardiovascular disease–free adults (aged ≥20 years) from the National Health and Nutrition Examination Survey 1988–1994 and subsequent 2-year cycles during 1999–2008. We calculated population prevalence of poor, intermediate, and ideal health behaviors and factors and also computed a composite, individual-level Cardiovascular Health Score for all 7 metrics (poor=0 points; intermediate=1 point; ideal=2 points; total range, 0–14 points). Prevalence of current and former smoking, hypercholesterolemia, and hypertension declined, whereas prevalence of obesity and dysglycemia increased through 2008. Physical activity levels and low diet quality scores changed minimally. Projections to 2020 suggest that obesity and impaired fasting glucose/diabetes mellitus could increase to affect 43% and 77% of US men and 42% and 53% of US women, respectively. Overall, population-level cardiovascular health is projected to improve by 6% overall by 2020 if current trends continue. Individual-level Cardiovascular Health Score projections to 2020 (men=7.4 [95% confidence interval, 5.7–9.1]; women=8.8 [95% confidence interval, 7.6–9.9]) fall well below the level needed to achieve a 20% improvement (men=9.4; women=10.1). Conclusions The American Heart Association 2020 target of improving cardiovascular health by 20% by 2020 will not be reached if current trends continue. PMID:22547667

Improving Citizen Preparedness Through Employee Disaster Preparedness Promotion in the Workplace

DTIC Science & Technology

2014-09-01

that lessons learned are not necessarily indicative of behavior change; a person may know an activity is beneficial or harmful , but may not readily...thesis, Naval Postgraduate School), 52. 110 Alice S. Ammerman et al., “The Efficacy of Behavioral Interventions to Modify Dietary Fat and Fruit...awarding higher-cost items (weather radio) that supplement a disaster preparedness kit provide an incentive while continuing to emphasize the

2004 termiticide report: The Forest Service continues to improve operations to meet the high demand for testing

Treesearch

Terry Wagner; Chris Peterson; Joe Mulrooney; Thomas Shelton

2005-01-01

Termiticide registrations have been newsworthy for years now, as highlighted in some of the recent USDA Forest Service termiticide reports published in this magazine. One issue driving the changes in pesticide registrations is the length of time required to bring new active ingredients to the market. This is one of several issues that affect the number of safe and...

Report on the FY 1986 Activities of the Defense Science Study Group. Volume 1.

DTIC Science & Technology

1987-05-01

Reactors Improved Techniques for Wavefront Sensing and Correction in Adaptive Optics Hypervelocity Launchers Underground Facilities 0 Automated...oceanography and sound propagation in partially coherent media such as the turbulent ocean. There are large fixed arrays such as the Sound Surveillance System...Aircraft Continuous Patrol Aircraft Miscellaneous Studies Review of the Plutonium Special Isotope Separation Program of the DOE 4r Fusion Fission Hybrid

Basis for the development of sustainable optimisation indicators for activated sludge wastewater treatment plants in the Republic of Ireland.

PubMed

Gordon, G T; McCann, B P

2015-01-01

This paper describes the basis of a stakeholder-based sustainable optimisation indicator (SOI) system to be developed for small-to-medium sized activated sludge (AS) wastewater treatment plants (WwTPs) in the Republic of Ireland (ROI). Key technical publications relating to best practice plant operation, performance audits and optimisation, and indicator and benchmarking systems for wastewater services are identified. Optimisation studies were developed at a number of Irish AS WwTPs and key findings are presented. A national AS WwTP manager/operator survey was carried out to verify the applied operational findings and identify the key operator stakeholder requirements for this proposed SOI system. It was found that most plants require more consistent operational data-based decision-making, monitoring and communication structures to facilitate optimised, sustainable and continuous performance improvement. The applied optimisation and stakeholder consultation phases form the basis of the proposed stakeholder-based SOI system. This system will allow for continuous monitoring and rating of plant performance, facilitate optimised operation and encourage the prioritisation of performance improvement through tracking key operational metrics. Plant optimisation has become a major focus due to the transfer of all ROI water services to a national water utility from individual local authorities and the implementation of the EU Water Framework Directive.

The Planetary Data System — Renewing Our Science Nodes in Order to Better Serve Our Science Community

NASA Astrophysics Data System (ADS)

Morgan, T. H.; McLaughlin, S.; Grayzeck, E. J.; Knopf, W.; McNutt, R. L., Jr.; Crichton, D. J.; New, M. H.

2015-12-01

In order to improve NASA's ability to provide an agile response to the needs of the Planetary Science Community, the Planetary Data System (PDS) is being transformed. NASA has used the highly successful virtual institute model (e.g., for NASA's Astrobiology Program) to re-compete the Science Nodes within the PDS Structure. We expect the new PDS will improve both archive searchability and product discoverability, continue the adaption of the new PDS4 Standard, and enhance our ability to work with other archive/curation activities within NASA and with the International community of space faring nations (through the International Planetary Data Alliance). PDS will continue to work with NASA missions from the initial Announcement of Opportunity through the end of mission to define, organize, and document the data. This process includes peer-review of data sets by members of the science community to ensure that the data sets are scientifically useful, effectively organized, and well documented. In this presentation we discuss recent changes in the PDS, and our future activities to build on these changes. Please visit our User Support Area at the meeting (Booth #446) if you have questions accessing our data sets or providing data to the PDS or about the new PDS structure.

[Effect of Glomus versiforme and Trichoderma harzianum on growth and quality of Salvia miltiorrhiza].

PubMed

Wang, Xue; Chen, Mei-Lan; Yang, Guang; Li, Xiao-Ming; Li, Peng-Ying; Chen, Min

2014-05-01

The present study aimed to investigate the effect of Glomus versiforme and Trichodema harzianum on the growth and quality of Salvia miltiorrhiza continuous cropping under field conditions. The field plot experiment was conducted, these active components in the plant were analyzed by HPLC, the root diseases incidence rate of S. miltiorrhiza determined by observation and counting, and relative parameters were measured. The data was statistically processed. The result showed that inoculation of G. versiforme and combined inoculation of G. versiforme with T. harzianum significantly decreased the root diseases incidence rate of S. miltiorrhiza, and combined inoculation of G. versiforme with T. harzianum was better than other treatments. All treatments improved accumulation of active ingredients in root. Inoculation of G. versiforme and combined inoculation of G. versiforme with T. harzianum significantly increased the content of salvianolic acid B and cryptotanshinone of root (P < 0.05), Inoculation of G. versiforme, T. harzianum and combined inoculation of G. versiforme with T. harzianum significantly enhanced the content of tanshinone I and tanshinone II(A) of the root (P < 0.05). It may conclude that inoculation of G. versiforme and combined inoculation of G. versiforme with T. harzianum can effectively reduce the root diseases incidence of continuous cropping S. miltiorrhiza, and improve the quality of S. miltiorrhiza.

Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting.

PubMed

Clarke, Christina M; Persaud, Drepaul David

2011-03-01

Many contemporary acute care facilities lack safe and effective clinical handover practices resulting in patient transitions that are vulnerable to discontinuities in care, medical errors, and adverse patient safety events. This article is intended to supplement existing handover improvement literature by providing practical guidance for leaders and managers who are seeking to improve the safety and the effectiveness of clinical handovers in the acute care setting. A 4-stage change model has been applied to guide the application of strategies for handover improvement. Change management and quality improvement principles, as well as concepts drawn from safety science and high-reliability organizations, were applied to inform strategies. A model for handover improvement respecting handover complexity is presented. Strategies targeted to stages of change include the following: 1. Enhancing awareness of handover problems and opportunities with the support of strategic directions, accountability, end user involvement, and problem complexity recognition. 2. Identifying solutions by applying and adapting best practices in local contexts. 3. Implementing locally adapted best practices supported by communication, documentation, and training. 4. Institutionalizing practice changes through integration, monitoring, and active dissemination. Finally, continued evaluation at every stage is essential. Although gaps in handover process and function knowledge remain, efforts to improve handover safety and effectiveness are still possible. Continued evaluation is critical in building this understanding and to ensure that practice changes lead to improvements in patient safety, organizational effectiveness, and patient and provider satisfaction. Through handover knowledge building, fundamental changes in handover policies and practices may be possible.

A usability study of a mobile monitoring system for congestive heart failure patients.

PubMed

Svagård, I; Austad, H O; Seeberg, T; Vedum, J; Liverud, A; Mathiesen, B M; Keller, B; Bendixen, O C; Osborne, P; Strisland, F

2014-01-01

Sensor-based monitoring of congestive heart-failure (CHF) patients living at home can improve quality of care, detect exacerbations of disease at an earlier stage and motivate the patient for better self care. This paper reports on a usability study of the ESUMS system that provides continuous measurements of heart rate, activity, upper body posture and skin temperature via a sensor belt and a smartphone as patient terminal. Five CHF patients were included in the trial, all recently discharged from hospital. The nurses experienced continuous heart rate, activity and posture monitoring as useful and objective tools that helped them in their daily assessment of patient health. They also saw the system as an important educational tool to help patients gain insight into their own condition. Three patients liked that they could have a view of their own physiological and activity data, however the smartphones used in the study turned out to be too complicated for the patients to operate. A smartphone is built to be a multi-purpose device, and this may (conceptually and practically) be incompatible with the patients' demands for ease of use.

Preventive and therapeutic effect of treadmill running on chronic stress-induced memory deficit in rats.

PubMed

Radahmadi, Maryam; Alaei, Hojjatallah; Sharifi, Mohammad Reza; Hosseini, Nasrin

2015-04-01

Previous results indicated that stress impairs learning and memory. In this research, the effects of preventive, therapeutic and regular continually running activity on chronic stress-induced memory deficit in rats were investigated. 70 male rats were randomly divided into seven groups as follows: Control, Sham, Stress-Rest, Rest-Stress, Stress-Exercise, Exercise-Stress and Exercise-Stress & Exercise groups. Chronic restraint stress was applied 6 h/day for 21days and treadmill running 1 h/day. Memory function was evaluated by the passive avoidance test. The results revealed that running activities had therapeutic effect on mid and long-term memory deficit and preventive effects on short and mid-term memory deficit in stressed rats. Regular continually running activity improved mid and long-term memory compared to Exercise-Stress group. The beneficial effects of exercise were time-dependent in stress conditions. Finally, data corresponded to the possibility that treadmill running had a more important role on treatment rather than on prevention on memory impairment induced by stress. Copyright © 2014 Elsevier Ltd. All rights reserved.

Design of an unified chassis controller for rollover prevention, manoeuvrability and lateral stability

NASA Astrophysics Data System (ADS)

Yoon, Jangyeol; Yim, Seongjin; Cho, Wanki; Koo, Bongyeong; Yi, Kyongsu

2010-11-01

This paper describes a unified chassis control (UCC) strategy to prevent vehicle rollover and improve both manoeuvrability and lateral stability. Since previous researches on rollover prevention are only focused on the reduction of lateral acceleration, the manoeuvrability and lateral stability cannot be guaranteed. For this reason, it is necessary to design a UCC controller to prevent rollover and improve lateral stability by integrating electronic stability control, active front steering and continuous damping control. This integration is performed through switching among several control modes and a simulation is performed to validate the proposed method. Simulation results indicate that a significant improvement in rollover prevention, manoeuvrability and lateral stability can be expected from the proposed UCC system.

Influenza immunizations in the elderly: a continuous quality improvement project.

PubMed

Juma, A; Evans, M F; Bloom, J

2000-08-01

As part of the continuous quality improvement program at The Toronto Hospital's Department of Family & Community Medicine (TTH-DFCM), it was considered necessary to examine the structures, processes and outcomes of influenza immunization for the elderly. The study sought to (a) document the current influenza immunization process; (b) quantify influenza immunization rates for elderly patients during two consecutive immunization seasons (1996 and 1997), and compare these rates across physician teams, attending staff vs. residents, patient gender, and patient age groups; (c) compare influenza immunization rates with other centers; and (d) identify barriers and propose solutions to improve influenza immunization rates in the elderly. Evaluation Formative Research. A computerized roster of 15,000 patients at The Toronto Hospital, Department of Family and Community Medicine, a University of Toronto academic teaching center. Active patients age 65 years and over. Influenza immunization. Physician Teams, Physician status, Patient gender, and Patient age group. Immunization rates of attendees increased from 75.4% to 78.7%; over 3% increase from 1996 to 1997. Major subgroups which benefited from increased immunization rates were patients in the Blue team, patients age 70-74 years, and female patients. This study presents a rigorous examination of the components of the influenza immunization program, and demonstrates improved immunization rates over a two-year period. Suggestions for future action have been identified. The study design can also serve as a model for future clinical quality improvement projects.

Understanding stakeholders' perspectives and experiences of general practice accreditation.

PubMed

Debono, Deborah; Greenfield, David; Testa, Luke; Mumford, Virginia; Hogden, Anne; Pawsey, Marjorie; Westbrook, Johanna; Braithwaite, Jeffrey

2017-07-01

To examine general practice accreditation stakeholders' perspectives and experiences to identify program strengths and areas for improvements. Individual (n=2) and group (n=9) interviews were conducted between September 2011-March 2012 with 52 stakeholders involved in accreditation in Australian general practices. Interviews were recorded, transcribed and thematically analysed. Member checking activities in April 2016 assessed the credibility and currency of the findings in light of current reforms. Overall, participants endorsed the accreditation program but identified several areas of concern. Noted strengths of the program included: program ownership, peer review and collaborative learning; access to Practice Incentives Program payments; and, improvements in safety and quality. Noted limitations in these and other aspects of the program offer potential for improvement: evidence for the impact of accreditation; resource demands; clearer outcome measures; and, specific experiences of accreditation. The effectiveness of accreditation as a strategy to improve safety and quality was shaped by the attitudes and experience of stakeholders. Strengths and weaknesses in the accreditation program influence, and are influenced by, stakeholder engagement and disengagement. After several accreditation cycles, the sector has the opportunity to reflect on, review and improve the process. This will be important if the continued or extended engagement of practices is to be realised to assure the continuation and effectiveness of the accreditation program. Copyright © 2017 Elsevier B.V. All rights reserved.

National Childhood Diabetes Program Activities in Turkey

PubMed Central

Hatun, Şükrü

2015-01-01

Recent census figures in Turkey show that out of a population of 76.6 million, 22.7 million (29.7%) are younger than 18 years old. The great majority (>95%) of pediatric cases of diabetes in Turkey are type 1 diabetes mellitus (T1DM). In recent years, with increase in number of pediatric endocrine centers around the country, the important issue of care for diabetic children and adolescents has been revived and major steps have been taken for improvement in pediatric care and its outreach to all diabetic children. The Childhood Diabetes Group continues its activities in cooperation with the Turkish Ministry of Health. A list of areas of interest of the Group include “School programs”, “Incidence/prevalence studies and national registry system”, “Educational guidelines for diabetes in children”, “Increasing the numbers of camps and summer schools for diabetic children”, “Organization of educational programs for the health team”, “National guidelines for transition of diabetic children to adult clinics”, “Improvement of school canteens”, “Educational spots” to improve awareness of diabetes. The activities of the Childhood Diabetes Group will be discussed in detail in this article. PMID:25800469

The Development of Motor Coordination in Drosophila Embryos

PubMed Central

Crisp, Sarah; Evers, Jan Felix; Fiala, André; Bate, Michael

2012-01-01

We use non-invasive muscle imaging to study onset of motor activity and emergence of coordinated movement in Drosophila embryos. Earliest movements are myogenic and neurally controlled muscle contractions first appear with the onset of bursting activity 17 hours after egg laying. Initial episodes of activity are poorly organised and coordinated crawling sequences only begin to appear after a further hour of bursting. Thus network performance improves during this first period of activity. The embryo continues to exhibit bursts of crawling like sequences until shortly before hatching, while other reflexes also mature. Bursting does not begin as a reflex response to sensory input but appears to reflect the onset of spontaneous activity in the motor network. It does not require GABA-ergic transmission, and using a light activated channel to excite the network we demonstrate activity dependent depression that may cause burst termination. PMID:18927150

[Continuity of nutritional care at discharge in the era of ICT].

PubMed

Martínez Olmos, Miguel Ángel

2015-05-07

Telemedicine represents the union of information technology and telecommunication services in health. This allows the improvement of health care, especially in underserved areas, bringing professionals working in continuing education and improving patient care at home. The application of telemedicine in various hospital complexes, clinics and health centers, has helped to provide a better service, within the parameters of efficiency, effectiveness, cost-benefit, with increasing satisfaction of medical staff and patients. The development and application of various types of telemedicine, the technological development of audio, text, video and data, and constant improvement of infrastructure in telecommunications, have favored the expansion and development of telemedicine in various medical specialties. The use of electronic health records by different health professionals can have a positive impact on the care provided to patients. This should also be supported by the development of better health policies, legal security and greater awareness in health professionals and patients regarding the potential benefits. Regarding the clinical activity in Nutrition, new technologies also provide an opportunity to improve in various educational, preventive, diagnostic and treatment aspects, including shared track between Nutrition Units and Primary Care Teams, for patients who need home nutritional care at, with shared protocols, providing teleconsultation in required cases and avoiding unnecessary travel to hospital.

Addition of acetate improves stability of power generation using microbial fuel cells treating domestic wastewater.

PubMed

Stager, Jennifer L; Zhang, Xiaoyuan; Logan, Bruce E

2017-12-01

Power generation using microbial fuel cells (MFCs) must provide stable, continuous conversion of organic matter in wastewaters into electricity. However, when relatively small diameter (0.8cm) graphite fiber brush anodes were placed close to the cathodes in MFCs, power generation was unstable during treatment of low strength domestic wastewater. One reactor produced 149mW/m 2 before power generation failed, while the other reactor produced 257mW/m 2 , with both reactors exhibiting severe power overshoot in polarization tests. Using separators or activated carbon cathodes did not result in stable operation as the reactors continued to exhibit power overshoot based on polarization tests. However, adding acetate (1g/L) to the wastewater produced stable performance during fed batch and continuous flow operation, and there was no power overshoot in polarization tests. These results highlight the importance of wastewater strength and brush anode size for producing stable and continuous power in compact MFCs. Copyright © 2017 Elsevier B.V. All rights reserved.

Implementing Continuous Improvement Management (CIM) in the Public Schools.

ERIC Educational Resources Information Center

Borgers, William E.; Thompson, Tommy A.

This book traces the restructuring of a Texas school district that moved from management by coercion to continuous improvement for quality. In 1990, the Dickinson Independent School District (Texas) began implementation of Continuous Improvement Management (CIM), based on the teachings of W. Edwards Deming, William Glasser, and J. M. Juran.…

AEL Continuous School Improvement Questionnaire. User Manual and Technical Report.

ERIC Educational Resources Information Center

Meehan, Merrill L.; Cowley, Kimberly S.; Craig, James R.; Balow, Nancy; Childers, Robert D.

The Continuous School Improvement Questionnaire (CSIQ) developed by the AEL helps a school staff gauge its performance on six dimensions related to continuous school improvement. Each member of the staff responds to the CSIQ individually. Although results might be used at the district or regional level, the most widely intended unit for applying…