Quality improvement in hospitals: how much does it reduce healthcare costs?

PubMed

Jones, S B

1995-01-01

The philosophy of W.E. Deming suggests that continuous quality improvement efforts, when properly applied, ultimately will lead to financial dividends and will help ensure business longevity. Reducing hospital charges can be exciting for the participants and can provide an impetus for expanding quality improvement efforts. Americans, however, tend to demand almost instant gratification and have limited patience for longer-term results. This factor, coupled with minimal knowledge of actual operational costs and inaccurate charge accounting systems, may lead hospital managers to misinterpret the potential net long-term effects of their quality improvement efforts. In the approaching environment of capitated reimbursement, such mistakes may have serious consequences.

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.

Quality improvement: the nurse's role.

PubMed

Moran, M J; Johnson, J E

1992-06-01

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

The Effects of 6 Months of Progressive High Effort Resistance Training Methods upon Strength, Body Composition, Function, and Wellbeing of Elderly Adults.

PubMed

Steele, James; Raubold, Kristin; Kemmler, Wolfgang; Fisher, James; Gentil, Paulo; Giessing, Jürgen

2017-01-01

The present study examined the progressive implementation of a high effort resistance training (RT) approach in older adults over 6 months and through a 6-month follow-up on strength, body composition, function, and wellbeing of older adults. Twenty-three older adults (aged 61 to 80 years) completed a 6-month supervised RT intervention applying progressive introduction of higher effort set end points. After completion of the intervention participants could choose to continue performing RT unsupervised until 6-month follow-up. Strength, body composition, function, and wellbeing all significantly improved over the intervention. Over the follow-up, body composition changes reverted to baseline values, strength was reduced though it remained significantly higher than baseline, and wellbeing outcomes were mostly maintained. Comparisons over the follow-up between those who did and those who did not continue with RT revealed no significant differences for changes in any outcome measure. Supervised RT employing progressive application of high effort set end points is well tolerated and effective in improving strength, body composition, function, and wellbeing in older adults. However, whether participants continued, or did not, with RT unsupervised at follow-up had no effect on outcomes perhaps due to reduced effort employed during unsupervised RT.

77 FR 42189 - Marine Recreational Fisheries of the United States; National Saltwater Angler Registry and State...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-18

... improvements to the design and management of survey and estimation methods used to produce marine recreational... to these effort surveys provides for continued pilot testing of effort sampling designs that use both... NMFS determine what specific sampling design to use in MRIP effort surveys on the Atlantic and Gulf...

Improving the professionalism of post-certification teacher through academic supervision in vocational schools

NASA Astrophysics Data System (ADS)

Satyawati, Sophia Tri; Widyanto, I. Putu; Suemy

2017-03-01

This paper examines the principal's efforts in improving the professionalism of post-certification teachers through academic supervision in vocational school. The certification of educators is expected to improve the professionalism of teachers, there are significant changes between the before and after receiving the certificate of educators. One of the efforts made by the principal on increasing the professionalism of teachers is to carry out academic supervision completely and continuously. This paper examines about how principals at vocational schools carry out the programmed academic supervision, and continuing through mentoring, evaluation and coaching. Academic supervision is performed by individual supervision techniques which includes: classroom or practical visit, classroom or practical observation, individual meetings, inter-class or practical places visit, and self-assessment.

Planning for Project Continuation.

ERIC Educational Resources Information Center

Berry, Grant, Jr.

Designed to help colleges plan for the successful continuation of educational improvement projects beyond the end of their original funding period, this report presents a case study of Pennsylvania College of Technology's (PCT's) efforts to ensure the continuation of a Title III faculty development program. After describing the the Title III…

Bioreactor design concepts

NASA Technical Reports Server (NTRS)

Bowie, William

1987-01-01

Two parallel lines of work are underway in the bioreactor laboratory. One of the efforts is devoted to the continued development and utilization of a laboratory research system. That system's design is intended to be fluid and dynamic. The sole purpose of such a device is to allow testing and development of equipment concepts and procedures. Some of the results of those processes are discussed. A second effort is designed to produce a flight-like bioreactor contained in a double middeck locker. The result of that effort has been to freeze a particular bioreactor design in order to allow fabrication of the custom parts. The system is expected to be ready for flight in early 1988. However, continued use of the laboratory system will lead to improvements in the space bioreactor. Those improvements can only be integrated after the initial flight series.

Course Development Cycle Time: A Framework for Continuous Process Improvement.

ERIC Educational Resources Information Center

Lake, Erinn

2003-01-01

Details Edinboro University's efforts to reduce the extended cycle time required to develop new courses and programs. Describes a collaborative process improvement framework, illustrated data findings, the team's recommendations for improvement, and the outcomes of those recommendations. (EV)

Continuity in Early Childhood: A Framework for Home, School, and Community Linkages. Revised Edition.

ERIC Educational Resources Information Center

Regional Educational Laboratories Early Childhood Collaboration Network.

This guide details a framework for supporting the efforts of home, school, and community partners to improve continuity and transition in early childhood. Following an introduction describing continuity in early childhood, the importance of a smooth transition, and the eight elements of early childhood continuity, the guide is presented in eight…

Continued improvements at one C3RS site

DOT National Transportation Integrated Search

2015-06-01

Human-factors-based solutions, along with process and technology innovations, can make significant contributions to improving safety in the railroad industry. As part of ongoing efforts to address human-factors, FRA implemented the Confidential Close...

Montana Certification Program Manual.

ERIC Educational Resources Information Center

Montana State Library, Helena.

The Montana Certification Program offers librarians, library staff members, and trustees a systematic and progressive method by which to track their continuing education (CE) efforts; the program also offers library boards and managers an opportunity to recognize staff efforts to improve their skills, ability, and knowledge. This first section of…

Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

PubMed

Kakyo, Tracy Alexis; Xiao, Lily Dongxia

2017-06-01

Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.

How Visual Management for Continuous Improvement Might Guide and Affect Hospital Staff: A Case Study.

PubMed

Ulhassan, Waqar; von Thiele Schwarz, Ulrica; Westerlund, Hugo; Sandahl, Christer; Thor, Johan

2015-01-01

Visual management (VM) tools such as whiteboards, often employed in Lean thinking applications, are intended to be helpful in improving work processes in different industries including health care. It remains unclear, however, how VM is actually applied in health care Lean interventions and how it might influence the clinical staff. We therefore examined how Lean-inspired VM using whiteboards for continuous improvement efforts related to the hospital staff's work and collaboration. Within a case study design, we combined semistructured interviews, nonparticipant observations, and photography on 2 cardiology wards. The fate of VM differed between the 2 wards; in one, it was well received by the staff and enhanced continuous improvement efforts, whereas in the other ward, it was not perceived to fit in the work flow or to make enough sense in order to be sustained. Visual management may enable the staff and managers to allow communication across time and facilitate teamwork by enabling the inclusion of team members who are not present simultaneously; however, its adoption and value seem contingent on finding a good fit with the local context. A combination of continuous improvement and VM may be helpful in keeping the staff engaged in the change process in the long run.

Development of a conceptual framework toward an integrated transportation system (continued).

DOT National Transportation Integrated Search

2011-07-01

As a continuing effort documented in the first phase project UMAR19-13, this research focuses : on the design of a prototype application under the framework toward an Integrated : Transportation System. More specifically, this research aims at improv...

Continuing Education: Bridging the Information Gap. Research Publication 76-1.

ERIC Educational Resources Information Center

State Univ. of New York, Ithaca. Cornell Inst. for Research and Development in Occupational Education.

As part of a statewide effort to contribute necessary information for the improvement of planning, administration, and delivery of continuing education services, the central region studies were an attempt to discover more about adult learning interests, the needs for continuing education services, and the present delivery system in an 11-county…

Productivity improvement in engineering at Rocketdyne

NASA Technical Reports Server (NTRS)

Nordlund, R. M.; Vogt, S. T.; Woo, A. K.

1985-01-01

The Rocketdyne Division of Rockwell International has embarked on a productivity improvement program in engineering. This effort included participation in the White Collar Productivity Improvement (WCPI) project sponsored by the American Productivity Center. A number of things have been learned through this project. It seems that any productivity improvement project should be employee driven. The Rocketdyne project was essentially started as a result of a grassroots effort to remove some particular hindrances, and employee enthusiasm was a prime factor in the continuing progress of the effort. A significant result was that awareness of problems at all levels increased. Many issues surfaced in the diagnostic phase, and were then noted and discussed. This process added legitimacy to issues that had previously been merely unspoken concerns. The initial feelings of many members of the pilot group was that significant changes would occur relatively quickly. It is now recognized that this will have to be an ongoing, long-term effort.

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)

75 FR 67948 - Proposed Information Collection; Comment Request; Marine Recreational Information Program (Marine...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-04

.... SUMMARY: The Department of Commerce, as part of its continuing effort to reduce paperwork and respondent..., and angler socioeconomic characteristics. These data are required to carry out provisions of the... anglers in an effort to improve the quality, resolution and timeliness of recreational fishing statistics...

DOD Financial Management: Significant Efforts Still Needed for Remediating Audit Readiness Deficiencies

DTIC Science & Technology

2017-02-01

19As defined in generally accepted government auditing standards, information technology controls...Financial Improvement and Audit Readiness (FIAR) Plan Status Report, while DOD continues to make progress in addressing information technology ...DOD FINANCIAL MANAGEMENT Significant Efforts Still Needed for Remediating Audit Readiness Deficiencies Report to

K-12 Teacher Participation in Online Professional Development

ERIC Educational Resources Information Center

McNamara, Catherine Louise

2010-01-01

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

Ninth Annual NASA/Contractors Conference on Quality and Productivity. World Class Excellence: The Journey Continues. Keynote presentations

NASA Technical Reports Server (NTRS)

Templeton, Geoffrey B. (Editor)

1992-01-01

This coference provided an excellent forum for the members of the NASA community to share their experience and expertise in an effort to continuously improve the quality of the US space program. The topics covered include the following: NASA's approach to continual improvement; commitment to total quality; total quality at AlliedSignal Aerospace; organizational TQM; recognition of the 1992 Low Trophy Finalists; announcement of the 1992 Low Trophy Recipients; and the changing face of aerospace contracting.

Highlights of contractor initiatives in quality enhancement and productivity improvement

NASA Technical Reports Server (NTRS)

1986-01-01

The NASA/Contractor Team efforts are presented as part of NASA's continuing effort to facilitate the sharing of quality and productivity improvement ideas among its contractors. This complilation is not meant to be a comprehensive review of contractor initiative nor does it necessarily express NASA's views. The submissions represent samples from a general survey, and were not edited by NASA. The efforts are examples of quality and productivity programs in private industry, and as such, highlight company efforts in individual areas. Topics range from modernization of equipment, hardware, and technology to management of human resources. Of particular interest are contractor initiatives which deal with measurement and evaluation data pertaining to quality and productivity performance.

POTENTIAL AQUATIC COMMUNITY IMPROVEMENT THROUGH A MULTIDISCIPLINARY STORMWATER MANAGEMENT EXPERIMENT

EPA Science Inventory

Small-scale urban stream restoration efforts (e.g., riparian planting and in-stream habitat structures) often fail to improve ecological structure and function due the continuous hydrologic and chemical disturbances posed by impervious surfaces upstream. Decentralized stormwater...

Continuous strife for better coverage and more details in ocean surface winds measurements - from Midori and ADEOS-2 to GCOM

NASA Technical Reports Server (NTRS)

Xie, X.; Liu, W.; Hu, H.; Tang, W.

2001-01-01

The series of joint U.S.-Japan spaceborne scatterometers missions to provide continuous measurements of ocean wind vectors is reviewed. Examples of the scientific impact of the continuous effort in improving spatial resolution and coverage are provided. The plan for the future is reviewed.

VVER Reactor Safety in Eastern Europe and Former Soviet Union

NASA Astrophysics Data System (ADS)

Papadopoulou, Demetra

2012-02-01

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

Government Actions to Control Terrorist Violence: A Case Study on Northern Ireland

DTIC Science & Technology

1988-03-01

Continue on reverse if necessary and identify by block number) E~~0! G~P I -OP ITerrorism; Government Legislation to Control Terrorism; Irish Re...of the British government’s efforts to legislate improvements in Northern Ireland. It appears that only through this process can peace and...international attention and has been the focus of much of the British government’s efforts to legislate improvements in Northern Ireland. It appears that

Lean Thinking in Libraries: A Case Study on Improving Shelving Turnaround

ERIC Educational Resources Information Center

Kress, Nancy J.

2007-01-01

The University of Chicago's Joseph Regenstein Library Bookstacks Department has used process mapping and continuous improvement to successfully improve its overall operations. The most recent efforts focus on Lean manufacturing, an initiative centered on eliminating waste in manufacturing processes. The conversion of the Bookstacks Department from…

Quality Indicators in Radiation Oncology

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

Albert, Jeffrey M.; Das, Prajnan, E-mail: prajdas@mdanderson.org

Oncologic specialty societies and multidisciplinary collaborative groups have dedicated considerable effort to developing evidence-based quality indicators (QIs) to facilitate quality improvement, accreditation, benchmarking, reimbursement, maintenance of certification, and regulatory reporting. In particular, the field of radiation oncology has a long history of organized quality assessment efforts and continues to work toward developing consensus quality standards in the face of continually evolving technologies and standards of care. This report provides a comprehensive review of the current state of quality assessment in radiation oncology. Specifically, this report highlights implications of the healthcare quality movement for radiation oncology and reviews existing efforts tomore » define and measure quality in the field, with focus on dimensions of quality specific to radiation oncology within the “big picture” of oncologic quality assessment efforts.« less

(abstract) Mission Operations and Control Assurance: Flight Operations Quality Improvements

NASA Technical Reports Server (NTRS)

Welz, Linda L.; Bruno, Kristin J.; Kazz, Sheri L.; Witkowski, Mona M.

1993-01-01

Mission Operations and Command Assurance (MO&CA), a recent addition to flight operations teams at JPL. provides a system level function to instill quality in mission operations. MO&CA's primary goal at JPL is to help improve the operational reliability for projects during flight. MO&CA tasks include early detection and correction of process design and procedural deficiencies within projects. Early detection and correction are essential during development of operational procedures and training of operational teams. MO&CA's effort focuses directly on reducing the probability of radiating incorrect commands to a spacecraft. Over the last seven years at JPL, MO&CA has become a valuable asset to JPL flight projects. JPL flight projects have benefited significantly from MO&CA's efforts to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit directly from previous and ongoing experience. Since MO&CA, like Total Quality Management (TQM), focuses on continuous improvement of processes and elimination of rework, we recommend that this effort be continued on NASA flight projects.

77 FR 7124 - Information Sharing With Agency Stakeholders; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-10

... efforts to transform itself into a customer-focused, high-performing organization. In this context, USDA's... relationships. As part of a larger effort to enhance stakeholder communication, APHIS is hosting an open meeting... headquarters for support? Why? As we continue to look at ways to improve our processes and enhance customer...

Achieving excellence--creating customer passion.

PubMed

Scheuing, E E

1999-08-01

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

Teachers' Perceptions of Their Ownership in the Educational Decision-Making Process

ERIC Educational Resources Information Center

Smith, Toni P.

2016-01-01

The educational system is in a continual state of refinement in an effort to improve effectiveness. Many decisions are made regarding policy and procedure at the individual school level ascending to the federal level. The majority workforce carrying out these reform efforts is comprised of classroom teachers. Teachers have the most direct…

Report: Additional Efforts Needed to Improve EPA’s Oversight of Assistance Agreements

EPA Pesticide Factsheets

Report #2002-P-00018, September 30, 2002. Although EPA developed corrective actions to improve oversight controls for assistance agreements, a number of EPA OIG, Agency, and GAO reviews determined that oversight continued to be a weakness.

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.

Defining the performance gap: Conducting a self-assessment

NASA Technical Reports Server (NTRS)

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

1992-01-01

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

Occupational commitment and job satisfaction mediate effort-reward imbalance and the intention to continue nursing.

PubMed

Satoh, Miho; Watanabe, Ikue; Asakura, Kyoko

2017-01-01

Occupational commitment and job satisfaction are major predictors of the intention to continue nursing. This study's purpose was to verify the mediating effects of job satisfaction and three components of occupational commitment on the relationship between effort-reward imbalance and the intention to continue nursing. A self-report questionnaire was distributed to 3977 nurses by the nursing department of 12 hospitals in the Tohoku and Kanto districts of Japan in 2013. Of these, 1531 (response rate: 38.5%) nurses returned the questionnaire by mail and the complete data that were provided by 1241 nurses (valid response rate: 31.2%) were analyzed. Structural equation modeling showed that the effort-reward ratio had negative effects on job satisfaction and affective and normative occupational commitment. Job satisfaction and affective and normative occupational commitment had positive effects on the intention to continue nursing, whereas the effort-reward ratio had no direct effect on the intention to continue nursing. Continuance occupational commitment was not a mediator, but it positively influenced the intention to continue nursing. The findings suggest that it is important to increase job satisfaction and affective and normative occupational commitment in order to enhance their buffering effects on the relationship between job stress and the intention to continue nursing. Measures to increase continuance occupational commitment also would be an effective method of strengthening the intention to continue nursing. Improvements in these areas should contribute to an increase in nurses' intention to continue nursing and prevent the loss of this precious human resource from the health sector. © 2016 Japan Academy of Nursing Science.

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

A New Alliance: Continuous Quality and Classroom Effectiveness. ASHE-ERIC Higher Education Report No. 6.

ERIC Educational Resources Information Center

Wolverton, Mimi

This report presents seven case studies and discusses the role of continuous quality improvement (CQI) in college classroom effectiveness efforts, particularly specific institutions where sustained CQI programs have affected college classroom practice, their common features, and lingering doubts about CQI. An introduction discusses general…

Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia

PubMed Central

2011-01-01

Introduction Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998. Methods This paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders. Results The health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor. Conclusions Despite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor. PMID:22067727

Continuous mutual improvement of macromolecular structure models in the PDB and of X-ray crystallographic software: the dual role of deposited experimental data

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

Terwilliger, Thomas C., E-mail: terwilliger@lanl.gov; Bricogne, Gerard, E-mail: terwilliger@lanl.gov; Los Alamos National Laboratory, Mail Stop M888, Los Alamos, NM 87507

Macromolecular structures deposited in the PDB can and should be continually reinterpreted and improved on the basis of their accompanying experimental X-ray data, exploiting the steady progress in methods and software that the deposition of such data into the PDB on a massive scale has made possible. Accurate crystal structures of macromolecules are of high importance in the biological and biomedical fields. Models of crystal structures in the Protein Data Bank (PDB) are in general of very high quality as deposited. However, methods for obtaining the best model of a macromolecular structure from a given set of experimental X-ray datamore » continue to progress at a rapid pace, making it possible to improve most PDB entries after their deposition by re-analyzing the original deposited data with more recent software. This possibility represents a very significant departure from the situation that prevailed when the PDB was created, when it was envisioned as a cumulative repository of static contents. A radical paradigm shift for the PDB is therefore proposed, away from the static archive model towards a much more dynamic body of continuously improving results in symbiosis with continuously improving methods and software. These simultaneous improvements in methods and final results are made possible by the current deposition of processed crystallographic data (structure-factor amplitudes) and will be supported further by the deposition of raw data (diffraction images). It is argued that it is both desirable and feasible to carry out small-scale and large-scale efforts to make this paradigm shift a reality. Small-scale efforts would focus on optimizing structures that are of interest to specific investigators. Large-scale efforts would undertake a systematic re-optimization of all of the structures in the PDB, or alternatively the redetermination of groups of structures that are either related to or focused on specific questions. All of the resulting structures should be made generally available, along with the precursor entries, with various views of the structures being made available depending on the types of questions that users are interested in answering.« less

The Social Intelligence of Principals: Links to Teachers' Continuous Improvement

ERIC Educational Resources Information Center

McQuade, Joan

2013-01-01

Despite multiple efforts to reform 21st education to better meet the needs of all students, school improvement successes have been sporadic and debatable. Research suggests that significant improvement lies within the purview of teachers and principals, and this current research provided the underpinnings for the study. Based on neuroscience…

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.

Incentives and Test-Based Accountability in Education

ERIC Educational Resources Information Center

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

2011-01-01

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

Which Aspects of Professional Commitment Can Effectively Retain Nurses in the Nursing Profession?

PubMed

Chang, Hao-Yuan; Shyu, Yea-Ing Lotus; Wong, May-Kuen; Friesner, Daniel; Chu, Tsung-Lan; Teng, Ching-I

2015-09-01

This study examined which aspects of professional commitment can effectively retain nurses in the nursing profession. This study used a longitudinal design, simple random sampling, and two-wave data collection to survey and follow up a representative sample of 579 nurses for 1 year in a major medical center in northern Taiwan. Items measuring each aspect of professional commitment came from Meyer et al.'s scale. In the second wave, administrative data were culled to determine whether these nurses remain employed as nurses. Structural equation modeling is used to analyze the data. Analytical results indicate that continuance commitment predicts nurse retention in the nursing profession (path coefficient = 0.34, p < .01). Institutional efforts to improve continuance commitment (e.g., improved salary structures and enhanced professional development opportunities) likely retain nurses in the nursing profession. The findings of this study indicate the importance of continuance intention in retaining nurses. Nursing managers who face staff retention issues may consider making efforts to improve nurse salary and employer-sponsored benefits. © 2015 Sigma Theta Tau International.

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.

Application Process Improvement Yields Results.

ERIC Educational Resources Information Center

Holesovsky, Jan Paul

1995-01-01

After a continuing effort to improve its grant application process, the department of medical microbiology and immunology at the University of Wisconsin-Madison is submitting many more applications and realizing increased funding. The methods and strategy used to make the process more efficient and effective are outlined. (Author/MSE)

Continuous quality improvement at work: the first team--Part I.

PubMed

Bolt, B J; Lehany-Trese, A M; Williams, T P

1994-01-01

This first part of a two-part article describes the process of making the theory of continuous quality improvement a reality. The successes, the failures, and the struggles of the first team effort are outlined. The evolution of the team approach is captured from the perspectives of the quality directors, the facilitator, and the team leader. The team project discussed in this article focused on inpatient admissions and the assignment of patients to observation status.

Improve strategic supplier performance using DMAIC to develop a Quality Improvement Plan

NASA Astrophysics Data System (ADS)

Jardim, Kevin P.

Supplier performance that meets the requirements of the customer has long plagued quality professionals. Despite the vast efforts by organizations to improve supplier performance, little has been done to standardize the plan to improve performance. This project presents a guideline and problem-solving strategy using a Define, Measure, Analyze, Improve, and Control (DMAIC) structured tool that will assist in the management and improvement of supplier performance. An analysis of benchmarked Quality Improvement Plans indicated that this topic needs more focus on how to accomplish improved supplier performance. This project is part of a growing body of supplier continuous improvement efforts. With the input of Zodiac Aerospace quality professionals this project's results provide a solution to Quality Improvement Plans and show objective evidence of its benefits. This project contributes to the future research on similar topics.

78 FR 14961 - Notice of Request for Collection of Public Information With the Use of a Survey

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-08

... account information. To facilitate CSC's mission and in an effort to continuously improve service delivery... Information With the Use of a Survey AGENCY: Rural Development, USDA. ACTION: Proposed collection; comments... Development's intention to request clearance for continuation of information collection to measure the quality...

Crowding out Latinos: Mexican Americans in the Public Consciousness.

ERIC Educational Resources Information Center

Portales, Marco

Despite efforts to improve perceptions about Mexican Americans and other Spanish-speaking people in the United States, Chicanos and other Latinos are not yet seen as typical American citizens. Latinos continue to receive poor educations, and the media continue to represent them in ways unaffected by the emergence of Chicano literature. This book…

Continuous mutual improvement of macromolecular structure models in the PDB and of X-ray crystallographic software: the dual role of deposited experimental data.

PubMed

Terwilliger, Thomas C; Bricogne, Gerard

2014-10-01

Accurate crystal structures of macromolecules are of high importance in the biological and biomedical fields. Models of crystal structures in the Protein Data Bank (PDB) are in general of very high quality as deposited. However, methods for obtaining the best model of a macromolecular structure from a given set of experimental X-ray data continue to progress at a rapid pace, making it possible to improve most PDB entries after their deposition by re-analyzing the original deposited data with more recent software. This possibility represents a very significant departure from the situation that prevailed when the PDB was created, when it was envisioned as a cumulative repository of static contents. A radical paradigm shift for the PDB is therefore proposed, away from the static archive model towards a much more dynamic body of continuously improving results in symbiosis with continuously improving methods and software. These simultaneous improvements in methods and final results are made possible by the current deposition of processed crystallographic data (structure-factor amplitudes) and will be supported further by the deposition of raw data (diffraction images). It is argued that it is both desirable and feasible to carry out small-scale and large-scale efforts to make this paradigm shift a reality. Small-scale efforts would focus on optimizing structures that are of interest to specific investigators. Large-scale efforts would undertake a systematic re-optimization of all of the structures in the PDB, or alternatively the redetermination of groups of structures that are either related to or focused on specific questions. All of the resulting structures should be made generally available, along with the precursor entries, with various views of the structures being made available depending on the types of questions that users are interested in answering.

Continuous mutual improvement of macromolecular structure models in the PDB and of X-ray crystallographic software: The dual role of deposited experimental data

DOE PAGES

Terwilliger, Thomas C.; Bricogne, Gerard

2014-09-30

Accurate crystal structures of macromolecules are of high importance in the biological and biomedical fields. Models of crystal structures in the Protein Data Bank (PDB) are in general of very high quality as deposited. However, methods for obtaining the best model of a macromolecular structure from a given set of experimental X-ray data continue to progress at a rapid pace, making it possible to improve most PDB entries after their deposition by re-analyzing the original deposited data with more recent software. This possibility represents a very significant departure from the situation that prevailed when the PDB was created, when itmore » was envisioned as a cumulative repository of static contents. A radical paradigm shift for the PDB is therefore proposed, away from the static archive model towards a much more dynamic body of continuously improving results in symbiosis with continuously improving methods and software. These simultaneous improvements in methods and final results are made possible by the current deposition of processed crystallographic data (structure-factor amplitudes) and will be supported further by the deposition of raw data (diffraction images). It is argued that it is both desirable and feasible to carry out small-scale and large-scale efforts to make this paradigm shift a reality. Small-scale efforts would focus on optimizing structures that are of interest to specific investigators. Large-scale efforts would undertake a systematic re-optimization of all of the structures in the PDB, or alternatively the redetermination of groups of structures that are either related to or focused on specific questions. All of the resulting structures should be made generally available, along with the precursor entries, with various views of the structures being made available depending on the types of questions that users are interested in answering.« less

Continuous mutual improvement of macromolecular structure models in the PDB and of X-ray crystallographic software: the dual role of deposited experimental data

PubMed Central

Terwilliger, Thomas C.; Bricogne, Gerard

2014-01-01

Accurate crystal structures of macromolecules are of high importance in the biological and biomedical fields. Models of crystal structures in the Protein Data Bank (PDB) are in general of very high quality as deposited. However, methods for obtaining the best model of a macromolecular structure from a given set of experimental X-ray data continue to progress at a rapid pace, making it possible to improve most PDB entries after their deposition by re-analyzing the original deposited data with more recent software. This possibility represents a very significant departure from the situation that prevailed when the PDB was created, when it was envisioned as a cumulative repository of static contents. A radical paradigm shift for the PDB is therefore proposed, away from the static archive model towards a much more dynamic body of continuously improving results in symbiosis with continuously improving methods and software. These simultaneous improvements in methods and final results are made possible by the current deposition of processed crystallographic data (structure-factor amplitudes) and will be supported further by the deposition of raw data (diffraction images). It is argued that it is both desirable and feasible to carry out small-scale and large-scale efforts to make this paradigm shift a reality. Small-scale efforts would focus on optimizing structures that are of interest to specific investigators. Large-scale efforts would undertake a systematic re-optimization of all of the structures in the PDB, or alternatively the redetermination of groups of structures that are either related to or focused on specific questions. All of the resulting structures should be made generally available, along with the precursor entries, with various views of the structures being made available depending on the types of questions that users are interested in answering. PMID:25286839

Continuous mutual improvement of macromolecular structure models in the PDB and of X-ray crystallographic software: The dual role of deposited experimental data

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

Terwilliger, Thomas C.; Bricogne, Gerard

Accurate crystal structures of macromolecules are of high importance in the biological and biomedical fields. Models of crystal structures in the Protein Data Bank (PDB) are in general of very high quality as deposited. However, methods for obtaining the best model of a macromolecular structure from a given set of experimental X-ray data continue to progress at a rapid pace, making it possible to improve most PDB entries after their deposition by re-analyzing the original deposited data with more recent software. This possibility represents a very significant departure from the situation that prevailed when the PDB was created, when itmore » was envisioned as a cumulative repository of static contents. A radical paradigm shift for the PDB is therefore proposed, away from the static archive model towards a much more dynamic body of continuously improving results in symbiosis with continuously improving methods and software. These simultaneous improvements in methods and final results are made possible by the current deposition of processed crystallographic data (structure-factor amplitudes) and will be supported further by the deposition of raw data (diffraction images). It is argued that it is both desirable and feasible to carry out small-scale and large-scale efforts to make this paradigm shift a reality. Small-scale efforts would focus on optimizing structures that are of interest to specific investigators. Large-scale efforts would undertake a systematic re-optimization of all of the structures in the PDB, or alternatively the redetermination of groups of structures that are either related to or focused on specific questions. All of the resulting structures should be made generally available, along with the precursor entries, with various views of the structures being made available depending on the types of questions that users are interested in answering.« less

NASA total quality management 1989 accomplishments report

NASA Technical Reports Server (NTRS)

Tai, Betty P. (Editor); Stewart, Lynne M. (Editor)

1990-01-01

NASA and contractor employees achieved many notable improvements in 1989. The highlights of those improvements, described in this seventh annual Accomplishments Report, demonstrate that the people who support NASA's activities are getting more involved in quality and continuous improvement efforts. Their gains solidly support NASA's and this Nation's goal to remain a leader in space exploration and in world-wide market competition, and, when communicated to others through avenues such as this report, foster improvement efforts across government and industry. The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories in this report reflect NASA principles set forth in the 1980's and are more commonly known today as Total Quality Management (TQM): top management leadership and support; strategic planning; focus on the customer; employee training and recognition; employee empowerment and teamwork; measurement and analysis; and quality assurance.

Continuous Space Estimation: Increasing WiFi-Based Indoor Localization Resolution without Increasing the Site-Survey Effort.

PubMed

Hernández, Noelia; Ocaña, Manuel; Alonso, Jose M; Kim, Euntai

2017-01-13

Although much research has taken place in WiFi indoor localization systems, their accuracy can still be improved. When designing this kind of system, fingerprint-based methods are a common choice. The problem with fingerprint-based methods comes with the need of site surveying the environment, which is effort consuming. In this work, we propose an approach, based on support vector regression, to estimate the received signal strength at non-site-surveyed positions of the environment. Experiments, performed in a real environment, show that the proposed method could be used to improve the resolution of fingerprint-based indoor WiFi localization systems without increasing the site survey effort.

Continuous Space Estimation: Increasing WiFi-Based Indoor Localization Resolution without Increasing the Site-Survey Effort †

PubMed Central

Hernández, Noelia; Ocaña, Manuel; Alonso, Jose M.; Kim, Euntai

2017-01-01

Although much research has taken place in WiFi indoor localization systems, their accuracy can still be improved. When designing this kind of system, fingerprint-based methods are a common choice. The problem with fingerprint-based methods comes with the need of site surveying the environment, which is effort consuming. In this work, we propose an approach, based on support vector regression, to estimate the received signal strength at non-site-surveyed positions of the environment. Experiments, performed in a real environment, show that the proposed method could be used to improve the resolution of fingerprint-based indoor WiFi localization systems without increasing the site survey effort. PMID:28098773

Feasibility study and verified design concept for new improved hot gas facility

NASA Technical Reports Server (NTRS)

1986-01-01

The MSFC Hot Gas Facility (HGF) was fabricated in 1975 as a temporary facility to provide immediate turnaround testing to support the SRB and ET TPS development. This facility proved to be very useful and was used to make more than 1300 runs, far more than ever intended in the original design. Therefore, it was in need of constant repair and needed to be replaced with a new improved design to support the continuing SRB/ET TPS product improvement and/or removal efforts. MSFC contracted with Lockheed-Huntsville to work on this improved design through contract NAS8-36304 Feasibility Study and Verified Design Concept for the New Improved Hot Gas Facility. The results of Lockheed-Huntsville's efforts under this contract are summarized.

Living donor liver transplant (LDLT) is the way forward in Asia.

PubMed

Rela, Mohamed; Reddy, Mettu Srinivas

2017-03-01

Living donor liver transplantation (LDLT) is currently the commonest form of liver transplantation in Asia. Efforts to improve the number of deceased donor liver transplantation have not been uniformly successful. We believe that THE unique combination of demographic, social, economic and political factors that exist in Asia will ensure that LDLT will continue to remain the predominant form of liver transplantation. While efforts to increase deceased donation rates should continue and intensify, progress in LDLT should also be supported and encouraged, as it will be the main workhorse of liver transplantation in Asia in the near and medium-term future.

Federal Efforts to Promote Innovative Schooling: Can They Succeed?

ERIC Educational Resources Information Center

Wortham, Sue C.

It is doubtful that federal programs are effective in initiating and maintaining improvements in education. Longitudinal studies of Head Start children and other studies commissioned by the Department of Education have indicated no proof that schools improved as a result of these federally funded programs. Project Developmental Continuity (PDC),…

Positioning continuing education: boundaries and intersections between the domains continuing education, knowledge translation, patient safety and quality improvement.

PubMed

Kitto, Simon; Bell, Mary; Peller, Jennifer; Sargeant, Joan; Etchells, Edward; Reeves, Scott; Silver, Ivan

2013-03-01

Public and professional concern about health care quality, safety and efficiency is growing. Continuing education, knowledge translation, patient safety and quality improvement have made concerted efforts to address these issues. However, a coordinated and integrated effort across these domains is lacking. This article explores and discusses the similarities and differences amongst the four domains in relation to their missions, stakeholders, methods, and limitations. This paper highlights the potential for a more integrated and collaborative partnership to promote networking and information sharing amongst the four domains. This potential rests on the premise that an integrated approach may result in the development and implementation of more holistic and effective interdisciplinary interventions. In conclusion, an outline of current research that is informed by the preliminary findings in this paper is also briefly discussed. The research concerns a comprehensive mapping of the relationships between the domains to gain an understanding of potential dissonances between how the domains represent themselves, their work and the work of their 'partner' domains.

Continued Development and Improvement of Pneumatic Heavy Vehicles

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

Robert J. Englar

2005-07-15

The objective of this applied research effort led by Georgia Tech Research Institute is the application of pneumatic aerodynamic technology previously developed and patented by us to the design of an appropriate Heavy Vehicle (HV) tractor-trailer configuration, and experimental confirmation of this pneumatic configuration's improved aerodynamic characteristics. In Phases I to IV of our previous DOE program (Reference 1), GTRI has developed, patented, wind-tunnel tested and road-tested blown aerodynamic devices for Pneumatic Heavy Vehicles (PHVs) and Pneumatic Sports Utility Vehicles (PSUVs). To further advance these pneumatic technologies towards HV and SUV applications, additional Phase V tasks were included in themore » first year of a continuing DOE program (Reference 2). Based on the results of the Phase IV full-scale test programs, these Phase V tasks extended the application of pneumatic aerodynamics to include: further economy and performance improvements; increased aerodynamic stability and control; and safety of operation of Pneumatic HVs. Continued development of a Pneumatic SUV was also conducted during the Phase V program. Phase V was completed in July, 2003; its positive results towards development and confirmation of this pneumatic technology are reported in References 3 and 4. The current Phase VI of this program was incrementally funded by DOE in order to continue this technology development towards a second fuel economy test on the Pneumatic Heavy Vehicle. The objectives of this current Phase VI research and development effort (Ref. 5) fall into two categories: (1) develop improved pneumatic aerodynamic technology and configurations on smaller-scale models of the advanced Pneumatic Heavy Vehicle (PHV); and based on these findings, (2) redesign, modify, and re-test the modified full-scale PHV test vehicle. This second objective includes conduct of an on-road preliminary road test of this configuration to prepare it for a second series of SAE Type-U fuel economy evaluations, as described in Ref. 5. Both objectives are based on the pneumatic technology already developed and confirmed for DOE OHVT/OAAT in Phases I-V. This new Phase VI effort was initiated by contract amendment to the Phase V effort using carryover FY02 funds. This were conducted under a new and distinct project number, GTRI Project A-6935, separate from the Phase I-IV program. However, the two programs are closely integrated, and thus Phase VI continues with the previous program and goals.« less

Project report: Alaska Iways architecture

DOT National Transportation Integrated Search

2005-01-01

The Alaska Department of Transportation and Public Facilities (ADOT&PF) is continually looking at ways to improve the efficiency, safety, and reliability of Alaskas transportation system. This effort includes the application of advanced communicat...

Breakout session: Diversity, cultural competence, and patient trust.

PubMed

Dy, Christopher J; Nelson, Charles L

2011-07-01

The patient population served by orthopaedic surgeons is becoming increasingly more diverse, but this is not yet reflected in our workforce. As the cultural diversity of our patient population grows, we must be adept at communicating with patients of all backgrounds. WHERE ARE WE NOW?: Efforts to improve the diversity of our workforce have been successful in increasing the number of female residents, but there has been no improvement in the number of African American and Hispanic residents. There is currently no centralized effort to recruit minority and female students to the specialty of orthopaedic surgery. The American Academy of Orthopaedic Surgeons has been leading workshops to train residents and practicing surgeons in communication skills and cultural competency. WHERE DO WE NEED TO GO?: We must train the current generation of orthopaedic surgeons to become adept at interacting with patients of all backgrounds. While initiatives for crosscultural communication in orthopaedic surgery have been established, they have not yet been universally incorporated into residency training and Continuing Medical Education programs. HOW DO WE GET THERE?: We must continue to recruit the brightest students of all backgrounds, with a concerted effort to provide equal opportunities for early guidance to all trainees. Opportunities to improve diversity among orthopaedic surgeons exist at many stages in a future physician's career path, including "shadowing" in high school and college and continuing with mentorship in medical school. Additional resources should be dedicated to teaching residents about the immediate relevancy of cultural competency, and faculty should model these proficiencies during their patient interactions.

The ethics of improving African traditional medical practice: scientific or African traditional research methods?

PubMed

Nyika, Aceme

2009-11-01

The disease burden in Africa, which is relatively very large compared with developed countries, has been attributed to various factors that include poverty, food shortages, inadequate access to health care and unaffordability of Western medicines to the majority of African populations. Although for 'old diseases' knowledge about the right African traditional medicines to treat or cure the diseases has been passed from generation to generation, knowledge about traditional medicines to treat newly emerging diseases has to be generated in one way or another. In addition, the existing traditional medicines have to be continuously improved, which is also the case with Western scientific medicines. Whereas one school of thought supports the idea of improving medicines, be they traditional or Western, through scientific research, an opposing school of thought argues that subjecting African traditional medicines to scientific research would be tantamount to some form of colonization and imperialism. This paper argues that continuing to use African traditional medicines for old and new diseases without making concerted efforts to improve their efficacy and safety is unethical since the disease burden affecting Africa may continue to rise in spite of the availability and accessibility of the traditional medicines. Most importantly, the paper commends efforts being made in some African countries to improve African traditional medicine through a combination of different mechanisms that include the controversial approach of scientific research on traditional medicines.

Improving Our Odds: Success through Continuous Risk Management

NASA Technical Reports Server (NTRS)

Greenhalgh, Phillip O.

2009-01-01

Launching a rocket, running a business, driving to work and even day-to-day living all involve some degree of risk. Risk is ever present yet not always recognized, adequately assessed and appropriately mitigated. Identification, assessment and mitigation of risk are elements of the risk management component of the "continuous improvement" way of life that has become a hallmark of successful and progressive enterprises. While the application of risk management techniques to provide continuous improvement may be detailed and extensive, the philosophy, ideals and tools can be beneficially applied to all situations. Experiences with the use of risk identification, assessment and mitigation techniques for complex systems and processes are described. System safety efforts and tools used to examine potential risks of the Ares I First Stage of NASA s new Constellation Crew Launch Vehicle (CLV) presently being designed are noted as examples. Recommendations from lessons learned are provided for the application of risk management during the development of new systems as well as for the improvement of existing systems. Lessons learned and suggestions given are also examined for applicability to simple systems, uncomplicated processes and routine personal daily tasks. This paper informs the reader of varied uses of risk management efforts and techniques to identify, assess and mitigate risk for improvement of products, success of business, protection of people and enhancement of personal life.

Current Calibration Efforts and Performance of the HST Space Telescope Imaging Spectrograph: Echelle Flux Calibration, the BAR5 Occulter, and Lamp Lifetimes

NASA Astrophysics Data System (ADS)

Monroe, TalaWanda R.; Aloisi, Alessandra; Debes, John H.; Jedrzejewski, Robert I.; Lockwood, Sean A.; Peeples, Molly S.; Proffitt, Charles R.; Riley, Allyssa; Walborn, Nolan R.

2016-06-01

The variety of operating modes of the Space Telescope Imaging Spectrograph (STIS) on the Hubble Space Telescope (HST) continues to allow STIS users to obtain unique, high quality observations and cutting-edge results 19 years after its installation on HST. STIS is currently the only instrument available to the astronomy community that allows high spectral and spatial resolution spectroscopy in the FUV and NUV, including echelle modes. STIS also supports solar-blind imaging in the FUV. In the optical, STIS provides long-slit, first-order spectra that take advantage of HST's superb spatial resolution, as well as several unique unfiltered coronagraphic modes, which continue to benefit the exoplanet and debris-disk communities. The STIS instrument team monitors the instrument’s health and performance over time to characterize the effects of radiation damage and continued use of the detectors and optical elements. Additionally, the STIS team continues to improve the quality of data products for the user community. We present updates on efforts to improve the echelle flux calibration of overlapping spectral orders due to changes in the grating blaze function since HST Servicing Mission 4, and efforts to push the contrast limit and smallest inner working angle attainable with the coronagraphic BAR5 occulter. We also provide updates on the performance of the STIS calibration lamps, including work to maintain the accuracy of the wavelength calibration for all modes.

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.

Improving Quality of Seal Leak Test Product using Six Sigma

NASA Astrophysics Data System (ADS)

Luthfi Malik, Abdullah; Akbar, Muhammad; Irianto, Dradjad

2016-02-01

Seal leak test part is a polyurethane material-based product. Based on past data, defect level of this product was 8%, higher than the target of 5%. Quality improvement effort was done using six sigma method that included phases of define, measure, analyse, improve, and control. In the design phase, a Delphi method was used to identify factors that were critical to quality. In the measure phase, stability and process capability was measured. Fault tree analysis (FTA) and failure mode and effect analysis (FMEA) were used in the next phase to analize the root cause and to determine the priority issues. Improve phase was done by compiling, selecting, and designing alternative repair. Some improvement efforts were identified, i.e. (i) making a checklist for maintenance schedules, (ii) making written reminder form, (iii) modifying the SOP more detail, and (iv) performing a major service to the vacuum machine. To ensure the continuity of improvement efforts, some control activities were executed, i.e. (i) controlling, monitoring, documenting, and setting target frequently, (ii) implementing reward and punishment system, (iii) adding cleaning tool, and (iv) building six sigma organizational structure.

Wake County Public School System (WCPSS) District Improvement: 2009-10 Implementation Status [Revised September 17, 2010]. E&R Report No. 10.16

ERIC Educational Resources Information Center

Bulgakov-Cooke, Dina

2010-01-01

In 2009-10 Wake County Public Schools System (WCPSS) exited District Improvement in reading and remained in level one for mathematics. All District Improvement efforts gained momentum. The Sheltered Instruction Observation Protocol (SIOP®) continued as the primary focus to meet the needs of limited English proficient (LEP) students in elementary…

Advanced liquid-cooled, turbocharged and intercooled stratified charge rotary engines for aircraft

NASA Technical Reports Server (NTRS)

Mount, Robert E.; Bartel, John; Hady, William F.

1987-01-01

Developments concerning stratified-charge rotary (SCR) engines over the past 10 years are reviewed. Aircraft engines being developed using SCR technology are shown and described, and the ability of such technology to meet general aviation engine needs is considered. Production timing and availability of SCR technology for the development of aviation rotary engines are discussed, and continuing efforts toward improving this technology, including NASA efforts, are described.

On solid ground. Revenue gains continue to outpace growth in expenses, allowing U.S. hospitals to enjoy record profit and margin.

PubMed

Evans, Melanie

2007-10-29

Hospitals enjoyed a surge in profits last year, reporting an aggregate profit margin of 6%. Executives at financially strong systems credit long-term efforts to improve performance for the results. Elizabeth Concordia, left, of the University of Pittsburgh Medical Center system, says its efforts stressed ongoing consolidation and integration to wipe out waste and errors.

Report: Saving the Chesapeake Bay Watershed Requires Better Coordination of Environmental and Agricultural Resources

EPA Pesticide Factsheets

Report #2007-P-00004, November 20, 2006. Despite significant efforts to improve water quality in the Chesapeake Bay watershed, excess nutrients and sediment continue to impair the Bay’s water quality.

The planet crossing asteroid survey: Progress in the analysis of populations and terrestrial-planet cratering rates

NASA Technical Reports Server (NTRS)

Helin, E. F.; Dunbar, R. S.

1984-01-01

The Planet-Crossing Asteroid Survey (PCAS) is making steady progress toward the accumulation of the data required to make improved estimates of the populations and cratering rates which can be compared with the existing record of impact events. The PCAS is the chief source of new objects on which to base these calculations over the past decade, and is an integral part of the continuing refinement of the estimates used in planetological applications. An adjunct effort to determine albedo statistics from photometry of UCAS plates is being pursued as well, to better define the magnitude frequency distributions of asteroids. This will improve the quality of the population and collision probability calculations. The survey effort continues to discover new asteroids whose orbital characteristics may reveal the origin and evolution mechanisms reponsible for the transport of the planet-crossing asteroids to the inner solar system.

Invited article: Neurology education research.

PubMed

Stern, Barney J; Lowenstein, Daniel H; Schuh, Lori A

2008-03-11

There is a need to rigorously study the neurologic education of medical students, neurology residents, and neurologists to determine the effectiveness of our educational efforts. We review the status of neurologic education research as it pertains to the groups of interest. We identify opportunities and impediments for education research. The introduction of the Accreditation Council for Graduate Medical Education core competencies, the Accreditation Council of Continuing Medical Education requirement to link continuing medical education to improved physician behavior and patient care, and the American Board of Medical Specialties/American Board of Psychiatry and Neurology-mandated maintenance of certification program represent research opportunities. Challenges include numerous methodologic issues such as definition of the theoretical framework of the study, adequate sample size ascertainment, and securing research funding. State-of-the-art education research will require multidisciplinary research teams and innovative funding strategies. The central goal of all concerned should be defining educational efforts that improve patient outcomes.

Federal metering data analysis needs and existing tools

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

Henderson, Jordan W.; Fowler, Kimberly M.

2015-07-01

Agencies have been working to improve their metering data collection, management, and analysis efforts over the last decade (since EPAct 2005) and will continue to address these challenges as new requirements and data needs come into place. Unfortunately there is no “one-size-fits-all” solution. As agencies continue to expand their capabilities to use metered consumption data to reducing resource use and improve operations, the hope is that shared knowledge will empower others to follow suit. This paper discusses the Federal metering data analysis needs and some existing tools.

How Approaches to Stuck-in-the-Mud School Funding Hinder Improvement

ERIC Educational Resources Information Center

Lazarín, Melissa

2013-01-01

Many state and education leaders continue to support and employ methods that prevent schools and principals from undertaking the efforts that they think are most needed to improve education in their classrooms. The use of state categorical grants--funds to school districts with strict limits on their use--exemplifies this lack of innovation in…

Leadership Behaviors for Continuous School Improvement

ERIC Educational Resources Information Center

Williams, Florence S.

2011-01-01

In an effort to improve student achievement in our nation's public schools, former President George W. Bush signed into law the No Child Left Behind (NCLB) Act of 2001. The NCLB Act requires that each State Department of Education establishes a set of standards for student achievement with a grading system for making adequate yearly progress (AYP)…

"What Do I Do with the Data Now?": Analyzing Assessment Information for Accountability and Improvement

ERIC Educational Resources Information Center

Pieper, Suzanne L.; Fulcher, Keston H.; Sundre, Donna L.; Erwin, T. Dary

2008-01-01

Most colleges and universities have implemented an assessment program of some kind in an effort to respond to calls for accountability from stakeholders as well as to continuously improve student learning on their campuses. While institutions administer assessment instruments to students and receive reports, many campuses do not reap the maximum…

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.

MTSS Coaching: Bridging Knowing to Doing

ERIC Educational Resources Information Center

Freeman, Jennifer; Sugai, George; Simonsen, Brandi; Everett, Susannah

2017-01-01

Improving educator effectiveness and school functioning requires continuous attention to practice selection, implementation fidelity, and progress monitoring, especially in the context of systemic school reform efforts. As such, supporting professional development must be targeted, comprehensive, efficient, and relevant. In particular, coaching…

TARDEC 30-Year Strategy Value Stream Analysis

DTIC Science & Technology

2015-07-01

reduce gun barrel weights and recoil loads, while maintaining or improving energy-on-target metrics. iv. Continue to invest in efforts to...capability, including steels , stainless steel and titanium alloys, among others. Physical Simulation & Test (PS&T) Mark Brudnak

U.S. Army Medical Research Institute of Infectious Disease Annual Progress Report, Fiscal Year 1985

DTIC Science & Technology

1985-10-01

response. 25. (U) 8410-8509-Tangential flow filtration was developed as a safer method of harvesting the 50-L anthrax fermenter cultures...yearly boosters. Efforts over several years have sought to improve this chemical vaccine through optimization of fermenter and recovery techniques so...A collaborative effort with WLAIR led to production of candidate human hybridomas to PA. Progrses: The 50-liter fermenter continues to be used

Multifunctional Thermal Structures Using Cellular Contact-Aided Complaint Mechanisms

DTIC Science & Technology

2016-10-31

control . During this research effort, designs of increasing sophistication consistently outstripped the ability to fabricate them. Basic questions...using   non -­dimensional  models   In continuing design research , a topology optimization approach was crafted to maximize the thermal performance of the...methods could conceivably produce the elegant but complex material and geometric designs contemplated. Continued research is needed to improve the

Multifunctional Thermal Structures Using Cellular Contract-Aided Complaint Mechanisms

DTIC Science & Technology

2017-01-26

control . During this research effort, designs of increasing sophistication consistently outstripped the ability to fabricate them. Basic questions...using   non -­dimensional  models   In continuing design research , a topology optimization approach was crafted to maximize the thermal performance of the...methods could conceivably produce the elegant but complex material and geometric designs contemplated. Continued research is needed to improve the

Guidelines for development of the Iowa statewide transportation improvement program (STIP). Revised.

DOT National Transportation Integrated Search

2004-01-01

The Transportation Equity Act for the 21st Century (TEA-21) continues the Intermodal Surface Transportation Efficiency Act of 1991's requirement for an extensive, ongoing cooperative planning effort for programming federal funding. Iowa's STIP is dev...

Guidelines for Preparing Economic Analysis (2010, revised 2014)

EPA Pesticide Factsheets

The Guidelines for Preparing Economic Analyses: External Review Draft have been prepared for review by the EPA Science Advisory Board and are part of a continuing effort by the U.S. EPA to develop improved economic guidance to support decision making.

Virgin Islands: Coral Bay Watershed Management (A Former EPA CARE Project)

EPA Pesticide Factsheets

The Coral Bay Watershed Management is a recipient of the Level II CARE cooperative agreement to continue and expand its collective efforts to stop erosion, sediment, and storm-water pollution of Coral Bay, improve solid waste management,

Seismic performance of steel pipe pile to cap beam moment resisting connections.

DOT National Transportation Integrated Search

2013-01-01

This research, a joint effort between AUTC and North Carolina State University, is a continuation of an ngoing project that investigated bridge and marine structure : design practices, aiming to identify improved connection design approaches to produ...

Improved Scheme of Modified Gaussian Deconvolution for Reflectance Spectra of Lunar Soils

NASA Technical Reports Server (NTRS)

Hiroi, T.; Pieters, C. M.; Noble, S. K.

2000-01-01

In our continuing effort for deconvolving reflectance spectra of lunar soils using the modified Gaussian model, a new scheme has been developed, including a new form of continuum. All the parameters are optimized with certain constraints.

Understanding and preventing military suicide.

PubMed

Bryan, Craig J; Jennings, Keith W; Jobes, David A; Bradley, John C

2012-01-01

The continual rise in the U.S. military's suicide rate since 2004 is one of the most vexing issues currently facing military leaders, mental health professionals, and suicide experts. Despite considerable efforts to address this problem, however, suicide rates have not decreased. The authors consider possible reasons for this frustrating reality, and question common assumptions and approaches to military suicide prevention. They further argue that suicide prevention efforts that more explicitly embrace the military culture and implement evidence-based strategies across the full spectrum of prevention and treatment could improve success. Several recommendations for augmenting current efforts to prevent military suicide are proposed.

78 FR 12221 - National School Lunch Program: Direct Certification Continuous Improvement Plans Required by the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-22

..., Hunger-Free Kids Act of 2010 AGENCY: Food and Nutrition Service, USDA. ACTION: Final rule. SUMMARY: This... Healthy, Hunger-Free Kids Act of 2010 designed to encourage States to improve direct certification efforts.../CNP/cnp.htm .) Section 101(b) of Public Law 111-296, the Healthy, Hunger-Free Kids Act of 2010 (HHFKA...

HSE training and competence assessment in the geophysical industry

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

Covil, M.W.; Soethout, J.A.; Reynolds, G.

1996-11-01

This paper looks at the efforts of the seismic geophysical industry to continually improve it`s health, safety and environmental performance, and in particular to improve the HSE behavior and understanding of individuals within the industry. Specifically it deals with the HSE training and assessment of competence of individuals in relation to their job responsibilities, based on best industry practice.

Quick and continuous improvement through kaizen blitz.

PubMed

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

1999-05-01

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

Year End Progress Report on Rattlesnake Improvements

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

Wang, Yaqi; DeHart, Mark David; Gleicher, Frederick Nathan

Rattlesnake is a MOOSE-based radiation transport application developed at INL to support modern multi-physics simulations. At the beginning of the last year, Rattlesnake was able to perform steady-state, transient and eigenvalue calculations for the multigroup radiation transport equations. Various discretization schemes, including continuous finite element method (FEM) with discrete ordinates method (SN) and spherical harmonics expansion method (PN) for the self-adjoint angular flux (SAAF) formulation, continuous FEM (CFEM) with SN for the least square (LS) formulation, diffusion approximation with CFEM and discontinuous FEM (DFEM), have been implemented. A separate toolkit, YAKXS, for multigroup cross section management was developed to supportmore » Rattlesnake calculations with feedback both from changes in the field variables, such as fuel temperature, coolant density, and etc., and in isotope inventory. The framework for doing nonlinear diffusion acceleration (NDA) within Rattlesnake has been set up, and both NDA calculations with SAAF-SN-CFEM scheme and Monte Carlo with OpenMC have been performed. It was also used for coupling BISON and RELAP-7 for the full-core multiphysics simulations. Within the last fiscal year, significant improvements have been made in Rattlesnake. Rattlesnake development was migrated into our internal GITLAB development environment at the end of year 2014. Since then total 369 merge requests has been accepted into Rattlesnake. It is noted that the MOOSE framework that Rattlesnake is based on is under continuous developments. Improvements made in MOOSE can improve the Rattlesnake. It is acknowledged that MOOSE developers spent efforts on patching Rattlesnake for the improvements made on the framework side. This report will not cover the code restructuring for better readability and modularity and documentation improvements, which we have spent tremendous effort on. It only details some of improvements in the following sections.« less

Monitoring and evaluation of disaster response efforts undertaken by local health departments: a rapid realist review.

PubMed

Gossip, Kate; Gouda, Hebe; Lee, Yong Yi; Firth, Sonja; Bermejo, Raoul; Zeck, Willibald; Jimenez Soto, Eliana

2017-06-29

Local health departments are often at the forefront of a disaster response, attending to the immediate trauma inflicted by the disaster and also the long term health consequences. As the frequency and severity of disasters are projected to rise, monitoring and evaluation (M&E) efforts are critical to help local health departments consolidate past experiences and improve future response efforts. Local health departments often conduct M&E work post disaster, however, many of these efforts fail to improve response procedures. We undertook a rapid realist review (RRR) to examine why M&E efforts undertaken by local health departments do not always result in improved disaster response efforts. We aimed to complement existing frameworks by focusing on the most basic and pragmatic steps of a M&E cycle targeted towards continuous system improvements. For these purposes, we developed a theoretical framework that draws on the quality improvement literature to 'frame' the steps in the M&E cycle. This framework encompassed a M&E cycle involving three stages (i.e., document and assess, disseminate and implement) that must be sequentially completed to learn from past experiences and improve future disaster response efforts. We used this framework to guide our examination of the literature and to identify any context-mechanism-outcome (CMO) configurations which describe how M&E may be constrained or enabled at each stage of the M&E cycle. This RRR found a number of explanatory CMO configurations that provide valuable insights into some of the considerations that should be made when using M&E to improve future disaster response efforts. Firstly, to support the accurate documentation and assessment of a disaster response, local health departments should consider how they can: establish a culture of learning within health departments; use embedded training methods; or facilitate external partnerships. Secondly, to enhance the widespread dissemination of lessons learned and facilitate inter-agency learning, evaluation reports should use standardised formats and terminology. Lastly, to increase commitment to improvement processes, local health department leaders should possess positive leadership attributes and encourage shared decision making. This study is among the first to conduct a synthesis of the CMO configurations which facilitate or hinder M&E efforts aimed at improving future disaster responses. It makes a significant contribution to the disaster literature and provides an evidence base that can be used to provide pragmatic guidance for improving M&E efforts of local health departments. PROSPERO 2015: CRD42015023526 .

Additive manufacturing technology in reconstructive surgery.

PubMed

Fuller, Scott C; Moore, Michael G

2016-10-01

Technological advances have been part and parcel of modern reconstructive surgery, in that practitioners of this discipline are continually looking for innovative ways to perfect their craft and improve patient outcomes. We are currently in a technological climate wherein advances in computers, imaging, and science have coalesced with resulting innovative breakthroughs that are not merely limited to improved outcomes and enhanced patient care, but may provide novel approaches to training the next generation of reconstructive surgeons. New developments in software and modeling platforms, imaging modalities, tissue engineering, additive manufacturing, and customization of implants are poised to revolutionize the field of reconstructive surgery. The interface between technological advances and reconstructive surgery continues to expand. Additive manufacturing techniques continue to evolve in an effort to improve patient outcomes, decrease operative time, and serve as instructional tools for the training of reconstructive surgeons.

New market opportunities for rice grains

USDA-ARS?s Scientific Manuscript database

Breeding efforts for rice have been focusing on increasing yield and improving quality (milling yield and grain quality), while maintaining cooked rice sensory properties to meet consumer preferences. These breeding targets will no doubt continue as the main foci for the rice industry. However, the ...

Semiannual Report: Oct 1, 2000 - Mar 31, 2001

EPA Pesticide Factsheets

Semiannual Report #EPA-350-K-01-001, May, 2001. Our new structure provides a solid foundation for the OIG's efforts to continuously improve its performance, and I am certain that it will greatly enhance our ability to be agents of positive change.

Challenges in Hospital-Associated Infection Management: A Unit Perspective.

PubMed

Stacy, Kathleen M

2015-01-01

Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.

Estimating benefits of past, current, and future reductions in smoking rates using a comprehensive model with competing causes of death.

PubMed

van Meijgaard, Jeroen; Fielding, Jonathan E

2012-01-01

Despite years of declining smoking prevalence, tobacco use is still the leading preventable contributor to illness and death in the United States, and the effect of past tobacco-use control efforts has not fully translated into improvements in health outcomes. The objective of this study was to use a life course model with multiple competing causes of death to elucidate the ongoing benefits of tobacco-use control efforts on US death rates. We used a continuous-time life course simulation model for the US population. We modeled smoking initiation and cessation and 20 leading causes of death as competing risks over the life span, with the risk of death for each cause dependent on past and current smoking status. Risk parameters were estimated using data from the National Health Interview Survey that were linked to follow-up mortality data. Up to 14% (9% for men, 14% for women) of the total gain in life expectancy since 1960 was due to tobacco-use control efforts. Past efforts are expected to further increase life expectancy by 0.9 years for women and 1.3 years for men. Additional reduction in smoking prevalence may eventually yield an average 3.4-year increase in life expectancy in the United States. Coronary heart disease is expected to increase as a share of total deaths. A dynamic individual-level model with multiple causes of death supports assessment of the delayed benefits of improved tobacco-use control efforts. We show that past smoking reduction efforts will translate into further increases in life expectancy in the coming years. Smoking will remain a major contributor to preventable illness and death, worthy of continued interventions.

Silicon dendritic web growth

NASA Technical Reports Server (NTRS)

Duncan, S.

1984-01-01

Technological goals for a silicon dendritic web growth program effort are presented. Principle objectives for this program include: (1) grow long web crystals front continuously replenished melt; (2) develop temperature distribution in web and melt; (3) improve reproductibility of growth; (4) develop configurations for increased growth rates (width and speed); (5) develop new growth system components as required for improved growth; and (6) evaluate quality of web growth.

Efforts to Improve Teacher Competence in Developing a Lesson Plan through Sustainable Guidance in SMKN 1 Mamuju

ERIC Educational Resources Information Center

Sudirman

2017-01-01

This study aims to improve the competence of teachers in preparing a lesson plan through continuous guidance in SMK 1 Mamuju, West Sulawesi province. Action research school is implemented through two cycles to see an increase in the competence of teachers write eleven components in the lesson plan. In the first cycle (first) all Master (twelve)…

CONTINUOUS FILAMENT CERAMIC FIBER

DTIC Science & Technology

high-silica glass compositions. NbB2 gave the most promising results of the materials examined. Time and temperature relationships as well as variations...in bath composition were investigated in an effort to improve premelt characteristics. The addition of V2O5 was particularly effective. It had been

Developing Alnus for use in intensive culture

Treesearch

Richard B. Hall; Gregory A. Miller; Terry L. Robison; Oghenekome U. Onokpise

1983-01-01

Provenance tests and one clonal test have been analyzed to provide guidelines for the continuing efforts on the genetic improvement of Alnus. Observations also are made on the need for experiments with other silvicultural alternatives that might be applied to the intensive culture of alders.

Arizona Commission of Indian Affairs 1983 Annual Report.

ERIC Educational Resources Information Center

Arizona Commission of Indian Affairs, Phoenix.

Intended to provide insight into the proceedings, transactions, and findings of the Arizona Commission of Indian Affairs, the 1983 annual report reflects the Commission's continued efforts to improve communications and understanding, and especially to strengthen working relationships between Arizona tribes and state government. The report…

Why is Improving Water Quality in the Gulf of Mexico so Critical?

EPA Pesticide Factsheets

The EPA regional offices and the Gulf of Mexico Program work with Gulf States to continue to maximize the efficiency and utility of water quality monitoring efforts for local managers by coordinating and standardizing state and federal water quality data

Training for Trade: Role of American Community Colleges.

ERIC Educational Resources Information Center

Wismer, Jack N.

Today, global competition affects almost every business or industry, often triggering corporate restructuring, downsizing, focus on continuous quality improvement, heightened efforts to globalize companies and increase exports. To meet the competitive challenges of a global economy, community colleges can better serve business and industry by…

Application of ISO 9000 Standards to Education and Training.

ERIC Educational Resources Information Center

Van den Berghe, Wouter

1998-01-01

ISO 9000 certification has the advantages of a measurable framework for quality efforts, continuous improvement, and better customer service. Drawbacks for education and training providers include volume of paperwork, ongoing cost, risk of a growing bureaucracy, and the difficulty of making changes quickly. (SK)

Developmental Challenges of SMES Technology for Applications

NASA Astrophysics Data System (ADS)

Rong, Charles C.; Barnes, Paul N.

2017-12-01

This paper reviews the current status of high temperature superconductor (HTS) based superconducting magnetic energy storage (SMES) technology as a developmental effort. Discussion centres on the major challenges in magnet optimization, loss reduction, cooling improvement, and new development of quench detection. The cryogenic operation for superconductivity in this technological application requires continued research and development, especially with a greater engineering effort that involves the end user. For the SMES-based technology to more fully mature, some suggestions are given for consideration and discussion.

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

Practical Approaches to Quality Improvement for Radiologists.

PubMed

Kelly, Aine Marie; Cronin, Paul

2015-10-01

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

Recent Enhancements to the National Transonic Facility

NASA Technical Reports Server (NTRS)

Kilgore, W. A.; Balakrishna, S.; Bobbitt, C. W.; Underwood, P.

2003-01-01

The National Transonic Facility continues to make enhancements to provide quality data in a safe, efficient and cost effective method for aerodynamic ground testing. Recent enhancements discussed in this paper include the restoration of reliability and improved performance of the heat exchanger systems resulting in the expansion of the NTF air operations envelope. Additionally, results are presented from a continued effort to reduce model dynamics through the use of a new stiffer balance and sting

Sustaining a quality improvement culture in local health departments applying for accreditation.

PubMed

Verma, Pooja; Moran, John W

2014-01-01

This article focuses on local health departments (LHDs) that are advanced in accreditation and quality improvement (QI) efforts and the barriers and facilitators associated with sustaining improvements and building an organizational culture of QI. To understand the barriers and facilitators associated with building and sustaining progress toward a QI culture in LHDs. Quantitative data from a self-reporting survey and qualitative data from telephone interviews. Twenty-two LHDs across the United States responded to the survey. Ten of the 22 LHD respondents participated in telephone interviews. QI lead staff at LHDs that are advanced in accreditation preparation and QI. Self-reported LHD survey ratings against indicators for a QI culture, and the identified barriers and facilitators around sustaining QI initiatives. Of the 6 domains of a QI culture measured in the survey, the percentages of respondents that scored themselves highly to at least 1 indicator in each domain are as follows: leadership commitment (100%); employee empowerment (100%); teamwork and collaboration (100%); continuous process improvement (86%); customer focus (72%); and QI infrastructure (64%). Qualitative data from 10 telephone interviews revealed that key barriers to sustaining progress around QI included staff turnover, budget cuts, and major crises or events that arise as priority. Key facilitators included leadership commitment, accreditation, and dedication of resources and staff time to QI. When engaging in QI, LHDs should consider investing efforts in gaining leadership support and dedicating staff time early in the QI journey to ensure that QI efforts and initiatives are sustained. Local health departments interested in developing a QI culture should also consider pursuing accreditation, as it provides a structured framework for continuous improvement. They should also actively develop QI knowledge and skills among all staff members to minimize the negative impact of staff turnover.

Interprofessionalism: Educating to meet patient needs.

PubMed

Kirch, Darrell G; Ast, Cori

2015-01-01

Interprofessional teams in health care are showing promise in achieving the triple aim-providing better care for the individual patient, reducing costs, and improving population health. To complement current changes in health care delivery in the United States, there is a growing consensus among health professions educators that students should be trained in interprofessional models prior to entering clinical practice. Current interprofessional education (IPE) efforts in anatomy education are producing positive results in enhancing professional respect, collaboration, and teamwork among health professions students. In spite of existing structural and cultural barriers to IPE, health professions educators must continue to lead and grow IPE efforts as a critical component to improving the health of our nation. © 2014 American Association of Anatomists.

Renovating Early Childhood Education Pedagogy: A Case Study in Vietnam

ERIC Educational Resources Information Center

Thao, Dang Phuong; Boyd, Wendy Anne

2014-01-01

Since 2003, the Vietnamese government has prioritised curriculum reform efforts and commitment to improving the quality of the national curriculum. The Vietnamese early childhood education renovation has encountered considerable changes and challenges, particularly in the area of pedagogical approaches. Many early childhood teachers continue to…

Principal Preparedness: Superintendent Perceptions of New Principals

ERIC Educational Resources Information Center

Cray, Martha; Weiler, Spencer C.

2011-01-01

National advocacy groups have undertaken significant efforts to define the performance capacities needed by principals to lead schools in this era of continuous improvement and accountability. There has been little articulation between the core skills essential to new principals and the leadership capacities of experienced peers. This study…

Tinder Elementary: A Case Study of the Quest Network.

ERIC Educational Resources Information Center

Howley-Rowe, Caitlin

In 1996, Quest staff began working with teams from school communities in three West Virginia county school districts to invigorate efforts for continuous school improvement. This first learning community consisted of students, teachers, administrators, parents, and community members, who ultimately wrote individual school visions and improvement…

Rois Langner | NREL

Science.gov Websites

engineer in the Commercial Buildings Research Group at NREL since 2010. Her research efforts have focused optimize building design and performance for military and large commercial buildings. She has also worked continual energy improvement, and more recently is working to support the small commercial building sector

The Robot in the Crib: A Developmental Analysis of Imitation Skills in Infants and Robots

ERIC Educational Resources Information Center

Demiris, Yiannis; Meltzoff, Andrew

2008-01-01

Interesting systems, whether biological or artificial, develop. Starting from some initial conditions, they respond to environmental changes, and continuously improve their capabilities. Developmental psychologists have dedicated significant effort to studying the developmental progression of infant imitation skills, because imitation underlies…

FOCUSING ON CHILDREN’S INHALATION DOSIMETRY AND HEALTH EFFECTS FOR RISK ASSESSMENT: AN INTRODUCTION

EPA Science Inventory

Substantial effort has been invested in improving children’s health risk assessment in recent years. However, the body of scientific evidence in support of children’s health assessment is constantly advancing requiring continual updating of risk assessment methods. Children’s i...

Social Studies Course of Study.

ERIC Educational Resources Information Center

Miller, John E.; Murphy, Terrence A.

This K-12 sequential course of study is the result of one school district's efforts to improve continuity in the social studies curriculum. Following an introduction and statement of philosophy, the program is organized around four basic educational areas--knowledge, application, valuing, and participation. Specific program goals include promoting…

An intelligent processing environment for real-time simulation

NASA Technical Reports Server (NTRS)

Carroll, Chester C.; Wells, Buren Earl, Jr.

1988-01-01

The development of a highly efficient and thus truly intelligent processing environment for real-time general purpose simulation of continuous systems is described. Such an environment can be created by mapping the simulation process directly onto the University of Alamba's OPERA architecture. To facilitate this effort, the field of continuous simulation is explored, highlighting areas in which efficiency can be improved. Areas in which parallel processing can be applied are also identified, and several general OPERA type hardware configurations that support improved simulation are investigated. Three direct execution parallel processing environments are introduced, each of which greatly improves efficiency by exploiting distinct areas of the simulation process. These suggested environments are candidate architectures around which a highly intelligent real-time simulation configuration can be developed.

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

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

Nishizawa, Eiichi

1995-03-01

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

Improvements to the Total Temperature Calibration of the NASA Glenn Icing Research Tunnel

NASA Technical Reports Server (NTRS)

Arrington, E. Allen; Gonsalez, Jose C.

2005-01-01

The ability to accurately set repeatable total temperature conditions is critical for collecting quality icing condition data, particularly near freezing conditions. As part of efforts to continually improve data quality in the NASA Glenn Icing Research Tunnel (IRT), new facility instrumentation and new calibration hardware for total temperature measurement were installed and new operational techniques were developed and implemented. This paper focuses on the improvements made in the calibration of total temperature in the IRT.

Improved blood glucose estimation through multi-sensor fusion.

PubMed

Xiong, Feiyu; Hipszer, Brian R; Joseph, Jeffrey; Kam, Moshe

2011-01-01

Continuous glucose monitoring systems are an integral component of diabetes management. Efforts to improve the accuracy and robustness of these systems are at the forefront of diabetes research. Towards this goal, a multi-sensor approach was evaluated in hospitalized patients. In this paper, we report on a multi-sensor fusion algorithm to combine glucose sensor measurements in a retrospective fashion. The results demonstrate the algorithm's ability to improve the accuracy and robustness of the blood glucose estimation with current glucose sensor technology.

Continual Improvement in Shuttle Logistics

NASA Technical Reports Server (NTRS)

Flowers, Jean; Schafer, Loraine

1995-01-01

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

A Upgrade of the Aeroheating Software "MINIVER"

NASA Technical Reports Server (NTRS)

Louderback, Pierce

2013-01-01

Many software packages assist engineers with performing flight vehicle analysis, but some of these packages have gone many years without updates or significant improvements to their workflows. One such software package, known as MINIVER, is a powerful yet lightweight tool used for aeroheating analyses. However, it is an aging program that has not seen major improvements within the past decade. As part of a collaborative effort with the Florida Institute of Technology, MINIVER has received a major user interface overhaul, a change in program language, and will be continually receiving updates to improve its capabilities. The user interface update includes a migration from a command-line interface to that of a graphical user interface supported in the Windows operating system. The organizational structure of the pre-processor has been transformed to clearly defined categories to provide ease of data entry. Helpful tools have been incorporated, including the ability to copy sections of cases as well as a generalized importer which aids in bulk data entry. A visual trajectory editor has been included, as well as a CAD Editor which allows the user to input simplified geometries in order to generate MINIVER cases in bulk. To demonstrate its continued effectiveness, a case involving the JAXA OREX flight vehicle will be included, providing comparisons to captured flight data as well as other computational solutions. The most recent upgrade effort incorporated the use of the CAD Editor, and current efforts are investigating methods to link MINIVER projects with SINDA/Fluint and Thermal Desktop.

An Upgrade of the Aeroheating Software "MINIVER"

NASA Technical Reports Server (NTRS)

Louderback, Pierce M.

2013-01-01

Many software packages assist engineers with performing flight vehicle analysis, but some of these packages have gone many years without updates or significant improvements to their workflows. One such software, known as MINIVER, is a powerful yet lightweight tool that is used for aeroheating analyses. However, it is an aging program that has not seen major improvements within the past decade. As part of a collaborative effort with Florida Institute of Technology, MINIVER has received a major user interface overhaul, a change in program language, and will be continually receiving updates to improve its capabilities. The user interface update includes a migration from a command-line interface to that of a graphical user interface supported in the Windows operating system. The organizational structure of the preprocessor has been transformed to clearly defined categories to provide ease of data entry. Helpful tools have been incorporated, including the ability to copy sections of cases as well as a generalized importer which aids in bulk data entry. A visual trajectory editor has been included, as well as a CAD Editor which allows the user to input simplified geometries in order to generate MINIVER cases in bulk. To demonstrate its continued effectiveness, a case involving the JAXA OREX flight vehicle will be included, providing comparisons to captured flight data as well as other computational solutions. The most recent upgrade effort incorporated the use of the CAD Editor, and current efforts are investigating methods to link MINIVER projects with SINDA/Fluint and Thermal Desktop.

Treating Wisely: The Surgeon's Role in Antibiotic Stewardship.

PubMed

Leeds, Ira L; Fabrizio, Anne; Cosgrove, Sara E; Wick, Elizabeth C

2017-05-01

: Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices. Local quality improvement efforts suggest that antibiotic misuse for surgical disease is common. Opportunities exist as part of day-to-day surgical care as well as through surgeons' interactions with nonsurgeon colleagues and policy experts. This article discusses the scope of the antibiotic misuse in surgery for surgical patients, and provides immediate practice improvements and also advocacy efforts surgeons can take to address the threat. We believe that surgical antibiotic prescribing patterns frequently do not adhere to evidence-based practices; surgeons are in a position to mitigate their ill effects; and antibiotic stewardship should be a part of every surgeons' practice.

False Premises, False Promises: The Mythical Character of Public Discourse about Education.

ERIC Educational Resources Information Center

Hawley, Willis D.

1985-01-01

Available research disproves a number of myths concerning educational quality, but the myths continue to influence educational reform efforts. The three categories of reform that could actually prove effective all affect teachers directly: salary raises, improved working conditions, and alterations in the professional structure of teaching. (PGD)

Critical and Transformative Practices in Professional Learning Communities

ERIC Educational Resources Information Center

Servage, Laura

2008-01-01

Professional learning communities (PLCs) have been held up as powerful structures for teachers' continuing professional development. In this work, the author has applied transformative learning theory to highlight the psychic risks of collaborative teacher learning, as well as the need for practical efforts to improve student learning--the means…

Continuing Efforts to Upgrade the Aeronautics Curriculum at Jacksonville University

ERIC Educational Resources Information Center

Terrell, Jerry L.; Merkt, Juan; Harrison, Jeffrey; Yates, Rhett

2012-01-01

The aviation industry is exceptionally dynamic. Advances in technology have enabled the industry to change drastically in a short period of time. The transition to jet propulsion advances in aerodynamics, avionics improvements, and introduction of revolutionary navigation systems have all occurred within the past 60 years. These advances have…

Expanding Quality for Infants and Toddlers: Colorado Implements Touchpoints

ERIC Educational Resources Information Center

Watson, Wendy; Koehn, Jo; Desrochers, Lisa

2012-01-01

As coordinators of local early childhood coalitions working to improve the quality of early childhood programs, the authors had been looking for ways to support early childhood professionals in their efforts to strengthen partnerships with families, support young children's healthy emotional development, and continue to promote developmentally…

45 CFR 2516.810 - What types of evaluations are grantees and subgrantees required to perform?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Welfare (Continued) CORPORATION FOR NATIONAL AND COMMUNITY SERVICE SCHOOL-BASED SERVICE-LEARNING PROGRAMS...? All grantees and subgrantees are required to perform internal evaluations which are ongoing efforts to assess performance and improve quality. Grantees and subgrantees may, but are not required to, arrange...

The College Completion Agenda: State Policy Guide. Latino Edition

ERIC Educational Resources Information Center

College Board Advocacy & Policy Center, 2011

2011-01-01

State public policy has been an important tool for improving the educational preparation and opportunity for many communities. However, without concerted statewide efforts it will continue to be difficult to substantially expand opportunities to accelerate higher education attainment and workforce preparation. Over the next 15 years, the states…

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…

A Mobile Application for Discovery

ERIC Educational Resources Information Center

Zylstra, Robert

2011-01-01

The last 5 years have heralded a number of important changes to virtual libraries in academic and public settings. Despite this continual effort to improve library catalogs and websites, the fundamentals of these online spaces remain relatively unchanged. Digital collections are within reach of many libraries, yet they remain difficult to…

A PROPOSED NEW SCHOOL FORMAT, CONTINUOUS PROGRESS CENTERS.

ERIC Educational Resources Information Center

GREAVES, JACK

SEATTLE, WASHINGTON, HAS MADE EFFORTS TO IMPROVE RACIAL BALANCE IN THE SCHOOLS BY INSTITUTING VOLUNTARY, MANDATORY, AND REVERSE TRANSFER PROGRAMS, IN WHICH 1500 NEGRO AND 90 WHITE STUDENTS HAVE ALREADY PARTICIPATED. MOREOVER IN ANTICIPATION OF INCREASED INMIGRATION, THE CITY HAS DEVELOPED A NEW TYPE OF SCHOOL STRUCTURE FOR URBAN LIVING, THE…

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…

A new chicken genome assembly provides insight into avian genome structure

USDA-ARS?s Scientific Manuscript database

The importance of the Gallus gallus (chicken) as a model organism and agricultural animal merits a continuation of sequence assembly improvement efforts. We present a new version of the chicken genome assembly (Gallus_gallus-5.0; GCA_000002315.3) built from combined long single molecule sequencing t...

Continuing Medical Education Reform for Competency-Based Education and Assessment

ERIC Educational Resources Information Center

Nahrwold, David L.

2005-01-01

The development of competency-based education and evaluation for residents and practicing physicians by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties (ABMS), respectively, includes the competency of practice-based learning and improvement. Efforts to implement this and the other competencies…

Meta-Analysis of Lost Ecosystem Attributes in Urban Streams and the Effectiveness of Out-of-Channel Management Practices

EPA Science Inventory

Watershed development is a leading cause of stream impairment, and it increasingly threatens the availability, quality, and sustainability of freshwater resources as human populations continue to grow and migrate. Most efforts have focused on trying to improve ecological conditio...

Holistic Mentoring and Coaching to Sustain Organizational Change and Innovation

ERIC Educational Resources Information Center

Hollywood, Kathryn G.; Blaess, Donna A.; Santin, Claudia; Bloom, Lisa

2016-01-01

Collaborative problem solving, creativity, innovation, and continuously improved performance outcomes are the normative expectations for organizations in the early 21st century. At the same time, workers seek not only equitable compensation for their efforts, but also opportunities for professional growth and development as well as acknowledgement…

MECHANIZATION OF FARM OPERATIONS IN 1965.

ERIC Educational Resources Information Center

SANDERS, GROVER H.

INCREASED MECHANIZATION, MORE EXTENSIVE USE OF CHEMICALS, AND OTHER TECHNOLOGICAL DEVELOPMENTS HAVE REDUCED FARM-LABOR NEEDS AND INCREASED AGRICULTURAL PRODUCTION. COTTON, SUGAR BEETS, POTATOES, AND VEGETABLES FOR PROCESSING ARE SOME OF THE CROPS REQUIRING FEWER MAN-HOURS DUE TO NEW OR IMPROVED TECHNOLOGY. CONTINUOUS EFFORT HAS BEEN MADE TO DESIGN…

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

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

ERIC Educational Resources Information Center

US Department of Education, 2006

2006-01-01

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

A Comparative Study between U.S. and Brazilian Acquisition Regulations and Practices

DTIC Science & Technology

2011-03-01

to describe continuous improvements efforts ( Render and Heizer , 2008). Caddick and Dale (1998) on their paper ‘The impact of quality management on...2002). Outsourcing in Edinburgh and the Lothians. European Journal of Purchasing and Supply Chain Management 8 (2) 83-95. Render , Barry; Heizer , Jay

PREFACE: SPECIAL ISSUE OF ATMOSPHERIC ENVIRONMENT, FOR PARTICULATE MATTER: ATMOSPHERIC SCIENCES, EXPOSURE AND THE FOURTH COLLOQUIUM ON PM AND HUMAN HEALTH

EPA Science Inventory

In a continuing effort to improve communications among the atmospheric sciences, policy, and health communities, an international specialty conference was initiated in 2001 that took place in April 2003 in Pittsburgh, PA. The conference entitled, "Particulate Matter: Atmospheric...

Language, Literacy, and Educational Reform: Rethinking the Issues.

ERIC Educational Resources Information Center

Reyes, Maria de la Luz; McCollum, Pamela A.

1992-01-01

In spite of increasing ethnic, linguistic, and socioeconomic diversity, educational reform efforts continue to target mainstream English-speaking U.S. public. The educational plans of the America 2000 initiative are no exception. This theme issue provides examples of classroom-based research in which educators try to improve literacy education for…

Improving Business-IT Alignment through Business Architecture

ERIC Educational Resources Information Center

Li, Chingmei

2010-01-01

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

Economic Development and Employment Opportunities for American Indians.

ERIC Educational Resources Information Center

Sandefur, Gary D.

American Indian unemployment remains high despite efforts by tribes and the federal government to improve employment opportunities. Persistently high unemployment among Indians has resulted in low family incomes and high poverty rates relative to Whites. Particularly serious on reservations, these continuing problems are related in part to low…

Instructors' Perceptions of Instructor Presence in Online Learning Environments

ERIC Educational Resources Information Center

Richardson, Jennifer C.; Besser, Erin; Koehler, Adrie; Lim, JiEun; Strait, Marquetta

2016-01-01

As online learning continues to grow significantly, various efforts have been explored and implemented in order to improve the instructional experiences of students. Specifically, research indicates that how an instructor establishes his or her presence in an online environment can have important implications for the students' overall learning…

FOCUSING ON CHILDREN'S INHALATION DOSIMETRY AND HEALTH EFFECTS FOR RISK ASSESSMENT: AN INTRODUCTION (Journal Article)

EPA Science Inventory

Substantial effort has been invested in improving children’s health risk assessment in recent years. However, the body of scientific evidence in support of children’s health assessment is constantly advancing requiring continual updating of risk assessment methods. Children’s i...

Solutions Network Formulation Report. The Potential Contribution of the Landsat Data Continuity Mission to the Mississippi Coastal Improvements Project

NASA Technical Reports Server (NTRS)

Hilbert, Kent; Anderson, Daniel; Lewis, David

2007-01-01

The 2005 hurricane season - especially Hurricane Katrina - left the Mississippi Gulf Coast devastated. In its efforts to assist in coastal re-building efforts, the U.S. Congress passed the Defense Appropriation Act of 2006. This legislation directed the Secretary of the Army, via the USACE, to generate reports discussing possible projects that would improve the State of Mississippi?s coastal region. These projects are referred to as the MsCIP. Data collected via the LDCM OLI could be used to evaluate the success of projects that result from the MsCIP by monitoring regional coastal changes associated with such projects. This Candidate Solution is in alignment with the Coastal Management, Water Management, and Disaster Management National Applications and will benefit society by improving the post-Hurricane Katrina Mississippi Gulf Coast.

Airborne Visible/Infrared Imaging Spectrometer (AVIRIS): Sensor improvements for 1994 and 1995

NASA Technical Reports Server (NTRS)

Sarture, C. M.; Chrien, T. G.; Green, R. O.; Eastwood, M. L.; Raney, J. J.; Hernandez, M. A.

1995-01-01

AVIRIS is a NASA-sponsored Earth-remote-sensing imaging spectrometer designed, built and operated by the Jet Propulsion Laboratory (JPL). While AVIRIS has been operational since 1989, major improvements have been completed in most of the sensor subsystems during the winter maintenance cycles. As a consequence of these efforts, the capabilities of AVIRIS to reliably acquire and deliver consistently high quality, calibrated imaging spectrometer data continue to improve annually, significantly over those in 1989. Improvements to AVIRIS prior to 1994 have been described previously. This paper details recent and planned improvements to AVIRIS in the sensor task.

Building capability throughout a change effort: leading the transformation of a police agency to community policing.

PubMed

Ford, J Kevin

2007-06-01

This case describes a change effort to move a police agency to become a community policing organization. The community policing effort was seen as a means to make a transformational change to become a learning organization with the goal of improving the delivery of police services. The case describes the steps taken to meet the new vision of community policing as well as the steps taken to deal with the challenges or realities of trying to make change happen. The lens for this case is the leadership role across the stages of change (exploration, planning, implementation, monitoring and institutionalization) in building capacity within the organization to sustain the change effort. The capacity building focused on incorporating systems thinking into the mindset of the members of the organization, breaking down the command and control mindset by building a new norm around high involvement of committed teams, and developing skill sets to support continuous learning and improvement in order to align organizational systems. A key lesson learned is that effective leaders do not just prepare an organization prior to a change effort. They must have the patience to constantly build the capacity for change among organizational members throughout the various stages of the change effort.

Homeland Defense: Continued Actions Needed to Improve Management of Air Sovereignty Alert Operations

DTIC Science & Technology

2012-01-01

Better Outcomes, GAO-10-374T (Washington, D.C.: May 20, 2009); Aviation Security : DHS and TSA Have Researched, Developed and Begun Deploying Passenger... Security : TSA Has Made Progress, but Additional Efforts Are Needed to Improve Security. GAO-11-938T. Washington, D.C.: September 16, 2011. Aviation ...Washington, D.C.: October 23, 2009. Related GAO Products Homeland Defense DOD Tactical Aircraft Aviation Security Risk Management Related GAO

Applying a Theory-Driven Framework to Guide Quality Improvement Efforts in Nursing Homes: The LOCK Model.

PubMed

Mills, Whitney L; Pimentel, Camilla B; Palmer, Jennifer A; Snow, A Lynn; Wewiorski, Nancy J; Allen, Rebecca S; Hartmann, Christine W

2018-05-08

Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.

Process' standardization and change management in higher education. The case of TEI of Athens

NASA Astrophysics Data System (ADS)

Chalaris, Ioannis; Chalaris, Manolis; Gritzalis, Stefanos; Belsis, Petros

2015-02-01

The establishment of mature operational procedures and the effort of standardizing and certifying these procedures is a particularly arduous and demanding task which requires strong commitment from management to the existing objectives, administrative stability and continuity, availability of resources, an adequate implementation team with support from all stakeholders and of course great tolerance until tangible results of the investment are shown. Ensuring these conditions, particularly in times of economic crisis, is an extremely difficult task for large organizations such as TEI of Athens where there is heterogeneity in personnel and changes in the administrative hierarchy arise plethora of additional difficulties and require an effective change management. In this work we depict the path of standardization and certification of administrative functions of TEI of Athens, with emphasis on difficulties encountered and how to address them and in particular issues of change management and the culture related to this effort. The requirement for infrastructure needed to be maintained in processes and tools process & strategic management is embodied, in order to evolve mechanisms for continuous improvement processes and storage / recovery of the resulting knowledge. The work concludes with a general design of a road map of internal audit and continuous improvement processes for a large institution of higher education.

Domains associated with successful quality improvement in healthcare - a nationwide case study.

PubMed

Brandrud, Aleidis Skard; Nyen, Bjørnar; Hjortdahl, Per; Sandvik, Leiv; Helljesen Haldorsen, Gro Sævil; Bergli, Maria; Nelson, Eugene C; Bretthauer, Michael

2017-09-13

There is a distinct difference between what we know and what we do in healthcare: a gap that is impairing the quality of the care and increasing the costs. Quality improvement efforts have been made worldwide by learning collaboratives, based on recognized continual improvement theory with limited scientific evidence. The present study of 132 quality improvement projects in Norway explores the conditions for improvement from the perspectives of the frontline healthcare professionals, and evaluates the effectiveness of the continual improvement method. An instrument with 25 questions was developed on prior focus group interviews with improvement project members who identified features that may promote or inhibit improvement. The questionnaire was sent to 189 improvement projects initiated by the Norwegian Medical Association, and responded by 70% (132) of the improvement teams. A sub study of their final reports by a validated instrument, made us able to identify the successful projects and compare their assessments with the assessments of the other projects. A factor analysis with Varimax rotation of the 25 questions identified five domains. A multivariate regression analysis was used to evaluate the association with successful quality improvements. Two of the five domains were associated with success: Measurement and Guidance (p = 0.011), and Professional environment (p = 0.015). The organizational leadership domain was not associated with successful quality improvements (p = 0.26). Our findings suggest that quality improvement projects with good guidance and focus on measurement for improvement have increased likelihood of success. The variables in these two domains are aligned with improvement theory and confirm the effectiveness of the continual improvement method provided by the learning collaborative. High performing professional environments successfully engaged in patient-centered quality improvement if they had access to: (a) knowledge of best practice provided by professional subject matter experts, (b) knowledge of current practice provided by simple measurement methods, assisted by (c) improvement knowledge experts who provided useful guidance on measurement, and made the team able to organize the improvement efforts well in spite of the difficult resource situation (time and personnel). Our findings may be used by healthcare organizations to develop effective infrastructure to support improvement and to create the conditions for making quality and safety improvement a part of everyone's job.

Effecting Student Learning for Historical Understanding

ERIC Educational Resources Information Center

Lee, Gorman

2014-01-01

While there have been recent efforts to improve the overall public education system in the United States, American students continue to graduate from U.S. public high schools with limited knowledge of U.S. history (Ravitch, 1988; Evans, 2004; Ross, 2006; St. Jarre, 2008; Dillon, 2011). This qualitative case study investigated how high school…

Annual Report of the Council of the Association for the Year Ending 31st December, 1976.

ERIC Educational Resources Information Center

Library Association, London (England).

Topics summarized in this annual report of the Library Association for 1976 include improved contact between branch and headquarters staff; continued international relations; efforts to capture interests of groups and individuals outside the Library Association; public lending right, and economic cuts; closer liaison with people and organizations…

Comparative Study of Antenna Elements for TDRSS Enhanced Multiple Access System

NASA Technical Reports Server (NTRS)

Kory, Carol L.; Lambert, Kevin; Acosta, Roberto; Nessel, James

2006-01-01

We compare three antennas, which are candidates for the TDRSS-Continuation enhanced MA array antenna elements. Measured and simulated data show very good agreement for all antenna elements. All of the antennas meet the specifications with the exception of the SBA isolation. However, improvements can likely be made with further design efforts.

Organizing for Effective Marketing Communications in Higher Education: Restructuring for Your Competitive Edge in Marketing.

ERIC Educational Resources Information Center

Sands, Gene C.; Smith, Rick J.

1999-01-01

Suggestions for restructuring marketing efforts within colleges and universities stress the institution's primary profit center: student recruitment and retention. Techniques such as continuous quality improvement and implementation of a task force concept are recommended as a way of synergistically employing all the institution's assets and…

Examining Attendance, Academic Performance, and Behavior in Obese Adolescents

ERIC Educational Resources Information Center

Daniels, Dianne Yow

2008-01-01

Although academics and safety continue to rank as high-priority issues in public schools, educators and administrators are beginning to recognize the importance of student health on school success. This move toward a holistic approach suggests that efforts to improve a student's physical, social, and emotional well-being are as important as…

High School Mathematics: State-Level Curriculum Standards and Graduation Requirements

ERIC Educational Resources Information Center

Reys, Barbara J.; Dingman, Shannon; Nevels, Nevels; Teuscher, Dawn

2007-01-01

In a continuing effort to improve student-learning opportunities in mathematics, state departments of education have focused on articulating standards or learning goals at all levels, including high school mathematics. A review of K-8 mathematics curriculum standards (many of which have been published since 2002) compiled by staff from the Center…

78 FR 27479 - Notice of Request for Approval To Continue To Collect New Information: Confidential Close Call...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-10

... project. This data collection effort is in support of a five-year research study aiming at improving rail... ongoing research study is conducted by the Office of Human Factors in the Federal Railroad Administration... DEPARTMENT OF TRANSPORTATION Research and Innovative Technology Administration [Docket Number RITA...

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…

Human Capital: A Self-Assessment Checklist for Agency Leaders. Version 1.

ERIC Educational Resources Information Center

Comptroller General of the U.S., Washington, DC.

This document presents and discusses a self-assessment checklist that the General Accounting Office (GAO) developed to enable agency leaders to examine their human capital efforts through a process consisting of the following stages: analyze and plan; implement change; and evaluate and continuously improve. The preface defines the term "human…

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

ERIC Educational Resources Information Center

Freiberg, Elizabeth J.

2014-01-01

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

Transitions and Re-Engagement through Second Chance Education

ERIC Educational Resources Information Center

Ross, Sharon; Gray, Jan

2005-01-01

The issue of school non-completion continues to be a matter of concern for policy makers and practitioners in Australia today. Despite the efforts of governments and school systems to improve participation and retention rates, often one in three students drop out of school before completing Year 12. Major factors influence non-completion and…

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.

A Perspective on Student Learning Outcome Assessment at Qatar University

ERIC Educational Resources Information Center

Al-Thani, Shaikha Jabor; Abdelmoneim, Ali; Daoud, Khaled; Cherif, Adel; Moukarzel, Dalal

2014-01-01

This paper provides a unique perspective on the student learning outcome assessment process as adopted and implemented at Qatar University from 2006 to 2012. The progress of the student learning outcome assessment and continuous improvement efforts at the university and the initiatives taken to establish a culture of assessment and evidence-based…

Multi-population selective genotyping to identify soybean (Glycine max (L.) Merr.) seed protein and oil QTLs

USDA-ARS?s Scientific Manuscript database

Plant breeders continually generate ever-higher yielding cultivars, but also want to improve seed constituent value, which in soybean [Glycine max (L.) Merr.] is seed protein and oil. Identification of genetic loci governing those two traits would facilitate that effort, and though genome-wide asso...

A Famine of Stories: Finding a Home in the Academy.

ERIC Educational Resources Information Center

Cooper, Joanne E.; Benham, Maenette; Collay, Michelle; Martinez-Aleman, Ana; Scherr, Mary Woods

1999-01-01

Explores a deeper understanding of the lives of women faculty through narratives in an effort to simultaneously improve those lives and to end the dearth of stories in academia. Offers four diverse women's reflections on creating a space for themselves in academia. Strategies described involve continual reflection on self-identity. (GCP)

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…

Effects of Differentiated Instruction on Student Achievement in Reading

ERIC Educational Resources Information Center

Gilbert, Darryl L.

2011-01-01

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

The Keys to Effective Schools: Educational Reform as Continuous Improvement.

ERIC Educational Resources Information Center

Hawley, Willis D., Ed.

Educational researchers and policy analysts concur increasingly that the organizational design and culture of schools can either enhance or hinder the effectiveness of school reform efforts. This book offers a series of essays that may help parents, educators, and policymakers understand and solve school organizational problems that get in the way…

Integrating Schools, Families, and Communities through Successful School Reform: The School Development Program.

ERIC Educational Resources Information Center

Haynes, Norris M.; Comer, James P.

1996-01-01

The concept of community is significant in the discourse on children's development and learning. In view of the continuing disintegration of childrens' supportive communities, efforts to reform and improve American education must include ways to reinvent and revive learning communities. This is the central work of the School Development Program…

Mapping modern software process engineering techniques onto an HEP development environment

NASA Astrophysics Data System (ADS)

Wellisch, J. P.

2003-04-01

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

The reductionist paradox: are the laws of chemistry and physics sufficient for the discovery of new drugs?

PubMed

Maggiora, Gerald M

2011-08-01

Reductionism is alive and well in drug-discovery research. In that tradition, we continually improve experimental and computational methods for studying smaller and smaller aspects of biological systems. Although significant improvements continue to be made, are our efforts too narrowly focused? Suppose all error could be removed from these methods, would we then understand biological systems sufficiently well to design effective drugs? Currently, almost all drug research focuses on single targets. Should the process be expanded to include multiple targets? Recent efforts in this direction have lead to the emerging field of polypharmacology. This appears to be a move in the right direction, but how much polypharmacology is enough? As the complexity of the processes underlying polypharmacology increase will we be able to understand them and their inter-relationships? Is "new" mathematics unfamiliar in much of physics and chemistry research needed to accomplish this task? A number of these questions will be addressed in this paper, which focuses on issues and questions not answers to the drug-discovery conundrum.

Improving the breed - Shuttle development

NASA Technical Reports Server (NTRS)

Brand, V.

1985-01-01

An evaluation is made of design improvements that have been made to the Space Shuttle System, and the performance gains obtained; the most important of these stem from efforts to refine procedures for rendezvous with stricken satellites, in order to repair them. Ascent performance has been improved through Space Shuttle Main Engine thrust improvements and external tank weight reductions. On-orbit living convenience has been enhanced by the addition of small sleeping compartments and a galley. Greater flexibility has been obtained for reentry and landing maneuvers. Attention is given to problems which continue to be posed by the thermal protection tiles.

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.

How Implementation of TQM and the Development of a Process Improvement Model, Within a Forward Support Battalion, Can Improve Preparation of the Material Condition Status Report (DA Form 2406)

DTIC Science & Technology

1990-12-01

studies for the continuing education of managers new to the TQM approach , for informing vendors of their responsibilities under a changed process, and...Department of Defense (DoD) is adopting a management approach known as Total Quality Management (TQM) in an effort to improve quality and productivity...individuals selected be highly knowledgeable about the operations in their shop or unit. The main function of PATs is to collect and summarize process data for

International quality improvement initiatives.

PubMed

Hickey, Patricia A; Connor, Jean A; Cherian, Kotturathu M; Jenkins, Kathy; Doherty, Kaitlin; Zhang, Haibo; Gaies, Michael; Pasquali, Sara; Tabbutt, Sarah; St Louis, James D; Sarris, George E; Kurosawa, Hiromi; Jonas, Richard A; Sandoval, Nestor; Tchervenkov, Christo I; Jacobs, Jeffery P; Stellin, Giovanni; Kirklin, James K; Garg, Rajnish; Vener, David F

2017-12-01

Across the globe, the implementation of quality improvement science and collaborative learning has positively affected the care and outcomes for children born with CHD. These efforts have advanced the collective expertise and performance of inter-professional healthcare teams. In this review, we highlight selected quality improvement initiatives and strategies impacting the field of cardiovascular care and describe implications for future practice and research. The continued leveraging of technology, commitment to data transparency, focus on team-based practice, and recognition of cultural norms and preferences ensure the success of sustainable models of global collaboration.

Improved Newborn Hearing Screening Follow-up Results in More Infants Identified

PubMed Central

Alam, Suhana; Gaffney, Marcus; Eichwald, John

2015-01-01

Longitudinal research suggests that efforts at the national, state, and local levels are leading to improved follow-up and data reporting. Data now support the assumption that the number of deaf or hard-of-hearing infants identified through newborn hearing screening increases with a reduction in the number of infants lost to follow-up. Documenting the receipt of services has made a noticeable impact on reducing lost to follow-up rates and early identification of infants with hearing loss; however, continued improvement and monitoring of services are still needed. PMID:23803975

Improved newborn hearing screening follow-up results in more infants identified.

PubMed

Alam, Suhana; Gaffney, Marcus; Eichwald, John

2014-01-01

Longitudinal research suggests that efforts at the national, state, and local levels are leading to improved follow-up and data reporting. Data now support the assumption that the number of deaf or hard-of-hearing infants identified through newborn hearing screening increases with a reduction in the number of infants lost to follow-up. Documenting the receipt of services has made a noticeable impact on reducing lost to follow-up rates and early identification of infants with hearing loss; however, continued improvement and monitoring of services are still needed.

F-35 Joint Strike Fighter: Current Outlook Is Improved, but Long-Term Affordability Is a Major Concern

DTIC Science & Technology

2013-03-01

and improvement efforts with DOD, F-35 program, and contractor officials. We toured the aircraft manufacturing plant , obtained production and supply...members of the contractor’s work force and DOD plant representatives. We evaluated DOD’s restructuring actions and impacts on the program, tracked...Testing of the final increment is expected to begin in 2014 and continue through 2016. Initial operational test and evaluation ( IOT &E) is

Randomized trial of the Availability, Responsiveness and Continuity (ARC) organizational intervention for improving youth outcomes in community mental health programs.

PubMed

Glisson, Charles; Hemmelgarn, Anthony; Green, Philip; Williams, Nathaniel J

2013-05-01

The primary objective of the study was to assess whether the Availability, Responsiveness and Continuity (ARC) organizational intervention improved youth outcomes in community based mental health programs. The second objective was to assess whether programs with more improved organizational social contexts following the 18-month ARC intervention had better youth outcomes than programs with less improved social contexts. Eighteen community mental health programs that serve youth between the ages of 5 and 18 were randomly assigned to ARC or control conditions. Clinicians (n = 154) in the participating programs completed the Organizational Social Context (OSC) measure at baseline and following the 18-month ARC organizational intervention. Caregivers of 393 youth who were served by the 18 programs (9 in ARC and 9 in control) completed the Shortform Assessment for Children (SAC) once a month for six months beginning at intake. Hierarchical linear models (HLM) analyses indicated that youth outcomes were significantly better in the programs that completed the 18 month ARC intervention. HLM analyses also showed that youth outcomes were best in the programs with the most improved organizational social contexts following the 18 month ARC intervention. Youth outcomes in community mental health programs can be improved with the ARC organizational intervention and outcomes are best in programs that make the most improvements in organizational social context. The relationships linking ARC, organizational social context, and youth outcomes suggest that service improvement efforts will be more successful if those efforts include strategies to improve the organizational social contexts in which the services are embedded. Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

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

PubMed

Lin Goh, Stella Seow

2018-01-01

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

Continuous Improvement in Battery Testing at the NASA/JSC Energy System Test Area

NASA Technical Reports Server (NTRS)

Boyd, William; Cook, Joseph

2003-01-01

The Energy Systems Test Area (ESTA) at the Lyndon B. Johnson Space Center in Houston, Texas conducts development and qualification tests to fulfill Energy System Division responsibilities relevant to ASA programs and projects. EST A has historically called upon a variety of fluid, mechanical, electrical, environmental, and data system capabilities spread amongst five full-service facilities to test human and human supported spacecraft in the areas of propulsion systems, fluid systems, pyrotechnics, power generation, and power distribution and control systems. Improvements at ESTA are being made in full earnest of offering NASA project offices an option to choose a thorough test regime that is balanced with cost and schedule constraints. In order to continue testing of enabling power-related technologies utilized by the Energy System Division, an especially proactive effort has been made to increase the cost effectiveness and schedule responsiveness for battery testing. This paper describes the continuous improvement in battery testing at the Energy Systems Test Area being made through consolidation, streamlining, and standardization.

Human Data Supporting Glyburide in Ischemic Stroke

PubMed Central

Sheth, Kevin N.; Simard, J. Marc; Elm, Jordan; Kronenberg, Golo; Kunte, Hagen; Kimberly, W. Taylor

2016-01-01

The SUR1-TRPM4 channel is a critical determinant of edema and hemorrhagic transformation after focal ischemia. Blockade of this channel by the small molecule glyburide results in improved survival and neurological outcome in multiple preclinical models of ischemic stroke. A robust, compelling body of evidence suggests that an intravenous (IV) formulation of glyburide, RP-1127, can prevent swelling and improve outcome in patients with stroke. Retrospective studies of diabetic stroke patients show improved outcomes in patients who are continued on sulfonylureas after stroke onset. Early phase II study of MRI and plasma biomarkers support the conclusion that RP-1127 may decrease swelling and hemorrhagic transformation. Finally, the ongoing phase II RP-1127 development program has demonstrated continued safety as well as feasibility of enrollment and tolerability of the intervention. Continued efforts to complete the ongoing phase IIb study and definitive efficacy studies are urgently needed to bring a candidate pharmacotherapy to a population of severe stroke patients that currently have no alternative. PMID:26463916

Human Data Supporting Glyburide in Ischemic Stroke.

PubMed

Sheth, Kevin N; Simard, J Marc; Elm, Jordan; Kronenberg, Golo; Kunte, Hagen; Kimberly, W Taylor

2016-01-01

The SUR1-TRPM4 channel is a critical determinant of edema and hemorrhagic transformation after focal ischemia. Blockade of this channel by the small molecule glyburide results in improved survival and neurological outcome in multiple preclinical models of ischemic stroke. A robust, compelling body of evidence suggests that an intravenous formulation of glyburide, RP-1127, can prevent swelling and improve outcome in patients with stroke. Retrospective studies of diabetic stroke patients show improved outcomes in patients who are continued on sulfonylureas after stroke onset. An early phase II study using magnetic resonance imaging and plasma biomarkers supports the conclusion that RP-1127 may decrease swelling and hemorrhagic transformation. Finally, the ongoing phase II RP-1127 development program has demonstrated continued safety as well as feasibility of enrollment and tolerability of the intervention. Continued efforts to complete the ongoing phase II study and definitive efficacy studies are needed to bring a candidate pharmacotherapy to a population of severe stroke patients that currently have no alternative.

Can NMR solve some significant challenges in metabolomics?

PubMed Central

Gowda, G.A. Nagana; Raftery, Daniel

2015-01-01

The field of metabolomics continues to witness rapid growth driven by fundamental studies, methods development, and applications in a number of disciplines that include biomedical science, plant and nutrition sciences, drug development, energy and environmental sciences, toxicology, etc. NMR spectroscopy is one of the two most widely used analytical platforms in the metabolomics field, along with mass spectrometry (MS). NMR's excellent reproducibility and quantitative accuracy, its ability to identify structures of unknown metabolites, its capacity to generate metabolite profiles using intact biospecimens with no need for separation, and its capabilities for tracing metabolic pathways using isotope labeled substrates offer unique strengths for metabolomics applications. However, NMR's limited sensitivity and resolution continue to pose a major challenge and have restricted both the number and the quantitative accuracy of metabolites analyzed by NMR. Further, the analysis of highly complex biological samples has increased the demand for new methods with improved detection, better unknown identification, and more accurate quantitation of larger numbers of metabolites. Recent efforts have contributed significant improvements in these areas, and have thereby enhanced the pool of routinely quantifiable metabolites. Additionally, efforts focused on combining NMR and MS promise opportunities to exploit the combined strength of the two analytical platforms for direct comparison of the metabolite data, unknown identification and reliable biomarker discovery that continue to challenge the metabolomics field. This article presents our perspectives on the emerging trends in NMR-based metabolomics and NMR's continuing role in the field with an emphasis on recent and ongoing research from our laboratory. PMID:26476597

Can NMR solve some significant challenges in metabolomics?

NASA Astrophysics Data System (ADS)

Nagana Gowda, G. A.; Raftery, Daniel

2015-11-01

The field of metabolomics continues to witness rapid growth driven by fundamental studies, methods development, and applications in a number of disciplines that include biomedical science, plant and nutrition sciences, drug development, energy and environmental sciences, toxicology, etc. NMR spectroscopy is one of the two most widely used analytical platforms in the metabolomics field, along with mass spectrometry (MS). NMR's excellent reproducibility and quantitative accuracy, its ability to identify structures of unknown metabolites, its capacity to generate metabolite profiles using intact bio-specimens with no need for separation, and its capabilities for tracing metabolic pathways using isotope labeled substrates offer unique strengths for metabolomics applications. However, NMR's limited sensitivity and resolution continue to pose a major challenge and have restricted both the number and the quantitative accuracy of metabolites analyzed by NMR. Further, the analysis of highly complex biological samples has increased the demand for new methods with improved detection, better unknown identification, and more accurate quantitation of larger numbers of metabolites. Recent efforts have contributed significant improvements in these areas, and have thereby enhanced the pool of routinely quantifiable metabolites. Additionally, efforts focused on combining NMR and MS promise opportunities to exploit the combined strength of the two analytical platforms for direct comparison of the metabolite data, unknown identification and reliable biomarker discovery that continue to challenge the metabolomics field. This article presents our perspectives on the emerging trends in NMR-based metabolomics and NMR's continuing role in the field with an emphasis on recent and ongoing research from our laboratory.

Research and demonstration to improve air quality for the U.S. animal feeding operations in the 21st century - a critical review.

PubMed

Ni, Ji-Qin

2015-05-01

There was an increasing interest in reducing production and emission of air pollutants to improve air quality for animal feeding operations (AFOs) in the U.S. in the 21st century. Research was focused on identification, quantification, characterization, and modeling of air pollutions; effects of emissions; and methodologies and technologies for scientific research and pollution control. Mitigation effects were on pre-excretion, pre-release, pre-emission, and post-emission. More emphasis was given on reducing pollutant emissions than improving indoor air quality. Research and demonstrations were generally continuation and improvement of previous efforts. Most demonstrated technologies were still in a limited scale of application. Future efforts are needed in many fundamental and applied research areas. Advancement in instrumentation, computer technology, and biological sciences and genetic engineering is critical to bring major changes in this area. Development in research and demonstration will depend on the actual political, economic, and environmental situations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Marquette University Department of Public Safety Implements New Command Information Center Technology

ERIC Educational Resources Information Center

Cooper, Sue

2008-01-01

Marquette University, established in 1881, is a private Catholic, Jesuit institution located in the heart of Milwaukee, Wisconsin. The university has a student population of more than 11,000 and more than 2,000 faculty and staff. In its effort to continually improve crime prevention and emergency preparedness Marquette's Department of Public…

Stress Responses and Decision Making in Child Protection Workers Faced with High Conflict Situations

ERIC Educational Resources Information Center

LeBlanc, Vicki R.; Regehr, Cheryl; Shlonsky, Aron; Bogo, Marion

2012-01-01

Introduction: The assessment of children at risk of abuse and neglect is a critical societal function performed by child protection workers in situations of acute stress and conflict. Despite efforts to improve the reliability of risk assessments through standardized measures, available tools continue to rely on subjective judgment. The goal of…

Investing in the Future: Educating Homeless Children and Youth. Illinois State Plan.

ERIC Educational Resources Information Center

Illinois State Board of Education, Springfield.

The plan describes a continuing effort in Illinois to improve access to education and school success for homeless children and youth. The Illinois plan was revised to meet the requirements of the Stewart B. McKinney Homeless Assistance Amendments Act of 1987 by reforming the original document into sections that highlight the major requirements of…

Environmental Quality - 1977: The Eighth Annual Report of the Council on Environmental Quality.

ERIC Educational Resources Information Center

Council on Environmental Quality, Washington, DC.

This eighth annual report considers the state of the environment and new or continuing efforts to improve it. The publication is divided into two chapters. The first chapter summarizes important environmental events of the past year. Events include new legislation, court rulings, major accidents, policy changes, and similar material. The second…

The Conferences for Undergraduate Women in Physics

NASA Astrophysics Data System (ADS)

Blessing, Susan

2014-03-01

The APS Conferences for Undergraduate Women in Physics (CUWiP) are the continuation of a grass-roots collaborative effort that began 2006. The goals of the conferences are to increase retention and improve career outcomes of undergraduate women in physics. I will discuss the conferences, including organization and participant response, and encourage participation--of both students and institutions.

Parent Educators in Early Intervention: Insights from Evaluations

ERIC Educational Resources Information Center

Edwards, Nicole Megan; Gallagher, Peggy A.

2014-01-01

In 1 state's Part C early intervention (EI) program, families are afforded a unique opportunity to connect with parent educators (PEs), parents of children who have received EI services, and who are trained to support EI families and staff with a range of tailored duties. In an effort to continually reflect and improve upon the role of PEs, the…

Preparation for Practice: Elementary Preservice Teachers Learning and Using Scientific Classroom Discourse Community Instructional Strategies

ERIC Educational Resources Information Center

Lewis, Elizabeth; Dema, Oxana; Harshbarger, Dena

2014-01-01

Despite historical national efforts to improve elementary science education, science instruction continues to be marginalized, varying by state. This study was designed to address the ongoing challenge of educating elementary preservice teachers (PSTs) to teach science. Elementary PSTs are one of the science education community's major links…

State-of-the-State 1994. Illinois: The Song without an End.

ERIC Educational Resources Information Center

Westbrook, Kathleen C.

This paper describes the state of public education in Illinois in 1994. Over the last 3 years, the state has tried to improve its educational system, but continues to fall short of its goal. Attempts to produce economic efficiencies come at the expense of educational programs in rural communities while decentralization efforts in Chicago try to…

If We Teach Them, They Can Learn: Young Students Views of Nature of Science during an Informal Science Education Program

ERIC Educational Resources Information Center

Quigley, Cassie; Pongsanon, Khemmawadee; Akerson, Valarie L.

2011-01-01

There have been substantial reform efforts in science education to improve students' understandings of science and its processes and provide continual support for students becoming scientifically literate (AAAS, "Benchmarks for science literacy," Oxford University Press, New York, 1993; NRC, National Academy Press, Washington, DC, 1996; NSTA,…

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

PubMed

Grubbs, S C

1994-05-01

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

The Reforms in Mathematics Education for Grades 1 through 12 in Albania from 1945 to 2000

ERIC Educational Resources Information Center

Mernacaj, Marash

2011-01-01

Between 1945 and 2000, the Communist government of Albania enacted a series of educational reforms focused upon increasing the academic quality and student access to the nation's educational system. While the country succeeded in enacting considerable reform efforts, there continues to be room for improvement. This dissertation considers the…

Science Teachers' Utilisation of Innovative Strategies for Teaching Senior School Science in Ilorin, Nigeria

ERIC Educational Resources Information Center

Oyelekan, Oloyede Solomon; Igbokwe, Emoyoke Faith; Olorundare, Adekunle Solomon

2017-01-01

Efforts have been made to improve science teaching in secondary schools in Nigeria, yet, students continue to perform poorly in science subjects. Many innovative teaching strategies have been developed by educators and found to impact significantly on students' academic performance when utilised. Hence, this study was aimed at examining science…

Recruitment and retention monitoring: facilitating the mission of the National Institute of Neurological Disorders and Stroke (NINDS)

PubMed Central

Roberts, J; Waddy, S; Kaufmann, P

2012-01-01

It is commonly accepted that inefficient recruitment and inadequate retention continue to threaten the completion of clinical trials intended to reduce the public health burden of neurological disease. This article will discuss the scientific, economic, and ethical implications of failure to recruit and retain adequate samples in clinical trials, including the consequences of failing to recruit adequately diverse samples. We will also discuss the more common challenges and barriers to efficient and effective recruitment and retention, and the impact these have on successful clinical trial planning. We will explain the newly established efforts within National Institute of Neurological Disorders and Stroke (NINDS) to monitor recruitment and retention with well-defined metrics and implementation of grant awards that include feasibility milestones for continued funding. Finally, we will describe our efforts to address some of the common challenges to recruitment and retention through assistance to investigators and coordinators with evidence-based support, tools, and resources for planning and strategizing recruitment and retention as well as a trans-NIH effort to improve awareness of clinical research in the general public. PMID:23230460

Sex Trafficking of Minors.

PubMed

Moore, Jessica L; Kaplan, Dana M; Barron, Christine E

2017-04-01

Sex trafficking is an increasingly recognized global health crisis affecting every country and region in the world. Domestic minor sex trafficking is a subset of commercial sexual exploitation of children, defined as engagement of minors (<18 years of age) in sexual acts for items of value (eg, food, shelter, drugs, money) involving children victimized within US borders. These involved youth are at risk for serious immediate and long-term physical and mental health consequences. Continued efforts are needed to improve preventive efforts, identification, screening, appropriate interventions, and subsequent resource provision for victimized and high-risk youth. Copyright © 2016 Elsevier Inc. All rights reserved.

Overview of chemical vapor infiltration

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

Besmann, T.M.; Stinton, D.P.; Lowden, R.A.

1993-06-01

Chemical vapor infiltration (CVI) is developing into a commercially important method for the fabrication of continuous filament ceramic composites. Current efforts are focused on the development of an improved understanding of the various processes in CVI and its modeling. New approaches to CVI are being explored, including pressure pulse infiltration and microwave heating. Material development is also proceeding with emphasis on improving the oxidation resistance of the interfacial layer between the fiber and matrix. This paper briefly reviews these subjects, indicating the current state of the science and technology.

Paths of Adoption: Routes to Continuous Process Improvement

DTIC Science & Technology

2014-07-01

To obtain a process the team will use: The Team Lead has worked on teams with good processes and wants their new team to start out on the right foot ...eventually going to have to eat the entire process-improvement elephant . So, how do you get the “Never- Adopters” to undertake the effort? The key is to...Air Warfare Center Abstract. This paper covers the different types of teams the authors have en- countered as NAVAIR Internal Process Coaches and how

Nonequilibrium radiation and chemistry models for aerocapture vehicle flowfields

NASA Technical Reports Server (NTRS)

Carlson, Leland A.

1990-01-01

The primary tasks during January 1990 to June 1990 have been the development and evaluation of various electron and electron-electronic energy equation models, the continued development of improved nonequilibrium radiation models for molecules and atoms, and the continued development and investigation of precursor models and their effects. In addition, work was initiated to develop a vibrational model for the viscous shock layer (VSL) nonequilibrium chemistry blunt body engineering code. Also, an effort was started associated with the effects of including carbon species, say from an ablator, in the flowfield.

Communicable diseases in the Eastern Mediterranean Region: prevention and control 2010-2011.

PubMed

Haq, Z; Mahjour, J; Khan, W

2013-10-01

One-third of all morbidities and mortalities in the Eastern Mediterranean Region are attributed to communicable diseases. A continued situation of war and conflict, and growing political unrest in the Region, coupled with factors such as travel and migration, and insufficient infrastructure and inadequate technical and managerial capacity ofthe programmes are the major challenges. Despite these challenges, the Region continued making progress towards the elimination of specific diseases such as lymphatic filariasis, measles, malaria, schistosomiasis and dracunculiasis during 2010-11. Coverage for vaccine-preventable diseases was enhanced. Preparedness and response to emerging (e.g. dengue fever in Pakistan and Yemen) and re-emerging (e.g. cholera in Sudan) infections was improved. The Region has continued its efforts for controlling tuberculosis and curbing HIV/AIDS. Looking ahead, the Region aims to improve surveillance and response capacities, legislation issues, coordination, bio-risk and bio-security and quality management in the coming years.

Single-Step BLUP with Varying Genotyping Effort in Open-Pollinated Picea glauca.

PubMed

Ratcliffe, Blaise; El-Dien, Omnia Gamal; Cappa, Eduardo P; Porth, Ilga; Klápště, Jaroslav; Chen, Charles; El-Kassaby, Yousry A

2017-03-10

Maximization of genetic gain in forest tree breeding programs is contingent on the accuracy of the predicted breeding values and precision of the estimated genetic parameters. We investigated the effect of the combined use of contemporary pedigree information and genomic relatedness estimates on the accuracy of predicted breeding values and precision of estimated genetic parameters, as well as rankings of selection candidates, using single-step genomic evaluation (HBLUP). In this study, two traits with diverse heritabilities [tree height (HT) and wood density (WD)] were assessed at various levels of family genotyping efforts (0, 25, 50, 75, and 100%) from a population of white spruce ( Picea glauca ) consisting of 1694 trees from 214 open-pollinated families, representing 43 provenances in Québec, Canada. The results revealed that HBLUP bivariate analysis is effective in reducing the known bias in heritability estimates of open-pollinated populations, as it exposes hidden relatedness, potential pedigree errors, and inbreeding. The addition of genomic information in the analysis considerably improved the accuracy in breeding value estimates by accounting for both Mendelian sampling and historical coancestry that were not captured by the contemporary pedigree alone. Increasing family genotyping efforts were associated with continuous improvement in model fit, precision of genetic parameters, and breeding value accuracy. Yet, improvements were observed even at minimal genotyping effort, indicating that even modest genotyping effort is effective in improving genetic evaluation. The combined utilization of both pedigree and genomic information may be a cost-effective approach to increase the accuracy of breeding values in forest tree breeding programs where shallow pedigrees and large testing populations are the norm. Copyright © 2017 Ratcliffe et al.

Addressing cancer disparities through community engagement: improving breast health among Haitian women.

PubMed

Meade, Cathy D; Menard, Janelle; Thervil, Claudine; Rivera, Marlene

2009-11-01

To describe processes for fostering community engagement among Haitian women to facilitate breast health education and outreach that are consonant with Haitians' cultural values, literacy, and linguistic skills. Existing breast cancer education and outreach efforts for Haitian immigrant communities were reviewed. Local community partners were the primary source of information and guided efforts to create a series of health-promoting activities. The resultant partnership continues to be linked to a larger communitywide effort to reduce cancer disparities led by the Tampa Bay Community Cancer Network. A systematic framework known as the CLEAN (Culture, Literacy, Education, Assessment, and Networking) Look Checklist guided efforts for improved communications. Community engagement forms the foundation for the development and adaptation of sustainable breast education and outreach. Understanding and considering aspects of Haitian culture are important to the provision of competent and meaningful care. Nurses should expand their skills, knowledge, and competencies to better address the changing demographics of their communities. Nurses also can play a critical role in the development of outreach programs that are relevant to the culture and literacy of Haitian women by forming mutually beneficial partnerships that can decrease health disparities in communities.

Achieving high survival of tournament-caught black bass: past efforts and future needs and opportunities

USGS Publications Warehouse

Schramm, Harold; Gilliland, Gene

2015-01-01

Rapid growth of black bass (Micropterus spp.) tournaments in the 1960s and 1970s caused concern among fisheries managers and anglers about the impacts of tournament-caused mortality on bass populations. Tournament organizers voluntarily implemented live-release events in the early 1980s. As catch-and-release practices became more common, procedures to improve the survival of tournament-caught fish were developed and have evolved. The objectives of this paper are to review education and outreach efforts to improve survival of tournament-caught black bass, suggest research needs and opportunities to achieve greater survival, and show the relevance of high survival to contemporary black bass management. Since 1985, a succession of informational products describing those techniques have been developed and distributed to anglers. Although research has confirmed the effectiveness of the recommended procedures and documented that angler and tournament organizer behavior has changed and the survival of tournament-caught black bass has increased, the impacts of the outreach efforts on tournament practices have not been quantified. Continued efforts towards increasing angler awareness of proper handling techniques may benefit from better communication, endorsement by professional anglers, and the use of incentives by state agencies to encourage better fish care.

Fluorescent proteins for quantitative microscopy: important properties and practical evaluation.

PubMed

Shaner, Nathan Christopher

2014-01-01

More than 20 years after their discovery, fluorescent proteins (FPs) continue to be the subject of massive engineering efforts yielding continued improvements. Among these efforts are many aspects that should be of great interest to quantitative imaging users. With new variants frequently introduced into the research community, "tried and true" FPs that have been relied on for many years may now be due for upgrades to more modern variants. However, the dizzying array of FPs now available can make the initial act of narrowing down the potential choices an intimidating prospect. This chapter describes the FP properties that most strongly impact their performance in quantitative imaging experiments, along with their physical origins as they are currently understood. A workflow for evaluating a given FP in the researcher's chosen experimental system (e.g., a specific cell line) is described. © 2014 Elsevier Inc. All rights reserved.

Lean management: innovative tools for engaging teams in continuous quality improvement.

PubMed

Perreault, Lucille; Vaillancourt, Lise; Filion, Catherine; Hadj, Camélia

2014-01-01

Lean management has proven to be a sustainable method to ensure a high level of patient care through innovation and teamwork. It involves a set of six tools that allow for visual management shared among team members. The team focuses their efforts on the improvement of organizational indicators in a standardized and engaging way, resulting in the sustainability of improvements. This article outlines the program's rollout at Montfort Hospital (l'Hôpital Montfort). In only a few months, two pilot units accomplished close to 50 improvements each. In addition, the organizational employee satisfaction questionnaire showed very positive results. Copyright © 2014 Longwoods Publishing.

Design of launch systems using continuous improvement process

NASA Technical Reports Server (NTRS)

Brown, Richard W.

1995-01-01

The purpose of this paper is to identify a systematic process for improving ground operations for future launch systems. This approach is based on the Total Quality Management (TQM) continuous improvement process. While the continuous improvement process is normally identified with making incremental changes to an existing system, it can be used on new systems if they use past experience as a knowledge base. In the case of the Reusable Launch Vehicle (RLV), the Space Shuttle operations provide many lessons. The TQM methodology used for this paper will be borrowed from the United States Air Force 'Quality Air Force' Program. There is a general overview of the continuous improvement process, with concentration on the formulation phase. During this phase critical analyses are conducted to determine the strategy and goals for the remaining development process. These analyses include analyzing the mission from the customers point of view, developing an operations concept for the future, assessing current capabilities and determining the gap to be closed between current capabilities and future needs and requirements. A brief analyses of the RLV, relative to the Space Shuttle, will be used to illustrate the concept. Using the continuous improvement design concept has many advantages. These include a customer oriented process which will develop a more marketable product and a better integration of operations and systems during the design phase. But, the use of TQM techniques will require changes, including more discipline in the design process and more emphasis on data gathering for operational systems. The benefits will far outweigh the additional effort.

Using Pilots to Assess the Value and Approach of CMMI Implementation

NASA Technical Reports Server (NTRS)

Godfrey, Sara; Andary, James; Rosenberg, Linda

2002-01-01

At Goddard Space Flight Center (GSFC), we have chosen to use Capability Maturity Model Integrated (CMMI) to guide our process improvement program. Projects at GSFC consist of complex systems of software and hardware that control satellites, operate ground systems, run instruments, manage databases and data and support scientific research. It is a challenge to launch a process improvement program that encompasses our diverse systems, yet is manageable in terms of cost effectiveness. In order to establish the best approach for improvement, our process improvement effort was divided into three phases: 1) Pilot projects; 2) Staged implementation; and 3) Sustainment and continual improvement. During Phase 1 the focus of the activities was on a baselining process, using pre-appraisals in order to get a baseline for making a better cost and effort estimate for the improvement effort. Pilot pre-appraisals were conducted from different perspectives so different approaches for process implementation could be evaluated. Phase 1 also concentrated on establishing an improvement infrastructure and training of the improvement teams. At the time of this paper, three pilot appraisals have been completed. Our initial appraisal was performed in a flight software area, considering the flight software organization as the organization. The second appraisal was done from a project perspective, focusing on systems engineering and acquisition, and using the organization as GSFC. The final appraisal was in a ground support software area, again using GSFC as the organization. This paper will present our initial approach, lessons learned from all three pilots and the changes in our approach based on the lessons learned.

Race and psychiatric services in post-apartheid South Africa: a preliminary study of psychiatrists' perceptions.

PubMed

Kohn, Robert; Szabo, Christopher P; Gordon, Alan; Allwood, Clifford W

2004-03-01

The primary objective of this study was to examine the perception of the quality of psychiatric services five years after apartheid, and specifically whether care for black patients had improved. A survey was distributed to South African psychiatrists during a national congress and by mail. The questionnaire focused on the quality of psychiatric care in general, for black and white patients, the racial composition of each respondent's psychiatric practice currently, and the racial composition of the psychiatric practice during apartheid. Psychiatric services in South Africa were viewed as deteriorating. The end of apartheid has done little to improve the quality of psychiatric care for both black and white patients. Although less pronounced, racial inequality in psychiatric care continues to exist. Psychiatric practices continue to be overrepresented with white patients. There remains a differential in quality of psychiatric care and further monitoring should continue. Continued efforts to improve racial equality and the need for greater awareness of cultural issues need to be addressed. Limitations of this study included possible social desirability bias, use of subjective rather than objective measures, and a survey that was limited in scope.

Annual Performance Report. FFY 2012. Revised Clarification April 30, 2014. APR Template-Part B.

ERIC Educational Resources Information Center

Bureau of Indian Education, 2014

2014-01-01

During school year (SY) 2012-2013, the Bureau of Indian Education (BIE) continued its efforts to improve the validity and reliability of data reporting. BIE data collections are dependent on school level entry (self-reporting) into the Native American Student Information System (NASIS) or into the BIE's Academic Report (formerly the BIEs…

When Will Our Values Finally Result in the Creation of New Pathways for Change--Change that We Can Believe In?

ERIC Educational Resources Information Center

Rusch, Frank R.; Wolfe, Pamela

2008-01-01

Despite efforts over the past several decades to improve the delivery of transition services for youth with disabilities, outcomes continue to be unacceptably dismal for most youth, including high rates of unemployment, residential independence, and financial dependence, concurrent with low rates of enrollment in college or other postsecondary…

Environmental Quality, the Seventh Annual Report of the Council on Environmental Quality.

ERIC Educational Resources Information Center

Council on Environmental Quality, Washington, DC.

This seventh annual report discusses the state of the environment and new or continuing efforts to improve it. The topics are treated in two parts. The first part discusses events of the past year and cites new legislation, court rulings, and other major developments affecting the environment. Part two focuses on conditions and trends by analyzing…

Impact of a Kentucky Maternal, Infant, and Early Childhood Home-Visitation Program on Parental Risk Factors

ERIC Educational Resources Information Center

Ferguson, Jonnisa M.; Vanderpool, Robin C.

2013-01-01

As public health organizations continue to implement maternal and child health home-visitation programs, more evaluation of these efforts is needed, particularly as it relates to improving parental behaviors. The purpose of our study was to assess the impact of families' participation in a home-visitation program offered by a central Kentucky…

When Money Might Matter: Using NELS88 to Examine the Weak Effects of School Funding

ERIC Educational Resources Information Center

Grubb, W. Norton

2006-01-01

In this article, the author continues to develop the perspective of the improved school finance, an effort to move beyond the conventional framing of funding and resource issues, presented in the article by Grubb, Huerta, and Goe in this issue. Here, the author presents the results of use of the National Educational Longitudinal Survey of the…

Mathematics Teachers' Learning: A Conceptual Framework and Synthesis of Research

ERIC Educational Resources Information Center

Goldsmith, Lynn T.; Doerr, Helen M.; Lewis, Catherine C.

2014-01-01

How do practicing mathematics teachers continue to develop the knowledge and habits of mind that enable them to teach well and to improve their teaching over time? The question of how (and what) teachers learn lies at the crux of any effort to provide high-quality mathematics teaching for all students. This article reviews 106 articles written…

Efficacy of treatments using MAT-28 for pine site preparation

Treesearch

Andrew Ezell; Jimmie Yeiser; Pat Minogue

2012-01-01

Site preparation for pine plantation establishment continues to be the principal use of herbicides in the South. Due to the timing of the work and the cost involved, these applications are critical in both biological and economic terms. In an effort to improve performance in both considerations, a study was undertaken to evaluate a number of herbicide compounds in site...

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

ERIC Educational Resources Information Center

Whipps-Johnson, Jamellah Renee

2016-01-01

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

The conferences for undergraduate women in physics

NASA Astrophysics Data System (ADS)

Blessing, Susan K.

2015-12-01

The American Physical Society Conferences for Undergraduate Women in Physics are the continuation of a grassroots collaborative effort that began in 2006. The goals of the conferences are to increase retention and improve career outcomes of undergraduate women in physics. I describe the conferences, including organization and participant response, and encourage other countries to host similar programs for their undergraduate women.

Crash Injury Management: Emergency Medical Services for Traffic Law Enforcement Officers. Instructor's Lesson Plans.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

To assist in the continuing efforts to improve the safety of the motorist on the nation's highways and roads, this instructor's guide provides a standardized approach for providing training in emergency medical care for first responders to traffic accidents. The objective of the course is to provide training in all aspects of emergency medical…

Crash Injury Management: Emergency Medical Services for Traffic Law Enforcement Officers. Student Study Guide.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

To assist in the continuing efforts to improve the safety of the motorist on the nation's highways and roads, this student guide provides a standardized approach for first responders to traffic accidents to learn emergency medical care. Training is provided in all aspects of emergency medical care required at the scene of a traffic accident.…

News and views in Histochemistry and Cell Biology.

PubMed

Asan, Esther; Drenckhahn, Detlev

2004-12-01

Advances in histochemical methodology and ingenious applications of novel and improved methods continue to confirm the standing of morphological means and approaches in research efforts, and contribute significantly to increasing our knowledge about structures and functions in all areas of the life sciences from cell biology to pathology. Reports published during recent months documenting this progress are summarized in the present review.

The Extent of and Reasons for Non Re-Enrollment: A Case of Korea National Open University

ERIC Educational Resources Information Center

Choi, Hyoseon; Lee, Yekyung; Jung, Insung; Latchem, Colin

2013-01-01

Despite continuous efforts to increase retention, dropout rates are high in distance universities. The objectives of this study were: 1) to investigate the extent and causes of non re-enrollment at a mega university, Korea National Open University; and 2) to suggest actions to improve the retention of students, in general, and those with higher…

Studies for the Loss of Atomic and Molecular Species from Io

NASA Technical Reports Server (NTRS)

Smyth, William H.

1998-01-01

Continued effort is reported to improve the emission rates of various emission lines for atomic oxygen and sulfur. Atomic hydrogen has been included as a new species in the neutral cloud model. The pertinent lifetime processes for hydrogen in the plasma torus and the relevant excitation processes for H Lyman-alpha emission in Io's atmosphere are discussed.

LAWS simulation: Sampling strategies and wind computation algorithms

NASA Technical Reports Server (NTRS)

Emmitt, G. D. A.; Wood, S. A.; Houston, S. H.

1989-01-01

In general, work has continued on developing and evaluating algorithms designed to manage the Laser Atmospheric Wind Sounder (LAWS) lidar pulses and to compute the horizontal wind vectors from the line-of-sight (LOS) measurements. These efforts fall into three categories: Improvements to the shot management and multi-pair algorithms (SMA/MPA); observing system simulation experiments; and ground-based simulations of LAWS.

A New Majority: Low Income Students in the South's Public Schools. SEF Research Report

ERIC Educational Resources Information Center

Suitts, Steve

2007-01-01

The year 2007 marks the 140th year of continuous efforts by the Southern Education Foundation (SEF) to improve Southern education quality and opportunity for all of the region's people, especially those whose life chances are hobbled by poverty. SEF has played a critical role in the South's long circuitous march toward realizing the American Dream…

Use of Research-Based Information by School Practitioners and Determinants of Use: A Review of Empirical Research

ERIC Educational Resources Information Center

Dagenais, Christian; Lysenko, Larysa; Abrami, Philip C.; Bernard, Robert M.; Ramde, Jean; Janosz, Michel

2012-01-01

The trend towards using research knowledge to improve policies and practices is on the rise. However, despite considerable effort and notable progress in recent years, it seems that school practitioners continue to make little use of research and it is not clear what conditions would facilitate or obstruct this use. This review focuses exclusively…

Surveillance for equity in maternal care in Zimbabwe.

PubMed

Taylor, C; Sanders, D; Bassett, M; Goings, S

1993-01-01

The great hope and promise of post-independence efforts to promote equitable health care in Zimbabwe started with three years of dramatic improvement. Commitment to correcting inequities which were as discriminatory as any country in the world produced rapid extension of health centre infrastructure and the improvement of district hospitals. The major constraint was the entrenched pattern of sophisticated, high-technology health care left by colonial administrators which continued to monopolize resources. In spite of the excellent beginning, development of services for the poor was thwarted by recession, prolonged drought and external military destabilization. The cutbacks in funding for health care have been particularly severe as a result of economic adjustment policies imposed by IMF. Political pressure moved the health system toward private entrepreneurship returning to earlier patterns of discrimination in favour of whites and urban residents. Efforts to promote high-risk monitoring have had little impact among the poor and those living in remote areas. Equity has become symbolic rather than real. The government of Zimbabwe maintains a continuing commitment to the original goals of equity through primary health care. International agencies also would like to find a way to help reallocate services. There seems to be recognition that little will be accomplished in improving health conditions unless services are provided to those in greatest need. Disparities in maternal care are especially severe and can be improved only by building infrastructure to provide antenatal and perinatal services.(ABSTRACT TRUNCATED AT 250 WORDS)

Toward Collective Impact for Climate Resilience: Maximizing Climate Change Education for Preparedness, Adaptation, and Mitigation

NASA Astrophysics Data System (ADS)

Ledley, T. S.; Niepold, F., III; McCaffrey, M.

2014-12-01

Increasing the capacity of society to make informed climate decisions based on scientific evidence is imperative. While a wide range of education programs and communication efforts to improve understanding and facilitate responsible effective decision-making have been developed in recent years, these efforts have been largely disconnected. The interdisciplinary and trans-disciplinary nature of the problems and potential responses to climate change requires a broad range of expertise and a strategy that overcomes the inherent limitations of isolated programs and efforts. To extend the reach and impact of climate change education and engagement efforts, it is necessary to have a coordination that results in greater collective impact. The Collective Impact model, as described by Kania & Kramer (2011), requires five elements: 1) a common agenda; 2) shared measurement systems; 3) mutually reinforcing activities; 4) continuous communication; and 5) a well-funded backbone support organization. The CLEAN Network has facilitated a series of discussions at six professional meetings from late 2012 through spring 2014 to begin to develop and define the elements of collective impact on climate change education and engagement. These discussions have focused on getting input from the community on a common agenda and what a backbone support organization could do to help extend their reach and impact and enable a longer-term sustainability. These discussions will continue at future meetings, with the focus shifting to developing a common agenda and shared metrics. In this presentation we will summarize the outcomes of these discussions thus far, especially with respect to what activities a backbone support organization might provide to help increase the collective impact of climate change education effort and invite others to join the development of public-private partnership to improve the nations climate literacy. The cumulative input into this evolving discussion on collective impact on climate literacy can be viewed at http://tinyurl.com/mgwndtr.

Can NMR solve some significant challenges in metabolomics?

PubMed

Nagana Gowda, G A; Raftery, Daniel

2015-11-01

The field of metabolomics continues to witness rapid growth driven by fundamental studies, methods development, and applications in a number of disciplines that include biomedical science, plant and nutrition sciences, drug development, energy and environmental sciences, toxicology, etc. NMR spectroscopy is one of the two most widely used analytical platforms in the metabolomics field, along with mass spectrometry (MS). NMR's excellent reproducibility and quantitative accuracy, its ability to identify structures of unknown metabolites, its capacity to generate metabolite profiles using intact bio-specimens with no need for separation, and its capabilities for tracing metabolic pathways using isotope labeled substrates offer unique strengths for metabolomics applications. However, NMR's limited sensitivity and resolution continue to pose a major challenge and have restricted both the number and the quantitative accuracy of metabolites analyzed by NMR. Further, the analysis of highly complex biological samples has increased the demand for new methods with improved detection, better unknown identification, and more accurate quantitation of larger numbers of metabolites. Recent efforts have contributed significant improvements in these areas, and have thereby enhanced the pool of routinely quantifiable metabolites. Additionally, efforts focused on combining NMR and MS promise opportunities to exploit the combined strength of the two analytical platforms for direct comparison of the metabolite data, unknown identification and reliable biomarker discovery that continue to challenge the metabolomics field. This article presents our perspectives on the emerging trends in NMR-based metabolomics and NMR's continuing role in the field with an emphasis on recent and ongoing research from our laboratory. Copyright © 2015 Elsevier Inc. All rights reserved.

Addressing Children's Oral Health in the New Millennium: Trends in the Dental Workforce

PubMed Central

Mertz, Elizabeth; Mouradian, Wendy

2009-01-01

The Surgeon General's Report on Oral Health (SGROH) and the Call to Action to Promote Oral Health outlined the need to increase the diversity, capacity and flexibility of the dental workforce to reduce oral health disparities. This paper provides an update on dental workforce trends since the SGROH in the context of children's oral health needs. Major challenges remain to ensure a workforce that is adequate to address the needs of all children. The dentist to population ratio is declining, while mal-distribution of dentists continues for rural and underserved communities. The diversity of the dental workforce has only improved slightly, while the diversity of the pediatric population has increased substantially. More pediatric dentists have been trained, and dental educational programs are preparing students for practice in underserved areas, but the impact of these efforts on underserved children is uncertain. Other workforce developments with the potential to improve children's oral health include: enhanced training in children's oral health for general dentists; expanded scope of practice for allied dental health professionals; new dental practitioners including the dental health aid therapist; and increased engagement of pediatricians and other medical practitioners in children's oral health. The evidence for increasing caries experience in young children points to the need for continued efforts to bolster the oral health workforce. However, workforce strategies alone will not be sufficient to change this situation. Requisite policy changes, educational efforts and strong partnerships with communities will be needed to effect substantive changes in children's oral health. PMID:19854121

Addressing children's oral health in the new millennium: trends in the dental workforce.

PubMed

Mertz, Elizabeth; Mouradian, Wendy E

2009-01-01

Oral Health in America: A Report of the Surgeon General (SGROH) and National Call to Action to Promote Oral Health outlined the need to increase the diversity, capacity, and flexibility of the dental workforce to reduce oral health disparities. This paper provides an update on dental workforce trends since the SGROH in the context of children's oral health needs. Major challenges remain to ensure a workforce that is adequate to address the needs of all children. The dentist-to-population ratio is declining while shortages of dentists continue in rural and underserved communities. The diversity of the dental workforce has only improved slightly, and the the diversity of the pediatric population has increased substantially. More pediatric dentists have been trained, and dental educational programs are preparing students for practice in underserved areas, but the impact of these efforts on underserved children is uncertain. Other workforce developments with the potential to improve children's oral health include enhanced training in children's oral health for general dentists, expanded scope of practice for allied dental health professionals, new dental practitioners including the dental health aid therapist, and increased engagement of pediatricians and other medical practitioners in children's oral health. The evidence for increasing caries experience in young children points to the need for continued efforts to bolster the oral health workforce. However, workforce strategies alone will not be sufficient to change this situation. Requisite policy changes, educational efforts, and strong partnerships with communities will be needed to effect substantive changes in children's oral health.

Designing Interventions that Last: A Classification of Environmental Behaviors in Relation to the Activities, Costs, and Effort Involved for Adoption and Maintenance

PubMed Central

Moore, Harriet E.; Boldero, Jennifer

2017-01-01

Policy makers draw on behavioral research to design interventions that promote the voluntary adoption of environmental behavior in societies. Many environmental behaviors will only be effective if they are maintained over the long-term. In the context of climate change and concerns about future water security, behaviors that involve reducing energy consumption and improving water quality must be continued indefinitely to mitigate global warming and preserve scarce resources. Previous reviews of environmental behavior have focused exclusively on factors related to adoption. This review investigates the factors that influence both adoption and maintenance, and presents a classification of environmental behaviors in terms of the activities, costs, and effort required for both adoption and maintenance. Three categories of behavior are suggested. One-off behaviors involve performing an activity once, such as purchasing an energy efficient washing machine, or signing a petition. Continuous behaviors involve the performance of the same set of behaviors for adoption and for maintenance, such as curbside recycling. Dynamic behaviors involve the performance of different behaviors for adoption and maintenance, such as revegetation. Behaviors can also be classified into four categories related to cost and effort: those that involve little cost and effort for adoption and maintenance, those that involve moderate cost and effort for adoption and maintenance, those that involve a high cost or effort for adoption and less for maintenance, and those that involve less cost or effort for adoption and a higher amount for maintenance. In order to design interventions that last, policy makers should consider the factors that influence the maintenance as well as the adoption of environmental behaviors. PMID:29163265

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.

Association between health worker motivation and healthcare quality efforts in Ghana.

PubMed

Alhassan, Robert Kaba; Spieker, Nicole; van Ostenberg, Paul; Ogink, Alice; Nketiah-Amponsah, Edward; de Wit, Tobias F Rinke

2013-08-14

Ghana is one of the sub-Saharan African countries making significant progress towards universal access to quality healthcare. However, it remains a challenge to attain the 2015 targets for the health related Millennium Development Goals (MDGs) partly due to health sector human resource challenges including low staff motivation. This paper addresses indicators of health worker motivation and assesses associations with quality care and patient safety in Ghana. The aim is to identify interventions at the health worker level that contribute to quality improvement in healthcare facilities. The study is a baseline survey of health workers (n = 324) in 64 primary healthcare facilities in two regions in Ghana. Data collection involved quality care assessment using the SafeCare Essentials tool, the National Health Insurance Authority (NHIA) accreditation data and structured staff interviews on workplace motivating factors. The Spearman correlation test was conducted to test the hypothesis that the level of health worker motivation is associated with level of effort by primary healthcare facilities to improve quality care and patient safety. The quality care situation in health facilities was generally low, as determined by the SafeCare Essentials tool and NHIA data. The majority of facilities assessed did not have documented evidence of processes for continuous quality improvement and patient safety. Overall, staff motivation appeared low although workers in private facilities perceived better working conditions than workers in public facilities (P <0.05). Significant positive associations were found between staff satisfaction levels with working conditions and the clinic's effort towards quality improvement and patient safety (P <0.05). As part of efforts towards attainment of the health related MDGs in Ghana, more comprehensive staff motivation interventions should be integrated into quality improvement strategies especially in government-owned healthcare facilities where working conditions are perceived to be the worst.

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

PubMed

Quon, Bradley S; Goss, Christopher H

2011-12-01

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

Evolution and outcomes of a quality improvement program.

PubMed

Thor, Johan; Herrlin, Bo; Wittlöv, Karin; Øvretveit, John; Brommels, Mats

2010-01-01

The purpose of this paper is to examine the outcomes and evolution over a five-year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it. The paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations. Overall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the "bigger picture" and the improvements achieved for patients and employees. Quality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied. This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five-year period and provides in-depth insight into an improvement program's changeable nature.

Publicly disclosed information about the quality of health care: response of the US public

PubMed Central

Schneider, E; Lieberman, T

2001-01-01

Public disclosure of information about the quality of health plans, hospitals, and doctors continues to be controversial. The US experience of the past decade suggests that sophisticated quality measures and reporting systems that disclose information on quality have improved the process and outcomes of care in limited ways in some settings, but these efforts have not led to the "consumer choice" market envisaged. Important reasons for this failure include limited salience of objective measures to consumers, the complexity of the task of interpretation, and insufficient use of quality results by organised purchasers and insurers to inform contracting and pricing decisions. Nevertheless, public disclosure may motivate quality managers and providers to undertake changes that improve the delivery of care. Efforts to measure and report information about quality should remain public, but may be most effective if they are targeted to the needs of institutional and individual providers of care. Key Words: public disclosure; quality of health care; quality improvement PMID:11389318

Continuous Czochralski growth. Development of advanced Czochralski growth process to produce low cost 150 kg silicon ingots from a single crucible for technology readiness

NASA Technical Reports Server (NTRS)

1982-01-01

The improvement of growth rates using radiation shielding and investigation of the crucible melt interaction for improved yields were emphasized. Growth runs were performed from both 15 and 16 inch diameter crucibles, producing 30 and 37 kg ingots respectively. Efforts to increase the growth rate of 150 mm diameter ingots were limited by temperature instabilities believed to be caused by undesirable thermal convections in the larger melts. The radiation shield improved the growth rate somewhat, but the thermal instability was still evident, leading to nonround ingots and loss of dislocation-free structure. A 38 kg crystal was grown to demonstrate the feasibility of producing 150 kg with four growth cycles. After the grower construction phase, the Hamco microprocessor control system was interfaced to the growth facility, including the sensor for automatic control of seeding temperature, and the sensor for automatic shouldering. Efforts focused upon optimization of the seeding, necking, and shoulder growth automation programs.

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

PubMed

Davis, David A; Rayburn, William F

2016-01-01

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

The Armstrong Institute: An Academic Institute for Patient Safety and Quality Improvement, Research, Training, and Practice.

PubMed

Pronovost, Peter J; Holzmueller, Christine G; Molello, Nancy E; Paine, Lori; Winner, Laura; Marsteller, Jill A; Berenholtz, Sean M; Aboumatar, Hanan J; Demski, Renee; Armstrong, C Michael

2015-10-01

Academic medical centers (AMCs) could advance the science of health care delivery, improve patient safety and quality improvement, and enhance value, but many centers have fragmented efforts with little accountability. Johns Hopkins Medicine, the AMC under which the Johns Hopkins University School of Medicine and the Johns Hopkins Health System are organized, experienced similar challenges, with operational patient safety and quality leadership separate from safety and quality-related research efforts. To unite efforts and establish accountability, the Armstrong Institute for Patient Safety and Quality was created in 2011.The authors describe the development, purpose, governance, function, and challenges of the institute to help other AMCs replicate it and accelerate safety and quality improvement. The purpose is to partner with patients, their loved ones, and all interested parties to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste in health care. A governance structure was created, with care mapped into seven categories, to oversee the quality and safety of all patients treated at a Johns Hopkins Medicine entity. The governance has a Patient Safety and Quality Board Committee that sets strategic goals, and the institute communicates these goals throughout the health system and supports personnel in meeting these goals. The institute is organized into 13 functional councils reflecting their behaviors and purpose. The institute works daily to build the capacity of clinicians trained in safety and quality through established programs, advance improvement science, and implement and evaluate interventions to improve the quality of care and safety of patients.

Public Health Opportunities for Promoting Health Equity in Cancer Prevention and Control in LGBT Populations.

PubMed

Massetti, Greta M; Ragan, Kathleen R; Thomas, Cheryll C; Ryerson, A Blythe

2015-10-20

Advances in cancer prevention, detection, and treatment have led to reductions in morbidity and premature mortality and improvements in quality of life. However, not all Americans have benefitted equally from these advances, and certain populations experience continued disparities in cancer care. Although research and public health efforts have highlighted the experiences of some groups, other populations have been relatively understudied, such as lesbian, gay, bisexual, and transgender (LGBT) individuals. Public health efforts in surveillance, research, programs, and partnerships can provide opportunities to advance health equity for LGBT at the population level and lead to better health outcomes for LGBT individuals with cancer.

Strategic planning as a focus for continuous improvement. A case study

NASA Technical Reports Server (NTRS)

Oneill, John W.; Gordon-Winkler, Lyn

1992-01-01

What do most of the successful people and organizations in our world have in common? Instead of worrying about the future, they work to create it. They have a plan, or a vision of what they want to accomplish and they focus their efforts on success. Strategic planning has been described as a disciplined, ongoing process to produce fundamental decisions and actions that shape what an organization is, what it does, and how it will respond to a changing environment. This case study discussion will evaluate the relationship between strategic planning and Total Quality Management (TQM), or continuous improvement, through the experience of the NASA Johnson Space Center in developing a strategy for the future. That experience clearly illustrates the value of strategic planning in setting the framework and establishing the overall thrust of continuous improvement initiatives. Equally significant, the fundamentals of a quality culture such as strong customer and supplier partnerships, participative involvement, open communications, and ownership were essential in overcoming the challenges inherent in the planning process. A reinforced management commitment to the quality culture was a clear, long-term benefit.

Landsat: building a strong future

USGS Publications Warehouse

Loveland, Thomas R.; Dwyer, John L.

2012-01-01

Conceived in the 1960s, the Landsat program has experienced six successful missions that have contributed to an unprecedented 39-year record of Earth Observations that capture global land conditions and dynamics. Incremental improvements in imaging capabilities continue to improve the quality of Landsat science data, while ensuring continuity over the full instrument record. Landsats 5 and 7 are still collecting imagery. The planned launch of the Landsat Data Continuity Mission in December 2012 potentially extends the Landsat record to nearly 50 years. The U.S. Geological Survey (USGS) Landsat archive contains nearly three million Landsat images. All USGS Landsat data are available at no cost via the Internet. The USGS is committed to improving the content of the historical Landsat archive though the consolidation of Landsat data held in international archives. In addition, the USGS is working on a strategy to develop higher-level Landsat geo- and biophysical datasets. Finally, Federal efforts are underway to transition Landsat into a sustained operational program within the Department of the Interior and to authorize the development of the next two satellites — Landsats 9 and 10.

Strategic planning as a focus for continuous improvement. A case study

NASA Astrophysics Data System (ADS)

Oneill, John W.; Gordon-Winkler, Lyn

What do most of the successful people and organizations in our world have in common? Instead of worrying about the future, they work to create it. They have a plan, or a vision of what they want to accomplish and they focus their efforts on success. Strategic planning has been described as a disciplined, ongoing process to produce fundamental decisions and actions that shape what an organization is, what it does, and how it will respond to a changing environment. This case study discussion will evaluate the relationship between strategic planning and Total Quality Management (TQM), or continuous improvement, through the experience of the NASA Johnson Space Center in developing a strategy for the future. That experience clearly illustrates the value of strategic planning in setting the framework and establishing the overall thrust of continuous improvement initiatives. Equally significant, the fundamentals of a quality culture such as strong customer and supplier partnerships, participative involvement, open communications, and ownership were essential in overcoming the challenges inherent in the planning process. A reinforced management commitment to the quality culture was a clear, long-term benefit.

Global Burden of Skin Disease: Inequities and Innovations.

PubMed

Seth, Divya; Cheldize, Khatiya; Brown, Danielle; Freeman, Esther F

2017-09-01

We review the current understanding of the burden of dermatological disease through the lens of the Global Burden of Disease project, evaluate the impact of skin disease on quality of life in a global context, explore socioeconomic implications, and finally summarize interventions towards improving quality of dermatologic care in resource-poor settings. The Global Burden of Disease project has shown that skin diseases continue to be the 4 th leading cause of nonfatal disease burden world-wide. However, research efforts and funding do not match with the relative disability of skin diseases. International and national efforts, such as the WHO List of Essential Medicines, are critical towards reducing the socioeconomic burden of skin diseases and increasing access to care. Recent innovations such as teledermatology, point-of-care diagnostic tools, and task-shifting help to provide dermatological care to underserved regions in a cost-effective manner. Skin diseases cause significant non-fatal disability worldwide, especially in resource-poor regions. Greater impetus to study the burden of skin disease in low resource settings and policy efforts towards delivering high quality care are essential in improving the burden of skin diseases.

Discovery of N-[4-[6-tert-Butyl-5-methoxy-8-(6-methoxy-2-oxo-1H-pyridin-3-yl)-3-quinolyl]phenyl]methanesulfonamide (RG7109), a Potent Inhibitor of the Hepatitis C Virus NS5B Polymerase

PubMed Central

Talamas, Francisco X.; Abbot, Sarah C.; Anand, Shalini; Brameld, Ken A.; Carter, David S.; Chen, Jun; Davis, Dana; de Vicente, Javier; Fung, Amy D.; Gong, Leyi; Harris, Seth F.; Inbar, Petra; Labadie, Sharada S.; Lee, Eun K.; Lemoine, Remy; Le Pogam, Sophie; Leveque, Vincent; Li, Jim; McIntosh, Joel; Nájera, Isabel; Park, Jaehyeon; Railkar, Aruna; Rajyaguru, Sonal; Sangi, Michael; Schoenfeld, Ryan C.; Staben, Leanna R.; Tan, Yunchou; Taygerly, Joshua P.; Villaseñor, Armando G.; Weller, Paul E.

2013-01-01

In the last few years, there have been many advances in the efforts to cure patients with hepatitis C virus (HCV). The ultimate goal of these efforts is to develop a combination therapy consisting of only direct-antiviral agents (DAA). In this paper, we discuss our efforts that led to the identification of a bicyclic template with potent activity against the NS5B polymerase, a critical enzyme on the life cycle of HCV. Continuing our exploration to improve the stilbene series, the 3,5,6,8-tetrasubstituted quinoline core was identified as replacement of the stilbene moiety. 6-Methoxy-2(1H)-pyridone was identified among several heterocyclic head groups to have the best potency. Solubility of the template was improved by replacing a planar aryl linker with a saturated pyrrolidine. Profiling of the most promising compounds led to the identification of quinoline 41 (RG7109) which was selected for advancement to clinical development. PMID:24195700

The Nucleation and Growth of Protein Crystals

NASA Technical Reports Server (NTRS)

Pusey, Marc

2004-01-01

Obtaining crystals of suitable size and high quality continues to be a major bottleneck in macromolecular crystallography. Currently, structural genomics efforts are achieving on average about a 10% success rate in going from purified protein to a deposited crystal structure. Growth of crystals in microgravity was proposed as a means of overcoming size and quality problems, which subsequently led to a major NASA effort in microgravity crystal growth, with the agency also funding research into understanding the process. Studies of the macromolecule crystal nucleation and growth process were carried out in a number of labs in an effort to understand what affected the resultant crystal quality on Earth, and how microgravity improved the process. Based upon experimental evidence, as well as simple starting assumptions, we have proposed that crystal nucleation occurs by a series of discrete self assembly steps, which 'set' the underlying crystal symmetry. This talk will review the model developed, and its origins, in our laboratory for how crystals nucleate and grow, and will then present, along with preliminary data, how we propose to use this model to improve the success rate for obtaining crystals from a given protein.

Mission operations and command assurance: Flight operations quality improvements

NASA Technical Reports Server (NTRS)

Welz, Linda L.; Bruno, Kristin J.; Kazz, Sheri L.; Potts, Sherrill S.; Witkowski, Mona M.

1994-01-01

Mission Operations and Command Assurance (MO&CA) is a Total Quality Management (TQM) task on JPL projects to instill quality in flight mission operations. From a system engineering view, MO&CA facilitates communication and problem-solving among flight teams and provides continuous solving among flight teams and provides continuous process improvement to reduce risk in mission operations by addressing human factors. The MO&CA task has evolved from participating as a member of the spacecraft team, to an independent team reporting directly to flight project management and providing system level assurance. JPL flight projects have benefited significantly from MO&CA's effort to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit from previous and ongoing flight experience.

Launch Vehicle Ascent Trajectory Simulation Using the Program to Optimize Simulated Trajectories II (POST2)

NASA Technical Reports Server (NTRS)

Lugo, Rafael A.; Shidner, Jeremy D.; Powell, Richard W.; Marsh, Steven M.; Hoffman, James A.; Litton, Daniel K.; Schmitt, Terri L.

2017-01-01

The Program to Optimize Simulated Trajectories II (POST2) has been continuously developed for over 40 years and has been used in many flight and research projects. Recently, there has been an effort to improve the POST2 architecture by promoting modularity, flexibility, and ability to support multiple simultaneous projects. The purpose of this paper is to provide insight into the development of trajectory simulation in POST2 by describing methods and examples of various improved models for a launch vehicle liftoff and ascent.

Tracking data in the office environment.

PubMed

Erickson, Ty B

2010-09-01

Data tracking in the office setting focuses on a narrow spectrum of the entire patient safety arena; however, when properly executed, data tracking increases staff members' awareness of the importance of patient safety. Data tracking is also a high-volume event and thereby continues to loop back on the consciousness of providers in all aspects of their practice. Improvement in date tracking will improve the collateral areas of patient safety such as proper medication usage, legibility of written communication, effective delegation of patient safety initiatives, and a collegial effort at developing teams for safety design processes.

AFSO 21: Identifying Potential Failure Points in Sustaining Continuous Process Improvement Across the Air Force

DTIC Science & Technology

2007-04-01

Michael W. Wynne, and the Air Force Chief of Staff, General T. Michael Moseley, “our strategy will be a comprehensive effort to improve our work processes...5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7...property of the United States government. ii AU/ACSC/2307/AY07 Preface I have always been a proponent of working smarter and not harder. I

Systems Engineering Education Development(SEED)Case Study

NASA Technical Reports Server (NTRS)

Bagg, Thomas C., III; Brumfield, Mark D.; Jamison, Donald E.; Granata, Raymond L.; Casey, Carolyn A.

2003-01-01

The Systems Engineering Development Program (SEED) was initiated to help Goddard resolve a Systems Engineering skill shortage. The chronology of events and the experiences of the pilot program are outlined to describe the development of the present program. The program goals are included in order to give a focus on what the developers saw as the program drivers. Lessons learned from a pilot program were incorporated into the present program. This program is constantly learning from its past efforts and looks for continuous improvement. We list several future ideas for improvement and change.

BATSE Solar Flare Spectroscopy

NASA Technical Reports Server (NTRS)

Schwartz, R. A.

1998-01-01

This final report describes the progress originally proposed: (1) the continued improvement of a software and database environment capable of supporting all users of BATSE solar data as well as providing scientific expertise and effort to the BATSE solar community; (2) the continued participation with the PI team and other guest investigators in the detailed analysis of the BATSE detectors' response at low energies; (3) using spectroscopic techniques to fully exploit the potential of electron time-of-flight studies; and, (4) a full search for flare gamma-ray line emission at 2.2 MeV from all GOES X-class flares observed with BATSE.

Strategies of bringing drug product marketing applications to meet current regulatory standards.

PubMed

Wu, Yan; Freed, Anita; Lavrich, David; Raghavachari, Ramesh; Huynh-Ba, Kim; Shah, Ketan; Alasandro, Mark

2015-08-01

In the past decade, many guidance documents have been issued through collaboration of global organizations and regulatory authorities. Most of these are applicable to new products, but there is a risk that currently marketed products will not meet the new compliance standards during audits and inspections while companies continue to make changes through the product life cycle for continuous improvement or market demands. This discussion presents different strategies to bringing drug product marketing applications to meet current and emerging standards. It also discusses stability and method designs to meet process validation and global development efforts.

Animals and the 3Rs in toxicology research and testing: The way forward.

PubMed

Stokes, W S

2015-12-01

Despite efforts to eliminate the use of animals in testing and the availability of many accepted alternative methods, animals are still widely used for toxicological research and testing. While research using in vitro and computational models has dramatically increased in recent years, such efforts have not yet measurably impacted animal use for regulatory testing and are not likely to do so for many years or even decades. Until regulatory authorities have accepted test methods that can totally replace animals and these are fully implemented, large numbers of animals will continue to be used and many will continue to experience significant pain and distress. In order to positively impact the welfare of these animals, accepted alternatives must be implemented, and efforts must be directed at eliminating pain and distress and reducing animal numbers. Animal pain and distress can be reduced by earlier predictive humane endpoints, pain-relieving medications, and supportive clinical care, while sequential testing and routine use of integrated testing and decision strategies can reduce animal numbers. Applying advances in science and technology to the development of scientifically sound alternative testing models and strategies can improve animal welfare and further reduce and replace animal use. © The Author(s) 2015.

2nd Annual Invited Experts Meeting on Simulation-Based Medical Training

DTIC Science & Technology

2005-12-01

medicine, government, and regulatory officials with medical simulation and patient safety experts. In 2005, TATRC continued its support of this effort...standardized patients allow students to interact with “actors” specifically trained to present their medical histories, simulate physical symptoms, and...simulation-based medical training benefits all of us, as follows: • Patients benefit from improved health outcomes and reduced errors and deaths

ERTS-B imagery interpretation techniques in the Tennessee Valley

NASA Technical Reports Server (NTRS)

Gonzalez, R. C. (Principal Investigator)

1973-01-01

There are no author-identified significant results in this report. The proposed investigation is a continuation of an ERTS-1 project. The principal missions are to serve as the principal supporter on computer and image processing problems for the multidisciplinary ERTS effort of the University of Tennessee, and to carry out research in improved methods for the computer processing, enhancement, and recognition of ERTS imagery.

Quality mind-set overcomes barriers to success.

PubMed

Anderson, C A; Daigh, R D

1991-02-01

To remove hindrances to fiscal strength, a healthcare facility needs a long-term, organization-wide strategy. Total quality management (TQM) can offer such a solution, but it requires a revised management philosophy. Under TQM, a hospital must adopt a workable definition of quality; develop a customer orientation; form organizational teams to study and revise work processes; involve all employees in quality efforts; and strive for continuous improvements.

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

ERIC Educational Resources Information Center

Ellis, Brian E.

2014-01-01

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

NASA total quality management 1990 accomplishments report

NASA Technical Reports Server (NTRS)

1991-01-01

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

Annual Performance Report. Bureau of Indian Education FFY 2011. Revised Clarification, May 17, 2013. APR Template-Part B

ERIC Educational Resources Information Center

Bureau of Indian Education, 2013

2013-01-01

During SY 2011-2012, the Bureau of Indian Education (BIE) continued their efforts to improve the validity and reliability of data reporting. BIE data collections are dependent on school level entry (self-reporting) into the Native American Student Information System (NASIS) or into the BIE's Annual Report from the schools. In addition, data…

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

PubMed

Ghosh, Basu

2009-06-11

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

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

PubMed Central

Ghosh, Basu

2009-01-01

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

Foam composite structures. [for fire retardant airframe materials

NASA Technical Reports Server (NTRS)

Delano, C. B.; Milligan, R. J.

1976-01-01

The need to include fire resistant foams into state of the art aircraft interior paneling to increase passenger safety in aircraft fires was studied. Present efforts were directed toward mechanical and fire testing of panels with foam inclusions. Skinned foam filled honeycomb and PBI structural foams were the two constructions investigated with attention being directed toward weight/performance/cost trade-off. All of the new panels demonstrated improved performance in fire and some were lighter weight but not as strong as the presently used paneling. Continued efforts should result in improved paneling for passenger safety. In particular the simple partial filling (fire side) of state-of-the-art honeycomb with fire resistant foams with little sacrifice in weight would result in panels with increased fire resistance. More important may be the retarded rate of toxic gas evolution in the fire due to the protection of the honeycomb by the foam.

Higher Order Chemistry Models in the CFD Simulation of Laser-Ablated Carbon Plumes

NASA Technical Reports Server (NTRS)

Greendyke, R. B.; Creel, J. R.; Payne, B. T.; Scott, C. D.

2005-01-01

Production of single-walled carbon nanotubes (SWNT) has taken place for a number of years and by a variety of methods such as laser ablation, chemical vapor deposition, and arc-jet ablation. Yet, little is actually understood about the exact chemical kinetics and processes that occur in SWNT formation. In recent time, NASA Johnson Space Center has devoted a considerable effort to the experimental evaluation of the laser ablation production process for SWNT originally developed at Rice University. To fully understand the nature of the laser ablation process it is necessary to understand the development of the carbon plume dynamics within the laser ablation oven. The present work is a continuation of previous studies into the efforts to model plume dynamics using computational fluid dynamics (CFD). The ultimate goal of the work is to improve understanding of the laser ablation process, and through that improved understanding, refine the laser ablation production of SWNT.

Achieving Space Shuttle ATO Using the Five-Segment Booster (FSB)

NASA Technical Reports Server (NTRS)

Sauvageau, Donald R.; McCool, Alex (Technical Monitor)

2001-01-01

As part of the continuing effort to identify approaches to improve the safety and reliability of the Space Shuttle system, a Five-Segment Booster (FSB) design was conceptualized as a replacement for the current Space Shuttle boosters. The FSB offers a simple, unique approach to improve astronaut safety and increase performance margin. To determine the feasibility of the FSB, a Phase A study effort was sponsored by NASA and directed by the Marshall Space Flight Center. This study was initiated in March of 1999 and completed in December of 2000. The basic objective of this study was to assess the feasibility of the FSB design concept and also estimate the cost and scope of a full-scale development program for the FSB. In order to ensure an effective and thorough evaluation of the FSB concept, four team members were put on contract to support various areas of importance in assessing the overall feasibility of the design approach.

Experience Transitioning Models and Data at the NOAA Space Weather Prediction Center

NASA Astrophysics Data System (ADS)

Berger, Thomas

2016-07-01

The NOAA Space Weather Prediction Center has a long history of transitioning research data and models into operations and with the validation activities required. The first stage in this process involves demonstrating that the capability has sufficient value to customers to justify the cost needed to transition it and to run it continuously and reliably in operations. Once the overall value is demonstrated, a substantial effort is then required to develop the operational software from the research codes. The next stage is to implement and test the software and product generation on the operational computers. Finally, effort must be devoted to establishing long-term measures of performance, maintaining the software, and working with forecasters, customers, and researchers to improve over time the operational capabilities. This multi-stage process of identifying, transitioning, and improving operational space weather capabilities will be discussed using recent examples. Plans for future activities will also be described.

High-Performance Polyimide Powder Coatings

NASA Technical Reports Server (NTRS)

2008-01-01

Much of the infrastructure at Kennedy Space Center and other NASA sites has been subjected to outside weathering effects for more than 40 years. Because much of this infrastructure has metallic surfaces, considerable effort is continually devoted to developing methods to minimize the effects of corrosion on these surfaces. These efforts are especially intense at KSC, where offshore salt spray and exhaust from Solid Rocket Boosters accelerate corrosion. Coatings of various types have traditionally been the choice for minimizing corrosion, and improved corrosion control methods are constantly being researched. Recent work at KSC on developing an improved method for repairing Kapton (polyimide)-based electrical wire insulation has identified polyimides with much lower melting points than traditional polyimides used for insulation. These lower melting points and the many other outstanding physical properties of polyimides (thermal stability, chemical resistance, and electrical properties) led us to investigate whether they could be used in powder coatings.

Improving Quality of Shoe Soles Product using Six Sigma

NASA Astrophysics Data System (ADS)

Jesslyn Wijaya, Athalia; Trusaji, Wildan; Akbar, Muhammad; Ma’ruf, Anas; Irianto, Dradjad

2018-03-01

A manufacture in Bandung produce kind of rubber-based product i.e. trim, rice rollers, shoe soles, etc. After penetrating the shoe soles market, the manufacture has met customer with tight quality control. Based on the past data, defect level of this product was 18.08% that caused the manufacture’s loss of time and money. Quality improvement effort was done using six sigma method that included phases of define, measure, analyse, improve, and control (DMAIC). In the design phase, the object’s problem and definition were defined. Delphi method was also used in this phase to identify critical factors. In the measure phase, the existing process stability and sigma quality level were measured. Fishbone diagram and failure mode and effect analysis (FMEA) were used in the next phase to analyse the root cause and determine the priority issues. Improve phase was done by designing alternative improvement strategy using 5W1H method. Some improvement efforts were identified, i.e. (i) modifying design of the hanging rack, (ii) create pantone colour book and check sheet, (iii) provide pedestrian line at compound department, (iv) buying stop watch, and (v) modifying shoe soles dies. Some control strategies for continuous improvement were proposed such as SOP or reward and punishment system.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

PubMed

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

PubMed Central

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271

Cystic Fibrosis Diagnostic Challenges over 4 Decades: Historical Perspectives and Lessons Learned.

PubMed

Farrell, Philip M; White, Terry B; Derichs, Nico; Castellani, Carlo; Rosenstein, Beryl J

2017-02-01

Because cystic fibrosis (CF) can be difficult to diagnose, and because information about the genetic complexities and pathologic basis of the disease has grown so rapidly over the decades, several consensus conferences have been held by the US CF Foundation, and a variety of other efforts to improve diagnostic practices have been organized by the European CF Society. Despite these efforts, the application of diagnostic criteria has been variable and caused confusion. To improve diagnosis and achieve standardization in terms and definitions worldwide, the CF Foundation in 2015 convened a committee of 32 experts in the diagnosis of CF from 9 countries. As part of the process, all previous consensus-seeking exercises sponsored by the CF Foundation, along with the important efforts of the European CF Society, were comprehensively and critically reviewed. The goal was to better understand why consensus conferences and their publications have not led to the desired results. Lessons learned from previous diagnosis consensus processes and products were identified. It was decided that participation in developing a consensus was generally not inclusive enough for global impact. It was also found that many efforts to address sweat test issues were valuable but did not always improve clinical practices as CF diagnostic testing evolved. It also became clear from this review that premature applications of potential diagnostic tests such as nasal potential difference and intestinal current measurement should be avoided until validation and standardization occur. Finally, we have learned that due to the significant and growing number of cases that are challenging to diagnose, an associated continuing medical education program is both desirable and necessary. It is necessary but not sufficient to organize and publish CF diagnosis consensus processes. Follow-up implementation efforts and monitoring practices seem essential. Copyright © 2016. Published by Elsevier Inc.

Waste minimization/pollution prevention study of high-priority waste streams

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

Ogle, R.B.

1994-03-01

Although waste minimization has been practiced by the Metals and Ceramics (M&C) Division in the past, the effort has not been uniform or formalized. To establish the groundwork for continuous improvement, the Division Director initiated a more formalized waste minimization and pollution prevention program. Formalization of the division`s pollution prevention efforts in fiscal year (FY) 1993 was initiated by a more concerted effort to determine the status of waste generation from division activities. The goal for this effort was to reduce or minimize the wastes identified as having the greatest impact on human health, the environment, and costs. Two broadmore » categories of division wastes were identified as solid/liquid wastes and those relating to energy use (primarily electricity and steam). This report presents information on the nonradioactive solid and liquid wastes generated by division activities. More specifically, the information presented was generated by teams of M&C staff members empowered by the Division Director to study specific waste streams.« less

A Recommendation on SLR Ranging to Future Global Navigation Satellite Systems

NASA Astrophysics Data System (ADS)

Labrecque, J. L.; Miller, J. J.; Pearlman, M.

2008-12-01

The multi-agency US Geodetic Requirements Working Group has recommended that Satellite Laser Retro- reflectors be installed on GPS III satellites as a principal component of the Positioning, Navigation, and Timing mandate of the Global Positioning System. The Working Group, which includes NASA, NGA, NOAA, NRL, USGS, and the USNO, echoes the Global Geodetic Observing System recommendation that SLR retro- reflectors be installed on all GNSS satellites. It is further recommended that the retro-reflectors conform to and hopefully exceed the minimum standard of the International Laser Ranging Service for retro-reflector cross sections of 100 million square meters for the HEO GNSS satellites to insure sufficiently accurate ranging by the global network of satellite laser ranging systems. The objective of this recommendation is to contribute to the improvement in the International Terrestrial Reference Frame, and its derivative the WGS84 reference frame, through continuing improvements in the characterization of the GPS orbits and clocks. Another objective is to provide an independent means of assessing the interoperability and accuracy of the GNSS systems and regional augmentation systems. The ranging to GNSS-mounted retro-reflectors will constitute a significant new means of space-based collocation to constrain the tie between the GPS and SLR networks that constitute over 50% of the data from which the ITRF is derived. The recommendation for the installation of SLR retro-reflectors aboard future GPS satellites is one of a number of efforts aimed at improving the accuracy and stability of ITRF. These steps are being coordinated with and supportive of the efforts of the GGOS and its services such at the VLBI2010 initiative, developing a next generation geodetic network, near real-time GPS positioning and EOP determination, and numerous efforts in the improvement of geodetic algorithms for GPS, SLR, VLBI, DORIS, and the determination of the ITRF. If past is prologue, the requirements of accuracy placed upon GNSS systems will continue to evolve at a factor of ten per decade for the lifetime of the GPS III, extending to 2025 and beyond. Global societal priorities such as sea level change measurement already require a factor of ten or more improvement in the accuracy and stability of the ITRF. Increasing accuracy requirements by civilian users for precision positioning and time keeping will certainly continue to grow at an exponential rate. The PNT accuracy of our GNSS systems will keep pace with these societal needs only if we equip the GNSS systems with the capability to identify and further reduce systematic errors.

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

Vendor management: a model for collaboration and quality improvement.

PubMed

Friedman, M D; Bailit, M H; Michel, J O

1995-11-01

The Massachusetts Medicaid agency, also known as the Division of Medical Assistance, has developed a quality-driven approach for managing its managed care suppliers. Such an approach has, as its foundation, principles of continuous quality improvement (CQI). Suppliers participate in an annual process whereby CQI goals are negotiated between the division and its suppliers. The division then works with suppliers to achieve such goals. A cornerstone of the division's approach is the notion that data can highlight an unlimited number of opportunities for improvement and that pursuit of such opportunities will ultimately result in meaningful improvements in the health status of recipients who are served by the division. The agency's approach involves five key steps: 1) the development of contractual terms and purchasing specifications; 2) the identification of improvement priorities; 3) the negotiation of improvement goals; 4) efforts directed at meeting improvement goals and measurement of success; and 5) collaboration to achieve mutual objectives. Overall, suppliers report many benefits of collaborative participation in CQI activities with the division. Suppliers have enhanced their understanding of the importance of meeting the needs of the customer and have further accrued benefits resulting from discussions with managed care vendors throughout the site regarding benchmarking of efforts and CQI efforts. Conversely, suppliers are challenged by the need to balance and allocate resources to meet increasing demands, which are not always consistent, from various purchasers, including the division. The division has been challenged in the evolution of its contract management strategy by an uneven level of knowledge among managed care vendors regarding CQI; goal setting and measurement issues; the length of time and level of effort required to develop good relationships with suppliers; and the critical importance of comparable, valid, and timely submission of data. Over the last three years, the division has seen a dramatic increase in the responsiveness of managed care suppliers to meet its needs as a purchaser. Specifically, this has been expressed through supplier ability to meet mutually negotiated improvement goals. The division is also pleased that it is beginning to achieve some measurable improvements in outcomes of care.

Effects of mindfulness meditation on three individuals with aphasia.

PubMed

Orenstein, Ellen; Basilakos, Alexandra; Marshall, Rebecca Shisler

2012-01-01

There is evidence to suggest that people with aphasia (PWA) may have deficits in attention stemming from the inefficient allocation of resources. The inaccurate perception of task demand, or sense of effort, may underlie the misallocation of the available attention resources. Given the lack of treatment options for improving attention in aphasia, Mindfulness Meditation, shown to improve attention in neurologically intact individuals, may prove effective in increasing attention in PWA. The purpose of the present study was to determine if Mindfulness Meditation improves divided attention or language in PWA and if it affects the overall sense of effort. A multiple baseline single-subject design was used to determine the effects of Mindfulness Meditation on divided attention for three PWA. Divided attention was measured using a non-linguistic divided attention task. Visual inspection of the data was used to determine changes in performance (sense of effort, reaction time and accuracy, language) over time. High performance observed on the attention measures suggests that PWA have varying degrees of attentional impairment that may surface when certain demands are presented. There were no observable changes in the performance on the sense of effort or language measures; however, measures of reaction time may indicate Mindfulness Meditation improved efficiency of task completion. All three participants reported that Mindfulness Meditation was easy to learn and carry out on a daily basis, and reported feeling more 'relaxed' and 'peaceful' after Mindfulness Meditation training than before. With the knowledge that PWA can learn meditative practices, and with such successful findings in neurologically intact individuals, it is important to continue evaluating the benefits of Mindfulness Meditation in PWA. © 2012 Royal College of Speech and Language Therapists.

An approach for using AVHRR data to monitor U.S. great plains grasslands

USGS Publications Warehouse

Reed, B.C.; Loveland, Thomas R.; Tieszen, L.L.

1996-01-01

Environmental monitoring requires regular observations regarding the status of the landscape- The concept behind most monitoring efforts using satellite data involve deriving normalized difference vegetation index (NDVI) values or accumulating the NDVI over a specified time period. These efforts attempt to estimate the continuous growth of green biomass by using continuous additions of NDVI as a surrogate measure. To build upon this concept, this study proposes three refinements; 1) use an objective definition of the current growing season to adjust the time window during which the NDVI is accumulated, 2) accumulate only the NDVI values which are affected by green vegetation, and 3) base monitoring units upon land cover type. These refinements improve the sensitivity of detecting interannual vegetation variability, reduce the need for extensive and detailed knowledge of ground conditions and crop calendars, provide a framework in which several types of monitoring can take place over diverse land cover types, and provide an objective time frame during which monitoring takes place.

The eighth NASA total quality management accomplishments report, 1990

NASA Technical Reports Server (NTRS)

1990-01-01

The eighth annual accomplishments report provides numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. NASA's continuous improvement efforts can provide insight for others to succeed in their own endeavors. The report covers: top management leadership and support, strategic planning, focus on the customer, employee training and recognition, employee empowerment and teamwork, measurement and analysis, and quality assurance.

Annual Performance Report 2009-2010. Bureau of Indian Education. Submitted February 1, 2011. Revised Clarification, April 18, 2011. APR Template-Part B (4)

ERIC Educational Resources Information Center

Bureau of Indian Education, 2011

2011-01-01

During SY 2009-2010, the Bureau of Indian Education (BIE) continued their efforts to improve the validity and reliability of data reporting. BIE data collections are dependent on school level entry (self reporting) into the Native American Student Information System (NASIS) or into the Bureau's Annual Report from the schools. In addition,…

Annual Performance Report 2010-2011. Bureau of Indian Education. Submitted February 1, 2012. Revised Clarification, April 17, 2012. APR Template-Part B (4)

ERIC Educational Resources Information Center

Bureau of Indian Education, 2012

2012-01-01

During SY 2010-2011, the Bureau of Indian Education (BIE) continued their efforts to improve the validity and reliability of data reporting. BIE data collections are dependent on school level entry (self-reporting) into the Native American Student Information System (NASIS) or into the Bureau's Annual Report from the schools. In addition,…

Physiological Indicators of Workload in a Remotely Piloted Aircraft Simulation

DTIC Science & Technology

2015-10-01

Aviation Psychology, 21(2), 105-122. Deci , E. L., & Ryan , R. M. (1991). Intrinsic motivation and self - determination in human behavior. In R. Steers...rankings (Martens, 1975). Furthermore, individuals have a tendency to challenge themselves in an effort to develop competence and prove self - determination ... Deci & Ryan , 1991). So, when presented with performance feedback, people are motivated to continuously improve their own performance, and beat the

School Lunch Program: Efforts Needed To Improve Nutrition and Encourage Healthy Eating. United States General Accounting Office Report to Congressional Requesters.

ERIC Educational Resources Information Center

Brown, Kay E.; Miller, Robert B.; Whitman-Miner, Dianne L.; Wallace, Shana B.; Fucile, Tamara L.; Schwimer, Daniel A.; Angulo, Karyn I.; Stenersen, Stanley G.

Over 15 percent of children are overweightdouble the rate in 1980. Children's diets are high in fat but low in fruits, vegetables, and other nutritious foods. The National School Lunch Program has had a continuing role in providing students with nutritious meals; however students must choose to eat the nutritious food and limit less healthful…

Chemical-Vapor Deposition Of Silicon Carbide

NASA Technical Reports Server (NTRS)

Cagliostro, D. E.; Riccitiello, S. R.; Ren, J.; Zaghi, F.

1993-01-01

Report describes experiments in chemical-vapor deposition of silicon carbide by pyrolysis of dimethyldichlorosilane in hydrogen and argon carrier gases. Directed toward understanding chemical-kinetic and mass-transport phenomena affecting infiltration of reactants into, and deposition of SiC upon, fabrics. Part of continuing effort to develop method of efficient and more nearly uniform deposition of silicon carbide matrix throughout fabric piles to make improved fabric/SiC-matrix composite materials.

Top 10 metrics for life science software good practices.

PubMed

Artaza, Haydee; Chue Hong, Neil; Corpas, Manuel; Corpuz, Angel; Hooft, Rob; Jimenez, Rafael C; Leskošek, Brane; Olivier, Brett G; Stourac, Jan; Svobodová Vařeková, Radka; Van Parys, Thomas; Vaughan, Daniel

2016-01-01

Metrics for assessing adoption of good development practices are a useful way to ensure that software is sustainable, reusable and functional. Sustainability means that the software used today will be available - and continue to be improved and supported - in the future. We report here an initial set of metrics that measure good practices in software development. This initiative differs from previously developed efforts in being a community-driven grassroots approach where experts from different organisations propose good software practices that have reasonable potential to be adopted by the communities they represent. We not only focus our efforts on understanding and prioritising good practices, we assess their feasibility for implementation and publish them here.

Time to finger point or fix? An invitation to join ongoing efforts to promote ethical authorship and other good publication practices.

PubMed

Woolley, Karen L; Gertel, Art; Hamilton, Cindy W; Jacobs, Adam; Snyder, Gene P

2013-01-01

In this commentary, we present evidence that unethical authorship (eg, guest and ghost authoring) and other publication practices are not restricted to the pharmaceutical industry; they also occur in academia. Such practices are not an industry problem--they are a research problem. To enhance trust in industry-sponsored research, companies have made rapid and far-reaching changes to their publication guidelines, policies, and procedures. Professional medical writers have adopted, and continue to implement, these changes. Although evidence indicates that industry practices are improving, there is certainly more to do, both in industry and academia. We invite readers to join ongoing efforts to promote ethical publication practices.

Optimizing Global Coronal Magnetic Field Models Using Image-Based Constraints

NASA Technical Reports Server (NTRS)

Jones-Mecholsky, Shaela I.; Davila, Joseph M.; Uritskiy, Vadim

2016-01-01

The coronal magnetic field directly or indirectly affects a majority of the phenomena studied in the heliosphere. It provides energy for coronal heating, controls the release of coronal mass ejections, and drives heliospheric and magnetospheric activity, yet the coronal magnetic field itself has proven difficult to measure. This difficulty has prompted a decades-long effort to develop accurate, timely, models of the field, an effort that continues today. We have developed a method for improving global coronal magnetic field models by incorporating the type of morphological constraints that could be derived from coronal images. Here we report promising initial tests of this approach on two theoretical problems, and discuss opportunities for application.

Research on enhancing the utilization of digital multispectral data and geographic information systems in global habitability studies

NASA Technical Reports Server (NTRS)

Martinko, Edward A.; Merchant, James W.

1988-01-01

During 1986 to 1987, the Kansas Applied Remote Sensing (KARS) Program continued to build upon long-term research efforts oriented towards enhancement and development of technologies for using remote sensing in the inventory and evaluation of land use and renewable resources (both natural and agricultural). These research efforts directly addressed needs and objectives of NASA's Land-Related Global Habitability Program as well as needs of and interests of public agencies and private firms. The KARS Program placed particular emphasis on two major areas: development of intelligent algorithms to improve automated classification of digital multispectral data; and integrating and merging digital multispectral data with ancillary data in spatial modes.

Driving Circuitry for Focused Ultrasound Noninvasive Surgery and Drug Delivery Applications

PubMed Central

El-Desouki, Munir M.; Hynynen, Kullervo

2011-01-01

Recent works on focused ultrasound (FUS) have shown great promise for cancer therapy. Researchers are continuously trying to improve system performance, which is resulting in an increased complexity that is more apparent when using multi-element phased array systems. This has led to significant efforts to reduce system size and cost by relying on system integration. Although ideas from other fields such as microwave antenna phased arrays can be adopted in FUS, the application requirements differ significantly since the frequency range used in FUS is much lower. In this paper, we review recent efforts to design efficient power monitoring, phase shifting and output driving techniques used specifically for high intensity focused ultrasound (HIFU). PMID:22346589

OPTIMIZING GLOBAL CORONAL MAGNETIC FIELD MODELS USING IMAGE-BASED CONSTRAINTS

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

Jones, Shaela I.; Davila, Joseph M.; Uritsky, Vadim, E-mail: shaela.i.jonesmecholsky@nasa.gov

The coronal magnetic field directly or indirectly affects a majority of the phenomena studied in the heliosphere. It provides energy for coronal heating, controls the release of coronal mass ejections, and drives heliospheric and magnetospheric activity, yet the coronal magnetic field itself has proven difficult to measure. This difficulty has prompted a decades-long effort to develop accurate, timely, models of the field—an effort that continues today. We have developed a method for improving global coronal magnetic field models by incorporating the type of morphological constraints that could be derived from coronal images. Here we report promising initial tests of thismore » approach on two theoretical problems, and discuss opportunities for application.« less

Top 10 metrics for life science software good practices

PubMed Central

2016-01-01

Metrics for assessing adoption of good development practices are a useful way to ensure that software is sustainable, reusable and functional. Sustainability means that the software used today will be available - and continue to be improved and supported - in the future. We report here an initial set of metrics that measure good practices in software development. This initiative differs from previously developed efforts in being a community-driven grassroots approach where experts from different organisations propose good software practices that have reasonable potential to be adopted by the communities they represent. We not only focus our efforts on understanding and prioritising good practices, we assess their feasibility for implementation and publish them here. PMID:27635232

Driving circuitry for focused ultrasound noninvasive surgery and drug delivery applications.

PubMed

El-Desouki, Munir M; Hynynen, Kullervo

2011-01-01

Recent works on focused ultrasound (FUS) have shown great promise for cancer therapy. Researchers are continuously trying to improve system performance, which is resulting in an increased complexity that is more apparent when using multi-element phased array systems. This has led to significant efforts to reduce system size and cost by relying on system integration. Although ideas from other fields such as microwave antenna phased arrays can be adopted in FUS, the application requirements differ significantly since the frequency range used in FUS is much lower. In this paper, we review recent efforts to design efficient power monitoring, phase shifting and output driving techniques used specifically for high intensity focused ultrasound (HIFU).

Formation Control of the MAXIM L2 Libration Orbit Mission

NASA Technical Reports Server (NTRS)

Folta, David; Hartman, Kate; Howell, Kathleen; Marchand, Belinda

2004-01-01

The Micro-Arcsecond Imaging Mission (MAXIM), a proposed concept for the Structure and Evolution of the Universe (SEU) Black Hole Imaging mission, is designed to make a ten million-fold improvement in X-ray image clarity of celestial objects by providing better than 0.1 microarcsecond imaging. To achieve mission requirements, MAXIM will have to improve on pointing by orders of magnitude. This pointing requirement impacts the control and design of the formation. Currently the architecture is comprised of 25 spacecraft, which will form the sparse apertures of a grazing incidence X-ray interferometer covering the 0.3-10 keV bandpass. This configuration will deploy 24 spacecraft as optics modules and one as the detector. The formation must allow for long duration continuous science observations and also for reconfiguration that permits re-pointing of the formation. In this paper, we provide analysis and trades of several control efforts that are dependent upon the pointing requirements and the configuration and dimensions of the MAXIM formation. We emphasize the utilization of natural motions in the Lagrangian regions that minimize the control efforts and we address both continuous and discrete control via LQR and feedback linearization. Results provide control cost, configuration options, and capabilities as guidelines for the development of this complex mission.

EURATOM safeguards efforts in the development of spent fuel verification methods by non-destructive assay

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

Matloch, L.; Vaccaro, S.; Couland, M.

The back end of the nuclear fuel cycle continues to develop. The European Commission, particularly the Nuclear Safeguards Directorate of the Directorate General for Energy, implements Euratom safeguards and needs to adapt to this situation. The verification methods for spent nuclear fuel, which EURATOM inspectors can use, require continuous improvement. Whereas the Euratom on-site laboratories provide accurate verification results for fuel undergoing reprocessing, the situation is different for spent fuel which is destined for final storage. In particular, new needs arise from the increasing number of cask loadings for interim dry storage and the advanced plans for the construction ofmore » encapsulation plants and geological repositories. Various scenarios present verification challenges. In this context, EURATOM Safeguards, often in cooperation with other stakeholders, is committed to further improvement of NDA methods for spent fuel verification. In this effort EURATOM plays various roles, ranging from definition of inspection needs to direct participation in development of measurement systems, including support of research in the framework of international agreements and via the EC Support Program to the IAEA. This paper presents recent progress in selected NDA methods. These methods have been conceived to satisfy different spent fuel verification needs, ranging from attribute testing to pin-level partial defect verification. (authors)« less

Development and Evaluation of a Pharmacogenomics Educational Program for Pharmacists

PubMed Central

Formea, Christine M.; Nicholson, Wayne T.; McCullough, Kristen B.; Berg, Kevin D.; Berg, Melody L.; Cunningham, Julie L.; Merten, Julianna A.; Ou, Narith N.; Stollings, Joanna L.

2013-01-01

Objectives. To evaluate hospital and outpatient pharmacists’ pharmacogenomics knowledge before and 2 months after participating in a targeted, case-based pharmacogenomics continuing education program. Design. As part of a continuing education program accredited by the Accreditation Council for Pharmacy Education (ACPE), pharmacists were provided with a fundamental pharmacogenomics education program. Evaluation. An 11-question, multiple-choice, electronic survey instrument was distributed to 272 eligible pharmacists at a single campus of a large, academic healthcare system. Pharmacists improved their pharmacogenomics test scores by 0.7 questions (pretest average 46%; posttest average 53%, p=0.0003). Conclusions. Although pharmacists demonstrated improvement, overall retention of educational goals and objectives was marginal. These results suggest that the complex topic of pharmacogenomics requires a large educational effort in order to increase pharmacists’ knowledge and comfort level with this emerging therapeutic opportunity. PMID:23459098

Society for Academic Continuing Medical Education Intervention Guideline Series: Guideline 2, Practice Facilitation.

PubMed

Van Hoof, Thomas J; Grant, Rachel E; Campbell, Craig; Colburn, Lois; Davis, David; Dorman, Todd; Fischer, Michael; Horsley, Tanya; Jacobs-Halsey, Virginia; Kane, Gabrielle; LeBlanc, Constance; Moore, Donald E; Morrow, Robert; Olson, Curtis A; Silver, Ivan; Thomas, David C; Turco, Mary; Kitto, Simon

2015-01-01

The Society for Academic Continuing Medical Education commissioned a study to clarify and, if possible, standardize the terminology for a set of important educational interventions. In the form of a guideline, this article describes one such intervention, practice facilitation, which is a common strategy in primary care to help practices develop capacity and infrastructure to support their ability to improve patient care. Based on a review of recent evidence and a facilitated discussion with US and Canadian experts, we describe practice facilitation, its terminology, and other important information about the intervention. We encourage leaders and researchers to consider and build on this guideline as they plan, implement, evaluate, and report practice facilitation efforts. Clear and consistent use of terminology is imperative, along with complete and accurate descriptions of interventions, to improve the use and study of practice facilitation.

Development and evaluation of a pharmacogenomics educational program for pharmacists.

PubMed

Formea, Christine M; Nicholson, Wayne T; McCullough, Kristen B; Berg, Kevin D; Berg, Melody L; Cunningham, Julie L; Merten, Julianna A; Ou, Narith N; Stollings, Joanna L

2013-02-12

Objectives. To evaluate hospital and outpatient pharmacists' pharmacogenomics knowledge before and 2 months after participating in a targeted, case-based pharmacogenomics continuing education program.Design. As part of a continuing education program accredited by the Accreditation Council for Pharmacy Education (ACPE), pharmacists were provided with a fundamental pharmacogenomics education program.Evaluation. An 11-question, multiple-choice, electronic survey instrument was distributed to 272 eligible pharmacists at a single campus of a large, academic healthcare system. Pharmacists improved their pharmacogenomics test scores by 0.7 questions (pretest average 46%; posttest average 53%, p=0.0003).Conclusions. Although pharmacists demonstrated improvement, overall retention of educational goals and objectives was marginal. These results suggest that the complex topic of pharmacogenomics requires a large educational effort in order to increase pharmacists' knowledge and comfort level with this emerging therapeutic opportunity.

Systems approach to managing educational quality in the engineering classroom

NASA Astrophysics Data System (ADS)

Grygoryev, Kostyantyn

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

Aerometrics' laser-based lane-tracker sensor: engineering and on-the-road evaluation of advanced prototypes

NASA Astrophysics Data System (ADS)

Schuler, Carlos A.; Tapos, Francis M.; Alayleh, Mehyeddine M.; Bachalo, William D.

1997-02-01

Aerometrics initiated and continues on the development an innovative laser-diode based device that provides a warning signal when a motor-vehicle deviates from the center of the lane. The device is based on a sensor that scans the roadway on either side of the vehicle and determines the lateral position relative to the existing painted lines marking the lane. The principles of operation of the sensor, and the results of Aerometrics' early testing were presented last year in this forum. This paper presents Aerometrics' continuing efforts in bringing the technology to market. New prototypes have been developed and tested. Aerometrics' engineering efforts and the use of latest technologies have resulted in a 24-fold reduction in sensor volume when compared to their predecessors and similar reductions in weight. The current prototype measures less than 9 cm X 8 cm X 7 cm, and can be easily fit within the cavity of rear-view mirror holders used in most present-day vehicles. Also, advances in signal conditioning and processing have improved the reliability of the sensor. Results of continuing testing of the sensor will be presented.

Five-year impact of a continuous quality improvement effort implemented by a network of diabetes outpatient clinics.

PubMed

2008-01-01

To evaluate the impact of a continuous quality improvement effort implemented by a network of diabetes outpatient clinics in Sicily, Italy. Twenty-two clinics adopted the same electronic medical record system. Process and intermediate outcomes indicators were identified and software was developed, enabling the extraction of the information needed for the profiling of quality of care. Data were centrally analyzed anonymously every year, and results were discussed in meetings with the participants. The performances of the different centers were ranked against the "best performers," and the reasons for variation were discussed. From 2001 to 2005, a total of 26,782 patients aged >or=18 years have been seen in the participating clinics. Rates of monitoring of A1C, blood pressure, lipid profile, and microalbuminuria constantly increased over the years. The percentage of individuals with A1C values

A Primer on Population Health Management and Its Perioperative Application.

PubMed

Boudreaux, Arthur M; Vetter, Thomas R

2016-07-01

The movement toward value-based payment models, driven by governmental policies, federal statutes, and market forces, is propelling the importance of effectively managing the health of populations to the forefront in the United States and other developed countries. However, for many anesthesiologists, population health management is a new or even foreign concept. A primer on population health management and its potential perioperative application is thus presented here. Although it certainly continues to evolve, population health management can be broadly defined as the specific policies, programs, and interventions directed at optimizing population health. The Population Health Alliance has created a particularly cogent conceptual framework and interconnected and very useful population health process model, which together identify the key components of population health and its management. Population health management provides a useful rationale for patients, providers, payers, and policymakers to move collectively away from the traditional system of individual, siloed providers to a more integrated, coordinated, team-based approach, thus creating a holistic view of the patient population. The goal of population health management is to keep the targeted patient population as healthy as possible, thus minimizing the need for costly interventions such as emergency department visits, acute hospitalizations, laboratory testing and imaging, and diagnostic and therapeutic procedures. Population health management strategies are increasingly more important to leaders of health care systems as the health of populations for which they care, especially in a strong cost risk-sharing environment, must be optimized. Most population health management efforts rely on a patient-centric team approach, coordination of care, effective communication, robust outcomes data analysis, and continuous quality improvement. Anesthesiologists have an opportunity to help lead these efforts in concert with their surgical and nursing colleagues. The Triple Aim of Healthcare includes (1) improving the patient experience of care (including quality and satisfaction); (2) improving the health of populations; and (3) reducing per-capita costs of care. The Perioperative Surgical Home essentially seeks to transform perioperative care by achieving the Triple Aim, including improving the health of the surgical population. Many health care delivery systems and many clinicians (including anesthesiologists) are just beginning their population health management journeys. However, by doing so, they are preparing to navigate a much greater risk-sharing landscape, where these efforts can create greater financial stability by preventing major financial loss. Anesthesiologists can and should be leaders in this effort to add value by improving the comprehensive continuum of care of our patients.

Spontaneous Effort During Mechanical Ventilation: Maximal Injury With Less Positive End-Expiratory Pressure.

PubMed

Yoshida, Takeshi; Roldan, Rollin; Beraldo, Marcelo A; Torsani, Vinicius; Gomes, Susimeire; De Santis, Roberta R; Costa, Eduardo L V; Tucci, Mauro R; Lima, Raul G; Kavanagh, Brian P; Amato, Marcelo B P

2016-08-01

We recently described how spontaneous effort during mechanical ventilation can cause "pendelluft," that is, displacement of gas from nondependent (more recruited) lung to dependent (less recruited) lung during early inspiration. Such transfer depends on the coexistence of more recruited (source) liquid-like lung regions together with less recruited (target) solid-like lung regions. Pendelluft may improve gas exchange, but because of tidal recruitment, it may also contribute to injury. We hypothesize that higher positive end-expiratory pressure levels decrease the propensity to pendelluft and that with lower positive end-expiratory pressure levels, pendelluft is associated with improved gas exchange but increased tidal recruitment. Crossover design. University animal research laboratory. Anesthetized landrace pigs. Surfactant depletion was achieved by saline lavage in anesthetized pigs, and ventilator-induced lung injury was produced by ventilation with high tidal volume and low positive end-expiratory pressure. Ventilation was continued in each of four conditions: positive end-expiratory pressure (low or optimized positive end-expiratory pressure after recruitment) and spontaneous breathing (present or absent). Tidal recruitment was assessed using dynamic CT and regional ventilation/perfusion using electric impedance tomography. Esophageal pressure was measured using an esophageal balloon manometer. Among the four conditions, spontaneous breathing at low positive end-expiratory pressure not only caused the largest degree of pendelluft, which was associated with improved ventilation/perfusion matching and oxygenation, but also generated the greatest tidal recruitment. At low positive end-expiratory pressure, paralysis worsened oxygenation but reduced tidal recruitment. Optimized positive end-expiratory pressure decreased the magnitude of spontaneous efforts (measured by esophageal pressure) despite using less sedation, from -5.6 ± 1.3 to -2.0 ± 0.7 cm H2O, while concomitantly reducing pendelluft and tidal recruitment. No pendelluft was observed in the absence of spontaneous effort. Spontaneous effort at low positive end-expiratory pressure improved oxygenation but promoted tidal recruitment associated with pendelluft. Optimized positive end-expiratory pressure (set after lung recruitment) may reverse the harmful effects of spontaneous breathing by reducing inspiratory effort, pendelluft, and tidal recruitment.

Global hunger: a challenge to agricultural, food, and nutritional sciences.

PubMed

Wu, Shiuan-Huei; Ho, Chi-Tang; Nah, Sui-Lin; Chau, Chi-Fai

2014-01-01

Hunger has been a concern for generations and has continued to plague hundreds of millions of people around the world. Although many efforts have been devoted to reduce hunger, challenges such as growing competitions for natural resources, emerging climate changes and natural disasters, poverty, illiteracy, and diseases are posing threats to food security and intensifying the hunger crisis. Concerted efforts of scientists to improve agricultural and food productivity, technology, nutrition, and education are imperative to facilitate appropriate strategies for defeating hunger and malnutrition. This paper provides some aspects of world hunger issues and summarizes the efforts and measures aimed to alleviate food problems from the food and nutritional sciences perspectives. The prospects and constraints of some implemented strategies for alleviating hunger and achieving sustainable food security are also discussed. This comprehensive information source could provide insights into the development of a complementary framework for dealing with the global hunger issue.

Electronic Records, Registries, and the Development of "Big Data": Crowd-Sourcing Quality toward Knowledge.

PubMed

Dewdney, Summer B; Lachance, Jason

2016-01-01

Despite many perceived advances in treatment over the past few decades, cancer continues to present a significant health burden, particularly to the aging US population. Forces including shrinking funding mechanisms, cost and quality concerns, as well as disappointing clinical outcomes have driven a surge of recent efforts into utilizing the technological innovation that has permeated other industries by leveraging large and complex data sets, so called "big data." In this review, we will review some of the history of oncology data collection, including the earliest data registries, as well as explore the future directions of this new brand of research while highlighting some of the more recent and promising efforts to harness the power of the electronic health record and the multitude of data co-located there, in an effort to improve individualized cancer-related outcomes in rapid real time.

FY16 Status Report on NEAMS Neutronics Activities

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

Lee, C. H.; Shemon, E. R.; Smith, M. A.

2016-09-30

The goal of the NEAMS neutronics effort is to develop a neutronics toolkit for use on sodium-cooled fast reactors (SFRs) which can be extended to other reactor types. The neutronics toolkit includes the high-fidelity deterministic neutron transport code PROTEUS and many supporting tools such as a cross section generation code MC 2-3, a cross section library generation code, alternative cross section generation tools, mesh generation and conversion utilities, and an automated regression test tool. The FY16 effort for NEAMS neutronics focused on supporting the release of the SHARP toolkit and existing and new users, continuing to develop PROTEUS functions necessarymore » for performance improvement as well as the SHARP release, verifying PROTEUS against available existing benchmark problems, and developing new benchmark problems as needed. The FY16 research effort was focused on further updates of PROTEUS-SN and PROTEUS-MOCEX and cross section generation capabilities as needed.« less

Investigative study of holographic recording materials development

NASA Technical Reports Server (NTRS)

1972-01-01

The potential of certain cis-trans isomers and doped LiNbO3 for the holographic read/write/erase memory application was investigated. The cis-trans work involved the photochemical investigation of a number of potential materials as well as specific molecular engineering efforts on alpha-methyl stilbene and its derivatives. These efforts resulted in an increase in the change in index of refraction, and thereby, in potential recording utility, of an order of magnitude. The work on LiNbO3 was directed toward a preliminary investigation of the dynamics of the writing process. Several samples and a variety of writing conditions were investigated. An unexpected and as yet unexplained improvement in material behavior with continued recycling was observed. In addition, some effort was devoted to an analysis of the physical conditions under which several current theories of the optical damage process are valid.

Early Experiences After Adopting a Quality Improvement Portfolio Into the Academic Advancement Process.

PubMed

Sehgal, Niraj L; Neeman, Naama; King, Talmadge E

2017-01-01

Academic medical centers (AMCs) and their academic departments are increasingly assuming leadership in the education, science, and implementation of quality improvement (QI) and patient safety efforts. Fostering, recognizing, and promoting faculty leading these efforts is challenging using traditional academic metrics for advancement. The authors adapted a nationally developed QI portfolio, adopted it into their own department's advancement process in 2012, and tracked its utilization and impact over the first two years of implementation. Sixty-seven QI portfolios were submitted with 100% of faculty receiving their requested academic advancement. Women represented 60% of the submitted portfolios, while the Divisions of General Internal Medicine and Hospital Medicine accounted for 60% of the submissions. The remaining 40% were from faculty in 10 different specialty divisions. Faculty attitudes about the QI portfolio were overwhelmingly positive, with 83% agreeing that it "was an effective tool for helping to better recognize faculty contributions in QI work" and 85% agreeing that it "was an effective tool for elevating the importance of QI work in our department." The QI portfolio was one part of a broader effort to create opportunities to recognize and support faculty involved in improvement work. Further adapting the tool to ensure that it complements-rather than duplicates-other elements of the advancement process is critical for continued utilization by faculty. This will also drive desired dissemination to other departments locally and other AMCs nationally who are similarly committed to cultivating faculty career paths in systems improvement.

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

Building an Evidence-Driven Child Welfare Workforce: A University–Agency Partnership

PubMed Central

Lery, Bridgette; Wiegmann, Wendy; Berrick, Jill Duerr

2016-01-01

The federal government increasingly expects child welfare systems to be more responsive to the needs of their local populations, connect strategies to results, and use continuous quality improvement (CQI) to accomplish these goals. A method for improving decision making, CQI relies on an inflow of high-quality data, up-to-date research evidence, and a robust organizational structure and climate that supports the deliberate use of evidence for decision making. This article describes an effort to build and support these essential system components through one public-private child welfare agency–university partnership. PMID:27429534

A new role for primary care teams in the United States after “Obamacare:” Track and improve health insurance coverage rates

PubMed Central

DeVoe, Jennifer; Angier, Heather; Hoopes, Megan; Gold, Rachel

2017-01-01

Maintaining continuous health insurance coverage is important. With recent expansions in access to coverage in the United States after “Obamacare,” primary care teams have a new role in helping to track and improve coverage rates and to provide outreach to patients. We describe efforts to longitudinally track health insurance rates using data from the electronic health record (EHR) of a primary care network and to use these data to support practice-based insurance outreach and assistance. Although we highlight a few examples from one network, we believe there is great potential for doing this type of work in a broad range of family medicine and community health clinics that provide continuity of care. By partnering with researchers through practice-based research networks and other similar collaboratives, primary care practices can greatly expand the use of EHR data and EHR-based tools targeting improvements in health insurance and quality health care. PMID:28966926

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

PubMed

Rondeau, Kent V; Wagar, Terry H

2002-01-01

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

Development of Mask Materials for EUVL

NASA Astrophysics Data System (ADS)

Heckle, Christine; Hrdina, Kenneth E.; Ackerman, Bradford G.; Navan, David W.

2002-12-01

Though the Semiconductor market is soft, the technology that drives it continues to march on. Corning has supplied the semiconductor market through two generations of lithography with KrF and ArF grade HPFS Glass; the established excellence will continue with the supply of CaF2 for 157nm and ULE Glass for 13nm. ULE Glass is a low expansion silicate glass that has historically been used for ground and spaced based telescope mirrors such as Gemini and Hubble. Industry experts have now identified ULE Glass as a material of choice for EUVL applications; but with new opportunities come new hurdles, and ULE Glass will need to be improved in order to meet the challenges of EUVL. The purpose of this presentation is to give the audience a general update of Corning's ULE Glass improvement effort for EUVL, with focus on EUV photomask requirements; it will include an overview of key ULE Glass properties, improvements that have been made, and a road map of work to be done.

Gene Ontology Consortium: going forward

PubMed Central

2015-01-01

The Gene Ontology (GO; http://www.geneontology.org) is a community-based bioinformatics resource that supplies information about gene product function using ontologies to represent biological knowledge. Here we describe improvements and expansions to several branches of the ontology, as well as updates that have allowed us to more efficiently disseminate the GO and capture feedback from the research community. The Gene Ontology Consortium (GOC) has expanded areas of the ontology such as cilia-related terms, cell-cycle terms and multicellular organism processes. We have also implemented new tools for generating ontology terms based on a set of logical rules making use of templates, and we have made efforts to increase our use of logical definitions. The GOC has a new and improved web site summarizing new developments and documentation, serving as a portal to GO data. Users can perform GO enrichment analysis, and search the GO for terms, annotations to gene products, and associated metadata across multiple species using the all-new AmiGO 2 browser. We encourage and welcome the input of the research community in all biological areas in our continued effort to improve the Gene Ontology. PMID:25428369

Biosecurity and Yield Improvement Technologies Are Strategic Complements in the Fight against Food Insecurity

PubMed Central

Cook, David C.; Fraser, Rob W.; Paini, Dean R.; Warden, Andrew C.; Lonsdale, W. Mark; De Barro, Paul J.

2011-01-01

The delivery of food security via continued crop yield improvement alone is not an effective food security strategy, and must be supported by pre- and post-border biosecurity policies to guard against perverse outcomes. In the wake of the green revolution, yield gains have been in steady decline, while post-harvest crop losses have increased as a result of insufficiently resourced and uncoordinated efforts to control spoilage throughout global transport and storage networks. This paper focuses on the role that biosecurity is set to play in future food security by preventing both pre- and post-harvest losses, thereby protecting crop yield. We model biosecurity as a food security technology that may complement conventional yield improvement policies if the gains in global farm profits are sufficient to offset the costs of implementation and maintenance. Using phytosanitary measures that slow global spread of the Ug99 strain of wheat stem rust as an example of pre-border biosecurity risk mitigation and combining it with post-border surveillance and invasive alien species control efforts, we estimate global farm profitability may be improved by over US$4.5 billion per annum. PMID:22022517

Managerial process improvement: a lean approach to eliminating medication delivery.

PubMed

Hussain, Aftab; Stewart, LaShonda M; Rivers, Patrick A; Munchus, George

2015-01-01

Statistical evidence shows that medication errors are a major cause of injuries that concerns all health care oganizations. Despite all the efforts to improve the quality of care, the lack of understanding and inability of management to design a robust system that will strategically target those factors is a major cause of distress. The paper aims to discuss these issues. Achieving optimum organizational performance requires two key variables; work process factors and human performance factors. The approach is that healthcare administrators must take in account both variables in designing a strategy to reduce medication errors. However, strategies that will combat such phenomena require that managers and administrators understand the key factors that are causing medication delivery errors. The authors recommend that healthcare organizations implement the Toyota Production System (TPS) combined with human performance improvement (HPI) methodologies to eliminate medication delivery errors in hospitals. Despite all the efforts to improve the quality of care, there continues to be a lack of understanding and the ability of management to design a robust system that will strategically target those factors associated with medication errors. This paper proposes a solution to an ambiguous workflow process using the TPS combined with the HPI system.

Geysers advanced direct contact condenser research

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

Henderson, J.; Bahning, T.; Bharathan, D.

1997-12-31

The first geothermal application of the Advanced Direct Contact Condenser (ADCC) technology developed by the National Renewable Energy Laboratory (NREL) is now operational and is being tested at The Geysers Power Plant Unit 11. This major research effort is being supported through the combined efforts of NREL, The Department of Energy (DOE), and Pacific Gas and Electric (PG&E). NREL and PG&E have entered into a Cooperative Research And Development Agreement (CRADA) for a project to improve the direct-contact condenser performance at The Geysers Power Plant. This project is the first geothermal adaptation of an advanced condenser design developed for themore » Ocean Thermal Energy Conversion (OTEC) systems. PG&E expects this technology to improve power plant performance and to help extend the life of the steam field by using steam more efficiently. In accordance with the CRADA, no money is transferred between the contracting parties. In this case the Department of Energy is funding NREL for their efforts in this project and PG&E is contributing funds in kind. Successful application of this technology at The Geysers will provide a basis for NREL to continue to develop this technology for other geothermal and fossil power plant systems.« less

Releasing captive-reared masked bobwhite for population recovery: A review

USGS Publications Warehouse

Gall, S.A.; Kuvlesky, W.P.; Gee, G.; Brennan, L.A.; Palmer, W.E.; Burger, L.W.; Pruden, T.L.

2000-01-01

Efforts to re-establish the endangered masked bobwhite (Colinus virginianus ridgwayi) to it's former southern Arizona range have been ongoing since establishment of the Buenos Aires National Wildlife Refuge in 1986. Pre-release conditioning techniques developed prior to Refuge establishment continued to be utilized in an effort to improve post-release survival of captive-reared masked bobwhite chicks. Foremost among these techniques was the use of wild Texas bobwhite (C. v. texanus) males as foster parents which were paired with all broods released on the Refuge. The efficacy of this technique was evaluated using radio telemetry in 1994, and the results indicated that the use of foster Texas males was not as effective as had been presumed because post-release chick survival was poor. Therefore, in 1995 pre-release conditioning protocol were modified in an effort to improve post-release survival. The primary intent of these modifications was to emphasize wild behavior among chicks prior to release. Modifications to established protocol included imprinting chicks to adult bobwhites immediately after eggs hatched and exposing 1-to-2 day old chicks to natural foods (insects and seeds) while they were in brooder units. Foster parents and their respective broods were then placed in flight pens that mimicked the natural conditions that would confront broods upon release. Family groups were held in flight pens for several weeks for acclimatization purposes and then transported to temporary enclosures erected at release sites where they were held for a week and then released. Finally all releases were conducted during fall after covey formation was apparent to ensure that foster parents and released chicks remained with a group of birds. Preliminary results indicated that post-release chick survival was higher than what was observed in 1994. Pre-conditioning research will continue in an effort to further quantify post-release survival of masked bobwhite chicks. Although the results of this research project are preliminary, it is possible that pre-release conditioning techniques developed for masked bobwhites will prove useful to quail reestablishment efforts throughout North America.

Shillapoo Wildlife Area, Annual Report 2007-2008.

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

Calkins, Brian

This report summarizes accomplishments, challenges and successes on WDFW's Shillapoo Wildlife Area funded under Bonneville Power Administration's (BPA) Wildlife Mitigation Program (BPA project No.2003-012-00) during the Fiscal Year 08 contract period October 1, 2007-September 30, 2008. The information presented here is intended to supplement that contained in BPA's PISCES contract development and reporting system. The organization below is by broad categories of work but references are made to individual work elements in the PISCES Statement of Work as appropriate. Significant progress was realized in almost all major work types. Of particular note was progress made in tree plantings and pasturemore » rehabilitation efforts. This year's tree planting effort included five sites detailed below and in terms of the number of plants was certainly the largest effort on the wildlife area to date in one season. The planting itself took a significant amount of time, which was anticipated. However, installation of mats and tubes took much longer than expected which impacted planned fence projects in particular. Survival of the plantings appears to be good. Improvement to the quality of waterfowl pasture habitats is evident on a number of sites due to replanting and weed control efforts. Continuing long-term weed control efforts will be key in improving this particular type of habitat. A prolonged cold, wet spring and a number of equipment breakdowns presented stumbling blocks that impacted schedules and ultimately progress on planned activities. The unusual spring weather delayed fieldwork on pasture planting projects as well as weed control and slowed the process of maintaining trees and shrubs. This time lag also caused the continued deferral of some of our fencing projects. The large brush hog mower had the driveline break twice and the smaller tractor had an engine failure that caused it to be down for over a month. We have modified our budget plan for next year to include a temporary employee that will work primarily on tree maintenance and fencing projects to make sure that we make progress in these areas and we will be investigating whether a heavier duty driveline can be obtained for the mower.« less

Dictionary-based image reconstruction for superresolution in integrated circuit imaging.

PubMed

Cilingiroglu, T Berkin; Uyar, Aydan; Tuysuzoglu, Ahmet; Karl, W Clem; Konrad, Janusz; Goldberg, Bennett B; Ünlü, M Selim

2015-06-01

Resolution improvement through signal processing techniques for integrated circuit imaging is becoming more crucial as the rapid decrease in integrated circuit dimensions continues. Although there is a significant effort to push the limits of optical resolution for backside fault analysis through the use of solid immersion lenses, higher order laser beams, and beam apodization, signal processing techniques are required for additional improvement. In this work, we propose a sparse image reconstruction framework which couples overcomplete dictionary-based representation with a physics-based forward model to improve resolution and localization accuracy in high numerical aperture confocal microscopy systems for backside optical integrated circuit analysis. The effectiveness of the framework is demonstrated on experimental data.

Soybean (Glycine max) transformation using mature cotyledonary node explants.

PubMed

Olhoft, Paula M; Donovan, Christopher M; Somers, David A

2006-01-01

Agrobacterium tumefaciens-mediated transformation of soybeans has been steadily improved since its development in 1988. Soybean transformation is now possible in a range of genotypes from different maturity groups using different explants as sources of regenerable cells, various selectable marker genes and selective agents, and different A. tumefaciens strains. The cotyledonary-node method has been extensively investigated and across a number of laboratories yields on average greater than 1% transformation efficiency (one Southern-positive, independent event per 100 cotyledonary-node explants). Continued improvements in the cotyledonary-node method concomitant with further increases in transformation efficiency will enhance broader adoption of this already productive transformation method for use in crop improvement and functional genomics research efforts.

A Mixed-Methods Research Framework for Healthcare Process Improvement.

PubMed

Bastian, Nathaniel D; Munoz, David; Ventura, Marta

2016-01-01

The healthcare system in the United States is spiraling out of control due to ever-increasing costs without significant improvements in quality, access to care, satisfaction, and efficiency. Efficient workflow is paramount to improving healthcare value while maintaining the utmost standards of patient care and provider satisfaction in high stress environments. This article provides healthcare managers and quality engineers with a practical healthcare process improvement framework to assess, measure and improve clinical workflow processes. The proposed mixed-methods research framework integrates qualitative and quantitative tools to foster the improvement of processes and workflow in a systematic way. The framework consists of three distinct phases: 1) stakeholder analysis, 2a) survey design, 2b) time-motion study, and 3) process improvement. The proposed framework is applied to the pediatric intensive care unit of the Penn State Hershey Children's Hospital. The implementation of this methodology led to identification and categorization of different workflow tasks and activities into both value-added and non-value added in an effort to provide more valuable and higher quality patient care. Based upon the lessons learned from the case study, the three-phase methodology provides a better, broader, leaner, and holistic assessment of clinical workflow. The proposed framework can be implemented in various healthcare settings to support continuous improvement efforts in which complexity is a daily element that impacts workflow. We proffer a general methodology for process improvement in a healthcare setting, providing decision makers and stakeholders with a useful framework to help their organizations improve efficiency. Published by Elsevier Inc.

Report to the Congressional Defense Committees: Status of the Department of Defense’s Business Transformation Efforts

DTIC Science & Technology

2008-03-15

information insures timely payment of entitlements and foregoes receipt of mutually exclusive payments. This depth of information supplies visibility and...reporting capability, and integration with authoritative data sources such as FPDS- NG, CCR, and contractor companies to improve data quality and reduce...manual entry requirements in Q2 FY09. • Continue to implement in theater, focusing on contingency contracts for private security companies and

Cabin Atmosphere Monitoring System (CAMS), pre-prototype model development continuation

NASA Technical Reports Server (NTRS)

Bursack, W. W.; Harris, W. A.

1975-01-01

The development of the Cabin Atmosphere Monitoring System (CAMS) is described. Attention was directed toward improving stability and reliability of the design using flight application guidelines. Considerable effort was devoted to the development of a temperature-stable RF/DC generator used for excitation of the quadrupole mass filter. Minor design changes were made in the preprototype model. Specific gas measurement examples are included along with a discussion of the measurement rationale employed.

JPRS Report West Europe

DTIC Science & Technology

1988-10-28

analysis effort can start. This analysis work will be done in the spring of 1989, and the Defense Commission is to be ready with its report at the end...production processes, electronic equipment and weapons promptly. JPRS-WER-88-061 28 October 1988 21 MILITARY The project JF 90 will eclipse all of the...by the numerical superiority of a potential enemy, his attack-oriented military doc- trine and equipment , and his continually improving all-weather

The pursuit of colostomy continence.

PubMed

Roberts, D J

1997-03-01

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

Structure Limits for a 30mm Annular Piston.

DTIC Science & Technology

1988-05-01

block at the rear, ending the cycle. III. STRESS ANALYSIS PROCEDURE tress data was generated using the SAAS -II finite element computer code. Applied...Plastics Avenue Rockford, IL 61125 Pittsfield, MA 01201-3698 1 Veritay Technology, Inc. 1 General Electric Company ATTN: E.B. Fisher Armament Systems... VALUATION Slit:ET/CHANGE 01- ADDRESS -hi s laboratoryN undertakes a continuing effort to improve the quality of the( re-ports it publishe,4. Yfour comments

Efforts to improve international migration statistics: a historical perspective.

PubMed

Kraly, E P; Gnanasekaran, K S

1987-01-01

During the past decade, the international statistical community has made several efforts to develop standards for the definition, collection and publication of statistics on international migration. This article surveys the history of official initiatives to standardize international migration statistics by reviewing the recommendations of the International Statistical Institute, International Labor Organization, and the UN, and reports a recently proposed agenda for moving toward comparability among national statistical systems. Heightening awareness of the benefits of exchange and creating motivation to implement international standards requires a 3-pronged effort from the international statistical community. 1st, it is essential to continue discussion about the significance of improvement, specifically standardization, of international migration statistics. The move from theory to practice in this area requires ongoing focus by migration statisticians so that conformity to international standards itself becomes a criterion by which national statistical practices are examined and assessed. 2nd, the countries should be provided with technical documentation to support and facilitate the implementation of the recommended statistical systems. Documentation should be developed with an understanding that conformity to international standards for migration and travel statistics must be achieved within existing national statistical programs. 3rd, the call for statistical research in this area requires more efforts by the community of migration statisticians, beginning with the mobilization of bilateral and multilateral resources to undertake the preceding list of activities.

Clinical trials recruitment planning: A proposed framework from the Clinical Trials Transformation Initiative.

PubMed

Huang, Grant D; Bull, Jonca; Johnston McKee, Kelly; Mahon, Elizabeth; Harper, Beth; Roberts, Jamie N

2018-03-01

Patient recruitment is widely recognized as a key determinant of success for clinical trials. Yet a substantial number of trials fail to reach recruitment goals-a situation that has important scientific, financial, ethical, and policy implications. Further, there are important effects on stakeholders who directly contribute to the trial including investigators, sponsors, and study participants. Despite efforts over multiple decades to identify and address barriers, recruitment challenges persist. To advance a more comprehensive approach to trial recruitment, the Clinical Trials Transformation Initiative (CTTI) convened a project team to examine the challenges and to issue actionable, evidence-based recommendations for improving recruitment planning that extend beyond common study-specific strategies. We describe our multi-stakeholder effort to develop a framework that delineates three areas essential to strategic recruitment planning efforts: (1) trial design and protocol development, (2) trial feasibility and site selection, and (3) communication. Our recommendations propose an upstream approach to recruitment planning that has the potential to produce greater impact and reduce downstream barriers. Additionally, we offer tools to help facilitate adoption of the recommendations. We hope that our framework and recommendations will serve as a guide for initial efforts in clinical trial recruitment planning irrespective of disease or intervention focus, provide a common basis for discussions in this area and generate targets for further analysis and continual improvement. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Association between health worker motivation and healthcare quality efforts in Ghana

PubMed Central

2013-01-01

Background Ghana is one of the sub-Saharan African countries making significant progress towards universal access to quality healthcare. However, it remains a challenge to attain the 2015 targets for the health related Millennium Development Goals (MDGs) partly due to health sector human resource challenges including low staff motivation. Purpose This paper addresses indicators of health worker motivation and assesses associations with quality care and patient safety in Ghana. The aim is to identify interventions at the health worker level that contribute to quality improvement in healthcare facilities. Methods The study is a baseline survey of health workers (n = 324) in 64 primary healthcare facilities in two regions in Ghana. Data collection involved quality care assessment using the SafeCare Essentials tool, the National Health Insurance Authority (NHIA) accreditation data and structured staff interviews on workplace motivating factors. The Spearman correlation test was conducted to test the hypothesis that the level of health worker motivation is associated with level of effort by primary healthcare facilities to improve quality care and patient safety. Results The quality care situation in health facilities was generally low, as determined by the SafeCare Essentials tool and NHIA data. The majority of facilities assessed did not have documented evidence of processes for continuous quality improvement and patient safety. Overall, staff motivation appeared low although workers in private facilities perceived better working conditions than workers in public facilities (P <0.05). Significant positive associations were found between staff satisfaction levels with working conditions and the clinic’s effort towards quality improvement and patient safety (P <0.05). Conclusion As part of efforts towards attainment of the health related MDGs in Ghana, more comprehensive staff motivation interventions should be integrated into quality improvement strategies especially in government-owned healthcare facilities where working conditions are perceived to be the worst. PMID:23945073

An alternate pathophysiologic paradigm of sepsis and septic shock

PubMed Central

Kumar, Anand

2014-01-01

The advent of modern antimicrobial therapy following the discovery of penicillin during the 1940s yielded remarkable improvements in case fatality rate of serious infections including septic shock. Since then, pathogens have continuously evolved under selective antimicrobial pressure resulting in a lack of significant improvement in clinical effectiveness in the antimicrobial therapy of septic shock despite ever more broad-spectrum and potent drugs. In addition, although substantial effort and money has been expended on the development novel non-antimicrobial therapies of sepsis in the past 30 years, clinical progress in this regard has been limited. This review explores the possibility that the current pathophysiologic paradigm of septic shock fails to appropriately consider the primacy of the microbial burden of infection as the primary driver of septic organ dysfunction. An alternate paradigm is offered that suggests that has substantial implications for optimizing antimicrobial therapy in septic shock. This model of disease progression suggests the key to significant improvement in the outcome of septic shock may lie, in great part, with improvements in delivery of existing antimicrobials and other anti-infectious strategies. Recognition of the role of delays in administration of antimicrobial therapy in the poor outcomes of septic shock is central to this effort. However, therapeutic strategies that improve the degree of antimicrobial cidality likely also have a crucial role. PMID:24184742

Recommended techniques for effective maintainability. A continuous improvement initiative of the NASA Reliability and Maintainability Steering Committee

NASA Technical Reports Server (NTRS)

1994-01-01

This manual presents a series of recommended techniques that can increase overall operational effectiveness of both flight and ground based NASA systems. It provides a set of tools that minimizes risk associated with: (1) restoring failed functions (both ground and flight based); (2) conducting complex and highly visible maintenance operations; and (3) sustaining a technical capability to support the NASA mission using aging equipment or facilities. It considers (1) program management - key elements of an effective maintainability effort; (2) design and development - techniques that have benefited previous programs; (3) analysis and test - quantitative and qualitative analysis processes and testing techniques; and (4) operations and operational design techniques that address NASA field experience. This document is a valuable resource for continuous improvement ideas in executing the systems development process in accordance with the NASA 'better, faster, smaller, and cheaper' goal without compromising safety.

Current and Emerging Therapies for Lupus Nephritis

PubMed Central

Parikh, Samir V.

2016-01-01

The introduction of corticosteroids and later, cyclophosphamide dramatically improved survival in patients with proliferative lupus nephritis, and combined administration of these agents became the standard-of-care treatment for this disease. However, treatment failures were still common and the rate of progression to ESRD remained unacceptably high. Additionally, treatment was associated with significant morbidity. Therefore, as patient survival improved, the goals for advancing lupus nephritis treatment shifted to identifying therapies that could improve long-term renal outcomes and minimize treatment-related toxicity. Unfortunately, progress has been slow and the current approaches to the management of lupus nephritis continue to rely on high-dose corticosteroids plus a broad-spectrum immunosuppressive agent. Over the past decade, an improved understanding of lupus nephritis pathogenesis fueled several clinical trials of novel drugs, but none have been found to be superior to the combination of a cytotoxic agent and corticosteroids. Despite these trial failures, efforts to translate mechanistic advances into new treatment approaches continue. In this review, we discuss current therapeutic strategies for lupus nephritis, briefly review recent advances in understanding the pathogenesis of this disease, and describe emerging approaches developed on the basis of these advances that promise to improve upon the standard-of-care lupus nephritis treatments. PMID:27283496

Implementation and Sequencing of Practice Transformation in Urban Practices with Underserved Patients.

PubMed

Quigley, Denise D; Predmore, Zachary S; Chen, Alex Y; Hays, Ron D

Patient-centered medical home (PCMH) has gained momentum as a model for primary-care health services reform. We conducted interviews at 14 primary care practices undergoing PCMH transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. We found clinics pursued a common sequence of changes in PCMH transformation: Clinics began with National Committee for Quality Assurance (NCQA) level 3 recognition, adding care coordination staff, reorganizing data flow among teams, and integrating with a centralized quality improvement and accountability infrastructure. Next, they realigned to support continuity of care. Then, clinics improved access by adding urgent care, patient portals, or extending hours. Most then improved planning and management of patient visits. Only a handful worked explicitly on improving access with same day slots, scheduling processes, and test result communication. The clinics' changes align with specific NCQA PCMH standards but also include adding physicians and services, culture changes, and improved communication with patients. NCQA PCMH level 3 recognition is only the beginning of a continuous improvement process to become patient centered. Full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy before changes to delivery of and access to care.

Marinopyrroles: Unique Drug Discoveries Based on Marine Natural Products.

PubMed

Li, Rongshi

2016-01-01

Natural products provide a successful supply of new chemical entities (NCEs) for drug discovery to treat human diseases. Approximately half of the NCEs are based on natural products and their derivatives. Notably, marine natural products, a largely untapped resource, have contributed to drug discovery and development with eight drugs or cosmeceuticals approved by the U.S. Food and Drug Administration and European Medicines Agency, and ten candidates undergoing clinical trials. Collaborative efforts from drug developers, biologists, organic, medicinal, and natural product chemists have elevated drug discoveries to new levels. These efforts are expected to continue to improve the efficiency of natural product-based drugs. Marinopyrroles are examined here as a case study for potential anticancer and antibiotic agents. © 2015 Wiley Periodicals, Inc.

Should the US abandon efforts to develop commercial fusion power

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

Kay, W.D.; Kinter, E.E.

1993-01-22

This article presents viewpoints and rationale for continuing and disbanding the US efforts to develop commercial fusion power. The views of W.D. Kay, an assistant professor of political science at Northeastern University, are presented regarding - yes, abandon efforts. Meanwhile, the views of Edwin Keutes, former director of the Magnetic Fusion Program for DOE, are presented for continued development.

Some reactions to a dry-land training programme for dinghy sailors.

PubMed Central

Wright, G.; Clarke, J.; Niinimaa, V.; Shephard, R. J.

1976-01-01

A dry-land winter training programme for dinghy-sailors is described. Individual elements include circuit training, specific exercises for muscle strength and endurance, and distance running. Ten international-class sailors followed a progressive regimen of this type for 14 weeks after completion of the 1973 season. Excess weight and skinfold thicknesses were reduced, while muscle strength, endurance and anaerobic capacity increased. Aerobic power remained substantially unchanged, although a smaller oxygen debt was incurred in reaching maximum effort. Team members were enthusiastic about the benefits gained from the training, commenting on their greater tolerance of the hiking position and all proposed to continue or to increase their efforts during subsequent winters. Racing results during 1974 were also an improvement on the 1973 record. However, it was difficult to link physiological gains to improvements in the relative rankings of individual competitors under either light or high wind conditions; the main factor changing relative standings seems to have been the additional year of competitive experiences in younger team members. PMID:963372

Some reactions to a dry-land training programme for dinghy sailors.

PubMed

Wright, G; Clarke, J; Niinimaa, V; Shephard, R J

1976-03-01

A dry-land winter training programme for dinghy-sailors is described. Individual elements include circuit training, specific exercises for muscle strength and endurance, and distance running. Ten international-class sailors followed a progressive regimen of this type for 14 weeks after completion of the 1973 season. Excess weight and skinfold thicknesses were reduced, while muscle strength, endurance and anaerobic capacity increased. Aerobic power remained substantially unchanged, although a smaller oxygen debt was incurred in reaching maximum effort. Team members were enthusiastic about the benefits gained from the training, commenting on their greater tolerance of the hiking position and all proposed to continue or to increase their efforts during subsequent winters. Racing results during 1974 were also an improvement on the 1973 record. However, it was difficult to link physiological gains to improvements in the relative rankings of individual competitors under either light or high wind conditions; the main factor changing relative standings seems to have been the additional year of competitive experiences in younger team members.

One NASA: Sharing Knowledge Through an Agency-wide Process Asset Library (PAL)

NASA Technical Reports Server (NTRS)

Truss, Baraka J.

2006-01-01

This poster session will cover the key purpose and components behind implementing the NASA PAL website. This session will present the current results, describing the process used to create the website, the current usage measure, and will demonstrate how NASA is truly becoming ONE. The target audience for the poster session includes those currently implementing the CMMI model and looking for PAL adoption techniques. To continue to be the leader in space, science and technology, NASA is using this agency-wide PAL to share knowledge, work products and lessons learned through this website. Many organizations have failed to recognize how the efforts of process improvement fit into overall organizational effort. However, NASA as an agency has adopted the benefits of process improvement by the creation of this website to foster communication between its ten centers. The poster session will cover the following, topics outlined below: 1) Website purpose; 2) Characteristics of the website; 3) User accounts status; 4) Website content size; and 5) Usage percentages.

A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates.

PubMed

Yokoe, Deborah S; Anderson, Deverick J; Berenholtz, Sean M; Calfee, David P; Dubberke, Erik R; Ellingson, Katherine D; Gerding, Dale N; Haas, Janet P; Kaye, Keith S; Klompas, Michael; Lo, Evelyn; Marschall, Jonas; Mermel, Leonard A; Nicolle, Lindsay E; Salgado, Cassandra D; Bryant, Kristina; Classen, David; Crist, Katrina; Deloney, Valerie M; Fishman, Neil O; Foster, Nancy; Goldmann, Donald A; Humphreys, Eve; Jernigan, John A; Padberg, Jennifer; Perl, Trish M; Podgorny, Kelly; Septimus, Edward J; VanAmringe, Margaret; Weaver, Tom; Weinstein, Robert A; Wise, Robert; Maragakis, Lisa L

2014-08-01

Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. They are the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).

Development of a banding database for North Pacific albatross: Implications for future data collection

USGS Publications Warehouse

Doherty, P.F.; Kendall, W.L.; Sillett, S.; Gustafson, M.; Flint, B.; Naughton, M.; Robbins, C.S.; Pyle, P.; Macintyre, Ian G.

2006-01-01

The effects of fishery practices on black-footed (Phoebastria nigripes) and Laysan albatross (Phoebastria immutabilis) continue to be a source of contention and uncertainty. Some of this uncertainty is a result of a lack of estimates of albatross demographic parameters such as survival. To begin to address these informational needs, a database of albatross banding and encounter records was constructed. Due to uncertainty concerning data collection and validity of assumptions required for mark-recapture analyses, these data should be used with caution. Although demographic parameter estimates are of interest to many, band loss rates, temporary emigration rates, and discontinuous banding effort can confound these estimates. We suggest a number of improvements in data collection that can help ameliorate problems, including the use of double banding and collecting data using a `robust? design. Additionally, sustained banding and encounter efforts are needed to maximize the value of these data. With these modifications, the usefulness of the banding data could be improved markedly.

Global Polio Eradication - Way Ahead.

PubMed

Bahl, Sunil; Bhatnagar, Pankaj; Sutter, Roland W; Roesel, Sigrun; Zaffran, Michel

2018-02-01

In 1988, the World Health Assembly resolved to eradicate poliomyelitis by the year 2000. Although substantial progress was achieved by 2000, global polio eradication proved elusive. In India, the goal was accomplished in 2011, and the entire South-East Asia Region was certified as polio-free in 2014. The year 2016 marks the lowest wild poliovirus type 1 case count ever, the lowest number of polio-endemic countries (Afghanistan, Nigeria and Pakistan), the maintenance of wild poliovirus type 2 eradication, and the continued absence of wild poliovirus type 3 detection since 2012. The year also marks the Global Polio Eradication Initiative (GPEI) moving into the post-cessation of Sabin type 2, after the effort of globally synchronized withdrawal of Sabin type 2 poliovirus in April 2016. Sustained efforts will be needed to ensure polio eradication is accomplished, to overcome the access and security issues, and continue to improve the quality and reach of field operations. After that, surveillance (the "eyes and ears") will move further to the center stage. Sensitive surveillance will monitor the withdrawal of all Sabin polioviruses, and with facility containment, constitute the cornerstones for eventual global certification of wild poliovirus eradication. An emergency response capacity is essential to institute timely control measures should polio still re-emerge. Simultaneously, the public health community needs to determine whether and how to apply the polio-funded infrastructure to other priorities (after the GPEI funding has stopped). Eradication is the primary goal, but securing eradication will require continued efforts, dedicated resources, and a firm commitment by the global public health community.

Low Power Wearable Systems for Continuous Monitoring of Environment and Health for Chronic Respiratory Disease

PubMed Central

Dieffenderfer, James; Goodell, Henry; Mills, Steven; McKnight, Michael; Yao, Shanshan; Lin, Feiyan; Beppler, Eric; Bent, Brinnae; Lee, Bongmook; Misra, Veena; Zhu, Yong; Oralkan, Omer; Strohmaier, Jason; Muth, John; Peden, David; Bozkurt, Alper

2016-01-01

We present our efforts towards enabling a wearable sensor system that allows for the correlation of individual environmental exposures to physiologic and subsequent adverse health responses. This system will permit a better understanding of the impact of increased ozone levels and other pollutants on chronic asthma conditions. We discuss the inefficiency of existing commercial off-the-shelf components to achieve continuous monitoring and our system-level and nano-enabled efforts towards improving the wearability and power consumption. Our system consists of a wristband, a chest patch, and a handheld spirometer. We describe our preliminary efforts to achieve a sub-milliwatt system ultimately powered by the energy harvested from thermal radiation and motion of the body with the primary contributions being an ultra-low power ozone sensor, an volatile organic compounds sensor, spirometer, and the integration of these and other sensors in a multimodal sensing platform. The measured environmental parameters include ambient ozone concentration, temperature, and relative humidity. Our array of sensors also assesses heart rate via photoplethysmography and electrocardiography, respiratory rate via photoplethysmography, skin impedance, three-axis acceleration, wheezing via a microphone, and expiratory airflow. The sensors on the wristband, chest patch, and spirometer consume 0.83, 0.96, and 0.01 milliwatts respectively. The data from each sensor is continually streamed to a peripheral data aggregation device and is subsequently transferred to a dedicated server for cloud storage. Future work includes reducing the power consumption of the system-on-chip including radio to reduce the entirety of each described system in the sub-milliwatt range. PMID:27249840

Low-Power Wearable Systems for Continuous Monitoring of Environment and Health for Chronic Respiratory Disease.

PubMed

Dieffenderfer, James; Goodell, Henry; Mills, Steven; McKnight, Michael; Yao, Shanshan; Lin, Feiyan; Beppler, Eric; Bent, Brinnae; Lee, Bongmook; Misra, Veena; Zhu, Yong; Oralkan, Omer; Strohmaier, Jason; Muth, John; Peden, David; Bozkurt, Alper

2016-09-01

We present our efforts toward enabling a wearable sensor system that allows for the correlation of individual environmental exposures with physiologic and subsequent adverse health responses. This system will permit a better understanding of the impact of increased ozone levels and other pollutants on chronic asthma conditions. We discuss the inefficiency of existing commercial off-the-shelf components to achieve continuous monitoring and our system-level and nano-enabled efforts toward improving the wearability and power consumption. Our system consists of a wristband, a chest patch, and a handheld spirometer. We describe our preliminary efforts to achieve a submilliwatt system ultimately powered by the energy harvested from thermal radiation and motion of the body with the primary contributions being an ultralow-power ozone sensor, an volatile organic compounds sensor, spirometer, and the integration of these and other sensors in a multimodal sensing platform. The measured environmental parameters include ambient ozone concentration, temperature, and relative humidity. Our array of sensors also assesses heart rate via photoplethysmography and electrocardiography, respiratory rate via photoplethysmography, skin impedance, three-axis acceleration, wheezing via a microphone, and expiratory airflow. The sensors on the wristband, chest patch, and spirometer consume 0.83, 0.96, and 0.01 mW, respectively. The data from each sensor are continually streamed to a peripheral data aggregation device and are subsequently transferred to a dedicated server for cloud storage. Future work includes reducing the power consumption of the system-on-chip including radio to reduce the entirety of each described system in the submilliwatt range.

Process Evaluation for Improving K12 Program Effectiveness: Case Study of a National Institutes of Health Building Interdisciplinary Research Careers in Women's Health Research Career Development Program.

PubMed

Raymond, Nancy C; Wyman, Jean F; Dighe, Satlaj; Harwood, Eileen M; Hang, Mikow

2018-06-01

Process evaluation is an important tool in quality improvement efforts. This article illustrates how a systematic and continuous evaluation process can be used to improve the quality of faculty career development programs by using the University of Minnesota's Building Interdisciplinary Research Careers in Women's Health (BIRCWH) K12 program as an exemplar. Data from a rigorous process evaluation incorporating quantitative and qualitative measurements were analyzed and reviewed by the BIRCWH program leadership on a regular basis. Examples are provided of how this evaluation model and processes were used to improve many aspects of the program, thereby improving scholar, mentor, and advisory committee members' satisfaction and scholar outcomes. A rigorous evaluation plan can increase the effectiveness and impact of a research career development plan.

Supersonic Aerodynamic Design Improvements of an Arrow-Wing HSCT Configuration Using Nonlinear Point Design Methods

NASA Technical Reports Server (NTRS)

Unger, Eric R.; Hager, James O.; Agrawal, Shreekant

1999-01-01

This paper is a discussion of the supersonic nonlinear point design optimization efforts at McDonnell Douglas Aerospace under the High-Speed Research (HSR) program. The baseline for these optimization efforts has been the M2.4-7A configuration which represents an arrow-wing technology for the High-Speed Civil Transport (HSCT). Optimization work on this configuration began in early 1994 and continued into 1996. Initial work focused on optimization of the wing camber and twist on a wing/body configuration and reductions of 3.5 drag counts (Euler) were realized. The next phase of the optimization effort included fuselage camber along with the wing and a drag reduction of 5.0 counts was achieved. Including the effects of the nacelles and diverters into the optimization problem became the next focus where a reduction of 6.6 counts (Euler W/B/N/D) was eventually realized. The final two phases of the effort included a large set of constraints designed to make the final optimized configuration more realistic and they were successful albeit with a loss of performance.

How leaders self-regulate their task performance: evidence that power promotes diligence, depletion, and disdain.

PubMed

DeWall, C Nathan; Baumeister, Roy F; Mead, Nicole L; Vohs, Kathleen D

2011-01-01

When leaders perform solitary tasks, do they self-regulate to maximize their effort, or do they reduce effort and conserve their resources? Our model suggests that power motivates self-regulation toward effective performance-unless the task is perceived as unworthy of leaders. Our 1st studies showed that power improves self-regulation and performance, even when resources for self-regulation are low (ego depletion). Additional studies showed that leaders sometimes disdain tasks they deem unworthy, by withholding effort (and therefore performing poorly). Ironically, during ego depletion, leaders skip the appraisal and, therefore, work hard regardless of task suitability, so that depleted leaders sometimes outperform nondepleted ones. Our final studies replicated these patterns with different tasks and even with simple manipulation of framing and perception of the same task (Experiment 5). Experiment 4 also showed that the continued high exertion of leaders when depleted takes a heavy toll, resulting in larger impairments later. The judicious expenditure of self-control resources among powerful people may help them prioritize their efforts to pursue their goals effectively. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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

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.

Community Hazard Vulnerability Assessments: How Technology Can Assist in Comprehension

DTIC Science & Technology

2013-09-01

strongly preferred learning style improved the most from pretest to posttest ” (p. 105). In addition, he states, 9 “Overall, the results of this study...was one of your greatest challenges; thank you for your continued efforts. To Ronald Wagenmann, the Upper Merion Township Manager, and to my...streams. No community is blessed with unlimited resources to expend on all of the demands placed upon it; as such, priorities must be determined and

Total Quality Management in Space Shuttle Main Engine manufacturing

NASA Technical Reports Server (NTRS)

Ding, J.

1992-01-01

The Total Quality Management (TQM) philosophy developed in the Marshall Space Flight Center (MSFC) is briefly reviewed and the ongoing TQM implementation effort which is being pursued through the continuous improvement (CI) process is discussed. TQM is based on organizational excellence which integrates the new supportive culture with the technical tools necessary to identify, assess, and correct manufacturing processes. Particular attention is given to the prime contractor's change to the organizational excellence management philosophy in SSME manufacturing facilities.

Quality consciousness...auditing for HIPAA Privacy Compliance.

PubMed

LePar, Kathleen

2004-01-01

The Health Insurance Portability and Accountability Act (HIPAA) privacy deadline has passed. Now it is essential to comply with the regulations. The stakes are high; therefore, a HIPAA Privacy Compliance Program must be part of an organization's quality initiatives. This article provides guidelines for the challenges of continual program improvement, successful cultural change, and effective monitoring of the existing program. Healthcare organizations will attain compliance goals through internal audits on the processes, policies, and training efforts of their HIPAA program.

Effectiveness of Personal Protective Equipment and Isolation Precautions in Protecting Healthcare Workers from Acquiring Severe Acute Respiratory Syndrome

DTIC Science & Technology

2005-07-21

workers in Singapore. 9 Epidemiol Infect. 2004; 132:797-803. 0 - Q: Risk and protective factors for nosocomial transmission of SARS in Tan Tock Seng ...transmission include wearing of a mask and hand hygiene. In order to improve hospital preparedness for possible future disease outbreaks, efforts in... hospital laundry attendant in Taiwan who continued working in spite of worsening symptoms. Ultimately this one worker was responsible for at least

Operation of the intensity monitors in beam transport lines at Fermilab during Run II¹

DOE PAGES

Crisp, J.; Fellenz, B.; Fitzgerald, J.; ...

2011-10-06

The intensity of charged particle beams at Fermilab must be kept within pre-determined safety and operational envelopes in part by assuring all beam within a few percent has been transported from any source to destination. Beam instensity monitors with toroidial pickups provide such beam intensity measurements in the transport lines between accelerators at FNAL. With Run II, much effort was made to continually improve the resolution and accuracy of the system.

The Evolution of U.S.-Turkish Relations in a Transatlantic Context

DTIC Science & Technology

2008-04-01

THE EVOLUTION OF U.s.-TURKIsH RELATIONs IN A TRANsATLANTIC CONTEXT Colloquium Report Frances G. Burwell Editor April 2008 This publication is a work ...PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) U.S. Army War College,Strategic Studies...need to continue addressing the issues identified. vi Such work should prove valuable to policymakers of both countries in their efforts to improve

How to study improvement interventions: a brief overview of possible study types

PubMed Central

Portela, Margareth Crisóstomo; Pronovost, Peter J; Woodcock, Thomas; Carter, Pam; Dixon-Woods, Mary

2015-01-01

Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made. PMID:25810415

Republished: How to study improvement interventions: a brief overview of possible study types

PubMed Central

Portela, Margareth Crisóstomo; Pronovost, Peter J; Woodcock, Thomas; Carter, Pam; Dixon-Woods, Mary

2015-01-01

Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made. PMID:26045562

Overview 2003 of NASA Multi-D Stirling Convertor Code Development and DOE and NASA Stirling Regenerator R and D Efforts

NASA Technical Reports Server (NTRS)

Tew, Roy; Ibrahim, Mounir; Simon, Terry; Mantell, Susan; Gedeon, David; Qiu, Songgang; Wood, Gary

2004-01-01

This paper win report on continuation through the third year of a NASA grant for multi-dimensional Stirling CFD code development and validation; continuation through the third and final year of a Department of Energy, Golden Field Office (DOE), regenerator research effort and a NASA grant for continuation of the effort through two additional years; and a new NASA Research Award for design, microfabrication and testing of a "Next Generation Stirling Engine Regenerator." Cleveland State University (CSU) is the lead organization for all three efforts, with the University of Minnesota (UMN) and Gedeon Associates as subcontractors. The Stirling Technology Company and Sun power, Inc. acted as unfunded consultants or participants through the third years of both the NASA multi-D code development and DOE regenerator research efforts; they win both be subcontractors on the new regenerator microfabrication contract.

Viscoplastic Characterization of Ti-6-4: Experiments

NASA Technical Reports Server (NTRS)

Lerch, Bradley A.; Arnold, Steven M.

2016-01-01

As part of a continued effort to improve the understanding of material time-dependent response, a series of mechanical tests have been conducted on the titanium alloy, Ti-6Al-4V. Tensile, creep, and stress relaxation tests were performed over a wide range of temperatures and strain rates to engage various amounts of time-dependent behavior. Additional tests were conducted that involved loading steps, overloads, dwell periods, and block loading segments to characterize the interaction between plasticity and time-dependent behavior. These data will be used to characterize a recently developed, viscoelastoplastic constitutive model with a goal toward better estimates of aerospace component behavior, resulting in improved safety.

GEH-4-42, 47; Hot pressed, I and E cooled fuel element irradiation

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

Neidner, R.

1959-11-02

In our continual effort to improve the present fuel elements which are irradiated in the numerous Hanford reactors, we have made what we believe to be a significant improvement in the hot pressing process for jacketing uranium fuel slugs. We are proposing a large scale evaluation testing program in the Hanford reactors but need the vital and basic information on the operating characteristics of this type slug under known and controlled operating conditions. We, therefore, have prepared two typical fuel slugs and will want them irradiated to about 1000 MWD/T exposure (this will require about four to five total cycles).

Complex Care Options for Patients With Advanced Heart Failure Approaching End of Life.

PubMed

Wordingham, Sara E; McIlvennan, Colleen K; Dionne-Odom, J Nicholas; Swetz, Keith M

2016-02-01

Care for patients with advanced cardiac disease continues to evolve in a complex milieu of therapeutic options, advanced technological interventions, and efforts at improving patient-centered care and shared decision-making. Despite improvements in quality of life and survival with these interventions, optimal supportive care across the advanced illness trajectory remains diverse and heterogeneous. Herein, we outline challenges in prognostication, communication, and caregiving in advanced heart failure and review the unique needs of patients who experience frequent hospitalizations, require chronic home inotropic support, and who have implantable cardioverter-defibrillators and mechanical circulatory support in situ, to name a few.

Development of Plant Control Diagnosis Technology and Increasing Its Applications

NASA Astrophysics Data System (ADS)

Kugemoto, Hidekazu; Yoshimura, Satoshi; Hashizume, Satoru; Kageyama, Takashi; Yamamoto, Toru

A plant control diagnosis technology was developed to improve the performance of plant-wide control and maintain high productivity of plants. The control performance diagnosis system containing this technology picks out the poor performance loop, analyzes the cause, and outputs the result on the Web page. Meanwhile, the PID tuning tool is used to tune extracted loops from the control performance diagnosis system. It has an advantage of tuning safely without process changes. These systems are powerful tools to do Kaizen (continuous improvement efforts) step by step, coordinating with the operator. This paper describes a practical technique regarding the diagnosis system and its industrial applications.

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.

Impact of a Brief Training on Medical Resident Screening for Alcohol Misuse and Illicit Drug Use

PubMed Central

Gunderson, Erik W.; Levin, Frances R.; Owen, Patricia

2011-01-01

Educational initiatives are needed to improve primary care substance use screening. This study assesses the impact on 24 medical residents of a 2.5-day curriculum combining experiential and manual-based training on screening for alcohol misuse and illicit drug use. A retrospective chart review of new primary care outpatients demonstrated that nearly all were asked about current alcohol use before and after curriculum participation. Adherence to national screening guidelines on quantification of alcohol consumption modestly improved (p < .05), as did inquiry about current illicit drug use (p < .05). Continued efforts are needed to enhance educational initiatives for primary care physicians. PMID:18393059

Impact of a brief training on medical resident screening for alcohol misuse and illicit drug use.

PubMed

Gunderson, Erik W; Levin, Frances R; Owen, Patricia

2008-01-01

Educational initiatives are needed to improve primary care substance use screening. This study assesses the impact on 24 medical residents of a 2.5-day curriculum combining experiential and manual-based training on screening for alcohol misuse and illicit drug use. A retrospective chart review of new primary care outpatients demonstrated that nearly all were asked about current alcohol use before and after curriculum participation. Adherence to national screening guidelines on quantification of alcohol consumption modestly improved (p < .05), as did inquiry about current illicit drug use (p < .05). Continued efforts are needed to enhance educational initiatives for primary care physicians.

Background and Epidemiology

PubMed Central

Sanders, Don B.; Fink, Aliza

2016-01-01

SYNOPSIS Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians. Significant advances in therapies and outcomes have occurred for people with CF over the past 30 years. Many of these improvements have come about through the concerted efforts of the US CF Foundation and international CF societies, networks of CF care centers, and the worldwide community of care providers, researchers, and patients and families. Despite these gains, there are still hurdles to overcome to continue to improve the quality of life, reduce CF complications, prolong survival, and ultimately cure CF. This article reviews the epidemiology of CF, including trends in incidence and prevalence, clinical characteristics, common complications, and survival. PMID:27469176

Studies with the USF/NASA toxicity screening test method - Exercise wheels and oxygen replenishment

NASA Technical Reports Server (NTRS)

Hilado, C. J.; Cumming, H. J.

1977-01-01

Continuing efforts to improve the University of San Francisco/NASA toxicity screening test method have included the addition of exercise wheels to provide a different measure of incapacitation, and oxygen replenishment to offset any effect of oxygen depletion by the test animals. The addition of exercise wheels limited the number of animals in each test and doubled the required number of tests without any significant improvement in reproducibility. Oxygen replenishment appears to have an effect on survival in the last 5 minutes of the 30-minute test, but the effect is expected to be similar for most materials.

Current Priorities for Public Health Practice in Addressing the Role of Human Genomics in Improving Population Health

PubMed Central

Khoury, Muin J.; Bowen, Michael S.; Burke, Wylie; Coates, Ralph J.; Dowling, Nicole F.; Evans, James P.; Reyes, Michele; St. Pierre, Jeannette

2017-01-01

In spite of accelerating human genome discoveries in a wide variety of diseases of public health significance, the promise of personalized health care and disease prevention based on genomics has lagged behind. In a time of limited resources, public health agencies must continue to focus on implementing programs that can improve health and prevent disease now. Nevertheless, public health has an important and assertive leadership role in addressing the promise and pitfalls of human genomics for population health. Such efforts are needed not only to implement what is known in genomics to improve health but also to reduce potential harm and create the infrastructure needed to derive health benefits in the future. PMID:21406285

United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit.

PubMed

Zhang, Xiaoming; Tai, Daniel; Pforsich, Hugh; Lin, Vernon W

This is a reevaluation of registered nurse (RN) supply and demand from 2016 to 2030 using a previously published work forecast model and grading methodology with more recent workforce data. There will be a shortage of 154 018 RNs by 2020 and 510 394 RNs by 2030; the South and West regions will have higher shortage ratios than Northeast and Midwest regions. This reflects a nearly 50% overall improvement when compared with the authors' prior study, and the low-performing states have improved from 18 "D" and 12 "F" grades as published earlier to 13 "D" and 1 "F" in this study. Although progress has been made, efforts to foster the pipelines for improving the nursing workforce need to be continued.

Knowing requires data

USGS Publications Warehouse

Naranjo, Ramon C.

2017-01-01

Groundwater-flow models are often calibrated using a limited number of observations relative to the unknown inputs required for the model. This is especially true for models that simulate groundwater surface-water interactions. In this case, subsurface temperature sensors can be an efficient means for collecting long-term data that capture the transient nature of physical processes such as seepage losses. Continuous and spatially dense network of diverse observation data can be used to improve knowledge of important physical drivers, conceptualize and calibrate variably saturated groundwater flow models. An example is presented for which the results of such analysis were used to help guide irrigation districts and water management decisions on costly upgrades to conveyance systems to improve water usage, farm productivity and restoration efforts to improve downstream water quality and ecosystems.

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

PubMed

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

1994-01-01

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

Transforming exoelectrogens for biotechnology using synthetic biology.

PubMed

TerAvest, Michaela A; Ajo-Franklin, Caroline M

2016-04-01

Extracellular electron transfer pathways allow certain bacteria to transfer energy between intracellular chemical energy stores and extracellular solids through redox reactions. Microorganisms containing these pathways, exoelectrogens, are a critical part of microbial electrochemical technologies that aim to impact applications in bioenergy, biosensing, and biocomputing. However, there are not yet any examples of economically viable microbial electrochemical technologies due to the limitations of naturally occurring exoelectrogens. Here we first briefly summarize recent discoveries in understanding extracellular electron transfer pathways, then review in-depth the creation of customized and novel exoelectrogens for biotechnological applications. We analyze engineering efforts to increase current production in native exoelectrogens, which reveals that modulating certain processes within extracellular electron transfer are more effective than others. We also review efforts to create new exoelectrogens and highlight common challenges in this work. Lastly, we summarize work utilizing engineered exoelectrogens for biotechnological applications and the key obstacles to their future development. Fueled by the development of genetic tools, these approaches will continue to expand and genetically modified organisms will continue to improve the outlook for microbial electrochemical technologies. © 2015 Wiley Periodicals, Inc.

The Continual Intercomparison of Radiation Codes: Results from Phase I

NASA Technical Reports Server (NTRS)

Oreopoulos, Lazaros; Mlawer, Eli; Delamere, Jennifer; Shippert, Timothy; Cole, Jason; Iacono, Michael; Jin, Zhonghai; Li, Jiangnan; Manners, James; Raisanen, Petri;

NASA GRC Stirling Technology Development Overview

NASA Technical Reports Server (NTRS)

Thieme, Lanny G.; Schreiber, Jeffrey G.

2003-01-01

The Department of Energy, Lockheed Martin (LM), Stirling Technology Company, and NASA Glenn Research Center (GRC) are developing a high-efficiency Stirling Radioisotope Generator (SRG) for potential NASA Space Science missions. The SRG is being developed for multimission use, including providing spacecraft onboard electric power for NASA deep space missions and power for unmanned Mars rovers. NASA GRC is conducting an in- house supporting technology project to assist in developing the Stirling convertor for space qualification and mission implementation. Preparations are underway for a thermalhacuum system demonstration and unattended operation during endurance testing of the 55-We Technology Demonstration Convertors. Heater head life assessment efforts continue, including verification of the heater head brazing and heat treatment schedules and evaluation of any potential regenerator oxidation. Long-term magnet aging tests are continuing to characterize any possible aging in the strength or demagnetization resistance of the permanent magnets used in the linear alternator. Testing of the magnet/lamination epoxy bond for performance and lifetime characteristics is now underway. These efforts are expected to provide key inputs as the system integrator, LM, begins system development of the SRG. GRC is also developing advanced technology for Stirling convertors. Cleveland State University (CSU) is progressing toward a multi-dimensional Stirling computational fluid dynamics code, capable of modeling complete convertors. Validation efforts at both CSU and the University of Minnesota are complementing the code development. New efforts have been started this year on a lightweight convertor, advanced controllers, high-temperature materials, and an end-to-end system dynamics model. Performance and mass improvement goals have been established for second- and third-generation Stirling radioisotope power systems.

Electronic medical records for otolaryngology office-based practice.

PubMed

Chernobilsky, Boris; Boruk, Marina

2008-02-01

Pressure is mounting on physicians to adopt electronic medical records. The field of health information technology is evolving rapidly with innovations and policies often outpacing science. We sought to review research and discussions about electronic medical records from the past year to keep abreast of these changes. Original scientific research, especially from otolaryngologists, is lacking in this field. Adoption rates are slowly increasing, but more of the burden is shouldered by physicians despite policy efforts and the clear benefits to third-party payers. Scientific research from the past year suggests lack of improvements and even decreasing quality of healthcare with electronic medical record adoption in the ambulatory care setting. The increasing prevalence and standardization of electronic medical record systems results in a new set of problems including rising costs, audits, difficulties in transition and public concerns about security of information. As major players in healthcare continue to push for adoption, increased effort must be made to demonstrate actual improvements in patient care in the ambulatory care setting. More scientific studies are needed to demonstrate what features of electronic medical records actually improve patient care. Otolaryngologists should help each other by disseminating research about improvement in patient outcomes with their systems since current adoption and outcomes policies do not apply to specialists.

On the use of controls for subsonic transport performance improvement: Overview and future directions

NASA Technical Reports Server (NTRS)

Gilyard, Glenn; Espana, Martin

1994-01-01

Increasing competition among airline manufacturers and operators has highlighted the issue of aircraft efficiency. Fewer aircraft orders have led to an all-out efficiency improvement effort among the manufacturers to maintain if not increase their share of the shrinking number of aircraft sales. Aircraft efficiency is important in airline profitability and is key if fuel prices increase from their current low. In a continuing effort to improve aircraft efficiency and develop an optimal performance technology base, NASA Dryden Flight Research Center developed and flight tested an adaptive performance seeking control system to optimize the quasi-steady-state performance of the F-15 aircraft. The demonstrated technology is equally applicable to transport aircraft although with less improvement. NASA Dryden, in transitioning this technology to transport aircraft, is specifically exploring the feasibility of applying adaptive optimal control techniques to performance optimization of redundant control effectors. A simulation evaluation of a preliminary control law optimizes wing-aileron camber for minimum net aircraft drag. Two submodes are evaluated: one to minimize fuel and the other to maximize velocity. This paper covers the status of performance optimization of the current fleet of subsonic transports. Available integrated controls technologies are reviewed to define approaches using active controls. A candidate control law for adaptive performance optimization is presented along with examples of algorithm operation.

Gaining and maintaining commitment to large-scale change in healthcare organizations.

PubMed

Narine, L; Persaud, D D

2003-08-01

Healthcare administrators have sought to improve the quality of healthcare services by using organizational change as a lever. Unfortunately, evaluations of organizational change efforts in areas such as total quality management (TQM), continuous quality improvement (CQI), and organizational restructuring have indicated that these change programmes have not fulfilled their promise in improving service delivery. Furthermore, there are no easy answers as to why so many large-scale change programmes are unsuccessful. The aim of this analysis is to provide insights into practices that may be utilized to improve the chances of successful change management. It is proposed that in order to effect change, implementers must first gain commitment to the change. This is done by ensuring organizational readiness for change, surfacing dissatisfaction with the present state, communicating a clear vision of the proposed change, promoting participation in the change effort, and developing a clear and consistent communication plan. However gaining commitment is not enough. Many change programmes have been initially perceived as being successful but long-term success has been elusive. Therefore, maintaining commitment during the uncertainty associated with the transition period is imperative. This can be done by successfully managing the transition using action steps such as consolidating change using feedback mechanisms and making the change a permanent part of the organization's culture.

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.

Treating alcoholism as a chronic disease: approaches to long-term continuing care.

PubMed

McKay, James R; Hiller-Sturmhofel, Susanne

2011-01-01

For many patients, alcohol and other drug (AOD) use disorders are chronic, recurring conditions involving multiple cycles of treatment, abstinence, and relapse. To disrupt this cycle, treatment can include continuing care to reduce the risk of relapse. The most commonly used treatment approach is initial intensive inpatient or outpatient care based on 12-step principles, followed by continuing care involving self-help groups, 12-step group counseling, or individual therapy. Although these programs can be effective, many patients drop out of initial treatment or do not complete continuing care. Thus, researchers and clinicians have begun to develop alternative approaches to enhance treatment retention in both initial and continuing care. One focus of these efforts has been the design of extended treatment models. These approaches increasingly blur the distinction between initial and continuing care and aim to prolong treatment participation by providing a continuum of care. Other researchers have focused on developing alternative treatment strategies (e.g., telephone-based interventions) that go beyond traditional settings and adaptive treatment algorithms that may improve outcomes for clients who do not respond well to traditional approaches.

Philosophy in medical education: a means of protecting mental health.

PubMed

Keller, Eric J

2014-08-01

This study sought to identify and examine less commonly discussed challenges to positive mental health faced by medical students, residents, and physicians with hopes of improving current efforts to protect the mental health of these groups. Additionally, this work aimed to suggest an innovative means of preventing poor mental health during medical education. Literature on medical student, resident, and physician mental health was carefully reviewed and a number of psychiatrists who treat physician-patients were interviewed. The culture of medicine, medical training, common physician psychology and identity, and conflicting professional expectations all seem to contribute to poor mental health among medical students, residents, and physicians. Many current efforts may be more successful by better addressing the negative effects of these characteristics of modern medicine. Programs aimed at promoting healthy mental lifestyles during medical education should continue to be developed and supported to mitigate the deleterious effects of the challenging environment of modern medicine. To improve these efforts, educators may consider incorporating philosophical discussions on meaning and fulfillment in life between medical students and faculty. Through medical school faculty members sharing and living out their own healthy outlooks on life, students may emulate these habits and the culture of medicine may become less challenging for positive mental health.

Developing effective policy and practice for health promotion in Scotland.

PubMed

Wimbush, Erica; Young, Ian; Robertson, Graham

2007-01-01

Scotland has recently embarked on a new phase of policy and infrastructure development for improving population health and reducing health inequalities that broadly conforms to the Ottawa Charter and WHO's strategic framework for the prevention and control of non-communicable diseases. The new phase is characterised by an integrated, cross-government approach to improving health with strengthened political and Scottish Executive leadership and investment since devolution. A comprehensive policy framework for improving young people's health and reducing inequalities has been developed across education, health, environment and social justice. It builds on an earlier phase of relative stability and continuity in the health promotion infrastructure with policy focused on CVD and cancer prevention and tackling the behavioural risk factors (smoking, alcohol, diet, physical activity) as well as sexual health and mental health and wellbeing. These national strategies are currently being implemented across Scotland. They combine promotion, prevention, treatment and protection goals and target both population-level and high-risk groups. Crosscutting government objectives and headline targets for addressing poverty, disadvantage and health inequalities now supplement the NHS health improvement targets on smoking, alcohol, physical activity, teenage pregnancy and child immunization. Within the health service, prevention efforts are largely concerned with primary care development (anticipatory care) and health system reform to maximize their impact on reducing health inequalities. Efforts to tackle the social determinants of health and reduce inequalities in health outcomes are beginning to be connected and mainstreamed across local government with Community Planning Partnerships as the main vehicle. National level mechanisms for integrated funding, planning and performance reporting to deliver shared priority outcomes have yet to be developed. The development of health improvement strategies has been founded upon a rich source of population health data to monitor changes and improvements, epidemiological studies and evaluation work. The key issues have been to find ways of intervening to accelerate the rate of improvement and to stem the growing health inequalities. A further challenge is to ensure that the lessons from reviews and evaluations of past programmes and strategies are not lost, but help to guide improvements in the complex delivery system and to inform future policy direction. Within the health service, prevention efforts are largely concerned with primary care development and health system reform. Efforts to reduce inequalities in health outcomes are beginning to be connected and mainstreamed across local government.

Gene Ontology Consortium: going forward.

PubMed

2015-01-01

The Gene Ontology (GO; http://www.geneontology.org) is a community-based bioinformatics resource that supplies information about gene product function using ontologies to represent biological knowledge. Here we describe improvements and expansions to several branches of the ontology, as well as updates that have allowed us to more efficiently disseminate the GO and capture feedback from the research community. The Gene Ontology Consortium (GOC) has expanded areas of the ontology such as cilia-related terms, cell-cycle terms and multicellular organism processes. We have also implemented new tools for generating ontology terms based on a set of logical rules making use of templates, and we have made efforts to increase our use of logical definitions. The GOC has a new and improved web site summarizing new developments and documentation, serving as a portal to GO data. Users can perform GO enrichment analysis, and search the GO for terms, annotations to gene products, and associated metadata across multiple species using the all-new AmiGO 2 browser. We encourage and welcome the input of the research community in all biological areas in our continued effort to improve the Gene Ontology. © The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.

Islet cell transplantation for the treatment of type 1 diabetes: recent advances and future challenges

PubMed Central

Bruni, Anthony; Gala-Lopez, Boris; Pepper, Andrew R; Abualhassan, Nasser S; Shapiro, AM James

2014-01-01

Islet transplantation is a well-established therapeutic treatment for a subset of patients with complicated type I diabetes mellitus. Prior to the Edmonton Protocol, only 9% of the 267 islet transplant recipients since 1999 were insulin independent for >1 year. In 2000, the Edmonton group reported the achievement of insulin independence in seven consecutive patients, which in a collaborative team effort propagated expansion of clinical islet transplantation centers worldwide in an effort to ameliorate the consequences of this disease. To date, clinical islet transplantation has established improved success with insulin independence rates up to 5 years post-transplant with minimal complications. In spite of marked clinical success, donor availability and selection, engraftment, and side effects of immunosuppression remain as existing obstacles to be addressed to further improve this therapy. Clinical trials to improve engraftment, the availability of insulin-producing cell sources, as well as alternative transplant sites are currently under investigation to expand treatment. With ongoing experimental and clinical studies, islet transplantation continues to be an exciting and attractive therapy to treat type I diabetes mellitus with the prospect of shifting from a treatment for some to a cure for all. PMID:25018643

The Quality Imperative for Palliative Care

PubMed Central

Kamal, Arif H.; Hanson, Laura C.; Casarett, David J.; Dy, Sydney M.; Pantilat, Steven Z.; Lupu, Dale; Abernethy, Amy P.

2015-01-01

Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the United States shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), “here is what we do,” and increase the focus on “this is how well we do it” and “let’s see how we can do it better.” It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline. PMID:25057987

Building diversity in a complex academic health center.

PubMed

South-Paul, Jeannette E; Roth, Loren; Davis, Paula K; Chen, Terence; Roman, Anna; Murrell, Audrey; Pettigrew, Chenits; Castleberry-Singleton, Candi; Schuman, Joel

2013-09-01

For 30 years, the many diversity-related health sciences programs targeting the University of Pittsburgh undergraduate campus, school of medicine, schools of the health sciences, clinical practice plan, and medical center were run independently and remained separate within the academic health center (AHC). This lack of coordination hampered their overall effectiveness in promoting diversity and inclusion. In 2007, a group of faculty and administrators from the university and the medical center recognized the need to improve institutional diversity and to better address local health disparities. In this article, the authors describe the process of linking the efforts of these institutions in a way that would be successful locally and applicable to other academic environments. First, they engaged an independent consultant to conduct a study of the AHC's diversity climate, interviewing current and former faculty and trainees to define the problem and identify areas for improvement. Next, they created the Physician Inclusion Council to address the findings of this study and to coordinate future efforts with institutional leaders. Finally, they formed four working committees to address (1) communications and outreach, (2) cultural competency, (3) recruitment, and (4) mentoring and retention. These committees oversaw the strategic development and implementation of all diversity and inclusion efforts. Together these steps led to structural changes within the AHC and the improved allocation of resources that have positioned the University of Pittsburgh to achieve not only diversity but also inclusion and to continue to address the health disparities in the Pittsburgh community.

An exploratory survey of methods used to develop measures of performance

NASA Astrophysics Data System (ADS)

Hamner, Kenneth L.; Lafleur, Charles A.

1993-09-01

Nonmanufacturing organizations are being challenged to provide high-quality products and services to their customers, with an emphasis on continuous process improvement. Measures of performance, referred to as metrics, can be used to foster process improvement. The application of performance measurement to nonmanufacturing processes can be very difficult. This research explored methods used to develop metrics in nonmanufacturing organizations. Several methods were formally defined in the literature, and the researchers used a two-step screening process to determine the OMB Generic Method was most likely to produce high-quality metrics. The OMB Generic Method was then used to develop metrics. A few other metric development methods were found in use at nonmanufacturing organizations. The researchers interviewed participants in metric development efforts to determine their satisfaction and to have them identify the strengths and weaknesses of, and recommended improvements to, the metric development methods used. Analysis of participants' responses allowed the researchers to identify the key components of a sound metrics development method. Those components were incorporated into a proposed metric development method that was based on the OMB Generic Method, and should be more likely to produce high-quality metrics that will result in continuous process improvement.

Gamma Ray Astronomy

NASA Technical Reports Server (NTRS)

Wu, S. T.

2000-01-01

The project has progressed successfully during this period of performance. The highlights of the Gamma Ray Astronomy teams efforts are: (1) Support daily BATSE data operations, including receipt, archival and dissemination of data, quick-look science analysis, rapid gamma-ray burst and transient monitoring and response efforts, instrument state-of-health monitoring, and instrument commanding and configuration; (2) On-going scientific analysis, including production and maintenance of gamma-ray burst, pulsed source and occultation source catalogs, gamma-ray burst spectroscopy, studies of the properties of pulsars and black holes, and long-term monitoring of hard x-ray sources; (3) Maintenance and continuous improvement of BATSE instrument response and calibration data bases; (4) Investigation of the use of solid state detectors for eventual application and instrument to perform all sky monitoring of X-Ray and Gamma sources with high sensitivity; and (5) Support of BATSE outreach activities, including seminars, colloquia and World Wide Web pages. The highlights of this efforts can be summarized in the publications and presentation list.

Next Generation Safeguards Initiative Efforts at Los Alamos National Laboratory: Developing Our Human Capital FY2015

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

Stevens, Rebecca S.; Hawkins Erpenbeck, Heather

2015-10-13

This report documents the accomplishments of the Safeguards HCD Fiscal Year 2015 (FY15) Project Work Plan, highlighting LANL’s work as well as the accomplishments of our NGSI-sponsored students, graduate and postdoctoral fellows, and mid-career professionals during this past year. While fiscal year 2015 has been a year of transition in the Human Capital Development area for LANL, we are working to revitalize our efforts to promote and develop Human Capital in Safeguards and Non-proliferation and are looking forward to implementing new initiatives in the coming fiscal year and continuing to transition the knowledge of staff who have been on assignmentmore » at IAEA and Headquarters to improve our support to HCD.« less

Before In Vivo Imaging: Evaluation of Fluorescent Probes Using Fluorescence Microscopy, Multiplate Reader, and Cytotoxicity Assays.

PubMed

Zhang, Shaojuan

2016-01-01

Fluorescent probes are widely utilized for noninvasive fluorescence imaging. Continuing efforts have been made in developing novel fluorescent probes with improved fluorescence quantum yield, enhanced target-specificity, and lower cytotoxicity. Before such probes are administrated into a living system, it is essential to evaluate the subcellular uptake, targeting specificity, and cytotoxicity in vitro. In this chapter, we briefly outline common methods used to evaluate fluorescent probes using fluorescence microscopy, multiplate reader, and cytotoxicity assay.

Historical perspectives and future directions in the surgical management of retroperitoneal sarcoma.

PubMed

Tseng, William W; Seo, Hyun Jae; Pollock, Raphael E; Gronchi, Alessandro

2018-01-01

Retroperitoneal sarcomas (RPS) have fascinated and intrigued physicians both past and present. Operative mortality rates were historically very high and complete resection was not possible for the majority of patients until only the last 2 decades. More recently, changes to the surgical approach and clinical decision-making in RPS have improved patient outcomes. With select integration of nonsurgical therapies, continued RPS-specific research, and ongoing collaborative efforts among major referral centers, the future appears promising. © 2017 Wiley Periodicals, Inc.

Design Considerations for an Integrated Solar Sail Diagnostics System

NASA Technical Reports Server (NTRS)

Jenkins, Christopher H. M.; Gough, Aaron R.; Pappa, Richard S.; Carroll, Joe; Blandino, Joseph R.; Miles, Jonathan J.; Rakoczy, John

2004-01-01

Efforts are continuing under NASA support to improve the readiness level of solar sail technology. Solar sails have one of the best chances to be the next gossamer spacecraft flown in space. In the gossamer spacecraft community thus far, solar sails have always been considered a "low precision" application compared with, say, radar or optical devices. However, as this paper shows, even low precision gossamer applications put extraordinary demands on structural measurement systems if they are to be traceable to use in space.

MRP (materiel requirements planning) II education: a team-building experience.

PubMed

Iemmolo, G R

1994-05-01

Conestoga Wood Specialties, a leader in the woodworking industry, is constantly striving for continuous improvement in manufacturing and service. Recently, the company embarked on a major MRP II education effort that served as a framework for team building. This team building concept has carried over into other aspects related to the business, such as the formalization of the sales and operations planning meeting. At Conestoga Wood, it is recognized that successful team building is necessary to achieve and maintain world-class performance.

Survival and Passage of Yearling and Subyearling Chinook Salmon and Juvenile Steelhead at McNary Dam, 2012

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

Hughes, James S.; Weiland, Mark A.; Woodley, Christa M.

The study was designed to evaluate the passage and survival of yearling and subyearling Chinook salmon and juvenile steelhead at McNary Dam as stipulated by the 2008 Biological Opinion and Fish Accords and to assess performance measures including route-specific fish passage proportions, travel times, and survival based upon a virtual/paired-release model. This study supports the USACE’s continual effort to improve conditions for juvenile anadromous fish passing through Columbia River dams.

DEVELOPMENT OF CONTINUOUS SOLVENT EXTRACTION PROCESSES FOR COAL DERIVED CARBON PRODUCTS

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

Elliot B. Kennel; Stephen P. Carpenter; Dady Dadyburjor

2006-03-27

The purpose of this DOE-funded effort is to develop continuous processes for solvent extraction of coal for the production of carbon products. These carbon products include materials used in metals smelting, especially in the aluminum and steel industries, as well as porous carbon structural material referred to as ''carbon foam'' and carbon fibers. During this reporting period, efforts have focused on the development of continuous processes for hydrogenation as well as continuous production of carbon foam and coke.

Umatilla River Basin Anadromus Fish Habitat Enhancement Project : 1994 Annual Report.

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

Shaw, R. Todd

1994-05-01

The Umatilla Basin Anadromous Fish Habitat Enhancement Project is funded under the Northwest Power Planning Council's Columbia River Basin Fish and Wildlife Program, Section 7.6-7.8 and targets the improvement of water quality and restoration of riparian areas, holding, spawning and rearing habitats of steelhead, spring and fall chinook and coho salmon. The project focused on implementing cooperative instream and riparian habitat improvements on private lands on the Umatilla Indian Reservation (hereafter referred to as Reservation) from April 1, 1988 to March 31, 1992. These efforts resulted in enhancement of the lower l/4 mile of Boston Canyon Creek, the lower 4more » river miles of Meacham Creek and 3.2 river miles of the Umatilla River in the vicinity of Gibbon, Oregon. In 1993, the project shifted emphasis to a comprehensive watershed approach, consistent with other basin efforts, and began to identify upland and riparian watershed-wide causative factors impacting fisheries habitat and natural fisheries production capabilities throughout the Umatilla River Watershed. During the 1994-95 project period, a one river mile demonstration project was implemented on two privately owned properties on Wildhorse Creek. This was the first watershed improvement project to be implemented by the Confederated Tribes of the Umatilla Indian Reservation (CTUIR) off of the Reservation. Four 15 year riparian easements and two right-of-way agreements were secured for enhancement of one river mile on Wildhorse Creek and l/2 river mile on Meacham Creek. Enhancements implemented between river mile (RM) 9.5 and RM 10.5 Wildhorse Creek included: (1) installation of 1.43 miles of smooth wire high tensile fence line and placement of 0.43 miles of fence posts and structures to restrict livestock from the riparian corridor, (2) construction of eighteen sediment retention structures in the stream channel to speed riparian recovery by elevating the stream grade, slowing water velocities and depositing sediments onto streambanks to provide substrate for revegetation, and (3) revegetation of the stream corridor, terraces and adjacent pasture areas with 644 pounds of native grass seed (when commercially available) or close species equivalents and 4,000 native riparian shrub/tree species to assist in floodplain recovery, stream channel stability and filtering of sediments during high flow periods. Three hundred pounds of native grass/legume seed (including other grasses/legumes exhibiting native species characteristics) were broadcast in existing Boston Canyon Creek, Meacham Creek and Umatilla River project areas. The addition of two properties into the project area between RM 4.25 and RM 4.75 Meacham Creek during the 1995-96 work period will provide nearly complete project coverage of lower Meacham Creek corridor areas on the Reservation. Water quality monitoring continued for temperature and turbidity throughout the upper Umatilla River Watershed. Survey of cross sections and photo documentation of riparian recovery within the project areas provided additional baseline data. Physical habitat surveys continued to be conducted to characterize habitat quality and to quantify various habitat types by area. This information will be utilized to assist in identification of habitat deficient areas within the watershed in which to focus habitat restoration efforts. These efforts were coordinated with the CTUIR Umatilla Basin Natural Production Monitoring and Evaluation (UBNPME) Project. Poor land use practices, which have altered natural floodplain dynamics and significantly reduced or eliminated fisheries habitat, continued to be identified in the Mission Creek Subbasin. Complied data is currently being incorporated into a data layer for a Geographic Information System (GIS) data base. This effort is being coordinated with the Natural Resource Conservation Service (NRCS). Community outreach efforts and public education opportunities continued during the reporting period. CTUIR cooperatively sponsored a bioengineering workshop on February 23, 1995 with the Oregon Department of Fish and Wildlife (ODFW). This workshop attracted a combined total 3f over 270 participants at day and evening sessions.« less

Using evidence-based accreditation standards to promote continuous quality improvement: the experiences of the San Mateo County Human Services Agency.

PubMed

Winship, Kathy; Lee, Selina Toy

2012-01-01

Following a difficult period of service provision, an agency determined that drastic changes were needed to improve agency-wide capacity and functioning. The agency engaged in an organizational level self-assessment aimed at identifying areas for improvement and beginning work towards determining professional standards for service. Results of this organizational self-assessment paved the way for pursuing accreditation of its services, and the agency became the first public agency in its state to be accredited by the Council on Accreditation in all eligible services. This case study describes this agency's efforts in engaging in an organizational self-assessment, the analysis and codification of their practices, and their eventual development of a systematized process for capturing, evaluating and improving practice. Copyright © Taylor & Francis Group, LLC

Composite ceramic superconducting wires for electric motor applications

NASA Astrophysics Data System (ADS)

Halloran, John W.

1988-12-01

This is the Second Quarterly report on a project to develop HTSC wire for an HTSC motor. The raw material for fiber production is an improved YBa2Cu3O(7-x) powder. Continuous spools of green YBa2Cu3O(7-x) fiber are being produced. The major effort in fiber spinning is aimed at improving fiber quality and reducing fiber. Binder burnout and sintering has been intensively investigated. Fiber sintering fibers is done by the rapid zone sintering method. A continuous furnace received near the end of this Quarter will be used for continuous sintering. Continuous silver coated green fiber are produced. We have made progress toward continuous cladding using the mechanical cladding concept. The melt spinning process was successfully applied to YBa2Cu3O(7-x) powders at 50 vol percent solids loadings. The cladding work centered on mechanical cladding of silver treated filaments by solder bonding to copper strips. Aluminum deposits on YBa2Cu3O(7-x) filament surfaces were produced by MOCVD at ATM, but the superconductivity was degraded. Electrical characterization work focused on methods of making low resistance contacts on YBa2Cu3O(7-x) filaments. Emerson Motor Division has begun work on DC heteropolar and homopolar motor designs. The mechanical stresses on conventional copper wires during winding have been characterized to determine the mechanical parameters of motor building.

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

PubMed Central

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

2015-01-01

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

Preventive intervention in diabetes: a new model for continuing medical education.

PubMed

Beaser, Richard S; Brown, Julie A

2013-04-01

Competence and skills in overcoming clinical inertia for diabetes treatment, and actually supporting and assisting the patient through adherence and compliance (as opposed to just reiterating what they "should" be doing and then assigning them the blame if they fail) is a key component to success in addressing diabetes, and to date it is a component that has received little formal attention. To improve and systematize diabetes care, it is critical to move beyond the "traditional" continuing medical education (CME) model of imparting knowledge as the entirety of the educational effort, and move toward a focus on Performance Improvement CME. This new approach does not just teach new information but also provides support for improvements where needed most within practice systems based on targeted data-based on self-assessments for the entire system of care. Joslin data conclude that this new approach will benefit support, clinical, and office teams as well as the specialist. In short, the Performance Improvement CME structure reflects the needed components of the successful practice today, particularly for chronic conditions such as diabetes, including the focus on interdisciplinary team care and on quality improvement, which is becoming more and more aligned with reimbursement schemes, public and private, in the U.S. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Implementation of a Socio-Ecological System Navigation Approach to Human Development in Sub-Saharan African Communities

PubMed Central

Gilioli, Gianni; Caroli, Anna Maria; Tikubet, Getachew; Herren, Hans R.; Baumgärtner, Johann

2014-01-01

This paper presents a framework for the development of socio-ecological systems towards enhanced sustainability. Emphasis is given to the dynamic properties of complex, adaptive social-ecological systems, their structure and to the fundamental role of agriculture. The tangible components that meet the needs of specific projects executed in Kenya and Ethiopia encompass project objectives, innovation, facilitation, continuous recording and analyses of monitoring data, that allow adaptive management and system navigation. Two case studies deal with system navigation through the mitigation of key constraints; they aim to improve human health thanks to anopheline malaria vectors control in Nyabondo (Kenya), and to improve cattle health through tsetse control and antitrypanosomal drug administration to cattle in Luke (Ethiopia). The second case deals with a socio-ecological navigation system to enhance sustainability, establishing a periurban diversified enterprise in Addis Ababa (Ethiopia) and developing a rural sustainable social-ecological system in Luke (Ethiopia). The project procedures are briefly described here and their outcomes are analysed in relation to the stated objectives. The methodology for human and cattle disease vector control were easier to implement than the navigation of social-ecological systems towards sustainability enhancement. The achievements considerably differed between key constraints removal and sustainability enhancement projects. Some recommendations are made to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability: i) technology system implementation should be carried out through an innovation system; ii) transparent monitoring information should be continuously acquired and evaluated for assessing the state of the system in relation to stated objectives for (a) improving the insight into the systems behaviour and (b) rationalizing decision support; iii) the different views of all stakeholders should be reconciled in a pragmatic approach to social-ecological system management. Significance for public health Recently, there is a growing interest in studying the link between human, animal and environmental health. The connection between these different dimensions is particularly important for developing countries in which people face the challenge of escaping vicious cycle of high diseases prevalence, food insecurity driven by absolute poverty and population growth, and natural capital as a poverty trap. The design and implementation of such efforts, aiming at human health improvement and poverty alleviation, should be framed into adaptive social-ecological system management perspectives. In this paper, we present few case studies dealing with human health improvement through anopheline malaria vectors control in Kenya, cattle health improvement through tsetse vectored nagana control, antitrypanosomal drug administration to cattle in Ethiopia and with the development of rural sustainable communities in Ethiopia. Some recommendations are given to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability. PMID:25170511

Implementation of a socio-ecological system navigation approach to human development in sub-saharan african communities.

PubMed

Gilioli, Gianni; Caroli, Anna Maria; Tikubet, Getachew; Herren, Hans R; Baumgärtner, Johann

2014-03-26

This paper presents a framework for the development of socio-ecological systems towards enhanced sustainability. Emphasis is given to the dynamic properties of complex, adaptive social-ecological systems, their structure and to the fundamental role of agriculture. The tangible components that meet the needs of specific projects executed in Kenya and Ethiopia encompass project objectives, innovation, facilitation, continuous recording and analyses of monitoring data, that allow adaptive management and system navigation. Two case studies deal with system navigation through the mitigation of key constraints; they aim to improve human health thanks to anopheline malaria vectors control in Nyabondo (Kenya), and to improve cattle health through tsetse control and antitrypanosomal drug administration to cattle in Luke (Ethiopia). The second case deals with a socio-ecological navigation system to enhance sustainability, establishing a periurban diversified enterprise in Addis Ababa (Ethiopia) and developing a rural sustainable social-ecological system in Luke (Ethiopia). The project procedures are briefly described here and their outcomes are analysed in relation to the stated objectives. The methodology for human and cattle disease vector control were easier to implement than the navigation of social-ecological systems towards sustainability enhancement. The achievements considerably differed between key constraints removal and sustainability enhancement projects. Some recommendations are made to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability: i) technology system implementation should be carried out through an innovation system; ii) transparent monitoring information should be continuously acquired and evaluated for assessing the state of the system in relation to stated objectives for (a) improving the insight into the systems behaviour and (b) rationalizing decision support; iii) the different views of all stakeholders should be reconciled in a pragmatic approach to social-ecological system management. Significance for public healthRecently, there is a growing interest in studying the link between human, animal and environmental health. The connection between these different dimensions is particularly important for developing countries in which people face the challenge of escaping vicious cycle of high diseases prevalence, food insecurity driven by absolute poverty and population growth, and natural capital as a poverty trap. The design and implementation of such efforts, aiming at human health improvement and poverty alleviation, should be framed into adaptive social-ecological system management perspectives. In this paper, we present few case studies dealing with human health improvement through anopheline malaria vectors control in Kenya, cattle health improvement through tsetse vectored nagana control, antitrypanosomal drug administration to cattle in Ethiopia and with the development of rural sustainable communities in Ethiopia. Some recommendations are given to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability.

Engineering microorganisms for improving polyhydroxyalkanoate biosynthesis.

PubMed

Chen, Guo-Qiang; Jiang, Xiao-Ran

2017-11-20

Biosynthesis of polyhydroxyalkanoates (PHA) has been studied since the 1920s. The biosynthesis pathways have been well understood and various attempts have been made to improve the PHA biosynthesis efficiency. Recent progresses have been focused on systematic improvements on PHA biosynthesis including changing growth pattern for rapid proliferation, engineering to enlarge cell sizes for more PHA accumulation space, reprogramming the PHA synthesis pathways using optimized RBS and promoter, redirecting metabolic flux to PHA synthesis using CRISPR/Cas9 tools, and very importantly, the employment of non-traditional host such as halophiles for reduced complexity on PHA production. All of the efforts should lead to ultrahigh PHA accumulation, controllable PHA compositions and molecular weights, open and continuous PHA production with gravity separation processes, resulting in competitive PHA production cost. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Sorensen, Christian

The effort to collect and process foam for the purpose of recycling performed by the Material Sustainability and Pollution Prevention (MSP2) team at Sandia National Laboratories is an incredible one, but in order to make it run more efficiently it needed some tweaking. This project started in June of 2015. We used the Value Stream Mapping process to allow us to look at the current state of the foam collection and processing operation. We then thought of all the possible ways the process could be improved. Soon after that we discussed which of the "dreams" were feasible. And finally, wemore » assigned action items to members of the team so as to ensure that the improvements actually occur. These improvements will then, due to varying factors, continue to occur over the next couple years.« less

Advances and Future Applications of Augmented Peripheral Nerve Regeneration

PubMed Central

Jones, Salazar; Eisenberg, Howard M.; Jia, Xiaofeng

2016-01-01

Peripheral nerve injuries remain a significant source of long lasting morbidity, disability, and economic costs. Much research continues to be performed in areas related to improving the surgical outcomes of peripheral nerve repair. In this review, the physiology of peripheral nerve regeneration and the multitude of efforts to improve surgical outcomes are discussed. Improvements in tissue engineering that have allowed for the use of synthetic conduits seeded with neurotrophic factors are highlighted. Selected pre-clinical and available clinical data using cell based methods such as Schwann cell, undifferentiated, and differentiated stem cell transplantation to guide and enhance peripheral nerve regeneration are presented. The limitations that still exist in the utility of neurotrophic factors and cell-based therapies are outlined. Strategies that are most promising for translation into the clinical arena are suggested. PMID:27618010

Sensor to User - NASA/EOS Data for Coastal Zone Management Applications Developed from Integrated Analyses: Verification, Validation and Benchmark Report

NASA Technical Reports Server (NTRS)

Hall, Callie; Arnone, Robert

2006-01-01

The NASA Applied Sciences Program seeks to transfer NASA data, models, and knowledge into the hands of end-users by forming links with partner agencies and associated decision support tools (DSTs). Through the NASA REASoN (Research, Education and Applications Solutions Network) Cooperative Agreement, the Oceanography Division of the Naval Research Laboratory (NRLSSC) is developing new products through the integration of data from NASA Earth-Sun System assets with coastal ocean forecast models and other available data to enhance coastal management in the Gulf of Mexico. The recipient federal agency for this research effort is the National Oceanic and Atmospheric Administration (NOAA). The contents of this report detail the effort to further the goals of the NASA Applied Sciences Program by demonstrating the use of NASA satellite products combined with data-assimilating ocean models to provide near real-time information to maritime users and coastal managers of the Gulf of Mexico. This effort provides new and improved capabilities for monitoring, assessing, and predicting the coastal environment. Coastal managers can exploit these capabilities through enhanced DSTs at federal, state and local agencies. The project addresses three major issues facing coastal managers: 1) Harmful Algal Blooms (HABs); 2) hypoxia; and 3) freshwater fluxes to the coastal ocean. A suite of ocean products capable of describing Ocean Weather is assembled on a daily basis as the foundation for this semi-operational multiyear effort. This continuous realtime capability brings decision makers a new ability to monitor both normal and anomalous coastal ocean conditions with a steady flow of satellite and ocean model conditions. Furthermore, as the baseline data sets are used more extensively and the customer list increased, customer feedback is obtained and additional customized products are developed and provided to decision makers. Continual customer feedback and response with new improved products are required between the researcher and customer. This document details the methods by which these coastal ocean products are produced including the data flow, distribution, and verification. Product applications and the degree to which these products are used successfully within NOAA and coordinated with the Mississippi Department of Marine Resources (MDMR) is benchmarked.

A New Technique for Mitigating Risk on US College Campuses

ERIC Educational Resources Information Center

Hughes, Stephanie; White, Rebecca J.; Hertz, Giles

2008-01-01

High-profile criminal acts continue to plague United States (US) college campuses despite recent efforts to implement more aggressive risk mitigation practices, such as criminal background checks. Despite these efforts, incidents such as the most recent shootings at Virginia Polytechnic Institute and State University continue to demonstrate that,…

Business continuity, emergency planning and special needs: How to protect the vulnerable.

PubMed

Reilly, Daniel

2015-01-01

Emergencies and disasters affect all segments of the population. Some segments are more at risk during the emergency response and recovery efforts owing to vulnerabilities that increase the risk of harm. These vulnerabilities are due to individuals' disabilities, which must be incorporated into emergency and business continuity planning. Some disabilities are obvious, such as impaired vision, hearing or mobility, while other are less evident, but equally disabling, such as cognitive disorders, geographical or language isolation, and numerous age-related factors. Taken together when creating emergency or business continuity plans, the issues identified as disabilities can be grouped by functionality and termed as special needs. This paper will detail the identification of special needs populations, explain how these persons are vulnerable during the emergency or disaster response and recovery process, and provide examples of how to partner with individuals within identified special needs populations to improve the planning process.

Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis.

PubMed

Scott, John W; Nyinawankusi, Jeanne D'Arc; Enumah, Samuel; Maine, Rebecca; Uwitonze, Eric; Hu, Yihan; Kabagema, Ignace; Byiringiro, Jean Claude; Riviello, Robert; Jayaraman, Sudha

2017-07-01

Injury is a major cause of premature death and disability in East Africa, and high-quality pre-hospital care is essential for optimal trauma outcomes. The Rwandan pre-hospital emergency care service (SAMU) uses an electronic database to evaluate and optimize pre-hospital care through a continuous quality improvement programme (CQIP), beginning March 2014. The SAMU database was used to assess pre-hospital quality metrics including supplementary oxygen for hypoxia (O2), intravenous fluids for hypotension (IVF), cervical collar placement for head injuries (c-collar), and either splinting (splint) or administration of pain medications (pain) for long bone fractures. Targets of >90% were set for each metric and daily team meetings and monthly feedback sessions were implemented to address opportunities for improvement. These five pre-hospital quality metrics were assessed monthly before and after implementation of the CQIP. Met and unmet needs for O2, IVF, and c-collar were combined into a summative monthly SAMU Trauma Quality Scores (STQ score). An interrupted time series linear regression model compared the STQ score during 14 months before the CQIP implementation to the first 14 months after. During the 29-month study period 3,822 patients met study criteria. 1,028 patients needed one or more of the five studied interventions during the study period. All five endpoints had a significant increase between the pre-CQI and post-CQI periods (p<0.05 for all), and all five achieved a post-CQI average of at least 90% completion. The monthly composite STQ scores ranged from 76.5 to 97.9 pre-CQI, but tightened to 86.1-98.7 during the post-CQI period. Interrupted time series analysis of the STQ score showed that CQI programme led to both an immediate improvement of +6.1% (p=0.017) and sustained monthly improvements in care delivery-improving at a rate of 0.7% per month (p=0.028). The SAMU experience demonstrates the utility of a responsive, data-driven quality improvement programme to yield significant immediate and sustained improvements in pre-hospital care for trauma in Rwanda. This programme may be used as an example for additional efforts engaging frontline staff with real-time data feedback in order to rapidly translate data collection efforts into improved care for the injured in a resource-limited setting. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improving efficiency and safety in external beam radiation therapy treatment delivery using a Kaizen approach.

PubMed

Kapur, Ajay; Adair, Nilda; O'Brien, Mildred; Naparstek, Nikoleta; Cangelosi, Thomas; Zuvic, Petrina; Joseph, Sherin; Meier, Jason; Bloom, Beatrice; Potters, Louis

Modern external beam radiation therapy treatment delivery processes potentially increase the number of tasks to be performed by therapists and thus opportunities for errors, yet the need to treat a large number of patients daily requires a balanced allocation of time per treatment slot. The goal of this work was to streamline the underlying workflow in such time-interval constrained processes to enhance both execution efficiency and active safety surveillance using a Kaizen approach. A Kaizen project was initiated by mapping the workflow within each treatment slot for 3 Varian TrueBeam linear accelerators. More than 90 steps were identified, and average execution times for each were measured. The time-consuming steps were stratified into a 2 × 2 matrix arranged by potential workflow improvement versus the level of corrective effort required. A work plan was created to launch initiatives with high potential for workflow improvement but modest effort to implement. Time spent on safety surveillance and average durations of treatment slots were used to assess corresponding workflow improvements. Three initiatives were implemented to mitigate unnecessary therapist motion, overprocessing of data, and wait time for data transfer defects, respectively. A fourth initiative was implemented to make the division of labor by treating therapists as well as peer review more explicit. The average duration of treatment slots reduced by 6.7% in the 9 months following implementation of the initiatives (P = .001). A reduction of 21% in duration of treatment slots was observed on 1 of the machines (P < .001). Time spent on safety reviews remained the same (20% of the allocated interval), but the peer review component increased. The Kaizen approach has the potential to improve operational efficiency and safety with quick turnaround in radiation therapy practice by addressing non-value-adding steps characteristic of individual department workflows. Higher effort opportunities are identified to guide continual downstream quality improvements. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Vibrio cholerae: lessons for mucosal vaccine design

PubMed Central

Bishop, Anne L; Camilli, Andrew

2011-01-01

The ability of Vibrio cholerae to persist in bodies of water will continue to confound our ability to eradicate cholera through improvements to infrastructure, and thus cholera vaccines are needed. We aim for an inexpensive vaccine that can provide long-lasting protection from all epidemic cholera infections, currently caused by O1 or O139 serogroups. Recent insights into correlates of protection, epidemiology and pathogenesis may help us design improved vaccines. This notwithstanding, we have come to appreciate that even marginally protective vaccines, such as oral whole-cell killed vaccines, if widely distributed, can provide significant protection, owing to herd immunity. Further efforts are still required to provide more effective protection of young children. PMID:21162623

Overview of NASA GRC Stirling Technology Development

NASA Technical Reports Server (NTRS)

Schreiber, Jeffrey G.; Thieme, Lanny G.

2004-01-01

The Stirling Radioisotope Generator (SRG) is currently being developed by Lockheed Martin Astronautics (LMA) under contract to the Department of Energy (DOE). The generator will be a high efficiency electric power source for NASA Space Science missions with the ability to operate in vacuum or in an atmosphere such as on Mars. High efficiency is obtained through the use of free-piston Stirling power conversion. Power output will be greater than 100 watts at the beginning of life with the decline in power largely due to the decay of the plutonium heat source. In support of the DOE SRG project, the NASA Glenn Research Center (GRC) has established a technology effort to provide data to ensure a successful transition to flight for what will be the first dynamic power system in space. Initially, a limited number of areas were selected for the effort, however this is now being expanded to more thoroughly cover key technical issues. There is also an advanced technology effort that is complementary to the near-term technology effort. Many of the tests use the 55-We Technology Demonstration Convertor (TDC). There have been multiple controller tests to support the LMA flight controller design effort. Preparation is continuing for a thermal/vacuum system demonstration. A pair of flight prototype TDC s have been placed on continuous operation. Heater head life assessment continues, with the material data being refined and the analysis moving toward the system perspective. Magnet aging tests continue to characterize any possible aging in the strength or demagnetization resistance of the magnets in the linear alternator. A reliability effort has been initiated to help guide the development activities with focus on the key components and subsystems. This paper will provide an overview of some of the GRC technical efforts, including the status, and a description of future efforts.

Meeting the challenge of food and energy security.

PubMed

Karp, Angela; Richter, Goetz M

2011-06-01

Growing crops for bioenergy or biofuels is increasingly viewed as conflicting with food production. However, energy use continues to rise and food production requires fuel inputs, which have increased with intensification. Focussing on the question of food or fuel is thus not helpful. The bigger, more pertinent, challenge is how the increasing demands for food and energy can be met in the future, particularly when water and land availability will be limited. Energy crop production systems differ greatly in environmental impact. The use of high-input food crops for liquid transport fuels (first-generation biofuels) needs to be phased out and replaced by the use of crop residues and low-input perennial crops (second/advanced-generation biofuels) with multiple environmental benefits. More research effort is needed to improve yields of biomass crops grown on lower grade land, and maximum value should be extracted through the exploitation of co-products and integrated biorefinery systems. Policy must continually emphasize the changes needed and tie incentives to improved greenhous gas reduction and environmental performance of biofuels.

Research, development and demonstration of nickel-iron batteries for electric-vehicle propulsion

NASA Astrophysics Data System (ADS)

1982-03-01

Full-size, prototype cell, module and battery fabrication and evaluation, aimed at advancing the technical capabilities of the nickel-iron battery, while simultaneously reducing its potential cost in materials and process areas are discussed. Improved electroprecipitation process nickel electrodes of design thickness (2.5 mm) are now being prepared that display stable capacities for the C/3 drain rate with less than 10% capacity decline for greater than 1000 test cycles. Iron electrodes of the composite-type are delivering 24 Ah at the target thickness (1.0 mm). Iron electrodes also are displaying capacity stability for greater than 1000 test cycles in continuing 3-plate cell tests. Finished cells delivered 57 to 63 Wh/kg at C/3, and have demonstrated cyclic stability up to 1200 cycles at 80 percent depth of discharge profiles. Modules exceeded 580 test cycles and remain on test. Reduction in nickel electrode swelling (and concurrent stack starvation), to improve cycling, continues to be an area of major effort to reach the final battery cycle life objectives.

Progress and biotechnological prospects in fish transgenesis.

PubMed

Tonelli, Fernanda M P; Lacerda, Samyra M S N; Tonelli, Flávia C P; Costa, Guilherme M J; de França, Luiz Renato; Resende, Rodrigo R

2017-11-01

The history of transgenesis is marked by milestones such as the development of cellular transdifferentiation, recombinant DNA, genetic modification of target cells, and finally, the generation of simpler genetically modified organisms (e.g. bacteria and mice). The first transgenic fish was developed in 1984, and since then, continuing technological advancements to improve gene transfer have led to more rapid, accurate, and efficient generation of transgenic animals. Among the established methods are microinjection, electroporation, lipofection, viral vectors, and gene targeting. Here, we review the history of animal transgenesis, with an emphasis on fish, in conjunction with major developments in genetic engineering over the past few decades. Importantly, spermatogonial stem cell modification and transplantation are two common techniques capable of revolutionizing the generation of transgenic fish. Furthermore, we discuss recent progress and future biotechnological prospects of fish transgenesis, which has strong applications for the aquaculture industry. Indeed, some transgenic fish are already available in the current market, validating continued efforts to improve economically important species with biotechnological advancements. Copyright © 2017. Published by Elsevier Inc.

Total Probability of Collision as a Metric for Finite Conjunction Assessment and Collision Risk Management

NASA Technical Reports Server (NTRS)

Frigm, Ryan C.; Hejduk, Matthew D.; Johnson, Lauren C.; Plakalovic, Dragan

2015-01-01

On-orbit collision risk is becoming an increasing mission risk to all operational satellites in Earth orbit. Managing this risk can be disruptive to mission and operations, present challenges for decision-makers, and is time-consuming for all parties involved. With the planned capability improvements to detecting and tracking smaller orbital debris and capacity improvements to routinely predict on-orbit conjunctions, this mission risk will continue to grow in terms of likelihood and effort. It is very real possibility that the future space environment will not allow collision risk management and mission operations to be conducted in the same manner as it is today. This paper presents the concept of a finite conjunction assessment-one where each discrete conjunction is not treated separately but, rather, as a continuous event that must be managed concurrently. The paper also introduces the Total Probability of Collision as an analogous metric for finite conjunction assessment operations and provides several options for its usage in a Concept of Operations.

Schools, Families, and the Prevention of Child Maltreatment: Lessons That Can Be Learned From a Literature Review.

PubMed

Admon Livny, Karen; Katz, Carmit

2018-04-01

Child maltreatment is a worldwide social problem that receives considerable attention. However, prevention efforts remain rare, allowing the phenomenon to continue and spread. The aim of the current article is to systematically review evidence-based prevention efforts that address schools and families as key stakeholders for preventing child maltreatment. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a thorough literature review revealed that only five programs matched the inclusion criteria for the current article. These programs were analyzed for several domains, including level of prevention, target population, participants, and the programs' outcomes. The current review highlights the urgent needs to develop, modify, and further evaluate prevention programs for child maltreatment in the context of the ecological model. More specifically, it illuminates the need to create and champion programs that enhance the collaboration between families and schools, both of which are key stakeholders within the phenomenon of child maltreatment. Collaboration between policymakers, researchers, and practitioners should guide future efforts by promoting cultural adaptation to such programs and by integrating children's perceptions to improve these efforts and to benefit everyone involved.

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 Human Student: The Essentiality of the Teacher-Student Connection in Higher Education

ERIC Educational Resources Information Center

Torrisi-Steele, Geraldine

2018-01-01

Higher education institutions are investing significant effort into the improvement of student success, retention and satisfaction. Some effort is being expended in research seeking to understand influencing factors, but the majority of effort is directed towards improving teaching quality. Effort to improve teaching quality is characterised by…

A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success.

PubMed

Olvera, David J; Stuhlmiller, David F E; Wolfe, Allen; Swearingen, Charles F; Pennington, Troy; Davis, Daniel P

2018-02-21

Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success. The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation. A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p < 0.01) and first-attempt success without desaturation (84% to 94%, p < 0.01) were observed. Overall intubation success increased from 95% to 99% over the study period, but the trend was not statistically significant (p = 0.311). An integrated advanced airway management program was successful in improving RSI intubation performance in a large air medical company.

Reassessing marketing of kidneys from the 2008 perspective.

PubMed

Friedman, Eli A; Friedman, Amy L

2009-01-01

Progressive improvements in all aspects of the kidney transplant regimen establish this form of renal replacement therapy as superior to peritoneal or hemodialysis in terms of extent of rehabilitation and long-term recipient survival. Continuous growth in the number of patients with kidney failure sustained by dialytic therapy has not been associated with substantially increased deceased donor kidney contributions, causing intensified stressful waiting periods for potential recipients lacking a live kidney donor. Neither public relation campaigns nor local government efforts have substantially increased kidney donation. Buying a donor kidney is illegal and condemned as fostering exploitation of poor people by the wealthy. Widely publicized examples of coercion of unwilling donors create a negative image of harmful, inhumane conduct deployed to obtain kidneys sold and transplanted under unsavory circumstances. Yet efforts to establish and test governmental programs to supervise and sustain acceptable standards for the sale and implantation of kidneys from fully informed, medically evaluated and protected, fairly compensated donors have been resisted and frustrated by those who consider such compensation loathsome. Accordingly, while selling kidneys is prohibited by law, pressure from those wanting to quench the number of deaths of wait-listed dialysis patients continues forcing reexamination of an issue that, like prohibition of the possession and sale of alcohol in the United States in 1920, places the will of a people in opposition to unreasonably restrictive laws. The debate continues.

Application of a Theoretical Model Toward Understanding Continued Food Insecurity Post Hurricane Katrina.

PubMed

Clay, Lauren A; Papas, Mia A; Gill, Kimberly; Abramson, David M

2018-02-01

Disaster recovery efforts focus on restoring basic needs to survivors, such as food, water, and shelter. However, long after the immediate recovery phase is over, some individuals will continue to experience unmet needs. Ongoing food insecurity has been identified as a post-disaster problem. There is a paucity of information regarding the factors that might place an individual at risk for continued food insecurity post disaster. Using data from a sample (n=737) of households severely impacted by Hurricane Katrina, we estimated the associations between food insecurity and structural, physical and mental health, and psychosocial factors 5 years after Hurricane Katrina. Logistic regression models were fit and odds ratios (OR) and 95% CI estimated. Nearly one-quarter of respondents (23%) reported food insecurity 5 years post Katrina. Marital/partner status (OR: 0.7, CI: 0.42, 0.99), self-efficacy (OR: 0.56, CI: 0.37, 0.84), sense of community (OR: 0.7, CI: 0.44, 0.98), and social support (OR: 0.59, CI: 0.39, 0.89) lowered the odds of food insecurity and explained most of the effects of mental health distress on food insecurity. Social support, self-efficacy, and being partnered were protective against food insecurity. Recovery efforts should focus on fostering social-support networks and increased self-efficacy to improve food insecurity post disaster. (Disaster Med Public Health Preparedness. 2018;12:47-56).

A progress report on seismic model studies

USGS Publications Warehouse

Healy, J.H.; Mangan, G.B.

1963-01-01

The value of seismic-model studies as an aid to understanding wave propagation in the Earth's crust was recognized by early investigators (Tatel and Tuve, 1955). Preliminary model results were very promising, but progress in model seismology has been restricted by two problems: (1) difficulties in the development of models with continuously variable velocity-depth functions, and (2) difficulties in the construction of models of adequate size to provide a meaningful wave-length to layer-thickness ratio. The problem of a continuously variable velocity-depth function has been partly solved by a technique using two-dimensional plate models constructed by laminating plastic to aluminum, so that the ratio of plastic to aluminum controls the velocity-depth function (Healy and Press, 1960). These techniques provide a continuously variable velocity-depth function, but it is not possible to construct such models large enough to study short-period wave propagation in the crust. This report describes improvements in our ability to machine large models. Two types of models are being used: one is a cylindrical aluminum tube machined on a lathe, and the other is a large plate machined on a precision planer. Both of these modeling techniques give promising results and are a significant improvement over earlier efforts.

Continuous Adaptive Population Reduction (CAPR) for Differential Evolution Optimization.

PubMed

Wong, Ieong; Liu, Wenjia; Ho, Chih-Ming; Ding, Xianting

2017-06-01

Differential evolution (DE) has been applied extensively in drug combination optimization studies in the past decade. It allows for identification of desired drug combinations with minimal experimental effort. This article proposes an adaptive population-sizing method for the DE algorithm. Our new method presents improvements in terms of efficiency and convergence over the original DE algorithm and constant stepwise population reduction-based DE algorithm, which would lead to a reduced number of cells and animals required to identify an optimal drug combination. The method continuously adjusts the reduction of the population size in accordance with the stage of the optimization process. Our adaptive scheme limits the population reduction to occur only at the exploitation stage. We believe that continuously adjusting for a more effective population size during the evolutionary process is the major reason for the significant improvement in the convergence speed of the DE algorithm. The performance of the method is evaluated through a set of unimodal and multimodal benchmark functions. In combining with self-adaptive schemes for mutation and crossover constants, this adaptive population reduction method can help shed light on the future direction of a completely parameter tune-free self-adaptive DE algorithm.

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.

Triple Aim in Canada: developing capacity to lead to better health, care and cost

PubMed Central

Farmanova, Elina; Kirvan, Christine; Verma, Jennifer; Mukerji, Geetha; Akunov, Nurdin; Phillips, Kaye; Samis, Stephen

2016-01-01

Abstract Quality problem Many modern health systems strive for ‘Triple Aim’ (TA)—better health for populations, improved experience of care for patients and lower costs of the system, but note challenges in implementation. Outcomes of applying TA as a quality improvement framework (QI) have started to be realized with early lessons as to why some systems make progress while others do not. Initial assessment Limited evidence is available as to how organizations create the capacity and infrastructure required to design, implement, evaluate and sustain TA systems. Choice of solution To support embedding TA across Canada, the Canadian Foundation for Healthcare Improvement supported enrolment of nine Canadian teams to participate in the Institute for Healthcare Improvement's TA Improvement Community. Implementation Structured support for TA design, implementation, evaluation and sustainability was addressed in a collaborative programme of webinars and action periods. Teams were coached to undertake and test small-scale improvements before attempting to scale. Evaluation A summative evaluation of the Canadian cohort was undertaken to assess site progress in building TA infrastructure across various healthcare settings. The evaluation explored the process of change, experiences and challenges and strategies for continuous QI. Lessons learned Delivering TA requires a sustained and coordinated effort supported by strong leadership and governance, continuous QI, engaged interdisciplinary teams and partnering within and beyond the healthcare sector. PMID:28423164

Triple Aim in Canada: developing capacity to lead to better health, care and cost.

PubMed

Farmanova, Elina; Kirvan, Christine; Verma, Jennifer; Mukerji, Geetha; Akunov, Nurdin; Phillips, Kaye; Samis, Stephen

2016-12-01

Many modern health systems strive for 'Triple Aim' (TA)-better health for populations, improved experience of care for patients and lower costs of the system, but note challenges in implementation. Outcomes of applying TA as a quality improvement framework (QI) have started to be realized with early lessons as to why some systems make progress while others do not. Limited evidence is available as to how organizations create the capacity and infrastructure required to design, implement, evaluate and sustain TA systems. To support embedding TA across Canada, the Canadian Foundation for Healthcare Improvement supported enrolment of nine Canadian teams to participate in the Institute for Healthcare Improvement's TA Improvement Community. Structured support for TA design, implementation, evaluation and sustainability was addressed in a collaborative programme of webinars and action periods. Teams were coached to undertake and test small-scale improvements before attempting to scale. A summative evaluation of the Canadian cohort was undertaken to assess site progress in building TA infrastructure across various healthcare settings. The evaluation explored the process of change, experiences and challenges and strategies for continuous QI. Delivering TA requires a sustained and coordinated effort supported by strong leadership and governance, continuous QI, engaged interdisciplinary teams and partnering within and beyond the healthcare sector. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care.

Making the hard work of recovery more attractive for those with substance use disorders

PubMed Central

McKay, James R.

2016-01-01

Background Research has led to improvements in the effectiveness of interventions for substance use disorders (SUD), but for the most part progress has been modest, particularly with regard to longer-term outcomes. Moreover, most individuals with SUD do not seek out treatment. Argument/analysis This paper presents two recommendations on how to improve treatment engagement and long-term outcomes for those with SUD. First, treatments should go beyond a focus on reducing or eliminating substance use to target greater access to and more time spent in experiences that will be enjoyable or otherwise rewarding to clients. Second, there must be sufficient incentives in the environment to justify the effort needed to sustain long-term abstinence for individuals who often have limited access to such incentives. Conclusions To increase rates of long-term recovery from substance misuse, treatments should link clients to reinforcers that will make continued abstinence more appealing. This work needs to extend beyond interventions focused on the individual or family to include the local community and national policy in an effort to more strongly incentivize longer-term recoveries. PMID:27535787

Collaborative Effort for a Centralized Worldwide Tuberculosis Relational Sequencing Data Platform.

PubMed

Starks, Angela M; Avilés, Enrique; Cirillo, Daniela M; Denkinger, Claudia M; Dolinger, David L; Emerson, Claudia; Gallarda, Jim; Hanna, Debra; Kim, Peter S; Liwski, Richard; Miotto, Paolo; Schito, Marco; Zignol, Matteo

2015-10-15

Continued progress in addressing challenges associated with detection and management of tuberculosis requires new diagnostic tools. These tools must be able to provide rapid and accurate information for detecting resistance to guide selection of the treatment regimen for each patient. To achieve this goal, globally representative genotypic, phenotypic, and clinical data are needed in a standardized and curated data platform. A global partnership of academic institutions, public health agencies, and nongovernmental organizations has been established to develop a tuberculosis relational sequencing data platform (ReSeqTB) that seeks to increase understanding of the genetic basis of resistance by correlating molecular data with results from drug susceptibility testing and, optimally, associated patient outcomes. These data will inform development of new diagnostics, facilitate clinical decision making, and improve surveillance for drug resistance. ReSeqTB offers an opportunity for collaboration to achieve improved patient outcomes and to advance efforts to prevent and control this devastating disease. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Making the hard work of recovery more attractive for those with substance use disorders.

PubMed

McKay, James R

2017-05-01

Research has led to improvements in the effectiveness of interventions for substance use disorders (SUD), but for the most part progress has been modest, particularly with regard to longer-term outcomes. Moreover, most individuals with SUD do not seek out treatment. This paper presents two recommendations on how to improve treatment engagement and long-term outcomes for those with SUD. First, treatments should go beyond a focus on reducing or eliminating substance use to target greater access to and more time spent in experiences that will be enjoyable or otherwise rewarding to clients. Secondly, there must be sufficient incentives in the environment to justify the effort needed to sustain long-term abstinence for individuals who often have limited access to such incentives. To increase rates of long-term recovery from substance misuse, treatments should link clients to reinforcers that will make continued abstinence more appealing. This work needs to extend beyond interventions focused on the individual or family to include the local community and national policy in an effort to incentivize longer-term recoveries more strongly. © 2016 Society for the Study of Addiction.

Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement.

PubMed

Dupont, Corinne; Occelli, Pauline; Deneux-Tharaux, Catherine; Touzet, Sandrine; Duclos, Antoine; Bouvier-Colle, Marie-Hélène; Rudigoz, René-Charles; Huissoud, Cyril

2014-07-01

Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement To use statistical process control charts to describe trends in the prevalence of severe postpartum haemorrhage after vaginal delivery. This assessment was performed 7 years after we initiated a continuous quality improvement programme that began with regular criteria-based audits Observational descriptive study, in a French maternity unit in the Rhône-Alpes region. Quarterly clinical audit meetings to analyse all cases of severe postpartum haemorrhage after vaginal delivery and provide feedback on quality of care with statistical process control tools. The primary outcomes were the prevalence of severe PPH after vaginal delivery and its quarterly monitoring with a control chart. The secondary outcomes included the global quality of care for women with severe postpartum haemorrhage, including the performance rate of each recommended procedure. Differences in these variables between 2005 and 2012 were tested. From 2005 to 2012, the prevalence of severe postpartum haemorrhage declined significantly, from 1.2% to 0.6% of vaginal deliveries (p<0.001). Since 2010, the quarterly rate of severe PPH has not exceeded the upper control limits, that is, been out of statistical control. The proportion of cases that were managed consistently with the guidelines increased for all of their main components. Implementation of continuous quality improvement efforts began seven years ago and used, among other tools, statistical process control charts. During this period, the prevalence of severe postpartum haemorrhage after vaginal delivery has been reduced by 50%. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Short term evaluation of respiratory effort by premature infants supported with bubble nasal continuous airway pressure using Seattle-PAP and a standard bubble device

PubMed Central

Welty, Stephen E.; Rusin, Craig G.; Stanberry, Larissa I.; Mandy, George T.; Gest, Alfred L.; Ford, Jeremy M.; Backes, Carl H.; Richardson, C. Peter; Howard, Christopher R.; Hansen, Thomas N.

2018-01-01

Background Almost one million prematurely born infants die annually from respiratory insufficiency, predominantly in countries with limited access to respiratory support for neonates. The primary hypothesis tested in the present study was that a modified device for bubble nasal continuous positive airway pressure (Bn-CPAP) would provide lower work of spontaneous breathing, estimated by esophageal pressure-rate products. Methods Infants born <32 weeks gestation and stable on Bn-CPAP with FiO2 <0.30 were studied within 72 h following delivery. Esophageal pressures during spontaneous breathing were measured during 2 h on standard Bn-CPAP, then 2 h with Bn-CPAP using a modified bubble device presently termed Seattle-PAP, which produces a different pattern of pressure fluctuations and which provided greater respiratory support in preclinical studies, then 2 h on standard Bn-CPAP. Results All 40 infants enrolled completed the study and follow-up through 36 wks post menstrual age or hospital discharge, whichever came first. No infants were on supplemental oxygen at completion of follow-up. No infants developed pneumothoraces or nasal trauma, and no adverse events attributed to the study were observed. Pressure-rate products on the two devices were not different, but effort of breathing, assessed by areas under esophageal pressure-time curves, was lower with Seattle-PAP than with standard Bn-CPAP. Conclusion Use of Seattle-PAP to implement Bn-CPAP lowers the effort of breathing exerted even by relatively healthy spontaneously breathing premature neonates. Whether the lower effort of breathing observed with Seattle-PAP translates to improvements in neonatal mortality or morbidity will need to be determined by studies in appropriate patient populations. PMID:29590143

[Advanced Composites Technology Initiatives

NASA Technical Reports Server (NTRS)

Julian, Mark R.

2002-01-01

This final report closes out the W02 NASA Grant #NCC5-646. The FY02 grant for advanced technology initiatives through the Advanced Composites Technology Institute in Bridgeport, WV, at the Robert C. Byrd Institute (RCBI) Bridgeport Manufacturing Technology Center, is complete; all funding has been expended. RCBI continued to expand access to technology; develop and implement a workforce-training curriculum; improve material development; and provide prototyping and demonstrations of new and advanced composites technologies for West Virginia composites firms. The FY 02 efforts supported workforce development, technical training and the HST development effort of a super-lightweight composite carrier prototype and expanded the existing technical capabilities of the growing aerospace industry across West Virginia to provide additional support for NASA missions. Additionally, the Composites Technology and Training Center was awarded IS0 9001 - 2000 certification and Cleanroom Class 1000 certification during this report period.

Continuation of surge life of transient voltage suppressor

NASA Technical Reports Server (NTRS)

Clark, O. M.

1977-01-01

Efforts expended in testing, analyzing and the development of a meaningful definition of the mean number of peak pulses before failure (mp2bf) levels of a family of transient voltage suppressor devices were documented. Tests were done to determine the ability of the transient suppressor to effectively and reliably protect against severe short term, millisecond range, and transient voltages of the types resulting from inductive load switching and induced lightning. Existing pulse testing instrumentation was utilized, interfaced to an automatic sequencing test rack accommodating up to 50 devices. Tests were performed in step stress increments of 25% beginning at 25% and extending thru 100% rated I(pp) for each voltage category. The four voltage types test were the 6.8V, 33V, 91V, and 190V. Engineering efforts addressed the problem of improving the reliability of the 190V types.

Distracted driving: prevalence, problems, and prevention.

PubMed

Overton, Tiffany L; Rives, Terry E; Hecht, Carrie; Shafi, Shahid; Gandhi, Rajesh R

2015-01-01

While the number of motor vehicle crashes has declined over the years, crashes resulting from distracted driving are increasing in the United States resulting in significant morbidity and mortality. The national public seems to be aware of the dangers associated with using technology while driving, but continues to engage in this dangerous behaviour, and may be unaware of or underestimate the impact of cell phone use on their own driving performance. Problems associated with distracted driving are not limited to novice or teenage drivers; multifaceted universal prevention efforts aimed at impacting large segments of the population may have the greatest impact. Legislation limiting drivers' cell phone use has had little impact, possibly due to low regulation and enforcement. Behaviour change programmes, improved vehicle safety, and public awareness campaigns have been developed as potential preventive efforts to reduce accidents caused by distracted drivers.

Recent Advances in 3D Time-Resolved Contrast-Enhanced MR Angiography

PubMed Central

Riederer, Stephen J.; Haider, Clifton R.; Borisch, Eric A.; Weavers, Paul T.; Young, Phillip M.

2015-01-01

Contrast-enhanced MR angiography (CE-MRA) was first introduced for clinical studies approximately 20 years ago. Early work provided 3 to 4 mm spatial resolution with acquisition times in the 30 sec range. Since that time there has been continuing effort to provide improved spatial resolution with reduced acquisition time, allowing high resolution three-dimensional (3D) time-resolved studies. The purpose of this work is to describe how this has been accomplished. Specific technical enablers have been: improved gradients allowing reduced repetition times, improved k-space sampling and reconstruction methods, parallel acquisition particularly in two directions, and improved and higher count receiver coil arrays. These have collectively made high resolution time-resolved studies readily available for many anatomic regions. Depending on the application, approximate 1 mm isotropic resolution is now possible with frame times of several seconds. Clinical applications of time-resolved CE-MRA are briefly reviewed. PMID:26032598

PRECISE:PRivacy-prEserving Cloud-assisted quality Improvement Service in hEalthcare

PubMed Central

Chen, Feng; Wang, Shuang; Mohammed, Noman; Cheng, Samuel; Jiang, Xiaoqian

2015-01-01

Quality improvement (QI) requires systematic and continuous efforts to enhance healthcare services. A healthcare provider might wish to compare local statistics with those from other institutions in order to identify problems and develop intervention to improve the quality of care. However, the sharing of institution information may be deterred by institutional privacy as publicizing such statistics could lead to embarrassment and even financial damage. In this article, we propose a PRivacy-prEserving Cloud-assisted quality Improvement Service in hEalthcare (PRECISE), which aims at enabling cross-institution comparison of healthcare statistics while protecting privacy. The proposed framework relies on a set of state-of-the-art cryptographic protocols including homomorphic encryption and Yao’s garbled circuit schemes. By securely pooling data from different institutions, PRECISE can rank the encrypted statistics to facilitate QI among participating institutes. We conducted experiments using MIMIC II database and demonstrated the feasibility of the proposed PRECISE framework. PMID:26146645

Perceived Benefits, Barriers, and Drivers of Telemedicine From the Perspective of Skilled Nursing Facility Administrative Staff Stakeholders.

PubMed

Driessen, Julia; Castle, Nicholas G; Handler, Steven M

2018-01-01

Potentially avoidable hospitalizations (PAHs) of skilled nursing facility (SNF) patients are common and costly. Telemedicine represents a unique approach to manage and potentially reduce PAHs in SNFs, having been used in a variety of settings to improve coordination of care and enhance access to providers. Nonetheless, broad implementation and use of telemedicine lags in SNFs relative to other health care settings. To understand why, we surveyed SNF administrative staff attending a 1-day telemedicine summit. Participants saw the highest value of telemedicine in improving the quality of care and reducing readmissions. They identified hospital and managed care telemedicine requirements as primary drivers of adoption. The most significant barrier to adoption was the initial investment required. A joint research-policy effort to improve the evidence base around telemedicine in SNFs and introduce incentives may improve adoption and continued use of telemedicine in this setting.

Warfarin therapy: in need of improvement after all these years

PubMed Central

Kimmel, Stephen E

2010-01-01

Background Warfarin therapy has been used clinically for over 60 years, yet continues to be problematic because of its narrow therapeutic index and large inter-individual variability in patient response. As a result, warfarin is a leading cause of serious medication-related adverse events, and its efficacy is also suboptimal. Objective To review factors that are responsible for variable response to warfarin, including clinical, environmental, and genetic factors, and to explore some possible approaches to improving warfarin therapy. Results Recent efforts have focused on developing dosing algorithms that included genetic information to try to improve warfarin dosing. These dosing algorithms hold promise, but have not been fully validated or tested in rigorous clinical trials. Perhaps equally importantly, adherence to warfarin is a major problem that should be addressed with innovative and cost-effective interventions. Conclusion Additional research is needed to further test whether interventions can be used to improve warfarin dosing and outcomes. PMID:18345947

PRECISE:PRivacy-prEserving Cloud-assisted quality Improvement Service in hEalthcare.

PubMed

Chen, Feng; Wang, Shuang; Mohammed, Noman; Cheng, Samuel; Jiang, Xiaoqian

2014-10-01

Quality improvement (QI) requires systematic and continuous efforts to enhance healthcare services. A healthcare provider might wish to compare local statistics with those from other institutions in order to identify problems and develop intervention to improve the quality of care. However, the sharing of institution information may be deterred by institutional privacy as publicizing such statistics could lead to embarrassment and even financial damage. In this article, we propose a PRivacy-prEserving Cloud-assisted quality Improvement Service in hEalthcare (PRECISE), which aims at enabling cross-institution comparison of healthcare statistics while protecting privacy. The proposed framework relies on a set of state-of-the-art cryptographic protocols including homomorphic encryption and Yao's garbled circuit schemes. By securely pooling data from different institutions, PRECISE can rank the encrypted statistics to facilitate QI among participating institutes. We conducted experiments using MIMIC II database and demonstrated the feasibility of the proposed PRECISE framework.

Advances in the use of odour as forensic evidence through optimizing and standardizing instruments and canines

PubMed Central

Furton, Kenneth G.; Caraballo, Norma Iris; Cerreta, Michelle M.; Holness, Howard K.

2015-01-01

This paper explores the advances made in identifying trace amounts of volatile organic compounds (VOCs) that originate from forensic specimens, such as drugs, explosives, live human scent and the scent of death, as well as the probative value for detecting such odours. The ability to locate and identify the VOCs liberated from or left by forensic substances is of increasing importance to criminal investigations as it can indicate the presence of contraband and/or associate an individual to a particular location or object. Although instruments have improved significantly in recent decades—with sensitivities now rivalling that of biological detectors—it is widely recognized that canines are generally still more superior for the detection of odourants due to their speed, versatility, ruggedness and discriminating power. Through advancements in the detection of VOCs, as well as increased standardization efforts for instruments and canines, the reliability of odour as evidence has continuously improved and is likely to continue to do so. Moreover, several legal cases in which this novel form of evidence has been accepted into US courts of law are discussed. As the development and implementation of best practice guidelines for canines and instruments increase, their reliability in detecting VOCs of interest should continue to improve, expanding the use of odour as an acceptable form of forensic evidence. PMID:26101287

Review article: safety aspects of anesthesia in under-resourced locations.

PubMed

Enright, Angela

2013-02-01

Improving patient safety during anesthesia and surgery is the focus of much effort worldwide. Major advances have occurred since the 1980s, especially in economically advantaged areas. This paper is a review of some of the challenges that face those who work in resource-poor areas of the world. There is a shortage of trained anesthesia providers, both physician and non-physician, and this is particularly acute outside urban areas. Anesthesia is still sometimes delivered by unqualified people, which results in expected high rates of morbidity and mortality. Residency training programs in low-income countries ought to increase their output as anesthesiologists must be available to supervise non-physician providers. All groups require continuing medical education. In addition, increased efforts are needed to recruit trainees into the specialty of anesthesia and to retain them locally. There is a well-recognized shortage of resources for anesthesia. Consequently, concerted efforts are necessary to ensure reliable supplies of drugs, and attention should be paid to the procurement of anesthesia equipment appropriate for the location. Biomedical support must also be developed. Lifebox is a charitable foundation dedicated to supplying pulse oximeters to low- and middle-income countries. Adoption of the World Health Organization's Surgical Safety Checklist could further reduce morbidity and mortality. Much time, effort, planning, and resources are required to ensure that anesthesia in low-income areas can reach internationally accepted standards. Such investment in anesthesia would result in wider access to surgical and obstetrical care, and the quality and safety of that care would be much improved.

The CPS Plasma Award at the Intel Science and Engineering Fair

NASA Astrophysics Data System (ADS)

Berry, Lee

2012-10-01

For the past eight years, the Coalition for Plasma Science (CPS) has presented an award for a plasma project at the Intel International Science and Engineering Fair (ISEF). We reported on the first five years of this award at the 2009 DPP Symposium. Pulsed neutron-producing experiments are a recurring topic, with the efforts now turning to applications. The most recent award at the Pittsburgh ISEF this past May was given for analysis of data from Brookhaven's Relativistic Heavy Ion Collider. The effort had the goal of understanding the fluid properties of the quark-gluon plasma. All of the CPS award-winning projects so far have been based on experiments, with four awards going to women students and four to men. In 2009 we noted that the number and quality of projects was improving. Since then, as we we predicted (hoped for), that trend has continued. The CPS looks forward to continuing its work with students who are excited about the possibilities of plasma. You too can share this excitement by judging at the 2013 fair in Phoenix on May 12-17. Information may be obtained by emailing cps@plasmacoalition.org.

Manufacturing of Wearable Sensors for Human Health and Performance Monitoring

NASA Astrophysics Data System (ADS)

Alizadeh, Azar

2015-03-01

Continuous monitoring of physiological and biological parameters is expected to improve performance and medical outcomes by assessing overall health status and alerting for life-saving interventions. Continuous monitoring of these parameters requires wearable devices with an appropriate form factor (lightweight, comfortable, low energy consuming and even single-use) to avoid disrupting daily activities thus ensuring operation relevance and user acceptance. Many previous efforts to implement remote and wearable sensors have suffered from high cost and poor performance, as well as low clinical and end-use acceptance. New manufacturing and system level design approaches are needed to make the performance and clinical benefits of these sensors possible while satisfying challenging economic, regulatory, clinical, and user-acceptance criteria. In this talk we will review several recent design and manufacturing efforts aimed at designing and building prototype wearable sensors. We will discuss unique opportunities and challenges provided by additive manufacturing, including 3D printing, to drive innovation through new designs, faster prototyping and manufacturing, distributed networks, and new ecosystems. We will also show alternative hybrid self-assembly based integration techniques for low cost large scale manufacturing of single use wearable devices. Coauthors: Prabhjot Singh and Jeffrey Ashe.

Health services and policy research in hepatology.

PubMed

Talwalkar, Jayant A

2014-05-01

This article examines recent health services and policy research studies in hepatology and liver transplantation. Critical issues include access to medical care, timeliness of referral and consultation, resource utilization in clinical practice, comparative effectiveness research, and the evaluation of care delivery models. Despite policymaking efforts, there continues to be unwarranted variation in access to subspecialty care and liver transplantation services based on race and geographic location. Variations in primary care and specialist awareness of practice guidelines for liver disease contribute to disparities in appropriateness and timeliness of treatments. Defining the cost-effectiveness of increased resource utilization for novel antiviral therapies and liver transplantation continues to stimulate controversy. Few comparative effectiveness studies in hepatology exist to date, yet a growing number of analyses using national datasets will help inform policy in this arena. Identifying care delivery models that demonstrate high value for populations with chronic liver disease is critical in the context of recent healthcare reform efforts. Health services and policy research is a growing field of investigation in hepatology and liver transplantation. Further emphasis on research training and workforce development in this area will be critical for understanding and improving patient-centered outcomes for this population.

USING DIVERSE EXPERTISE TO ADVANCE CLIMATE CHANGE FISHERIES SCIENCE.

PubMed

Mulvaney, Kate K; Druschke, Caroline Gottschalk

2017-11-15

As climate change continues to impact New England's coastal ecosystems and their related fisheries, the need for measuring, projecting, interpreting, and applying those impacts for adaptive management is expanding. In New England, different types of formal and informal research efforts that involve collaboration between the fishing community and traditional university and government researchers continue to develop to address some of this need. To better understand the opportunities and challenges that these collaborative research efforts face, we conducted semi-structured interviews with 18 members of the fishing and research communities who are engaged in advancing New England climate change and fisheries science. Participants showed clear concern for the impacts of climate change on New England fisheries and about the insufficient availability of the necessary science to manage for those impacts. They also noted a number of challenges in collaborative research, including poor communication and a lack of trust among fishers, researchers, and decision makers, as well as a lack of perceived credibility for research coming out of the fishing community. We identify a number of opportunities for improving collaboration and communication among these groups, which could build upon the identified value of existing collaborations.

Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System.

PubMed

Dulin, Michael F; Lovin, Carol A; Wright, Jean A

2016-01-01

The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the healthcare system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest healthcare systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA2) group in 2012. DA2 has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System.

PubMed

Dulin, Michael F; Lovin, Carol A; Wright, Jean A

2017-01-01

The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the health-care system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest health-care systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA) group in 2012. DA has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

Conservation Action Planning: Lessons learned from the St. Marys River watershed biodiversity conservation planning process

USGS Publications Warehouse

Patterson, Tamatha A.; Grundel, Ralph

2014-01-01

Conservation Action Planning (CAP) is an adaptive management planning process refined by The Nature Conservancy (TNC) and embraced worldwide as the Open Standards for the Practice of Conservation. The CAP process facilitates open, multi-institutional collaboration on a common conservation agenda through organized actions and quantified results. While specifically designed for conservation efforts, the framework is adaptable and flexible to multiple scales and can be used for any collaborative planning effort. The CAP framework addresses inception; design and development of goals, measures, and strategies; and plan implementation and evaluation. The specific components of the CAP include defining the project scope and conservation targets; assessing the ecological viability; ascertaining threats and surrounding situation; identifying opportunities and designing strategies for action; and implementing actions and monitoring results. In 2007, TNC and a multidisciplinary graduate student team from the University of Michigan's School of Natural Resources and Environment initiated a CAP for the St. Marys River, the connecting channel between Lake Superior and Lake Huron, and its local watershed. The students not only gained experience in conservation planning, but also learned lessons that notably benefited the CAP process and were valuable for any successful collaborative effort—a dedicated core team improved product quality, accelerated the timeline, and provided necessary support for ongoing efforts; an academic approach in preparation for engagement in the planning process brought applicable scientific research to the forefront, enhanced workshop facilitation, and improved stakeholder participation; and early and continuous interactions with regional stakeholders improved cooperation and built a supportive network for collaboration.

Using Claims Data to Generate Clinical Flags Predicting Short-term Risk of Continued Psychiatric Hospitalizations

PubMed Central

Stein, Bradley D.; Pangilinan, Maria; Sorbero, Mark J; Marcus, Sue; Donahue, Sheila; Xu, Yan; Smith, Thomas E; Essock, Susan M

2014-01-01

Objective As health information technology advances, efforts to use administrative data to inform real-time treatment planning for individuals are increasing, despite few empirical studies demonstrating that such administrative data predict subsequent clinical events. Medicaid claims for individuals with frequent psychiatric hospitalizations were examined to test how well patterns of service use predict subsequent high short-term risk of continued psychiatric hospitalizations. Methods Medicaid claims files from New York and Pennsylvania were used to identify Medicaid recipients aged 18-64 with two or more inpatient psychiatric admissions during a target year ending March 31, 2009. Definitions from a quality-improvement initiative were used to identify patterns of inpatient and outpatient service use and prescription fills suggestive of clinical concerns. Generalized estimating equations and Markov models were applied to examine claims through March, 2011, to see what patterns of service use were sufficiently predictive of additional hospitalizations to be clinically useful. Results 11,801 unique individuals in New York and 1,859 in Pennsylvania identified met the cohort definition. In both Pennsylvania and New York, multiple recent hospitalizations, but not failure to use outpatient services or failure to fill medication prescriptions, were significant predictors of high risk of continued frequent hospitalizations, with odds ratios greater than 4.0. Conclusions Administrative data can be used to identify individuals at high risk of continued frequent hospitalizations. Such information could be used by payers and system administrators to authorize special services (e.g., mobile outreach) for such individuals as part of efforts to promote service engagement and prevent rapid rehospitalizations. PMID:25022360

Wartime women giving birth: narratives of pregnancy and childbirth, Britain c. 1939-1960.

PubMed

Davis, Angela

2014-09-01

Women in Second World War Britain benefitted from measures to improve maternal and child health. Infant and maternal mortality rates continued to fall, new drugs became available, and efforts were made to improve the health of mothers and babies through the provision of subsidised milk and other foodstuffs. However, in return, women were also expected to contribute to the war effort through motherhood, and this reflected wider cultural ideas in the North Atlantic world in the first half of the twentieth century which equated maternity with military service. The aim of this article is to examine the interplay between narratives of birth and narratives of war in the accounts of maternity from women of the wartime generation. It will explore how the military-maternity analogy sheds light on women's experiences of pregnancy and childbirth in Britain during the Second World War, whilst also considering maternity within women's wider role as 'domestic soldiers', contributing to the war effort through their traditional work as housewives and mothers. In doing so, the article reveals the complexity of women's narratives. It demonstrates that they do not simply conform to the 'medical vs. social' binary, but reflect the wider cultural context in which women gave birth. Women incorporated the dominant discourses of the period, namely those around war, into their accounts. Copyright © 2012 Elsevier Ltd. All rights reserved.

Wartime women giving birth: Narratives of pregnancy and childbirth, Britain c. 1939–1960

PubMed Central

Davis, Angela

2014-01-01

Women in Second World War Britain benefitted from measures to improve maternal and child health. Infant and maternal mortality rates continued to fall, new drugs became available, and efforts were made to improve the health of mothers and babies through the provision of subsidised milk and other foodstuffs. However, in return, women were also expected to contribute to the war effort through motherhood, and this reflected wider cultural ideas in the North Atlantic world in the first half of the twentieth century which equated maternity with military service. The aim of this article is to examine the interplay between narratives of birth and narratives of war in the accounts of maternity from women of the wartime generation. It will explore how the military-maternity analogy sheds light on women’s experiences of pregnancy and childbirth in Britain during the Second World War, whilst also considering maternity within women’s wider role as ‘domestic soldiers’, contributing to the war effort through their traditional work as housewives and mothers. In doing so, the article reveals the complexity of women’s narratives. It demonstrates that they do not simply conform to the ‘medical vs. social’ binary, but reflect the wider cultural context in which women gave birth. Women incorporated the dominant discourses of the period, namely those around war, into their accounts. PMID:24361165

Technology Applications Team: Applications of aerospace technology

NASA Technical Reports Server (NTRS)

1993-01-01

Highlights of the Research Triangle Institute (RTI) Applications Team activities over the past quarter are presented in Section 1.0. The Team's progress in fulfilling the requirements of the contract is summarized in Section 2.0. In addition to our market-driven approach to applications project development, RTI has placed increased effort on activities to commercialize technologies developed at NASA Centers. These Technology Commercialization efforts are summarized in Section 3.0. New problem statements prepared by the Team in the reporting period are presented in Section 4.0. The Team's transfer activities for ongoing projects with the NASA Centers are presented in Section 5.0. Section 6.0 summarizes the status of four add-on tasks. Travel for the reporting period is described in Section 7.0. The RTI Team staff and consultants and their project responsibilities are listed in Appendix A. The authors gratefully acknowledge the contributions of many individuals to the RTI Technology Applications Team program. The time and effort contributed by managers, engineers, and scientists throughout NASA were essential to program success. Most important to the program has been a productive working relationship with the NASA Field Center Technology Utilization (TU) Offices. The RTI Team continues to strive for improved effectiveness as a resource to these offices. Industry managers, technical staff, medical researchers, and clinicians have been cooperative and open in their participation. The RTI Team looks forward to continuing expansion of its interaction with U.S. industry to facilitate the transfer of aerospace technology to the private sector.

Relationship-centered health care as a Lean intervention.

PubMed

Dunsford, Jennifer; Reimer, Laura E

2017-12-01

Continuous improvement efforts, recognized in much literature as Lean management techniques have been used in efforts to improve efficiency in democratic health care contexts for some time to varying degrees of success. The complexity of the health care system is magnified by the sheer number of processes and sub processes required to deliver value within a bureaucratic environment, while maintaining some level of compassionate and personalized care. There is inherent tension between what is required to be efficient and what is required to be caring and this conflict presses against Lean practice at the level of delivery.Administration and care intersect at the point of the patient's experience. In order to achieve the dual goals of improved value and lower costs, the application of Lean thinking for meaningful health care reform must acknowledge the fundamental dichotomy between the impersonal tasks required to provide health services, and human interactions. Meaningful health care reform requires an acknowledgement of this distinction, currently not recognized in literature. While administrative process improvements are necessary, they are insufficient to achieve a sustainable and caring health care system. Lean thinking must be applied differently for administrative processes and patient care encounters, because these are fundamentally different processes. In this way, Lean principles will effectively contribute to sustainable health system improvements. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Heroic Reliability Improvement in Manned Space Systems

NASA Technical Reports Server (NTRS)

Jones, Harry W.

2017-01-01

System reliability can be significantly improved by a strong continued effort to identify and remove all the causes of actual failures. Newly designed systems often have unexpected high failure rates which can be reduced by successive design improvements until the final operational system has an acceptable failure rate. There are many causes of failures and many ways to remove them. New systems may have poor specifications, design errors, or mistaken operations concepts. Correcting unexpected problems as they occur can produce large early gains in reliability. Improved technology in materials, components, and design approaches can increase reliability. The reliability growth is achieved by repeatedly operating the system until it fails, identifying the failure cause, and fixing the problem. The failure rate reduction that can be obtained depends on the number and the failure rates of the correctable failures. Under the strong assumption that the failure causes can be removed, the decline in overall failure rate can be predicted. If a failure occurs at the rate of lambda per unit time, the expected time before the failure occurs and can be corrected is 1/lambda, the Mean Time Before Failure (MTBF). Finding and fixing a less frequent failure with the rate of lambda/2 per unit time requires twice as long, time of 1/(2 lambda). Cutting the failure rate in half requires doubling the test and redesign time and finding and eliminating the failure causes.Reducing the failure rate significantly requires a heroic reliability improvement effort.

Increasing science literacy among the educated elite

NASA Astrophysics Data System (ADS)

Bender, Carl M.

1997-03-01

The Physics Department at Washington University is making a serious and continuing effort to raise the level of understanding of science for bright students who do not intend to take further courses in science or mathematics. We have established a course called Physics and Society, which considers such issues as availability of energy, nuclear power, nuclear weapons, the greenhouse effect, the ozone hole, risk analysis, the scientific method, and claims of the paranormal. By examining such topics quantitatively, we hope to improve the students' ability to grasp and assess critically the problems that society faces.

Wind and Solar Data Projections from the U.S. Energy Information Administration: Past Performance and Planned Enhancements

EIA Publications

2016-01-01

In an effort to improve EIA's approach to providing accurate, comprehensive data, and useful projections for policy analysis, EIA has conducted a review of its historical data and projections of capacity, generation, and cost projections for wind and solar technologies. While EIA's internal processes and engagement with stakeholders are both continuing, this paper shares some early findings of EIA's current review of our wind and solar data and projections, focusing in part on some of the issues that have been publicly raised by EIA's critics.

Dr. Kenneth Plotkins Myriad Contribution to the National Aeronautics and Space Administrations Supersonic Mission

NASA Technical Reports Server (NTRS)

Haering, Edward A.

2017-01-01

The world as a whole and NASA in particular, owes a large debt of gratitude to Dr. Kenneth Plotkin for his decades of service in the field of sonic boom research and advancement of quiet supersonic transportation. This presentation will highlight the contributions of Dr. Plotkin to a myriad of NASA projects. One of the largest efforts was the assembly and continual improvement of sonic boom propagation software tools, collectively called PCBoom, which allowed the analysis of real and imagined vehicles from Mach cutoff conditions to the hypersonic.

Early steps in protein synthesis and their regulation: a background study related to the biological effects of radiation. Progress report, July 1, 1975--June 30, 1976

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

Zamecnik, P.C.

This is a continuing study of protein synthesis, involving a search for the role of Ap/sub 4/A and other unusual nucleotides in growth regulation; studies of the mechanism of action of aminoacyl-tRNA ligases and the effect thereof on protein synthesis; a search for new regulators of the translation step, in cell-free systems; and an effort to improve the sensitivity and quantitation of chemical sequencing at the 3'-end of messenger RNA.

CRISPR genetic screens to discover host-virus interactions.

PubMed

McDougall, William M; Perreira, Jill M; Reynolds, Erin C; Brass, Abraham L

2018-04-01

Viruses impose an immense burden on human health. With the goal of treating and preventing viral infections, researchers have carried out genetic screens to improve our understanding of viral dependencies and identify potential anti-viral strategies. The emergence of CRISPR genetic screening tools has facilitated this effort by enabling host-virus screens to be undertaken in a more versatile and fidelitous manner than previously possible. Here we review the growing number of CRISPR screens which continue to increase our understanding of host-virus interactions. Copyright © 2018 Elsevier B.V. All rights reserved.

"What Controls the Structure and Stability of the Ocean Meridional Overturning Circulation: Implications for Abrupt Climate Change?"

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

Fedorov, Alexey

2013-11-23

The central goal of this research project is to understand the properties of the ocean meridional overturning circulation (MOC) – a topic critical for understanding climate variability and stability on a variety of timescales (from decadal to centennial and longer). Specifically, we have explored various factors that control the MOC stability and decadal variability in the Atlantic and the ocean thermal structure in general, including the possibility abrupt climate change. We have also continued efforts on improving the performance of coupled ocean-atmosphere GCMs.

Improving Platinum Efficiency:. Nanoformulations

NASA Astrophysics Data System (ADS)

Carmona, Rolando; Liang, Xing-Jie

2013-09-01

Platinum-based drugs continue being the support of therapy for many different kinds of cancer. Cancer patients often present irreversible resistance to platinum after repeated treatment in clinic. Despite of the great efforts, chemoresistance (intrinsic or acquired) already is a major limitation in the management of this disease. In this review, the last current research on cancer characteristic and cancer chemical resistance is summarized, the major and novel strategies to reverse resistance to platinum- based drugs are discussed and this article mainly emphasizes the contribution of nanotechnology and combination therapies to target sites and reduce the cancer chemoresistance.

Leprosy: ancient disease remains a public health problem nowadays.

PubMed

Noriega, Leandro Fonseca; Chiacchio, Nilton Di; Noriega, Angélica Fonseca; Pereira, Gilmayara Alves Abreu Maciel; Vieira, Marina Lino

2016-01-01

Despite being an ancient disease, leprosy remains a public health problem in several countries -particularly in India, Brazil and Indonesia. The current operational guidelines emphasize the evaluation of disability from the time of diagnosis and stipulate as fundamental principles for disease control: early detection and proper treatment. Continued efforts are needed to establish and improve quality leprosy services. A qualified primary care network that is integrated into specialized service and the development of educational activities are part of the arsenal in the fight against the disease, considered neglected and stigmatizing.

Electron tubes for industrial applications

NASA Astrophysics Data System (ADS)

Gellert, Bernd

1994-05-01

This report reviews research and development efforts within the last years for vacuum electron tubes, in particular power grid tubes for industrial applications. Physical and chemical effects are discussed that determine the performance of todays devices. Due to the progress made in the fundamental understanding of materials and newly developed processes the reliability and reproducibility of power grid tubes could be improved considerably. Modern computer controlled manufacturing methods ensure a high reproducibility of production and continuous quality certification according to ISO 9001 guarantees future high quality standards. Some typical applications of these tubes are given as an example.

DoD Cybersecurity Weakness as Reported in Audit Reports Issued From August 1, 2014, Through July 31, 2015 (REDACTED)

DTIC Science & Technology

2015-09-25

Protocol Version 6 ( IPv6 ). The Federal and DoD requirements were not completed because the DoD Chief Information Officer (CIO) and U.S. Cyber Command...had not made IPv6 a priority. Further, the DoD CIO did not have a current plan of action and milestones to advance DoD IPv6 migration efforts...According to the report, the continued use of IPv4 will delay the potential benefits of IPv6 , such as improved communication, warfighter mobility

Patient-Centered Specialty Practice: Defining the Role of Specialists in Value-Based Health Care.

PubMed

Ward, Lawrence; Powell, Rhea E; Scharf, Michael L; Chapman, Andrew; Kavuru, Mani

2017-04-01

Health care is at a crossroads and under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. However, primary care accounts for only a small portion of total health-care spending, and there is a need for policies and frameworks to support high-quality, cost-efficient care in specialty practices of the medical neighborhood. The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance. The key elements of the PCSP model include processes to support timely access to referral requests, improved communication and coordination with patients and referring clinicians, reduced unnecessary and duplicative testing, and an emphasis on continuous measurement of quality, safety, and performance improvement for a population of patients. Evidence to support the model remains limited, and estimates of net costs and value to practices are not fully understood. The PCSP model holds promise for promoting value-based health care in specialty practices. The continued development of appropriate incentives is required to ensure widespread adoption. Copyright © 2017. Published by Elsevier Inc.