Evaluation of a Pain Management Education Program and Operational Guideline on Nursing Practice, Attitudes, and Pain Management.

PubMed

Bonkowski, Sara L; De Gagne, Jennie C; Cade, Makia B; Bulla, Sally A

2018-04-01

Nurses lack adequate pain management knowledge, which can result in poorly managed postsurgical pain. This study aimed to develop, implement, and evaluate pain management education and operational guidelines to improve nursing knowledge and pain management. This quality improvement project employed convenience samples of surgical oncology nurses and postoperative patients. The intervention involved an online module, live education, and operational guideline for pain management. Nurses completed pre- and postintervention practice and attitudes surveys. Random chart reviews of intravenous narcotic administrations the day before discharge were completed to evaluate whether narcotic administration changed after intervention. Readmissions and Hospital Consumer Assessment of Healthcare Providers and Systems data were collected to determine whether the intervention influenced patient satisfaction. A statistically significant improvement in nursing practice and intravenous narcotic administrations demonstrated changes to pain management practices employed by the nursing staff. Although not statistically significant, fewer pain-related readmissions occurred postintervention. Findings demonstrate that targeted pain management continuing education, paired with operational guidelines, improves nursing practice and decreases intravenous narcotic administrations prior to discharge. J Contin Educ Nurs. 2018;49(4):178-185. Copyright 2018, SLACK Incorporated.

Identifying configurations of behavior change techniques in effective medication adherence interventions: a qualitative comparative analysis.

PubMed

Kahwati, Leila; Viswanathan, Meera; Golin, Carol E; Kane, Heather; Lewis, Megan; Jacobs, Sara

2016-05-04

Interventions to improve medication adherence are diverse and complex. Consequently, synthesizing this evidence is challenging. We aimed to extend the results from an existing systematic review of interventions to improve medication adherence by using qualitative comparative analysis (QCA) to identify necessary or sufficient configurations of behavior change techniques among effective interventions. We used data from 60 studies in a completed systematic review to examine the combinations of nine behavior change techniques (increasing knowledge, increasing awareness, changing attitude, increasing self-efficacy, increasing intention formation, increasing action control, facilitation, increasing maintenance support, and motivational interviewing) among studies demonstrating improvements in adherence. Among the 60 studies, 34 demonstrated improved medication adherence. Among effective studies, increasing patient knowledge was a necessary but not sufficient technique. We identified seven configurations of behavior change techniques sufficient for improving adherence, which together accounted for 26 (76 %) of the effective studies. The intervention configuration that included increasing knowledge and self-efficacy was the most empirically relevant, accounting for 17 studies (50 %) and uniquely accounting for 15 (44 %). This analysis extends the completed review findings by identifying multiple combinations of behavior change techniques that improve adherence. Our findings offer direction for policy makers, practitioners, and future comparative effectiveness research on improving adherence.

Health Literacy in Orthopaedic Trauma Patients.

PubMed

Cosic, Filip; Kimmel, Lara; Edwards, Elton

2017-03-01

This study aimed to determine the level of health literacy in a postoperative orthopaedic trauma population and to evaluate the efficacy of a simple predischarge discussion strategy, targeted at improving health literacy. A pre-post intervention study was conducted from April 2014 to January 2015. Academic Level 1 trauma center. One hundred ninety consecutive orthopaedic trauma patients with operatively managed lower limb fractures were recruited. All eligible participants agreed to participate. The first ninety-nine patients received usual care (UC). The following 91 patients received a structured predischarge discussion, including x-rays, written and verbal information, from the orthopaedic staff (DG). Patients were then randomized into health literacy evaluation before first outpatient review or after first outpatient review. The primary outcome measure was a questionnaire determining health literacy. Ninety-six (97%) of the UC patients and 87 (96%) of the discussion patients (DG) completed the interview. UC preoutpatient (n = 46) demonstrated a mean score of 4.67 of a maximum 8. UC postoutpatient (n = 50) demonstrated a mean score of 5.42. DG preoutpatient (n = 47) demonstrated a mean score of 6.70. DG postoutpatient (n = 40) demonstrated a mean score of 7.08. Australian orthopaedic trauma patients demonstrate poor health literacy, with this not showing improvement after their first outpatient follow-up visit. The use of a time efficient, structured predischarge discussion improved patient health literacy. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The CF6 jet engine performance improvement: New front mount

NASA Technical Reports Server (NTRS)

Fasching, W. A.

1979-01-01

The New Front Mount was evaluated in component tests including stress, deflection/distortion and fatigue tests. The test results demonstrated a performance improvement of 0.1% in cruise sfc, 16% in compressor stall margin and 10% in compressor stator angle margin. The New Front Mount hardware successfully completed 35,000 simulated flight cycles endurance testing.

A Virtual Patient Software Program to Improve Pharmacy Student Learning in a Comprehensive Disease Management Course

PubMed Central

Casale, Jillian P.; Skirvin, J. Andrew; DiVall, Margarita V.

2013-01-01

Objective. To implement and assess the impact of a virtual patient pilot program on pharmacy students’ clinical competence skills. Design. Pharmacy students completed interactive software-based patient case scenarios embedded with drug-therapy problems as part of a course requirement at the end of their third year. Assessment. Assessments included drug-therapy problem competency achievement, performance on a pretest and posttest, and pilot evaluation survey instrument. Significant improvements in students’ posttest scores demonstrated advancement of clinical skills involving drug-therapy problem solving. Students agreed that completing the pilot program improved their chronic disease management skills and the program summarized the course series well. Conclusion. Using virtual patient technology allowed for assessment of student competencies and improved learning outcomes. PMID:24159213

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

Rossi, Tuomas P., E-mail: tuomas.rossi@alumni.aalto.fi; Sakko, Arto; Puska, Martti J.

We present an approach for generating local numerical basis sets of improving accuracy for first-principles nanoplasmonics simulations within time-dependent density functional theory. The method is demonstrated for copper, silver, and gold nanoparticles that are of experimental interest but computationally demanding due to the semi-core d-electrons that affect their plasmonic response. The basis sets are constructed by augmenting numerical atomic orbital basis sets by truncated Gaussian-type orbitals generated by the completeness-optimization scheme, which is applied to the photoabsorption spectra of homoatomic metal atom dimers. We obtain basis sets of improving accuracy up to the complete basis set limit and demonstrate thatmore » the performance of the basis sets transfers to simulations of larger nanoparticles and nanoalloys as well as to calculations with various exchange-correlation functionals. This work promotes the use of the local basis set approach of controllable accuracy in first-principles nanoplasmonics simulations and beyond.« less

Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas.

PubMed

Lee, Cheng-Chia; Chen, Ching-Jen; Chen, Shao-Ching; Yang, Huai-Che; Lin, Chung Jung; Wu, Chih-Chun; Chung, Wen-Yuh; Guo, Wan-Yuo; Hung-Chi Pan, David; Shiau, Cheng-Ying; Wu, Hsiu-Mei

2018-05-01

OBJECTIVE Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS). METHODS Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors' institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm 3 (range 6.2-40.3 cm 3 ). The median prescribed margin dose was 16.5 Gy (range 15-18 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression. RESULTS All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14-186 months). The median latency period from GKS to obliteration was 21 months (range 8-186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration. CONCLUSIONS Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.

FastLane: Agile Drop Notification for Datacenter Networks

DTIC Science & Technology

2013-10-23

interactivity dead- lines mean that networks are increasingly evaluated on high percentile completion times of these short flows. Achieving consistent flow...triggering retransmissions based on out-of-order delivery. We evaluate FastLane in a number of scenarios, us- ing both testbed experiments and simulations...Results from our evaluation demonstrate that FastLane improves the 99.9th percentile completion time of short flows by up to 75% compared to TCP

Increased oil production and reserves from improved completion techniques in the Bluebell field, Uinta Basin. Quarterly technical report, October 1, 1996--December 31, 1996

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

Morgan, C.D.

1997-02-01

The objective of this project is to increase oil production and reserves in the Uinta Basin by demonstrating improved completion techniques. Low productivity of Uinta Basin wells is caused by gross production intervals of several thousand feet that contain perforated thief zones, water-bearing zones, and unperforated oil-bearing intervals. Geologic and engineering characterization and computer simulation of the Green River and Wasatch formations in the Bluebell field will determine reservoir heterogeneities related to fractures and depositional trends. This will be followed by drilling and recompletion of several wells to demonstrate improved completion techniques based on the reservoir characterization. Transfer of themore » project results will be an ongoing component of the project. The recompletion of the Michelle Ute 7-1 well commenced and is the first step in the three-well demonstration. As part of the recompletion, the gross productive interval was logged, additional beds were perforated, and the entire interval was stimulated with a three-stage acid treatment. The operator attempted to stimulate the well at high pressure (about 10,000 pounds per square inch (psi) [68,950 kPa]) at three separate packer locations. But at each location the pressure would not hold. As a result, all three stages were pumped at a lower pressure (6500 psi maximum [44,820 kPa]) from one packer location. As of December 31, 1996, the operator was tripping in the hole with the production packer and tubing to begin swab testing the well.« less

A novel critical skills curriculum for surgical interns incorporating simulation training improves readiness for acute inpatient care.

PubMed

Antonoff, Mara B; Shelstad, Ryan C; Schmitz, Connie; Chipman, Jeffrey; D'Cunha, Jonathan

2009-01-01

Surgical interns encounter complex, acute care situations often managed with limited supervision. Furthermore, medical school training does not adequately prepare students for special surgical considerations. Using simulation training, we implemented a course aimed at improving surgical intern readiness for responding to unique, life-threatening issues encountered in daily surgical care. Twenty University of Minnesota surgical interns participated in the 3-week course. The first session consisted of interactive didactics and simulation covering hypoxia, shock, and metabolic disturbances; the second session addressed cardiopulmonary emergencies, including ventricular assist device and pacemaker use. Electronic simulation scenarios comprised the third session, allowing learners to demonstrate learned/practiced skills. The outcomes were assessed objectively (pretest and posttest) and subjectively (standardized feedback evaluations). Fifteen learners completed the pretest and posttest. The mean absolute score increase was 14% with average relative score improvement of 43%. Twenty learners completed feedback evaluations using a standard 5-point Likert scale. Respondents scored the first 2 sessions on topic importance (5 = very important), giving the first session 4.90 (+/- 0.31) and the second session 4.45 (+/- 0.89). Respondents ranked their confidence in executing practiced skills on actual patients (5 = very confident) as 4.24 (+/- 0.71). There was uniform support for the value of the electronic simulation scenarios as enhanced learning tools. We developed a course for surgical interns incorporating didactics and simulation. Learners demonstrated objective improvement in testing and reported that the course topics were highly important. After course completion, learners provided feedback indicating a high level of confidence in executing practiced skills, suggesting improved preparation for acute surgical care.

Development and Assessment of a Transoral Robotic Surgery Curriculum to Train Otolaryngology Residents.

PubMed

White, Joseph; Sharma, Arun

2018-05-30

(1) To develop a multifaceted didactic and hands-on curriculum to prepare otolaryngology residents to perform transoral robotic surgery (TORS) and safely transition to the operating room. (2) To assess the effectiveness of the TORS curriculum. Learning objectives were developed and a curriculum was formulated utilizing five unique modalities: focused didactic reading, online training modules, backpack console simulations, videos of TORS cases, and hands-on cadaveric dissections with the robotic surgical system in a simulated operating room. The trainees completed a nine-item self-assessment of their skill level using a Likert scale. Five senior otolaryngology residents completed the TORS curriculum. Before and after the cadaveric dissections, there was improvement in each of the nine items assessed. Composite scores were calculated and there was significant improvement from predissection (15.2 ± 2.2) to postdissection (31.4 ± 1.9) (p = 0.002). The current study demonstrates the feasibility of implementing a multifaceted TORS curriculum which incorporates robotic cadaveric dissection for otolaryngology residents. Residents demonstrate marked improvement in skills with the TORS curriculum. A TORS curriculum which includes robotic cadaveric dissection can improve surgical skills and serve as a key component of residency TORS education. © 2018 S. Karger AG, Basel.

The role of anatomy demonstrators: A surgical trainees' perspective.

PubMed

Smith, C F; Gami, B; Standfield, N; Davies, D C

2018-04-01

Core Surgical Trainees (CST) in the London (UK) Postgraduate School of Surgery receive clinical anatomy teaching in their first year of training, and, in their second year, give 30 sessions of anatomy teaching to medical and other students. This study set out to investigate the role of demonstrators from the perspective of the trainees. A focus group was convened to ascertain trainees' perspectives on demonstrating anatomy and to identify problems and improvement strategies to optimize their ability to enhance students' learning. A questionnaire was formulated and all second-year CST (n = 186-from two cohorts) in the London Postgraduate School of Surgery were invited. A total of 109 out of 186 trainees completed the questionnaire. A high percentage (98%) of trainees that completed the questionnaire responded that demonstrating was an invaluable part of their training. Sixty-two per cent responded that anatomy teaching they received in their first year of core surgical training helped them in their teaching role and 80% responded that it helped them prepare for surgical training. The study also revealed the need for improved communication between trainees and the London Postgraduate School of Surgery/Medical Schools/National Health Service Trusts to address issues such as trainees' perceived difficulty in fulfilling their teaching session requirement. The stakeholders have acknowledged and addressed the outcomes to improve the experience for both surgical trainees and students. The results indicate that anatomy demonstrating delivers important benefits to early surgical trainees, in addition to those received by the students that they teach. Clin. Anat. 31:409-416, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

The effect of within-session instruction on lumbopelvic motion during a lower limb movement in people with and people without low back pain

PubMed Central

Scholtes, Sara A.; Norton, Barbara J.; Lang, Catherine E.; Van Dillen, Linda R.

2010-01-01

The purpose of the current study was to examine how effectively people with and people without low back pain (LBP) modify lumbopelvic motion during a limb movement test. Nineteen subjects with LBP and 20 subjects without LBP participated. Kinematic data were collected while subjects performed active hip lateral rotation (HLR) in prone. Subjects completed trials (1) using their natural method (Natural condition) of performing HLR, and (2) following standardized instructions to modify lumbopelvic motion while performing HLR (Modified condition). Variables of interest included (1) the amount of HLR completed prior to the start of lumbopelvic motion, and (2) the maximum amount of lumbopelvic motion demonstrated during HLR. Compared to the Natural Condition, all subjects improved their performance during the Modified condition by (1) completing a greater amount of HLR prior to the start of lumbopelvic motion, and (2) demonstrating less lumbopelvic motion (P<0.01 for all comparisons). There was a tendency for people without LBP to demonstrate a greater difference in maximal lumbopelvic rotation between the Natural and Modified conditions (P=0.07). In conclusion, people are able to modify lumbopelvic motion following instruction. Further study is needed to determine if people without LBP improve lumbopelvic motion following instruction to a greater extent than people with LBP. PMID:20627798

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

Albrecht H. Mayer

Asea Brown Boveri (ABB) has completed its technology based program. The results developed under Work Breakdown Structure (WBS) 8, concentrated on technology development and demonstration have been partially implemented in newer turbine designs. A significant improvement in heat rate and power output has been demonstrated. ABB will use the knowledge gained to further improve the efficiency of its Advanced Cycle System, which has been developed and introduced into the marked out side ABB's Advanced Turbine System (ATS) activities. The technology will lead to a power plant design that meets the ATS performance goals of over 60% plant efficiency, decreased electricitymore » costs to consumers and lowest emissions.« less

Phosphoric acid electric utility fuel cell technology development

NASA Astrophysics Data System (ADS)

Breault, R. D.; Briggs, T. A.; Congdon, J. V.; Gelting, R. L.; Goller, G. J.; Luoma, W. L.; McCloskey, M. W.; Mientek, A. P.; Obrien, J. J.; Randall, S. A.

1985-07-01

Improved cross pressure tolerance has been demonstrated for electrodes containing impregnated seals. Electrodes, cooler assemblies, separator plates and reactant manifolds for the third 10-ft(2) short stack were completed. Assembly of the third 10-ft(2) short stack was initiated.

Fine tuning GPS clock estimation in the MCS

NASA Technical Reports Server (NTRS)

Hutsell, Steven T.

1995-01-01

With the completion of a 24 operational satellite constellation, GPS is fast approaching the critical milestone, Full Operational Capability (FOC). Although GPS is well capable of providing the timing accuracy and stability figures required by system specifications, the GPS community will continue to strive for further improvements in performance. The GPS Master Control Station (MCS) recently demonstrated that timing improvements are always composite Clock, and hence, Kalman Filter state estimation, providing a small improvement to user accuracy.

Improving ED specimen TAT using Lean Six Sigma.

PubMed

Sanders, Janet H; Karr, Tedd

2015-01-01

Lean and Six Sigma are continuous improvement methodologies that have garnered international fame for improving manufacturing and service processes. Increasingly these methodologies are demonstrating their power to also improve healthcare processes. The purpose of this paper is to discuss a case study for the application of Lean and Six Sigma tools in the reduction of turnaround time (TAT) for Emergency Department (ED) specimens. This application of the scientific methodologies uncovered opportunities to improve the entire ED to lab system for the specimens. This case study provides details on the completion of a Lean Six Sigma project in a 1,000 bed tertiary care teaching hospital. Six Sigma's Define, Measure, Analyze, Improve, and Control methodology is very similar to good medical practice: first, relevant information is obtained and assembled; second, a careful and thorough diagnosis is completed; third, a treatment is proposed and implemented; and fourth, checks are made to determine if the treatment was effective. Lean's primary goal is to do more with less work and waste. The Lean methodology was used to identify and eliminate waste through rapid implementation of change. The initial focus of this project was the reduction of turn-around-times for ED specimens. However, the results led to better processes for both the internal and external customers of this and other processes. The project results included: a 50 percent decrease in vials used for testing, a 50 percent decrease in unused or extra specimens, a 90 percent decrease in ED specimens without orders, a 30 percent decrease in complete blood count analysis (CBCA) Median TAT, a 50 percent decrease in CBCA TAT Variation, a 10 percent decrease in Troponin TAT Variation, a 18.2 percent decrease in URPN TAT Variation, and a 2-5 minute decrease in ED registered nurses rainbow draw time. This case study demonstrated how the quantitative power of Six Sigma and the speed of Lean worked in harmony to improve the blood draw process for a 1,000 bed tertiary care teaching hospital. The blood draw process is a standard process used in hospitals to collect blood chemistry and hematology information for clinicians. The methods used in this case study demonstrated valuable and practical applications of process improvement methodologies that can be used for any hospital process and/or service environment. While this is not the first case study that has demonstrated the use of continuous process improvement methodologies to improve a hospital process, it is unique in the way in which it utilizes the strength of the project focussed approach that adheres more to the structure and rigor of Six Sigma and relied less on the speed of lean. Additionally, the application of these methodologies in healthcare is emerging research.

Emergency in the clinic: a simulation curriculum to improve outpatient safety.

PubMed

Espey, Eve; Baty, Gillian; Rask, John; Chungtuyco, Michelle; Pereda, Brenda; Leeman, Lawrence

2017-12-01

Emergency response skills are essential when events such as seizure, anaphylaxis, or hemorrhage occur in the outpatient setting. As services and procedures increasingly move outside the hospital, training to manage complications may improve outcomes. The objective of this study was to evaluate a simulation-based curriculum in outpatient emergency management skills with the outcome measures of graded objective performance and learner self-efficacy. This pre- and postcurriculum study enrolled residents and fellows in Obstetrics and Gynecology and Family Medicine in a simulation-based, outpatient emergency management curriculum. Learners completed self-efficacy questionnaires and were videotaped managing 3 medical emergency scenarios (seizure, over-sedation/cardiopulmonary arrest, and hemorrhage) in the simulation laboratory both before and after completion of the curriculum. Evaluators who were blinded to training level scored the simulation performance videotapes using a graded rubric with critical action checklists. Scenario scores were assigned in 5 domains and globally. Paired t-tests were used to determine differences pre- and postcurriculum. Thirty residents completed the curriculum and pre- and postcurriculum testing. Subjects' objective performance scores improved in all 5 domains (P<.05) in all scenarios. When scores were stratified by level of training, all participants demonstrated global improvement. When scores were stratified by previous outpatient simulation experience, subjects with previous experience improved in all but management of excess sedation. Pre- and postcurriculum self-efficacy evaluations demonstrated improvement in all 7 measured areas: confidence, use of appropriate resources, communication skills, complex airway management, bag mask ventilation, resuscitation, and hemorrhage management. Self-efficacy assessment showed improvement in confidence managing outpatient emergencies (P=.001) and ability to communicate well in emergency situations (P<.001). A simulation-based curriculum improved both self-efficacy and objectively rated performance scores in management of outpatient medical emergencies. Simulation-based curricula should be incorporated into residency education. Copyright © 2017 Elsevier Inc. All rights reserved.

Water electrolysis system refurbishment and testing

NASA Technical Reports Server (NTRS)

Greenough, B. M.

1972-01-01

The electrolytic oxygen generator for the back-up water electrolysis system in a 90-day manned test was refurbished, improved and subjected to a 182-day bench test. The performance of the system during the test demonstrated the soundness of the basic electrolysis concept, the high development status of the automatic controls which allowed completely hands-off operation, and the capability for orbital operation. Some design improvements are indicated.

Looking to nature for solutions

NASA Astrophysics Data System (ADS)

Turner, Will R.

2018-01-01

Completely stopping fossil fuel use may not be enough to avoid dangerous climate change. Recent research on the mitigation potential of conservation, restoration, and improved land management demonstrates that natural solutions can reduce emissions and remove atmospheric CO2 while safeguarding food security and biodiversity.

Trying Out a New Dictionary.

ERIC Educational Resources Information Center

Benson, Morton; Benson, Evelyn

1988-01-01

Describes the BBI Combinatory Dictionary of English and demonstrates its usefulness for advanced learners of English by administering a monolingual completion test, first without a dictionary and then with the BBI, to Hungarian and Russian English teachers. Both groups' scores improved dramatically on the posttest. (LMO)

Nursing students' mathematic calculation skills.

PubMed

Rainboth, Lynde; DeMasi, Chris

2006-12-01

This mixed method study used a pre-test/post-test design to evaluate the efficacy of a teaching strategy in improving beginning nursing student learning outcomes. During a 4-week student teaching period, a convenience sample of 54 sophomore level nursing students were required to complete calculation assignments, taught one calculation method, and mandated to attend medication calculation classes. These students completed pre- and post-math tests and a major medication mathematic exam. Scores from the intervention student group were compared to those achieved by the previous sophomore class. Results demonstrated a statistically significant improvement from pre- to post-test and the students who received the intervention had statistically significantly higher scores on the major medication calculation exam than did the students in the control group. The evaluation completed by the intervention group showed that the students were satisfied with the method and outcome.

Developing pharmacy student communication skills through role-playing and active learning.

PubMed

Luiz Adrian, Julie Ann; Zeszotarski, Paula; Ma, Carolyn

2015-04-25

To evaluate the impact on pharmacy students of a communication course, which used role-playing to develop active-learning skills. Students role-playing pharmacists in patient care scenarios were critiqued by students and pharmacist faculty members. Grading was performed using the rubric inspired by Bruce Berger's Communication Skills for Pharmacists. Written skills were evaluated using student written critique questionnaires. Students completed precourse and postcourse self-assessment surveys. Preceptor evaluations were analyzed for course impact. Students demonstrated improvement in oral skills based on role-play scores (45.87/50) after practice sessions. The average score based on the student questionnaire was 9.31/10. Gain was demonstrated in all defined course objectives. Impact on introductory pharmacy practice experience (IPPE) communication objectives was insignificant. Student evaluations for course and teaching strategy reflected a high average. Study results demonstrated improvement in oral and written communication skills that may help improve interprofessional teamwork between pharmacists and other health care providers.

A randomized double-blind, placebo-controlled trial of minocycline in children and adolescents with fragile x syndrome.

PubMed

Leigh, Mary Jacena S; Nguyen, Danh V; Mu, Yi; Winarni, Tri I; Schneider, Andrea; Chechi, Tasleem; Polussa, Jonathan; Doucet, Paul; Tassone, Flora; Rivera, Susan M; Hessl, David; Hagerman, Randi J

2013-04-01

Minocycline rescued synaptic abnormalities and improved behavior in the fragile X mouse model. Previous open-label human studies demonstrated benefits in individuals with fragile X syndrome (FXS); however, its efficacy in patients with FXS has not been assessed in a controlled trial. Randomized, double-blind, placebo-controlled, crossover trial in individuals with FXS, aged 3.5 years to 16 years (n = 55, mean age 9.2 [SD, 3.6] years). Participants were randomized to minocycline or placebo for 3 months and then switched to the other treatment. Sixty-nine subjects were screened and 66 were randomized. Fifty-five subjects (83.3%) completed at least the first period and 48 (72.7%) completed the full trial. Intention-to-treat analysis demonstrated significantly greater improvements in one primary outcome, Clinical Global Impression Scale-Improvement after minocycline compared with placebo (2.49 ± 0.13 and 2.97 ± 0.13, respectively, p = .0173) and greater improvement in ad hoc analysis of anxiety and mood-related behaviors on the Visual Analog Scale (minocycline: 5.26 cm ± 0.46 cm, placebo: 4.05 cm ± 0.46 cm; p = .0488). Side effects were not significantly different during the minocycline and placebo treatments. No serious adverse events occurred on minocycline. Results may be potentially biased by study design weaknesses, including unblinding of subjects when they completed the study, drug-related side effects unblinding, and preliminary efficacy analysis results known to investigators. Minocycline treatment for 3 months in children with FXS resulted in greater global improvement than placebo. Treatment for 3 months appears safe; however, longer trials are indicated to further assess benefits, side effects, and factors associated with a clinical response to minocycline.

A Randomized Double-Blind, Placebo-Controlled Trial of Minocycline in Children and Adolescents with Fragile X Syndrome

PubMed Central

Leigh, Mary Jacena S.; Nguyen, Danh V.; Mu, Yi; Winarni, Tri I.; Schneider, Andrea; Chechi, Tasleem; Polussa, Jonathan; Doucet, Paul; Tassone, Flora; Rivera, Susan M.; Hessl, David; Hagerman, Randi J.

2013-01-01

Objective Minocycline rescued synaptic abnormalities and improved behavior in the fragile X mouse model. Prior open-label human studies demonstrated benefits in individuals with fragile X syndrome (FXS); however, its efficacy in patients with FXS has not been assessed in a controlled trial. Method Randomized, double-blind, placebo-controlled, crossover trial in individuals with FXS, ages 3.5-16 years (n=55, mean age 9.2 (SD 3.6 years)). Participants were randomized to minocycline or placebo for three months, then switched to the other treatment. Results Sixty-nine subjects were screened and 66 were randomized. Fifty-five subjects (83.3%) completed at least the first period and 48 (72.7%) completed the full trial. Intention-to-treat analysis demonstrated significantly greater improvements in one primary outcome, Clinical Global Impression Scale-Improvement after minocycline compared to placebo (2.49 ±0.13, 2.97 ±0.13, respectively, p 0.0173) and greater improvement in ad hoc analysis of anxiety and mood-related behaviors on the Visual Analoge Scale (minocycline 5.26 cm ±0.46 cm, placebo 4.05 cm±0.46cm; p 0.0488). Side effects were not significantly different during the minocycline and placebo treatments. No serious adverse events occurred on minocycline. Results may be potentially biased by study design weaknesses, including unblinding of subjects when they completed the study, drug-related side effects unblinding and preliminary efficacy analysis results known to investigators. Conclusion Minocycline treatment for three months in children with FXS resulted in greater global improvement than placebo. Treatment for three months appears safe; however, longer trials are indicated to further assess benefits, side effects, and factors associated with a clinical response to minocycline. PMID:23572165

Upgrades for the CMS simulation

DOE PAGES

Lange, D. J.; Hildreth, M.; Ivantchenko, V. N.; ...

2015-05-22

Over the past several years, the CMS experiment has made significant changes to its detector simulation application. The geometry has been generalized to include modifications being made to the CMS detector for 2015 operations, as well as model improvements to the simulation geometry of the current CMS detector and the implementation of a number of approved and possible future detector configurations. These include both completely new tracker and calorimetry systems. We have completed the transition to Geant4 version 10, we have made significant progress in reducing the CPU resources required to run our Geant4 simulation. These have been achieved throughmore » both technical improvements and through numerical techniques. Substantial speed improvements have been achieved without changing the physics validation benchmarks that the experiment uses to validate our simulation application for use in production. As a result, we will discuss the methods that we implemented and the corresponding demonstrated performance improvements deployed for our 2015 simulation application.« less

Slicing of Silicon into Sheet Material. Silicon Sheet Growth Development for the Large Area Silicon Sheet Task of the Low Cost Solar Array Project

NASA Technical Reports Server (NTRS)

Fleming, J. R.; Holden, S. C.; Wolfson, R. G.

1979-01-01

The use of multiblade slurry sawing to produce silicon wafers from ingots was investigated. The commercially available state of the art process was improved by 20% in terms of area of silicon wafers produced from an ingot. The process was improved 34% on an experimental basis. Economic analyses presented show that further improvements are necessary to approach the desired wafer costs, mostly reduction in expendable materials costs. Tests which indicate that such reduction is possible are included, although demonstration of such reduction was not completed. A new, large capacity saw was designed and tested. Performance comparable with current equipment (in terms of number of wafers/cm) was demonstrated.

Treatment with sirolimus results in complete responses in patients with autoimmune lymphoproliferative syndrome

PubMed Central

Teachey, David T.; Greiner, Robert; Seif, Alix; Attiyeh, Edward; Bleesing, Jack; Choi, John; Manno, Catherine; Rappaport, Eric; Schwabe, Dirk; Sheen, Cecilia; Sullivan, Kathleen E.; Zhuang, Hongming; Wechsler, Daniel S.; Grupp, Stephan A.

2010-01-01

Summary We hypothesized that sirolimus, an mTOR inhibitor, may be effective in patients with autoimmune lymphoproliferative syndrome (ALPS) and treated patients who were intolerant to or failed other therapies. Four patients were treated for autoimmune cytopenias; all had a rapid complete or near complete response. Two patients were treated for autoimmune arthritis and colitis, demonstrating marked improvement. Three patients had complete resolution of lymphadenopathy and splenomegaly and all patients had a reduction in double negative T cells, a population hallmark of the disease. Based on these significant responses, we recommend that sirolimus be considered as second-line therapy for patients with steroid-refractory disease. PMID:19208097

Outcomes of complete vs targeted approaches to endoscopic sinus surgery.

PubMed

DeConde, Adam S; Suh, Jeffrey D; Mace, Jess C; Alt, Jeremiah A; Smith, Timothy L

2015-08-01

Functional endoscopic sinus surgery (FESS) was historically predicated on targeted widening of narrow anatomic structures that caused postobstructive persistent sinus inflammation. It is now clear that chronic rhinosinusitis (CRS) is a multifactorial disease with subsets of patients which may require a more extensive surgical approach. This study compares quality-of-life (QOL) and disease severity outcomes after FESS based on the extent of surgical intervention. Participants with CRS were prospectively enrolled into an ongoing, multi-institutional, observational, cohort study. Surgical extent was determined by physician discretion. Participants undergoing bilateral frontal sinusotomy, ethmoidectomy, maxillary antrostomy, and sphenoidotomy were considered to have undergone "complete" surgery, whereas all other participants were categorized as receiving "targeted" surgery. Improvement was evaluated between surgical subgroups with at least 6-month follow-up using the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Brief Smell Inventory Test (B-SIT). A total of 311 participants met inclusion criteria with 147 subjects undergoing complete surgery and 164 targeted surgery. A higher prevalence of asthma, acetylsalicylic acid (ASA) sensitivity, nasal polyposis, and a history of prior sinus surgery (p ≤ 0.002) was present in participants undergoing complete surgery. Mean improvement in SNOT-22 (28.1 ± 21.9 vs 21.9 ± 20.6; p = 0.011) and B-SIT (0.8 ± 3.1 vs 0.2 ± 2.4; p = 0.005) was greater in subjects undergoing complete surgery. Regression models demonstrated a 5.9 ± 2.5 greater relative mean improvement on SNOT-22 total scores with complete surgery over targeted approaches (p = 0.016). Complete surgery was an independent predictor of greater postoperative SNOT-22 score improvement, yet did not achieve clinical significance. Further study is needed to determine the optimal surgical extent. © 2015 ARS-AAOA, LLC.

A quality improvement initiative to increase HPV vaccine rates using an educational and reminder strategy with parents of preteen girls.

PubMed

Cassidy, Brenda; Braxter, Betty; Charron-Prochownik, Denise; Schlenk, Elizabeth A

2014-01-01

A quality improvement project was undertaken to determine if an evidence-based educational brochure and reminder system can increase human papillomavirus (HPV) vaccine uptake and dose completion rates. Development of a brochure to promote HPV vaccine uptake was based on predictors of parental acceptance and Health Belief Model concepts. Electronic alerts prompted telephone reminders for dose completion. This quality improvement project utilized a quasi-experimental design with 24 parents of preteen girls from a private pediatric practice and a historical control group of 29 parents. HPV vaccine rates were compared between the groups. A significant difference in HPV vaccine uptake (χ(2) = 11.668, P = .001; odds ratio [OR] = 9.429, 95% confidence interval [CI] = 2.686-33.101) and dose completion (χ(2) = 16.171, P < .001; OR = 22.500, 95% CI = 4.291-117.990) rates were found between the historical control and intervention groups. Parents who received the clinical protocol were 9.4 times and 22.5 times more likely to have HPV vaccine uptake and dose completion, respectively. Low national HPV vaccine rates demonstrate the need for theory-based vaccine delivery programs. These results show that an evidence-based educational brochure and reminder system appeared to improve HPV vaccine uptake and dose completion rates at this private pediatric practice. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Preparing medical students for obstetrics and gynecology milestone level one: a description of a pilot curriculum

PubMed Central

Morgan, Helen; Marzano, David; Lanham, Michael; Stein, Tamara; Curran, Diana; Hammoud, Maya

2014-01-01

Background The implementation of the Accreditation Council for Graduate Medical Education (ACGME) Milestones in the field of obstetrics and gynecology has arrived with Milestones Level One defined as the level expected of an incoming first-year resident. Purpose We designed, implemented, and evaluated a 4-week elective for fourth-year medical school students, which utilized a multimodal approach to teaching and assessing the Milestones Level One competencies. Methods The 78-hour curriculum utilized traditional didactic lectures, flipped classroom active learning sessions, a simulated paging curriculum, simulation training, embalmed cadaver anatomical dissections, and fresh-frozen cadaver operative procedures. We performed an assessment of student knowledge and surgical skills before and after completion of the course. Students also received feedback on their assessment and management of eight simulated paging scenarios. Students completed course content satisfaction surveys at the completion of each of the 4 weeks. Results Students demonstrated improvement in knowledge and surgical skills at the completion of the course. Paging confidence trended toward improvement at the completion of the course. Student satisfaction was high for all of the course content, and the active learning components of the curriculum (flipped classroom, simulation, and anatomy sessions) had higher scores than the traditional didactics in all six categories of our student satisfaction survey. Conclusions This pilot study demonstrates a practical approach for preparing fourth-year medical students for the expectations of Milestones Level One in obstetrics and gynecology. This curriculum can serve as a framework as medical schools and specific specialties work to meet the first steps of the ACGME's Next Accreditation System. PMID:25430640

An intervention study to test Locker's conceptual framework of oral health in edentulous elders.

PubMed

Yamaga, Eijiro; Sato, Yusuke; Minakuchi, Shunsuke

2018-06-01

To test a previously described conceptual framework of oral health in edentulous elders using an intervention study that included complete denture replacement. Confirmatory factor analysis (CFA) was also conducted to substantiate construct validity. To date, the model proposed by Locker has been tested on edentulous elders using structural equation model (SEM) analysis. However, cross-sectional designs and the Short-Form Oral Health Impact Profile (OHIP-14) cannot adequately express cause-effect relationships and distribution in edentulous patients. Accordingly, the authors investigated Locker's model using an interventional design that included complete denture replacement using the OHIP for edentulous subjects (OHIP-EDENT). A total of 265 edentulous participants who visited the Dental Hospital of Tokyo Medical and Dental University (Tokyo, Japan) for new complete dentures were recruited. Locker's model was investigated, and CFA was performed using the change in subscale scores in the Japanese version of the OHIP-EDENT before and after complete denture replacement. CFA demonstrated an excellent model fit after adding several covariates. The Locker model also met the criteria of fit in all indices after 1 nonsignificant path was omitted. All path coefficients were significant. The findings of the present interventional study demonstrated an empirical fit to Locker's model in edentulous elders using SEM analysis, which included complete denture replacement. It is anticipated that clarification of causal mechanisms of oral health-related quality of life will lead to improvement of overall quality of life, thus maintaining or improving the activities of normal daily life for edentulous elders. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

A pilot study: mindfulness meditation intervention in COPD.

PubMed

Chan, Roxane Raffin; Giardino, Nicholas; Larson, Janet L

2015-01-01

Living well with chronic obstructive pulmonary disease (COPD) requires people to manage disease-related symptoms in order to participate in activities of daily living. Mindfulness practice is an intervention that has been shown to reduce symptoms of chronic disease and improve accurate symptom assessment, both of which could result in improved disease management and increased wellness for people with COPD. A randomized controlled trial was conducted to investigate an 8-week mindful meditation intervention program tailored for the COPD population and explore the use of breathing timing parameters as a possible physiological measure of meditation uptake. Results demonstrated that those randomized to the mindful meditation intervention group (N=19) had a significant increase in respiratory rate over time as compared to those randomized to the wait-list group (N=22) (P=0.045). It was also found that the mindful meditation intervention group demonstrated a significant decrease in level of mindfulness over time as compared to the wait-list group (P=0.023). When examining participants from the mindful meditation intervention who had completed six or more classes, it was found that respiratory rate did not significantly increase in comparison to the wait-list group. Furthermore, those who completed six or more classes (N=12) demonstrated significant improvement in emotional function in comparison to the wait-list group (P=0.032) even though their level of mindfulness did not improve. This study identifies that there may be a complex relationship between breathing parameters, emotion, and mindfulness in the COPD population. The results describe good feasibility and acceptability for meditation interventions in the COPD population.

A pilot study: mindfulness meditation intervention in COPD

PubMed Central

Chan, Roxane Raffin; Giardino, Nicholas; Larson, Janet L

2015-01-01

Living well with chronic obstructive pulmonary disease (COPD) requires people to manage disease-related symptoms in order to participate in activities of daily living. Mindfulness practice is an intervention that has been shown to reduce symptoms of chronic disease and improve accurate symptom assessment, both of which could result in improved disease management and increased wellness for people with COPD. A randomized controlled trial was conducted to investigate an 8-week mindful meditation intervention program tailored for the COPD population and explore the use of breathing timing parameters as a possible physiological measure of meditation uptake. Results demonstrated that those randomized to the mindful meditation intervention group (N=19) had a significant increase in respiratory rate over time as compared to those randomized to the wait-list group (N=22) (P=0.045). It was also found that the mindful meditation intervention group demonstrated a significant decrease in level of mindfulness over time as compared to the wait-list group (P=0.023). When examining participants from the mindful meditation intervention who had completed six or more classes, it was found that respiratory rate did not significantly increase in comparison to the wait-list group. Furthermore, those who completed six or more classes (N=12) demonstrated significant improvement in emotional function in comparison to the wait-list group (P=0.032) even though their level of mindfulness did not improve. This study identifies that there may be a complex relationship between breathing parameters, emotion, and mindfulness in the COPD population. The results describe good feasibility and acceptability for meditation interventions in the COPD population. PMID:25767382

A Microfluidic Cytometer for Complete Blood Count With a 3.2-Megapixel, 1.1- μm-Pitch Super-Resolution Image Sensor in 65-nm BSI CMOS.

PubMed

Liu, Xu; Huang, Xiwei; Jiang, Yu; Xu, Hang; Guo, Jing; Hou, Han Wei; Yan, Mei; Yu, Hao

2017-08-01

Based on a 3.2-Megapixel 1.1- μm-pitch super-resolution (SR) CMOS image sensor in a 65-nm backside-illumination process, a lens-free microfluidic cytometer for complete blood count (CBC) is demonstrated in this paper. Backside-illumination improves resolution and contrast at the device level with elimination of surface treatment when integrated with microfluidic channels. A single-frame machine-learning-based SR processing is further realized at system level for resolution correction with minimum hardware resources. The demonstrated microfluidic cytometer can detect the platelet cells (< 2 μm) required in CBC, hence is promising for point-of-care diagnostics.

A Module on Death and Dying to Develop Empathy in Student Pharmacists

PubMed Central

Olin, Jacqueline L.; Thornton, Phillip L.; Dolder, Christian R.; Hanrahan, Conor

2011-01-01

Objective To implement an integrated module on death and dying into a 15-week bioethics course and determine whether it increased student pharmacists’ empathy. Design Students participated in a 5-week death and dying module that included presentation of the film Wit, an interactive lecture on hospice, and a lecture on the ethics of pain management. Assessment Fifty-six students completed the 30-item Balanced Emotional Empathy Scale (BEES) before and after completing the module and wrote a reflective essay. Students demonstrated an appreciation of patient-specific values in their essay. Quantitative data collected via BEES scores demonstrated significant improvement in measured empathy. Conclusion A 5-week instructional model on death and dying significantly increased student empathy. PMID:21769147

A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module.

PubMed

Boggan, Joel C; Cheely, George; Shah, Bimal R; Heffelfinger, Randy; Springall, Deanna; Thomas, Samantha M; Zaas, Aimee; Bae, Jonathan

2014-09-01

Systematically engaging residents in large programs in quality improvement (QI) is challenging. To coordinate a shared QI project in a large residency program using an online tool. A web-based QI tool guided residents through a 2-phase evaluation of performance of foot examinations in patients with diabetes. In phase 1, residents completed reviews of health records with online data entry. Residents were then presented with personal performance data relative to peers and were prompted to develop improvement plans. In phase 2, residents again reviewed personal performance. Rates of performance were compared at the program and clinic levels for each phase, with data presented for residents. Acceptability was measured by the number of residents completing each phase. Feasibility was measured by estimated faculty, programmer, and administrator time and costs. Seventy-nine of 86 eligible residents (92%) completed improvement plans and reviewed 1471 patients in phase 1, whereas 68 residents (79%) reviewed 1054 patient charts in phase 2. Rates of performance of examination increased significantly between phases (from 52% to 73% for complete examination, P < .001). Development of the tool required 130 hours of programmer time. Project analysis and management required 6 hours of administrator and faculty time monthly. An online tool developed and implemented for program-wide QI initiatives successfully engaged residents to participate in QI activities. Residents using this tool demonstrated improvement in a selected quality target. This tool could be adapted by other graduate medical education programs or for faculty development.

Targeting L-Selectin to Improve Neurologic and Urologic Function After Spinal Cord Injury

DTIC Science & Technology

2013-10-01

locomotor recovery. When cystometry was performed at the end of the study, 29/34 (~85%) of mice exhibited partial or complete voluntary bladder...0.05). Following euthanasia , bladders were removed, weighed, and normalized to total bodyweight (Figure 11C). One-way ANOVA demonstrated no

Effect of a novel video game on stroke knowledge of 9- to 10-year-old, low-income children.

PubMed

Williams, Olajide; Hecht, Mindy F; DeSorbo, Alexandra L; Huq, Saima; Noble, James M

2014-03-01

Improving actionable stroke knowledge of a witness or bystander, which in some cases are children, may improve response to an acute stroke event. We used a quasiexperimental pre-test post-test design to evaluate actionable stroke knowledge of 210 children aged 9 to 10 years in response to a single, 15-minute exposure to a stroke education video game conducted in the school computer laboratory. After immediate post-test, we provided remote password-protected online video game access and encouraged children to play at their leisure from home. An unannounced delayed post-test occurred 7 weeks later. Two hundred ten children completed pretest, 205 completed immediate post-test, whereas 198 completed delayed post-test. One hundred fifty-six (74%) children had Internet access at home, and 41 (26%), mostly girls, played the video game remotely. There was significant improvement in stroke symptom composite scores, calling 911, and all individual stroke knowledge items, including a distractor across the testing sequence (P<0.05). Children who played the video game remotely demonstrated significant improvement in knowledge of 1 symptom (sudden imbalance) compared with children who did not (P<0.05), although overall composite scores showed no difference. Stroke education video games may represent novel means for improving and sustaining actionable stroke knowledge of children.

Interventions to improve delivery of isoniazid preventive therapy: an overview of systematic reviews

PubMed Central

2014-01-01

Background Uptake of isoniazid preventive therapy (IPT) to prevent tuberculosis has been poor, particularly in the highest risk populations. Interventions to improve IPT delivery could promote implementation. The large number of existing systematic reviews on treatment adherence has made drawing conclusions a challenge. To provide decision makers with the evidence they need, we performed an overview of systematic reviews to compare different organizational interventions to improve IPT delivery as measured by treatment completion among those at highest risk for the development of TB disease, namely child contacts or HIV-infected individuals. Methods We searched the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects (DARE), and MEDLINE up to August 15, 2012. Two authors used a standardized data extraction form and the AMSTAR instrument to independently assess each review. Results Six reviews met inclusion criteria. Interventions included changes in the setting/site of IPT delivery, use of quality monitoring mechanisms (e.g., directly observed therapy), IPT delivery integration into other healthcare services, and use of lay health workers. Most reviews reported a combination of outcomes related to IPT adherence and treatment completion rate but without a baseline or comparison rate. Generally, we found limited evidence to demonstrate that the studied interventions improved treatment completion. Conclusions While most of the interventions were not shown to improve IPT completion, integration of tuberculosis and HIV services yielded high treatment completion rates in some settings. The lack of data from high burden TB settings limits applicability. Further research to assess different IPT delivery interventions, including those that address barriers to care in at-risk populations, is urgently needed to identify the most effective practices for IPT delivery and TB control in high TB burden settings. PMID:24886159

Mastery-Based Virtual Reality Robotic Simulation Curriculum: The First Step Toward Operative Robotic Proficiency.

PubMed

Hogg, Melissa E; Tam, Vernissia; Zenati, Mazen; Novak, Stephanie; Miller, Jennifer; Zureikat, Amer H; Zeh, Herbert J

Hepatobiliary surgery is a highly complex, low-volume specialty with long learning curves necessary to achieve optimal outcomes. This creates significant challenges in both training and measuring surgical proficiency. We hypothesize that a virtual reality curriculum with mastery-based simulation is a valid tool to train fellows toward operative proficiency. This study evaluates the content and predictive validity of robotic simulation curriculum as a first step toward developing a comprehensive, proficiency-based pathway. A mastery-based simulation curriculum was performed in a virtual reality environment. A pretest/posttest experimental design used both virtual reality and inanimate environments to evaluate improvement. Participants self-reported previous robotic experience and assessed the curriculum by rating modules based on difficulty and utility. This study was conducted at the University of Pittsburgh Medical Center (Pittsburgh, PA), a tertiary care academic teaching hospital. A total of 17 surgical oncology fellows enrolled in the curriculum, 16 (94%) completed. Of 16 fellows who completed the curriculum, 4 fellows (25%) achieved mastery on all 24 modules; on average, fellows mastered 86% of the modules. Following curriculum completion, individual test scores improved (p < 0.0001). An average of 2.4 attempts was necessary to master each module (range: 1-17). Median time spent completing the curriculum was 4.2 hours (range: 1.1-6.6). Total 8 (50%) fellows continued practicing modules beyond mastery. Survey results show that "needle driving" and "endowrist 2" modules were perceived as most difficult although "needle driving" modules were most useful. Overall, 15 (94%) fellows perceived improvement in robotic skills after completing the curriculum. In a cohort of board-certified general surgeons who are novices in robotic surgery, a mastery-based simulation curriculum demonstrated internal validity with overall score improvement. Time to complete the curriculum was manageable. Published by Elsevier Inc.

The direct liquefaction proof of concept program

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

Comolli, A.G.; Lee, L.K.; Pradhan, V.R.

1995-12-31

The goal of the Proof of Concept (POC) Program is to develop Direct Coal Liquefaction and associated transitional technologies towards commercial readiness for economically producing premium liquid fuels from coal in an environmentally acceptable manner. The program focuses on developing the two-stage liquefaction (TSL) process by utilizing geographically strategic feedstocks, commercially feasible catalysts, new prototype equipment, and testing co-processing or alternate feedstocks and improved process configurations. Other high priority objectives include dispersed catalyst studies, demonstrating low rank coal liquefaction without solids deposition, improving distillate yields on a unit reactor volume basis, demonstrating ebullated bed operations while obtaining scale-up data, demonstratingmore » optimum catalyst consumption using new concepts (e.g. regeneration, cascading), producing premium products through on-line hydrotreating, demonstrating improved hydrogen utilization for low rank coals using novel heteroatom removal methods, defining and demonstrating two-stage product properties for upgrading; demonstrating efficient and economic solid separation methods, examining the merits of integrated coal cleaning, demonstrating co-processing, studying interactions between the preheater and first and second-stage reactors, improving process operability by testing and incorporating advanced equipment and instrumentation, and demonstrating operation with alternate coal feedstocks. During the past two years major PDU Proof of Concept runs were completed. POC-1 with Illinois No. 6 coal and POC-2 with Black Thunder sub-bituminous coal. Results from these operations are continuing under review and the products are being further refined and upgraded. This paper will update the results from these operations and discuss future plans for the POC program.« less

Developing Pharmacy Student Communication Skills through Role-Playing and Active Learning

PubMed Central

Zeszotarski, Paula; Ma, Carolyn

2015-01-01

Objective. To evaluate the impact on pharmacy students of a communication course, which used role-playing to develop active-learning skills. Design. Students role-playing pharmacists in patient care scenarios were critiqued by students and pharmacist faculty members. Grading was performed using the rubric inspired by Bruce Berger’s Communication Skills for Pharmacists. Written skills were evaluated using student written critique questionnaires. Students completed precourse and postcourse self-assessment surveys. Preceptor evaluations were analyzed for course impact. Assessment. Students demonstrated improvement in oral skills based on role-play scores (45.87/50) after practice sessions. The average score based on the student questionnaire was 9.31/10. Gain was demonstrated in all defined course objectives. Impact on introductory pharmacy practice experience (IPPE) communication objectives was insignificant. Student evaluations for course and teaching strategy reflected a high average. Conclusion. Study results demonstrated improvement in oral and written communication skills that may help improve interprofessional teamwork between pharmacists and other health care providers. PMID:25995519

Demonstration of a Large-Scale Tank Assembly via Circumferential Friction Stir Welds

NASA Technical Reports Server (NTRS)

Jones, Clyde S.; Adams, Glynn; Colligan, Kevin

2000-01-01

A collaborative effort between NASA/Marshall Space Flight Center and the Michoud Unit of Lockheed Martin Space Systems Company was undertaken to demonstrate assembly of a large-scale aluminum tank using circumferential friction stir welds. The hardware used to complete this demonstration was fabricated as a study of near-net- shape technologies. The tooling used to complete this demonstration was originally designed for assembly of a tank using fusion weld processes. This presentation describes the modifications and additions that were made to the existing fusion welding tools required to accommodate circumferential friction stir welding, as well as the process used to assemble the tank. The tooling modifications include design, fabrication and installation of several components. The most significant components include a friction stir weld unit with adjustable pin length capabilities, a continuous internal anvil for 'open' circumferential welds, a continuous closeout anvil, clamping systems, an external reaction system and the control system required to conduct the friction stir welds and integrate the operation of the tool. The demonstration was intended as a development task. The experience gained during each circumferential weld was applied to improve subsequent welds. Both constant and tapered thickness 14-foot diameter circumferential welds were successfully demonstrated.

Citicoline Treatment Improves Measures of Impulsivity and Task Performance in Chronic Marijuana Smokers: A Pilot BOLD fMRI Study

PubMed Central

Gruber, Staci A.; Sagar, Kelly A.; Dahlgren, Mary Kathryn; Gonenç, Atilla; Conn, Nina A.; Winer, Jeffrey P.; Penetar, David; Lukas, Scott E.

2015-01-01

Objective Citicoline is an endogenous nucleotide that has historically been used to treat stroke, traumatic brain injury, and cognitive dysfunction. Research has also shown that citicoline treatment is associated with improved cognitive performance in substance-abusing populations. We hypothesized that marijuana (MJ) smokers who received citicoline would demonstrate improvement in cognitive performance as well as increased neural efficiency during tasks of cognitive control relative to those who received placebo. Method The current study tested this hypothesis by examining the effects of citicoline in treatment-seeking chronic MJ smokers. In an 8-week double-blind, placebo-controlled study, 19 MJ smokers were randomly assigned via a double-blind procedure to the citicoline (8 Males, 2 Females) or placebo group (9 Males, 0 Females). All participants completed fMRI scanning at baseline and after 8 weeks of treatment during two cognitive measures of inhibitory processing, the Multi Source Interference Test (MSIT) and Stroop Color Word Test, and also completed the Barratt Impulsiveness Scale (BIS-11), a self-report measure of impulsivity. Results Following the 8 week trial, MJ smokers treated with citicoline demonstrated significantly lower levels of behavioral impulsivity, improved task accuracy on both the MSIT and Stroop tasks, and exhibited significantly different patterns of brain activation relative to baseline levels and relative to those who received placebo. Conclusions Findings suggest that citicoline may facilitate the treatment of MJ use disorders by improving the cognitive skills necessary to fully engage in comprehensive treatment programs. PMID:26658924

Evaluation of an Online Program To Teach Microbiology to Internal Medicine Residents

PubMed Central

Burd, Eileen M.; Kraft, Colleen S.; Armstrong, Wendy S.; Lenorr, Kenya; Spicer, Jennifer O.; Martin, Donna; del Rio, Carlos

2014-01-01

Microbiology rounds are an integral part of infectious disease consultation service. During microbiology rounds, we highlight microbiology principles using vignettes. We created case-based, interactive, microbiology online modules similar to the vignettes presented during microbiology rounds. Since internal medicine residents rotating on our infectious disease elective have limited time to participate in rounds and learn microbiology, our objective was to evaluate the use of the microbiology online modules by internal medicine residents. We asked residents to complete 10 of 25 online modules during their infectious disease elective. We evaluated which modules they chose and the change in their knowledge level. Forty-six internal medicine residents completed assessments given before and after accessing the modules with an average of 11/20 (range, 6 to 19) and 16/20 (range, 9 to 20) correct questions, respectively (average improvement, 5 questions; P = 0.0001). The modules accessed by more than 30 residents included those related to Clostridium difficile, anaerobes, Candida spp., Streptococcus pneumoniae, influenza, Mycobacterium tuberculosis, and Neisseria meningitidis. We demonstrated improved microbiology knowledge after completion of the online modules. This improvement may not be solely attributed to completing the online modules, as fellows and faculty may have provided additional microbiology education during the rotation. PMID:25392364

Evaluation of an online program to teach microbiology to internal medicine residents.

PubMed

Guarner, Jeannette; Burd, Eileen M; Kraft, Colleen S; Armstrong, Wendy S; Lenorr, Kenya; Spicer, Jennifer O; Martin, Donna; del Rio, Carlos

2015-01-01

Microbiology rounds are an integral part of infectious disease consultation service. During microbiology rounds, we highlight microbiology principles using vignettes. We created case-based, interactive, microbiology online modules similar to the vignettes presented during microbiology rounds. Since internal medicine residents rotating on our infectious disease elective have limited time to participate in rounds and learn microbiology, our objective was to evaluate the use of the microbiology online modules by internal medicine residents. We asked residents to complete 10 of 25 online modules during their infectious disease elective. We evaluated which modules they chose and the change in their knowledge level. Forty-six internal medicine residents completed assessments given before and after accessing the modules with an average of 11/20 (range, 6 to 19) and 16/20 (range, 9 to 20) correct questions, respectively (average improvement, 5 questions; P = 0.0001). The modules accessed by more than 30 residents included those related to Clostridium difficile, anaerobes, Candida spp., Streptococcus pneumoniae, influenza, Mycobacterium tuberculosis, and Neisseria meningitidis. We demonstrated improved microbiology knowledge after completion of the online modules. This improvement may not be solely attributed to completing the online modules, as fellows and faculty may have provided additional microbiology education during the rotation. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

SpaceX Recovery Training

NASA Image and Video Library

2018-02-28

On February 28, SpaceX completed a demonstration of their ability to recover the crew and capsule after a nominal water splashdown. This marks an important recovery milestone and joint test. The timeline requirement from splashdown to crew egress onboard the ship is one hour, and the recovery team demonstrated that they can accomplish this operation under worst-case conditions in under 45 minutes. Further improvements are planned to shorten the recovery time even more as the team works to build a process that is safe, repeatable, and efficient.

Self-assessment and goal-setting is associated with an improvement in interviewing skills.

PubMed

Hanley, Kathleen; Zabar, Sondra; Charap, Joseph; Nicholson, Joseph; Disney, Lindsey; Kalet, Adina; Gillespie, Colleen

2014-01-01

Purpose Describe the relationship between medical students' self-assessment and goal-setting (SAGS) skills and development of interviewing skills during the first-year doctoring course. Method 157 first-year medical students completed three two-case standardized patient (SP) interviews. After each of the first two, students viewed videotapes of their interview, completed a SAGS worksheet, and reviewed a selected tape segment in a seminar. SAGS was categorized into good and poor quality and interviewing skills were rated by trained raters. Results SAGS improved over time (37% good week 1 vs. 61% good week 10). Baseline SAGS and interviewing skills were not associated. Initial SAGS quality was associated with change in interviewing skills - those with poor-quality SAGS demonstrated a decrease and those with good-quality SAGS demonstrated an increase in scores by 17 weeks (ANOVA F=4.16, p=0.024). For students whose SAGS skills were good at both week 1 and 10, interviewing skills declined in weeks 1-10 and then increased significantly at week 17. For those whose SAGS remained 'poor' in weeks 1-10, interviewing skills declined in weeks 10-17. Conclusions In general, the quality of students' SAGS improved over time. Poor baseline SAGS skills and failure to improve were associated with a decrease in interviewing skills at 17 weeks. For students with better SAGS, interviewing skills increased at week 17. Improvement in SAGS skills was not associated with improved interviewing skills. Understanding structured self-assessment skills helps identify student characteristics that influence progressive mastery of communication skills and therefore may inform curriculum and remediation tailoring.

Self-assessment and goal-setting is associated with an improvement in interviewing skills.

PubMed

Hanley, Kathleen; Zabar, Sondra; Charap, Joseph; Nicholson, Joseph; Disney, Lindsey; Kalet, Adina; Gillespie, Colleen

2014-01-01

Describe the relationship between medical students' self-assessment and goal-setting (SAGS) skills and development of interviewing skills during the first-year doctoring course. 157 first-year medical students completed three two-case standardized patient (SP) interviews. After each of the first two, students viewed videotapes of their interview, completed a SAGS worksheet, and reviewed a selected tape segment in a seminar. SAGS was categorized into good and poor quality and interviewing skills were rated by trained raters. SAGS improved over time (37% good week 1 vs. 61% good week 10). Baseline SAGS and interviewing skills were not associated. Initial SAGS quality was associated with change in interviewing skills - those with poor-quality SAGS demonstrated a decrease and those with good-quality SAGS demonstrated an increase in scores by 17 weeks (ANOVA F=4.16, p=0.024). For students whose SAGS skills were good at both week 1 and 10, interviewing skills declined in weeks 1-10 and then increased significantly at week 17. For those whose SAGS remained 'poor' in weeks 1-10, interviewing skills declined in weeks 10-17. In general, the quality of students' SAGS improved over time. Poor baseline SAGS skills and failure to improve were associated with a decrease in interviewing skills at 17 weeks. For students with better SAGS, interviewing skills increased at week 17. Improvement in SAGS skills was not associated with improved interviewing skills. Understanding structured self-assessment skills helps identify student characteristics that influence progressive mastery of communication skills and therefore may inform curriculum and remediation tailoring.

Two-treatment protocol for skin laxity using 90-Watt dynamic monopolar radiofrequency device with real-time impedance intelligence monitoring.

PubMed

McDaniel, David; Weiss, Robert; Weiss, Margaret; Mazur, Chris; Griffen, Charmaine

2014-09-01

Multiple devices are currently on the market that employ radiofrequency to non-invasively treat skin laxity and wrinkle reduction. The study device was a unique monopolar radiofrequency device FDA cleared for the treatment of wrinkles and rhytids. The delivery system allows constant monitoring of the real-time local skin impedance changes, which allows radiofrequency energy to be more uniformly dosed over an entire treatment area. The objective was to validate effectiveness of a modified treatment protocol for a unique monopolar radiofrequency device, which has been engineered with greater power and self-monitoring circuitry. Twenty-four female subjects received bilateral monopolar radiofrequency treatments to the mid and lower face from the sub malar region to the submentum. Subjects completed 1 and 3 month follow ups with digital imaging. Skin biopsies (on 4 subjects) and ultrasound measurements (on 12 subjects) were completed. Assessments demonstrated a reduction in skin laxity of 35%, a reduction in fine lines/wrinkles of 42%, and a reduction in the appearance of global photodamage of 33%. Expert photograding demonstrated 92% of subjects showing at least a mild improvement in skin laxity at three months post treatment. 50 MHz ultrasound measurements in 12 subjects showed an increase of 19% in skin density. Histology showed a marked increase in dermal collagen and elastin fibers in two subjects who demonstrated a clinically noticeable reduction in skin laxity and minimal changes in two subjects who demonstrated minimal clinical improvements. There were no significant adverse events reported. This modified radiofrequency device and treatment protocol was well tolerated and produced improvements in the appearance of skin laxity and overall anti-aging effects in the majority of subjects. Objective measurements including ultrasound and histology help explain the clinical outcome.

Intelligent Mortality Reporting with FHIR

PubMed Central

Hoffman, Ryan A.; Wu, Hang; Venugopalan, Janani; Braun, Paula; Wang, May D.

2017-01-01

One pressing need in the area of public health is timely, accurate, and complete reporting of deaths and the conditions leading up to them. Fast Healthcare Interoperability Resources (FHIR) is a new HL7 interoperability standard for electronic health record (EHR), while Sustainable Medical Applications and Reusable Technologies (SMART)-on-FHIR enables third-party app development that can work “out of the box”. This research demonstrates the feasibility of developing SMART-on-FHIR applications to enable medical professionals to perform timely and accurate death reporting within multiple different jurisdictions of US. We explored how the information on a standard certificate of death can be mapped to resources defined in the FHIR standard (DSTU2). We also demonstrated analytics for potentially improving the accuracy and completeness of mortality reporting data. PMID:28804791

Collaborative Testing: Cognitive and Interpersonal Processes Related to Enhanced Test Performance

ERIC Educational Resources Information Center

Kapitanoff, Susan H.

2009-01-01

Research has demonstrated that collaborative testing, working on tests in groups, leads to improved test scores but the mechanism by which this occurs has not been specified. Three factors were proposed as mediators: cognitive processes, interpersonal interactions and reduced test-anxiety. Thirty-three students completed a multiple-choice exam…

Using a Teaching Model To Correct Known Misconceptions in Electrochemistry.

ERIC Educational Resources Information Center

Huddle, Penelope Ann; White, Margaret Dawn; Rogers, Fiona

2000-01-01

Describes a concrete teaching model designed to eliminate students' misconceptions about current flow in electrochemistry. The model uses a semi-permeable membrane rather than a salt bridge to complete the circuit and demonstrate the maintenance of cell neutrality. Concludes that use of the model led to improvement in students' understanding at…

How Fit Are Elementary Children in Grades 2-4?

ERIC Educational Resources Information Center

Lemlech, Johanna K.

As part of a Feelin' Good intervention program to improve the physical fitness of children in grades 2 through 4, 603 students were tested for muscle strength and flexibility. Complete pre- and posttest data were obtained from 388 students. Two muscle strength tests and two flexibility tests demonstrated consistent sex differences in performance.…

Effectiveness of a School- and Community-based Academic Asthma Health Education Program on Use of Effective Asthma Self-care Behaviors in Older School-age Students

PubMed Central

Kintner, Eileen K.; Cook, Gwendolyn; Marti, C. Nathan; Allen, April; Stoddard, Debbie; Harmon, Phyllis; Gomes, Melissa; Meeder, Linda; Van Egeren, Laurie A.

2014-01-01

Purpose The purpose was to evaluate the effectiveness of SHARP, an academic asthma health education and counseling program, on fostering use of effective asthma self-care behaviors. Design and Methods This was a phase III, two-group, cluster randomized, single-blinded, longitudinal design guided the study. Caregivers of 205 fourth- and fifth-grade students completed the asthma health behaviors survey at pre-intervention and 1, 12, and 24 months post-intervention. Analysis involved multilevel modeling. Results All students demonstrated improvement in episode management, risk-reduction/prevention, and health promotion behaviors; SHARP students demonstrated increased improvement in episode management and risk-reduction/prevention behaviors. Practice Implications Working with schoolteachers, nurses can improve use of effective asthma self-care behaviors. PMID:25443867

Educational Intervention in a Medically Underserved Area.

PubMed

Atance, Joel; Mickalis, Morgan; Kincade, Brianna

2018-04-01

Medical students from rural and medically underserved areas (MUAs) are more likely than their peers to practice medicine in rural areas and MUAs. However, students from MUAs are also more likely to face socioeconomic barriers to a career in medicine. To determine whether a week-long summer enrichment experience (SEE) at Edward Via College of Osteopathic Medicine-Carolinas could successfully teach high school students from MUAs basic biomedical concepts and foster an interest in medicine and the health sciences. The SEE program is open to high school students in the Spartanburg, South Carolina, area. The program includes interactive lectures, laboratories, demonstrations on gross anatomy prosections, demonstrations on medical simulation models, tours of emergency vehicles, an introduction to osteopathic manipulative medicine, and student-led research projects. Participants were asked to complete a 15-question quiz that assessed their knowledge of basic biomedical concepts and a 10-question survey that assessed their attitudes toward careers in medicine and health sciences. Both the quiz and the survey were completed on both the first and final days of the program. The data were analyzed using paired t tests. Participant knowledge of basic biomedical concepts, as determined by the quiz scores, increased after completion of the program (9.1 average correct answers vs 12.6 average correct answers) (P<.001). Participant attitude toward medicine and the health sciences improved in 9 of the 10 items surveyed after completion of the program (P<.05). Participant knowledge of basic biomedical concepts and their knowledge of and interest in careers in the health sciences improved after completing the SEE program. These findings suggest that educational interventions for high school students could help to develop primary care physicians for rural areas and MUAs and that there is a role for osteopathic medical schools to nurture these students as early as possible.

Assessing Demographic Differences in Patient-Perceived Improvement in Facial Appearance and Quality of Life Following Rhinoplasty

PubMed Central

Schwitzer, Jonathan A.; Albino, Frank P.; Mathis, Ryan K.; Scott, Amie M.; Gamble, Laurie; Baker, Stephen B.

2015-01-01

Background As rhinoplasty patient demographics evolve, surgeons must consider the impact of demographics on patient satisfaction. Objectives The objective of this study was to identify independent demographic predictors of differences in satisfaction with appearance and quality of life following rhinoplasty utilizing the FACE-Q patient-reported outcome instrument. Methods Patients presenting for rhinoplasty completed the following FACE-Q scales: Satisfaction with Facial Appearance, Satisfaction with Nose, Social Function, and Psychological Well-being. Higher FACE-Q scores indicate greater satisfaction with appearance or superior quality of life. Pre- and post-treatment scores were compared in the context of patient demographics. Results The scales were completed by 59 patients. Women demonstrated statistically significant improvements in Satisfaction with Facial Appearance and quality of life while men only experienced significant improvement in Satisfaction with Facial appearance. Caucasians demonstrated statistically significant improvement in Satisfaction with Facial Appearance and quality of life while non-Caucasians did not. Patients younger than 35 years old were more likely to experience enhanced Satisfaction with Facial Appearance and quality of life compared with patients older than 35 years old. Patients with income ≥$100,000 were more likely to experience significant increases in Satisfaction with Facial Appearance and quality of life than patients with incomes <$100,000. Conclusions In an objective study using a validated patient-reported outcome instrument, the authors were able to quantify differences in the clinically meaningful change in perception of appearance and quality of life that rhinoplasty patients gain based on demographic variables. The authors also demonstrated that these variables are potential predictors of differences in satisfaction. Level of Evidence 3 Therapeutic PMID:26063837

Assessing Demographic Differences in Patient-Perceived Improvement in Facial Appearance and Quality of Life Following Rhinoplasty.

PubMed

Schwitzer, Jonathan A; Albino, Frank P; Mathis, Ryan K; Scott, Amie M; Gamble, Laurie; Baker, Stephen B

2015-09-01

As rhinoplasty patient demographics evolve, surgeons must consider the impact of demographics on patient satisfaction. The objective of this study was to identify independent demographic predictors of differences in satisfaction with appearance and quality of life following rhinoplasty utilizing the FACE-Q patient-reported outcome instrument. Patients presenting for rhinoplasty completed the following FACE-Q scales: Satisfaction with Facial Appearance, Satisfaction with Nose, Social Function, and Psychological Well-being. Higher FACE-Q scores indicate greater satisfaction with appearance or superior quality of life. Pre- and post-treatment scores were compared in the context of patient demographics. The scales were completed by 59 patients. Women demonstrated statistically significant improvements in Satisfaction with Facial Appearance and quality of life while men only experienced significant improvement in Satisfaction with Facial appearance. Caucasians demonstrated statistically significant improvement in Satisfaction with Facial Appearance and quality of life while non-Caucasians did not. Patients younger than 35 years old were more likely to experience enhanced Satisfaction with Facial Appearance and quality of life compared with patients older than 35 years old. Patients with income ≥$100,000 were more likely to experience significant increases in Satisfaction with Facial Appearance and quality of life than patients with incomes <$100,000. In an objective study using a validated patient-reported outcome instrument, the authors were able to quantify differences in the clinically meaningful change in perception of appearance and quality of life that rhinoplasty patients gain based on demographic variables. The authors also demonstrated that these variables are potential predictors of differences in satisfaction. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

The Effect of Ramelteon on Heartburn Symptoms of Patients With Gastroesophageal Reflux Disease and Chronic Insomnia: A Pilot Study.

PubMed

Jha, Lokesh K; Fass, Ronnie; Gadam, Rakshith; Maradey-Romero, Carla; Nasrollah, Laya; Hershcovici, Tiberiu; Quan, Stuart F; Dickman, Ram

2016-02-01

There is a bidirectional relationship between gastroesophageal reflux disease (GERD) and sleep. It has been demonstrated that antireflux treatment can improve sleep quality in GERD patients with nighttime reflux. Patients with heartburn and/or regurgitation ≥3 times/week and insomnia for ≥3 months were included. Patients were assessed at baseline with the demographic, GERD symptom assessment scale, Epworth sleepiness scale, Berlin sleep apnea, Pittsburgh sleep quality index, and the Insomnia severity index questionnaires. Subjects underwent an upper endoscopy followed by pH testing. Subsequently, subjects were randomized, in a double-blind, placebo-controlled trial, to receive either ramelteon 8 mg or placebo before bedtime for 4 weeks. During the last week of treatment, subjects completed a daily GERD symptom and sleep diary and underwent actigraphy. Sixteen patients completed the study, 8 in each arm (mean age and M/F were 48.5 vs. 57.8 y, and 8/0 vs. 6/2, respectively). Patients who received ramelteon demonstrated a statistically significant decrease in symptom score as compared with those who received placebo for daytime heartburn (-42% vs. -29%), nighttime heartburn (-42% vs. 78%), 24-hour heartburn (-42% vs. -3%), and 24-hour acid regurgitation (-26% vs. 19%) (all P<0.05). Insomnia severity index score was significantly reduced in patients receiving ramelteon as compared with placebo (-46% vs. -5%, P<0.05). Ramelteon group also demonstrated a significant improvement in sleep efficiency and sleep latency, as compared with placebo, P<0.05). No significant adverse events were observed with ramelteon. Ramelteon significantly improved symptoms in patients with GERD. In addition, ramelteon significantly improved patients' sleep experience. Further studies are needed in the future (NCT01128582).

Teaching and assessing resident competence in practice-based learning and improvement.

PubMed

Ogrinc, Greg; Headrick, Linda A; Morrison, Laura J; Foster, Tina

2004-05-01

We designed, implemented, and evaluated a 4-week practice-based learning and improvement (PBLI) elective. Eleven internal medicine residents from 2 separate residency programs participated in the PBLI elective and 22 other residents comprised a comparison group. Residents in each group had similar pretest Quality Improvement Knowledge Application Tool scores; but after the PBLI elective, participant scores were significantly higher. Also, participants' self-assessed ratings of PBLI skills increased after the rotation and remained elevated 6 months afterward. In this curriculum, residents completed a project to improve patient care and demonstrated their knowledge on an evaluation tool in a way that was superior to nonparticipants.

Teaching and Assessing Resident Competence in Practice-based Learning and Improvement

PubMed Central

Ogrinc, Greg; Headrick, Linda A; Morrison, Laura J; Foster, Tina

2004-01-01

We designed, implemented, and evaluated a 4-week practice-based learning and improvement (PBLI) elective. Eleven internal medicine residents from 2 separate residency programs participated in the PBLI elective and 22 other residents comprised a comparison group. Residents in each group had similar pretest Quality Improvement Knowledge Application Tool scores; but after the PBLI elective, participant scores were significantly higher. Also, participants’ self-assessed ratings of PBLI skills increased after the rotation and remained elevated 6 months afterward. In this curriculum, residents completed a project to improve patient care and demonstrated their knowledge on an evaluation tool in a way that was superior to nonparticipants. PMID:15109311

A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module

PubMed Central

Boggan, Joel C.; Cheely, George; Shah, Bimal R.; Heffelfinger, Randy; Springall, Deanna; Thomas, Samantha M.; Zaas, Aimee; Bae, Jonathan

2014-01-01

Background Systematically engaging residents in large programs in quality improvement (QI) is challenging. Objective To coordinate a shared QI project in a large residency program using an online tool. Methods A web-based QI tool guided residents through a 2-phase evaluation of performance of foot examinations in patients with diabetes. In phase 1, residents completed reviews of health records with online data entry. Residents were then presented with personal performance data relative to peers and were prompted to develop improvement plans. In phase 2, residents again reviewed personal performance. Rates of performance were compared at the program and clinic levels for each phase, with data presented for residents. Acceptability was measured by the number of residents completing each phase. Feasibility was measured by estimated faculty, programmer, and administrator time and costs. Results Seventy-nine of 86 eligible residents (92%) completed improvement plans and reviewed 1471 patients in phase 1, whereas 68 residents (79%) reviewed 1054 patient charts in phase 2. Rates of performance of examination increased significantly between phases (from 52% to 73% for complete examination, P < .001). Development of the tool required 130 hours of programmer time. Project analysis and management required 6 hours of administrator and faculty time monthly. Conclusions An online tool developed and implemented for program-wide QI initiatives successfully engaged residents to participate in QI activities. Residents using this tool demonstrated improvement in a selected quality target. This tool could be adapted by other graduate medical education programs or for faculty development. PMID:26279782

Improving Project Management with Simulation and Completion Distribution Functions

NASA Technical Reports Server (NTRS)

Cates, Grant R.

2004-01-01

Despite the critical importance of project completion timeliness, management practices in place today remain inadequate for addressing the persistent problem of project completion tardiness. A major culprit in late projects is uncertainty, which most, if not all, projects are inherently subject to. This uncertainty resides in the estimates for activity durations, the occurrence of unplanned and unforeseen events, and the availability of critical resources. In response to this problem, this research developed a comprehensive simulation based methodology for conducting quantitative project completion time risk analysis. It is called the Project Assessment by Simulation Technique (PAST). This new tool enables project stakeholders to visualize uncertainty or risk, i.e. the likelihood of their project completing late and the magnitude of the lateness, by providing them with a completion time distribution function of their projects. Discrete event simulation is used within PAST to determine the completion distribution function for the project of interest. The simulation is populated with both deterministic and stochastic elements. The deterministic inputs include planned project activities, precedence requirements, and resource requirements. The stochastic inputs include activity duration growth distributions, probabilities for events that can impact the project, and other dynamic constraints that may be placed upon project activities and milestones. These stochastic inputs are based upon past data from similar projects. The time for an entity to complete the simulation network, subject to both the deterministic and stochastic factors, represents the time to complete the project. Repeating the simulation hundreds or thousands of times allows one to create the project completion distribution function. The Project Assessment by Simulation Technique was demonstrated to be effective for the on-going NASA project to assemble the International Space Station. Approximately $500 million per month is being spent on this project, which is scheduled to complete by 2010. NASA project stakeholders participated in determining and managing completion distribution functions produced from PAST. The first result was that project stakeholders improved project completion risk awareness. Secondly, using PAST, mitigation options were analyzed to improve project completion performance and reduce total project cost.

Educational videos for practitioners attending Baby Friendly Hospital Initiative workshops supporting breastfeeding positioning, attachment and hand expression skills: Effects on knowledge and confidence.

PubMed

Wallace, Louise M; Ma, Yuanying; Qiu, Li Qian; Dunn, Orla M

2018-04-26

UNICEF Baby Friendly Initiative (BFHI) is the global standard for maternity and community services requiring all practitioners to be trained to support mothers in the essential skills of supporting positioning and attachment, and hand expression. These studies aim to rigorously assess knowledge in nurses, midwives, and doctors in these skills, tested before and after watching short videos demonstrating these skills. Practitioners were attending BFHI education, and the video study was additional. In Phase 1 clinicians in England were randomised to one of two videos (practitioner role play or clinical demonstration). The results showed improvements in knowledge and confidence, and a preference for clinical demonstration by mothers and infants. The clinical demonstration video was evaluated in China in Phase 2 where expert trainers viewed the video after completing the BHFI workshop, and in Phase 3 practitioners viewed the video before the BHFI workshop. Phase 2 with expert trainers only showed improvement in knowledge of hand expression but not positioning and attachment. In Phase 3 clinicians showed improved knowledge for both skills. In all Phases there were statistically significant improvements in confidence in practice in both skills. Viewing short videos increased knowledge, particularly about teaching hand expression, and confidence in both skills. Copyright © 2018. Published by Elsevier Ltd.

Pilot Study Evaluating a Practice-Based Learning and Improvement Curriculum Focusing on the Development of System-Level Quality Improvement Skills

PubMed Central

Tomolo, Anne M; Lawrence, Renée H; Watts, Brook; Augustine, Sarah; Aron, David C; Singh, Mamta K

2011-01-01

Background We developed a practice-based learning and improvement (PBLI) curriculum to address important gaps in components of content and experiential learning activities through didactics and participation in systems-level quality improvement projects that focus on making changes in health care processes. Methods We evaluated the impact of our curriculum on resident PBLI knowledge, self-efficacy, and application skills. A quasi-experimental design assessed the impact of a curriculum (PBLI quality improvement systems compared with non-PBLI) on internal medicine residents' learning during a 4-week ambulatory block. We measured application skills, self-efficacy, and knowledge by using the Systems Quality Improvement Training and Assessment Tool. Exit evaluations assessed time invested and experiences related to the team projects and suggestions for improving the curriculum. Results The 2 groups showed differences in change scores. Relative to the comparison group, residents in the PBLI curriculum demonstrated a significant increase in the belief about their ability to implement a continuous quality improvement project (P  =  .020), comfort level in developing data collection plans (P  =  .010), and total knowledge scores (P < .001), after adjusting for prior PBLI experience. Participants in the PBLI curriculum also demonstrated significant improvement in providing a more complete aim statement for a proposed project after adjusting for prior PBLI experience (P  =  .001). Exit evaluations were completed by 96% of PBLI curriculum participants who reported high satisfaction with team performance. Conclusion Residents in our curriculum showed gains in areas fundamental for PBLI competency. The observed improvements were related to fundamental quality improvement knowledge, with limited gain in application skills. This suggests that while heading in the right direction, we need to conceptualize and structure PBLI training in a way that integrates it throughout the residency program and fosters the application of this knowledge and these skills. PMID:22379523

Pilot study evaluating a practice-based learning and improvement curriculum focusing on the development of system-level quality improvement skills.

PubMed

Tomolo, Anne M; Lawrence, Renée H; Watts, Brook; Augustine, Sarah; Aron, David C; Singh, Mamta K

2011-03-01

We developed a practice-based learning and improvement (PBLI) curriculum to address important gaps in components of content and experiential learning activities through didactics and participation in systems-level quality improvement projects that focus on making changes in health care processes. We evaluated the impact of our curriculum on resident PBLI knowledge, self-efficacy, and application skills. A quasi-experimental design assessed the impact of a curriculum (PBLI quality improvement systems compared with non-PBLI) on internal medicine residents' learning during a 4-week ambulatory block. We measured application skills, self-efficacy, and knowledge by using the Systems Quality Improvement Training and Assessment Tool. Exit evaluations assessed time invested and experiences related to the team projects and suggestions for improving the curriculum. The 2 groups showed differences in change scores. Relative to the comparison group, residents in the PBLI curriculum demonstrated a significant increase in the belief about their ability to implement a continuous quality improvement project (P  =  .020), comfort level in developing data collection plans (P  =  .010), and total knowledge scores (P < .001), after adjusting for prior PBLI experience. Participants in the PBLI curriculum also demonstrated significant improvement in providing a more complete aim statement for a proposed project after adjusting for prior PBLI experience (P  =  .001). Exit evaluations were completed by 96% of PBLI curriculum participants who reported high satisfaction with team performance. Residents in our curriculum showed gains in areas fundamental for PBLI competency. The observed improvements were related to fundamental quality improvement knowledge, with limited gain in application skills. This suggests that while heading in the right direction, we need to conceptualize and structure PBLI training in a way that integrates it throughout the residency program and fosters the application of this knowledge and these skills.

Reexamining the iconic dihadron correlation measurement demonstrating jet quenching

NASA Astrophysics Data System (ADS)

Nattrass, Christine

2018-03-01

Early measurements at the BNL Relativistic Heavy Ion Collider (RHIC) demonstrated jet quenching through the suppression of pairs of high momentum hadrons. These dihadron correlations have a large correlated background. As understanding of the background improved, it was recognized in the field that a significant term was omitted from the background and several dihadron correlation results were quantitatively and qualitatively incorrect. The original measurements demonstrating jet quenching have not been revisited. These measurements are repeated in this paper in a kinematic range similar to the original measurement using publicly available data, applying current knowledge about the background. The new results are qualitatively consistent with the previous results, demonstrating complete suppression of the away side within uncertainties.

Participation in a novel treatment component during residential substance use treatment is associated with improved outcome: a pilot study.

PubMed

Decker, Kathleen P; Peglow, Stephanie L; Samples, Carl R

2014-05-16

A person-centered substance use treatment component, the Natural Recovery Program, was developed. The Natural Recovery Program is comprised of small group therapy combined with pursuit of hobbies. This was a pilot study of the program and was not randomized. A retrospective record review of 643 veterans in an inpatient mental health recovery and rehabilitation program was analyzed to determine if participants of Natural Recovery had a different rate of treatment completion than those who elected to participate in the core program alone. Univariate and multivariate analyses were conducted on: participation in the Natural Recovery Program; co-morbid psychiatric disorders; and legal, medical, and psychiatric issues. Participation in Natural Recovery was significantly associated with successful treatment completion when analyzed by univariate analysis (p = 0.01). Other significant variables associated with successful completion included: no co-morbid psychiatric diagnosis, fewer prior suicide attempts, and no homelessness prior to admission. Binary logistic regression demonstrated that participation in Natural Recovery was associated with improved treatment completion, even when other variables were considered (p = 0.01). Treatment retention was longer for patients who participated in Natural Recovery, even if they did not complete treatment. The Natural Recovery Program was associated with improved outcomes, as measured by treatment retention in the first 60 days and by treatment completion. Participants of Natural Recovery with co-morbid psychiatric disorders completed treatment at a higher rate than those with co-morbid psychiatric disorders who participated in the core program. Patients reported high satisfaction with the program. This program may be a valuable adjunct to residential treatment.

Participation in a novel treatment component during residential substance use treatment is associated with improved outcome: a pilot study

PubMed Central

2014-01-01

Background A person-centered substance use treatment component, the Natural Recovery Program, was developed. The Natural Recovery Program is comprised of small group therapy combined with pursuit of hobbies. Methods This was a pilot study of the program and was not randomized. A retrospective record review of 643 veterans in an inpatient mental health recovery and rehabilitation program was analyzed to determine if participants of Natural Recovery had a different rate of treatment completion than those who elected to participate in the core program alone. Univariate and multivariate analyses were conducted on: participation in the Natural Recovery Program; co-morbid psychiatric disorders; and legal, medical, and psychiatric issues. Results Participation in Natural Recovery was significantly associated with successful treatment completion when analyzed by univariate analysis (p = 0.01). Other significant variables associated with successful completion included: no co-morbid psychiatric diagnosis, fewer prior suicide attempts, and no homelessness prior to admission. Binary logistic regression demonstrated that participation in Natural Recovery was associated with improved treatment completion, even when other variables were considered (p = 0.01). Treatment retention was longer for patients who participated in Natural Recovery, even if they did not complete treatment. Conclusions The Natural Recovery Program was associated with improved outcomes, as measured by treatment retention in the first 60 days and by treatment completion. Participants of Natural Recovery with co-morbid psychiatric disorders completed treatment at a higher rate than those with co-morbid psychiatric disorders who participated in the core program. Patients reported high satisfaction with the program. This program may be a valuable adjunct to residential treatment. PMID:24886745

Cardiac rehabilitation attendance and outcomes in coronary artery disease patients.

PubMed

Martin, Billie-Jean; Hauer, Trina; Arena, Ross; Austford, Leslie D; Galbraith, P Diane; Lewin, Adriane M; Knudtson, Merril L; Ghali, William A; Stone, James A; Aggarwal, Sandeep G

2012-08-07

Cardiac rehabilitation (CR) is an efficacious yet underused treatment for patients with coronary artery disease. The objective of this study was to determine the association between CR completion and mortality and resource use. We conducted a prospective cohort study of 5886 subjects (20.8% female; mean age, 60.6 years) who had undergone angiography and were referred for CR in Calgary, AB, Canada, between 1996 and 2009. Outcomes of interest included freedom from emergency room visits, hospitalization, and survival in CR completers versus noncompleters, adjusted for clinical covariates, treatment strategy, and coronary anatomy. Hazard ratios for events for CR completers versus noncompleters were also constructed. A propensity model was used to match completers to noncompleters on baseline characteristics, and each outcome was compared between propensity-matched groups. Of the subjects referred for CR, 2900 (49.3%) completed the program, and an additional 554 subjects started but did not complete CR. CR completion was associated with a lower risk of death, with an adjusted hazard ratio of 0.59 (95% confidence interval, 0.49-0.70). CR completion was also associated with a decreased risk of all-cause hospitalization (adjusted hazard ratio, 0.77; 95% confidence interval, 0.71-0.84) and cardiac hospitalization (adjusted hazard ratio, 0.68; 95% confidence interval, 0.55-0.83) but not with emergency room visits. Propensity-matched analysis demonstrated a persistent association between CR completion and reduced mortality. Among those coronary artery disease patients referred, CR completion is associated with improved survival and decreased hospitalization. There is a need to explore reasons for nonattendance and to test interventions to improve attendance after referral.

Does Replacing Live Demonstration With Instructional Videos Improve Student Satisfaction and Osteopathic Manipulative Treatment Examination Performance?

PubMed

Seals, Ryan; Gustowski, Sharon M; Kominski, Carol; Li, Feiming

2016-11-01

Instructional videos for osteopathic manipulative treatment (OMT) are a potentially valuable resource for novice learners. To evaluate student experiences and the effectiveness of instructional videos in lieu of live faculty demonstration in a second-year osteopathic manipulative medicine course. Faculty created and produced written instructions and videos for selected Still and facilitated positional release techniques. These materials incorporated curricular design principles and psychomotor skills development strategies. During a second-year OMT skills laboratory session, students used the videos as the primary source for technique demonstration and instruction. Table trainers monitored and assisted students per their request or if errors were observed. Students completed surveys regarding their previous experiences in the OMT skills laboratory sessions (presession survey) and the video-based instructional one (postsession survey). One month after the survey, students were also asked to complete a postexamination survey. Student scores on the skills competency examination were compared with scores from the previous year. Of the 230 students, 162 (70%), 135 (59%), and 86 (37%) responded to the presession, postsession, and postexamination surveys, respectively. The majority of students indicated that the OMT videos helped them feel more prepared (98%) and more confident for their examination (78%), were a valuable addition to learning (97%), and would help increase confidence in using osteopathic manipulative medicine on patients (84%). Two-thirds of students indicated that the videos were superior to faculty demonstration from the stage. Compared with students from the previous year, no statistically significant improvement was noted on the total clinical competency examination scores. The faculty-created videos for teaching OMT techniques did not improve scores on the clinical competency examination but had subjective benefits as part of the OMT laboratory sessions. Instructional videos can serve as an alternative to live demonstration to allow more time in the laboratory for assessment and feedback.

Wave-Rotor-Enhanced Gas Turbine Engine Demonstrator

NASA Technical Reports Server (NTRS)

Welch, Gerard E.; Paxson, Daniel E.; Wilson, Jack; Synder, Philip H.

1999-01-01

The U.S. Army Research Laboratory, NASA Glenn Research Center, and Rolls-Royce Allison are working collaboratively to demonstrate the benefits and viability of a wave-rotor-topped gas turbine engine. The self-cooled wave rotor is predicted to increase the engine overall pressure ratio and peak temperature by 300% and 25 to 30%. respectively, providing substantial improvements in engine efficiency and specific power. Such performance improvements would significantly reduce engine emissions and the fuel logistics trails of armed forces. Progress towards a planned demonstration of a wave-rotor-topped Rolls-Royce Allison model 250 engine has included completion of the preliminary design and layout of the engine, the aerodynamic design of the wave rotor component and prediction of its aerodynamic performance characteristics in on- and off-design operation and during transients, and the aerodynamic design of transition ducts between the wave rotor and the high pressure turbine. The topping cycle increases the burner entry temperature and poses a design challenge to be met in the development of the demonstrator engine.

Characterization of complete particles (VSV-G/SIN-GFP) and empty particles (VSV-G/EMPTY) in human immunodeficiency virus type 1-based lentiviral products for gene therapy: potential applications for improvement of product quality and safety.

PubMed

Zhao, Yuan; Keating, Kenneth; Dolman, Carl; Thorpe, Robin

2008-05-01

Lentiviral vectors persist in the host and are therefore ideally suited for long-term gene therapy. To advance the use of lentiviral vectors in humans, improvement of their production, purification, and characterization has become increasingly important and challenging. In addition to cellular contaminants derived from packaging cells, empty particles without therapeutic function are the major impurities that compromise product safety and efficacy. Removal of empty particles is difficult because of their innate similarity in particle size and protein composition to the complete particles. We propose that comparison of the properties of lentiviral products with those of purposely expressed empty particles may reveal potential differences between empty and complete particles. For this, three forms of recombinant lentiviral samples, that is, recombinant vesicular stomatitis virus glycoprotein (VSV-G) proteins, empty particles (VSV-G/Empty), and complete particles (VSV-G/SIN-GFP) carrying viral RNA, were purified by size-exclusion chromatography (SEC). The SEC-purified samples were further analyzed by immunoblotting with six antibodies to examine viral and cellular proteins associated with the particles. This study has demonstrated, for the first time, important differences between VSV-G/Empty particles and complete VSV-G/SIN-GFP particles. Differences include the processing of Gag protein and the inclusion of cellular proteins in the particles. Our findings support the development of improved production, purification, and characterization methods for lentiviral products.

Amorphous silicon carbide passivating layers for crystalline-silicon-based heterojunction solar cells

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

Boccard, Mathieu; Holman, Zachary C.

Amorphous silicon enables the fabrication of very high-efficiency crystalline-silicon-based solar cells due to its combination of excellent passivation of the crystalline silicon surface and permeability to electrical charges. Yet, amongst other limitations, the passivation it provides degrades upon high-temperature processes, limiting possible post-deposition fabrication possibilities (e.g., forcing the use of low-temperature silver pastes). We investigate the potential use of intrinsic amorphous silicon carbide passivating layers to sidestep this issue. The passivation obtained using device-relevant stacks of intrinsic amorphous silicon carbide with various carbon contents and doped amorphous silicon are evaluated, and their stability upon annealing assessed, amorphous silicon carbide beingmore » shown to surpass amorphous silicon for temperatures above 300 °C. We demonstrate open-circuit voltage values over 700 mV for complete cells, and an improved temperature stability for the open-circuit voltage. Transport of electrons and holes across the hetero-interface is studied with complete cells having amorphous silicon carbide either on the hole-extracting side or on the electron-extracting side, and a better transport of holes than of electrons is shown. Also, due to slightly improved transparency, complete solar cells using an amorphous silicon carbide passivation layer on the hole-collecting side are demonstrated to show slightly better performances even prior to annealing than obtained with a standard amorphous silicon layer.« less

Amorphous silicon carbide passivating layers for crystalline-silicon-based heterojunction solar cells

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

Boccard, Mathieu; Holman, Zachary C.

With this study, amorphous silicon enables the fabrication of very high-efficiency crystalline-silicon-based solar cells due to its combination of excellent passivation of the crystalline silicon surface and permeability to electrical charges. Yet, amongst other limitations, the passivation it provides degrades upon high-temperature processes, limiting possible post-deposition fabrication possibilities (e.g., forcing the use of low-temperature silver pastes). We investigate the potential use of intrinsic amorphous silicon carbide passivating layers to sidestep this issue. The passivation obtained using device-relevant stacks of intrinsic amorphous silicon carbide with various carbon contents and doped amorphous silicon are evaluated, and their stability upon annealing assessed, amorphousmore » silicon carbide being shown to surpass amorphous silicon for temperatures above 300°C. We demonstrate open-circuit voltage values over 700 mV for complete cells, and an improved temperature stability for the open-circuit voltage. Transport of electrons and holes across the hetero-interface is studied with complete cells having amorphous silicon carbide either on the hole-extracting side or on the electron-extracting side, and a better transport of holes than of electrons is shown. Also, due to slightly improved transparency, complete solar cells using an amorphous silicon carbide passivation layer on the hole-collecting side are demonstrated to show slightly better performances even prior to annealing than obtained with a standard amorphous silicon layer.« less

Amorphous silicon carbide passivating layers for crystalline-silicon-based heterojunction solar cells

DOE PAGES

Boccard, Mathieu; Holman, Zachary C.

2015-08-14

With this study, amorphous silicon enables the fabrication of very high-efficiency crystalline-silicon-based solar cells due to its combination of excellent passivation of the crystalline silicon surface and permeability to electrical charges. Yet, amongst other limitations, the passivation it provides degrades upon high-temperature processes, limiting possible post-deposition fabrication possibilities (e.g., forcing the use of low-temperature silver pastes). We investigate the potential use of intrinsic amorphous silicon carbide passivating layers to sidestep this issue. The passivation obtained using device-relevant stacks of intrinsic amorphous silicon carbide with various carbon contents and doped amorphous silicon are evaluated, and their stability upon annealing assessed, amorphousmore » silicon carbide being shown to surpass amorphous silicon for temperatures above 300°C. We demonstrate open-circuit voltage values over 700 mV for complete cells, and an improved temperature stability for the open-circuit voltage. Transport of electrons and holes across the hetero-interface is studied with complete cells having amorphous silicon carbide either on the hole-extracting side or on the electron-extracting side, and a better transport of holes than of electrons is shown. Also, due to slightly improved transparency, complete solar cells using an amorphous silicon carbide passivation layer on the hole-collecting side are demonstrated to show slightly better performances even prior to annealing than obtained with a standard amorphous silicon layer.« less

Hemodynamic changes in systolic and diastolic function during isoproterenol challenge predicts symptomatic response to myectomy in hypertrophic cardiomyopathy with labile obstruction.

PubMed

Prasad, Megha; Geske, Jeffrey B; Sorajja, Paul; Ommen, Steve R; Schaff, Hartzell V; Gersh, Bernard J; Nishimura, Rick A

2016-11-15

We aimed to assess the utility of changes in systolic and diastolic function by isoproterenol challenge in predicting symptom resolution post-myectomy in selected patients with hypertrophic cardiomyopathy (HCM) and labile obstruction. In a subset of symptomatic HCM patients without resting/provocable obstruction on noninvasive assessment, isoproterenol challenge during hemodynamic catheterization may elicit labile left ventricular outflow tract (LVOT) obstruction, and demonstrate the effect of obstruction on diastolic function. These changes may determine whether patients achieve complete symptom resolution post-myectomy. Between February 2003 and April 2009, 18 symptomatic HCM patients without LVOT obstruction on noninvasive testing underwent isoproterenol provocation and septal myectomy due to presence of provocable gradient and were followed for 4 (IQR 3-7) years. Thirteen (72.2%) had complete symptom resolution, while 5 (27.8%) had improved, but persistent symptoms. Those with provoked gradient >100 mm Hg or increase in left atrial pressure (LAP) with isoproterenol had symptom resolution. Symptomatic HCM patients without LVOT gradient on noninvasive testing may demonstrate labile obstruction with isoproterenol. With isoproterenol, patients with high LVOT gradient or increase in LAP concomitant with an increase in gradient achieved complete symptom resolution post-myectomy. Thus, improved diastolic filling as well as outflow gradient production in patients with HCM may predict symptom response to myectomy. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Develop feedback system for intelligent dynamic resource allocation to improve application performance.

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

Gentile, Ann C.; Brandt, James M.; Tucker, Thomas

2011-09-01

This report provides documentation for the completion of the Sandia Level II milestone 'Develop feedback system for intelligent dynamic resource allocation to improve application performance'. This milestone demonstrates the use of a scalable data collection analysis and feedback system that enables insight into how an application is utilizing the hardware resources of a high performance computing (HPC) platform in a lightweight fashion. Further we demonstrate utilizing the same mechanisms used for transporting data for remote analysis and visualization to provide low latency run-time feedback to applications. The ultimate goal of this body of work is performance optimization in the facemore » of the ever increasing size and complexity of HPC systems.« less

Quality evaluation of health information system's architectures developed using the HIS-DF methodology.

PubMed

López, Diego M; Blobel, Bernd; Gonzalez, Carolina

2010-01-01

Requirement analysis, design, implementation, evaluation, use, and maintenance of semantically interoperable Health Information Systems (HIS) have to be based on eHealth standards. HIS-DF is a comprehensive approach for HIS architectural development based on standard information models and vocabulary. The empirical validity of HIS-DF has not been demonstrated so far. Through an empirical experiment, the paper demonstrates that using HIS-DF and HL7 information models, semantic quality of HIS architecture can be improved, compared to architectures developed using traditional RUP process. Semantic quality of the architecture has been measured in terms of model's completeness and validity metrics. The experimental results demonstrated an increased completeness of 14.38% and an increased validity of 16.63% when using the HIS-DF and HL7 information models in a sample HIS development project. Quality assurance of the system architecture in earlier stages of HIS development presumes an increased quality of final HIS systems, which supposes an indirect impact on patient care.

Complete analog control of the carrier-envelope-phase of a high-power laser amplifier.

PubMed

Feng, C; Hergott, J-F; Paul, P-M; Chen, X; Tcherbakoff, O; Comte, M; Gobert, O; Reduzzi, M; Calegari, F; Manzoni, C; Nisoli, M; Sansone, G

2013-10-21

In this work we demonstrate the development of a complete analog feedback loop for the control of the carrier-envelope phase (CEP) of a high-average power (20 W) laser operating at 10 kHz repetition rate. The proposed method combines a detection scheme working on a single-shot basis at the full-repetition-rate of the laser system with a fast actuator based either on an acousto-optic or on an electro-optic crystal. The feedback loop is used to correct the CEP fluctuations introduced by the amplification process demonstrating a CEP residual noise of 320 mrad measured on a single-shot basis. The comparison with a feedback loop operating at a lower sampling rate indicates an improvement up to 45% in the residual noise. The measurement of the CEP drift for different integration times clearly evidences the importance of the single-shot characterization of the residual CEP drift. The demonstrated scheme could be efficiently applied for systems approaching the 100 kHz repetition rate regime.

Evaluation of an audiological rehabilitation program for spouses of people with hearing loss.

PubMed

Preminger, Jill E; Meeks, Suzanne

2010-05-01

Since the psychosocial effects of hearing loss are different in the spouse (SP) than in the person with hearing loss (PHL), it seems reasonable that rehabilitation programs designed for PHLs may need to be adapted to benefit SPs. To evaluate the effectiveness of training in communication strategies and psychosocial exercises for SPs of PHLs by determining whether SPs who completed the group class had improved mood, reduced stress, improved marital communication, and greater awareness of their partners' hearing loss-related quality of life (HL-QOL) in comparison with SPs who did not participate in a group class. Additionally, to determine whether PHLs of SPs who participated in a group audiological rehabilitation (AR) class had significantly improved mood, reduced stress, improved marital communication, and better HL-QOL scores in comparison with PHLs whose SPs did not participate in a group class. A randomized controlled study. A total of 72 individuals participated in the study, 36 PHLs and 36 SPs. The PHLs were hearing aid users or cochlear implant users; the SPs had normal or near normal hearing. PHLs in the control group participated in a traditional group AR program while their SPs received no treatment. PHLs in the experimental group also participated in a traditional group AR program while their SPs participated in a treatment program designed for SPs of PHLs. Classes consisted of 90 min sessions meeting once a week for four weeks. All participants completed questionnaires measuring HL-QOL (the SPs filled out third-party reports of HL-QOL), stress, mood (positive affect and negative affect), and communication in the marriage. Scales were completed three times: prior to the AR program, within two weeks after completing the AR program, and 6 mo later. SP awareness of their PHL's HL-QOL was measured by comparing preclass and 6 mo scores with reported critical difference values. Preclass, postclass and 6 mo data were examined with repeated measures ANOVAs. All SPs reported significant improvements in third-party HL-QOL between the preclass and postclass visit. At the 6 mo visit, these reports remained consistent in the control SPs but declined in the experimental SPs. Awareness of HL-QOL in PHLs was improved in SPs who participated in AR classes and remained consistent in SPs who did not. All SPs demonstrated a trend (moderate effect sizes) for decreased stress and decreased negative affect after they and/or their partners completed the AR program. All PHLs demonstrated significant improvements in HL-QOL, significant reductions in stress, significant decreases in negative affect, and significant improvements in marital communication. There were no differences in outcome across the experimental and control PHLs. When PHLs participate in an AR program, they receive significant improvements in QOL (quality of life). Congruence (as defined by similar scores) between SP and PHL assessments of HL-QOL improved in the experimental group, suggesting that the principal impact of the AR program on SPs was improved understanding of PHL experiences with hearing loss. American Academy of Audiology.

Ethnic Favoritism in Primary Education in Kenya: Effects of Coethnicity with the President

ERIC Educational Resources Information Center

Li, Jia

2018-01-01

This study measures the effect of ethnic favoritism on primary education using data from the Kenya Demographic and Health Survey. In line with previous studies, this study confirms that having a coethnic president is expected to improve the likelihood of completing primary education. This study demonstrates that ethnic favoritism operates at the…

Effectiveness of a caregiver education program on providing oral care to individuals with intellectual and developmental disabilities.

PubMed

Fickert, Nancy A; Ross, Diana

2012-06-01

Caregivers who work in community living arrangements or intermediate care facilities are responsible for the oral hygiene of individuals with intellectual and developmental disabilities. Oral hygiene training programs do not exist in many organizations, despite concerns about the oral care of this population. The purpose of this study was to determine the effectiveness of a caregiver educational program. This study used a quasi-experimental one-group pretest/posttest design with repeated measures to describe the outcomes of an educational program. Program participants demonstrated oral hygiene skills on each other while being scored by a trained observer, after which they completed an oral hygiene compliance survey. After three months, a follow-up included the same posttest, demonstration of oral hygiene skills, and repeat of the compliance survey. Paired-sample t-tests of oral hygiene knowledge showed a statistically significant improvement from pretest to posttest and from pretest to three-month posttest. Oral hygiene skills and compliance improved. Results demonstrate evidence that caregiver education improves knowledge, skill, and compliance in oral hygiene. Further studies are required to demonstrate the value of providing oral hygiene education and training for caregivers of individuals with intellectual and developmental disabilities.

The Feasibility and Potential Impact of Brain Training Games on Cognitive and Emotional Functioning in Middle-Aged Adults.

PubMed

McLaughlin, Paula M; Curtis, Ashley F; Branscombe-Caird, Laura M; Comrie, Janna K; Murtha, Susan J E

2018-02-01

To investigate whether a commercially available brain training program is feasible to use with a middle-aged population and has a potential impact on cognition and emotional well-being (proof of concept). Fourteen participants (ages 46-55) completed two 6-week training conditions using a crossover (counterbalanced) design: (1) experimental brain training condition and (2) active control "find answers to trivia questions online" condition. A comprehensive neurocognitive battery and a self-report measure of depression and anxiety were administered at baseline (first time point, before training) and after completing each training condition (second time point at 6 weeks, and third time point at 12 weeks). Cognitive composite scores were calculated for participants at each time point. Study completion and protocol adherence demonstrated good feasibility of this brain training protocol in healthy middle-aged adults. Exploratory analyses suggested that brain training was associated with neurocognitive improvements related to executive attention, as well as improvements in mood. Overall, our findings suggest that brain training programs are feasible in middle-aged cohorts. We propose that brain training games may be linked to improvements in executive attention and affect by promoting cognitive self-efficacy in middle-aged adults.

Women with provoked vestibulodynia experience clinically significant reductions in pain regardless of treatment: results from a 2-year follow-up study.

PubMed

Davis, Seth N P; Bergeron, Sophie; Binik, Yitzchak M; Lambert, Bernard

2013-12-01

Provoked vestibulodynia (PVD) is a prevalent genital pain syndrome that has been assumed to be chronic, with little spontaneous remission. Despite this assumption, there is a dearth of empirical evidence regarding the progression of PVD in a natural setting. Although many treatments are available, there is no single treatment that has demonstrated efficacy above others. The aims of this secondary analysis of a prospective study were to (i) assess changes over a 2-year period in pain, depressive symptoms, and sexual outcomes in women with PVD; and (ii) examine changes based on treatment(s) type. Participants completed questionnaire packages at Time 1 and a follow-up package 2 years later. Visual analog scale of genital pain, Global Measure of Sexual Satisfaction, Female Sexual Function Index, Beck Depression Inventory, Dyadic Adjustment Scale, and sexual intercourse attempts over the past month. Two hundred thirty-nine women with PVD completed both time one and two questionnaires. For the sample as a whole, there was significant improvement over 2 years on pain ratings, sexual satisfaction, sexual function, and depressive symptoms. The most commonly received treatments were physical therapy, sex/psychotherapy, and medical treatment, although 41.0% did not undergo any treatment. Women receiving no treatment also improved significantly on pain ratings. No single treatment type predicted better outcome for any variable except depressive symptoms, in which women who underwent surgery were more likely to improve. These results suggest that PVD may significantly reduce in severity over time. Participants demonstrated clinically significant pain improvement, even when they did not receive treatment. Furthermore, the only single treatment type predicting better outcomes was surgery, and only for depressive symptoms, accounting for only 2.3% of the variance. These data do not demonstrate the superiority of any one treatment and underscore the need to have control groups in PVD treatment trials, otherwise improvements may simply be the result of natural progression. © 2013 International Society for Sexual Medicine.

Training Rapid Stepping Responses in an Individual With Stroke

PubMed Central

Inness, Elizabeth L.; Komar, Janice; Biasin, Louis; Brunton, Karen; Lakhani, Bimal; McIlroy, William E.

2011-01-01

Background and Purpose Compensatory stepping reactions are important responses to prevent a fall following a postural perturbation. People with hemiparesis following a stroke show delayed initiation and execution of stepping reactions and often are found to be unable to initiate these steps with the more-affected limb. This case report describes a targeted training program involving repeated postural perturbations to improve control of compensatory stepping in an individual with stroke. Case Description Compensatory stepping reactions of a 68-year-old man were examined 52 days after left hemorrhagic stroke. He required assistance to prevent a fall in all trials administered during his initial examination because he showed weight-bearing asymmetry (with more weight borne on the more-affected right side), was unable to initiate stepping with the right leg (despite blocking of the left leg in some trials), and demonstrated delayed response times. The patient completed 6 perturbation training sessions (30–60 minutes per session) that aimed to improve preperturbation weight-bearing symmetry, to encourage stepping with the right limb, and to reduce step initiation and completion times. Outcomes Improved efficacy of compensatory stepping reactions with training and reduced reliance on assistance to prevent falling were observed. Improvements were noted in preperturbation asymmetry and step timing. Blocking the left foot was effective in encouraging stepping with the more-affected right foot. Discussion This case report demonstrates potential short-term adaptations in compensatory stepping reactions following perturbation training in an individual with stroke. Future work should investigate the links between improved compensatory step characteristics and fall risk in this vulnerable population. PMID:21511992

Emergency Preparedness Education for Nurses: Core Competency Familiarity Measured Utilizing an Adapted Emergency Preparedness Information Questionnaire.

PubMed

Georgino, Madeline M; Kress, Terri; Alexander, Sheila; Beach, Michael

2015-01-01

The purpose of this project was to measure trauma nurse improvement in familiarity with emergency preparedness and disaster response core competencies as originally defined by the Emergency Preparedness Information Questionnaire after a focused educational program. An adapted version of the Emergency Preparedness Information Questionnaire was utilized to measure familiarity of nurses with core competencies pertinent to first responder capabilities. This project utilized a pre- and postsurvey descriptive design and integrated education sessions into the preexisting, mandatory "Trauma Nurse Course" at large, level I trauma center. A total of 63 nurses completed the intervention during May and September 2014 sessions. Overall, all 8 competencies demonstrated significant (P < .001; 98% confidence interval) improvements in familiarity. In conclusion, this pilot quality improvement project demonstrated a unique approach to educating nurses to be more ready and comfortable when treating victims of a disaster.

Conjugated polyelectrolyte hole transport layer for inverted-type perovskite solar cells

PubMed Central

Choi, Hyosung; Mai, Cheng-Kang; Kim, Hak-Beom; Jeong, Jaeki; Song, Seyeong; Bazan, Guillermo C.; Kim, Jin Young; Heeger, Alan J.

2015-01-01

Organic–inorganic hybrid perovskite materials offer the potential for realization of low-cost and flexible next-generation solar cells fabricated by low-temperature solution processing. Although efficiencies of perovskite solar cells have dramatically improved up to 19% within the past 5 years, there is still considerable room for further improvement in device efficiency and stability through development of novel materials and device architectures. Here we demonstrate that inverted-type perovskite solar cells with pH-neutral and low-temperature solution-processable conjugated polyelectrolyte as the hole transport layer (instead of acidic PEDOT:PSS) exhibit a device efficiency of over 12% and improved device stability in air. As an alternative to PEDOT:PSS, this work is the first report on the use of an organic hole transport material that enables the formation of uniform perovskite films with complete surface coverage and the demonstration of efficient, stable perovskite/fullerene planar heterojunction solar cells. PMID:26081865

Jason 1 Investigation: Altimetric Studies of Ocean Tidal Dynamics

NASA Technical Reports Server (NTRS)

Egbert, Gary D.

2004-01-01

Two papers on tidal dissipation were completed and published. The first of these extended our earlier work, which focused on the dominant M2 constituent, to include 7 additional constituents. In addition to confirming a total deep water dissipation total very close to 1 TW, this study demonstrated significant differences in the distribution of dissipation between diurnal and semi-diurnal constituents. The second paper involved an extensive modeling study of tides in the present day and the last glacial maximum. In this study we showed that accuracy of tidal solutions for the present day Ocean were significantly improved by including a parameterization of internal tide drag over rough topography in the deep ocean. It was also demonstrated that a complete self-consistent treatment of Ocean self attraction and tidal loading was required for accurate solutions.

Structured training on the da Vinci Skills Simulator leads to improvement in technical performance of robotic novices.

PubMed

Walliczek-Dworschak, U; Mandapathil, M; Förtsch, A; Teymoortash, A; Dworschak, P; Werner, J A; Güldner, C

2017-02-01

The increasing use of minimally invasive techniques such as robotic-assisted devices raises the question of how to acquire robotic surgery skills. The da Vinci Skills Simulator has been demonstrated to be an effective training tool in previous reports. To date, little data are available on how to acquire proficiency through simulator training. We investigated the outcome of a structured training programme for robotic surgical skills by robotic novices. This prospective study was conducted from January to December 2013 using the da Vinci Skills Simulator. Twenty participants, all robotic novices, were enrolled in a 4-week training curriculum. After a brief introduction to the simulator system, three consecutive repetitions of five selected exercises (Match Board 1, 2, 3 and Ring and Rail 1, 2) were performed in a defined order on days 1, 8, 15 and 22. On day 22, one repetition of a previously unpractised more advanced module (Needle Targeting) was also performed. After completion of each study day, the overall performance, time to completion, economy in motion, instrument collisions, excessive instrument force, instruments out of view, master workspace range and number of drops were analysed. Comparing the first and final repetition, overall score and time needed to complete all exercises, economy of motion and instrument collisions were significantly improved in nearly all exercises. Regarding the new exercise, a positive training effect could be demonstrated. While its overall entry score was significantly higher, the time to completion and economy of motion were significantly lower than the scores on the first repetition of the previous 5 exercises. It could be shown that training on the da Vinci Skills Simulator led to an improvement in technical performance of robotic novices. With regard to a new exercise, the training had a positive effect on the technical performance. © 2016 John Wiley & Sons Ltd.

Finding Nemo: hybrid assembly with Oxford Nanopore and Illumina reads greatly improves the clownfish (Amphiprion ocellaris) genome assembly

PubMed Central

Austin, Christopher M; Hammer, Michael P; Lee, Yin Peng; Gan, Han Ming

2018-01-01

Abstract Background Some of the most widely recognized coral reef fishes are clownfish or anemonefish, members of the family Pomacentridae (subfamily: Amphiprioninae). They are popular aquarium species due to their bright colours, adaptability to captivity, and fascinating behavior. Their breeding biology (sequential hermaphrodites) and symbiotic mutualism with sea anemones have attracted much scientific interest. Moreover, there are some curious geographic-based phenotypes that warrant investigation. Leveraging on the advancement in Nanopore long read technology, we report the first hybrid assembly of the clown anemonefish (Amphiprion ocellaris) genome utilizing Illumina and Nanopore reads, further demonstrating the substantial impact of modest long read sequencing data sets on improving genome assembly statistics. Results We generated 43 Gb of short Illumina reads and 9 Gb of long Nanopore reads, representing approximate genome coverage of 54× and 11×, respectively, based on the range of estimated k-mer-predicted genome sizes of between 791 and 967 Mbp. The final assembled genome is contained in 6404 scaffolds with an accumulated length of 880 Mb (96.3% BUSCO-calculated genome completeness). Compared with the Illumina-only assembly, the hybrid approach generated 94% fewer scaffolds with an 18-fold increase in N50 length (401 kb) and increased the genome completeness by an additional 16%. A total of 27 240 high-quality protein-coding genes were predicted from the clown anemonefish, 26 211 (96%) of which were annotated functionally with information from either sequence homology or protein signature searches. Conclusions We present the first genome of any anemonefish and demonstrate the value of low coverage (∼11×) long Nanopore read sequencing in improving both genome assembly contiguity and completeness. The near-complete assembly of the A. ocellaris genome will be an invaluable molecular resource for supporting a range of genetic, genomic, and phylogenetic studies specifically for clownfish and more generally for other related fish species of the family Pomacentridae. PMID:29342277

Finding Nemo: hybrid assembly with Oxford Nanopore and Illumina reads greatly improves the clownfish (Amphiprion ocellaris) genome assembly.

PubMed

Tan, Mun Hua; Austin, Christopher M; Hammer, Michael P; Lee, Yin Peng; Croft, Laurence J; Gan, Han Ming

2018-03-01

Some of the most widely recognized coral reef fishes are clownfish or anemonefish, members of the family Pomacentridae (subfamily: Amphiprioninae). They are popular aquarium species due to their bright colours, adaptability to captivity, and fascinating behavior. Their breeding biology (sequential hermaphrodites) and symbiotic mutualism with sea anemones have attracted much scientific interest. Moreover, there are some curious geographic-based phenotypes that warrant investigation. Leveraging on the advancement in Nanopore long read technology, we report the first hybrid assembly of the clown anemonefish (Amphiprion ocellaris) genome utilizing Illumina and Nanopore reads, further demonstrating the substantial impact of modest long read sequencing data sets on improving genome assembly statistics. We generated 43 Gb of short Illumina reads and 9 Gb of long Nanopore reads, representing approximate genome coverage of 54× and 11×, respectively, based on the range of estimated k-mer-predicted genome sizes of between 791 and 967 Mbp. The final assembled genome is contained in 6404 scaffolds with an accumulated length of 880 Mb (96.3% BUSCO-calculated genome completeness). Compared with the Illumina-only assembly, the hybrid approach generated 94% fewer scaffolds with an 18-fold increase in N50 length (401 kb) and increased the genome completeness by an additional 16%. A total of 27 240 high-quality protein-coding genes were predicted from the clown anemonefish, 26 211 (96%) of which were annotated functionally with information from either sequence homology or protein signature searches. We present the first genome of any anemonefish and demonstrate the value of low coverage (∼11×) long Nanopore read sequencing in improving both genome assembly contiguity and completeness. The near-complete assembly of the A. ocellaris genome will be an invaluable molecular resource for supporting a range of genetic, genomic, and phylogenetic studies specifically for clownfish and more generally for other related fish species of the family Pomacentridae.

Test-Enhanced E-Learning Strategies in Postgraduate Medical Education: A Randomized Cohort Study.

PubMed

DelSignore, Lisa A; Wolbrink, Traci A; Zurakowski, David; Burns, Jeffrey P

2016-11-21

The optimal design of pedagogical strategies for e-learning in graduate and postgraduate medical education remains to be determined. Video-based e-learning use is increasing, with initial research suggesting that taking short breaks while watching videos (independent of answering test questions) may improve learning by focusing attention on the content presented. Interspersed test questions may also improve knowledge acquisition and retention. To examine the effect of interspersed test questions and periodic breaks on immediate knowledge acquisition and retention at 6 months by pediatric residents engaged in video-based e-learning. First- and second-year pediatric residents were randomized to 1 of the following 3 groups: viewing the complete video uninterrupted (full video), viewing the video interrupted with unrelated logic puzzles (logic puzzles), or viewing the video interrupted with brief comprehension test questions (short answer questions). Residents answered pre- and post-tests before and after video viewing, followed by a retention test at 6 months. Primary outcome included comparison of the change in test scores between groups. A total of 49 residents completed the initial testing session. All 3 learning groups had comparable mean increases in immediate knowledge gain, but with no significant differences between groups (F 2,46 =0.35, P=.71). Thirty-five residents completed retention testing with comparable degrees of knowledge retention in the full video and short answer test questions groups (P<.001), but no significant change in the logic puzzles group (F 1,32 =2.44, P=.13). Improved knowledge gain was not demonstrated among residents answering interspersed questions or completing logic puzzles during interrupted online video viewing when compared with residents viewing uninterrupted video content. However, residents who either participated in uninterrupted video viewing or answered interspersed questions during interrupted video viewing demonstrated significant knowledge retention at 6 months. ©Lisa A DelSignore, Traci A Wolbrink, David Zurakowski, Jeffrey P Burns. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.11.2016.

Improving ECG Competence in Medical Trainees in a UK District General Hospital

PubMed Central

McAloon, Christopher; Leach, Helen; Gill, Simrat; Aluwalia, Arun; Trevelyan, Jasper

2014-01-01

Background Competency in electrocardiogram (ECG) interpretation is central to undergraduate and postgraduate clinical training. Studies have demonstrated ECGs are interpreted sub-optimally. Our study compares the effectiveness of two learning strategies to improve competence and confidence. Method A 1-month prospective randomized study compared the strategies in two cohorts: undergraduate third year medical students and postgraduate foundation year one (FY1) doctors. Both had blinded randomization to one of these learning strategies: focused teaching program (FTP) and self-directed learning (SDL). All volunteers completed a confidence questionnaire before and after allocation learning strategy and an ECG recognition multiple choice question (MCQ) paper at the end of the learning period. Results The FTP group of undergraduates demonstrated a significant difference in successfully interpreting “ventricular tachycardia” (P = 0.046) and “narrow complex tachycardia” (P = 0.009) than the SDL group. Participant confidence increased in both learning strategies. FTP confidence demonstrated a greater improvement than SDL for both cohorts. Conclusion A dedicated teaching program can improve trainee confidence and competence in ECG interpretation. A larger benefit is observed in undergraduates and those undertaking a FTP. PMID:28392875

Strength training for a child with suspected developmental coordination disorder.

PubMed

Menz, Stacy M; Hatten, Kristin; Grant-Beuttler, Marybeth

2013-01-01

Children with developmental coordination disorder (DCD) demonstrate difficulty with feedforward motor control and use varied compensatory strategies. To examine gross motor function changes following strength training in a child with motor control difficulties. A girl aged 6 years 11 months, with apraxia and hypotonia, and demonstrating motor delays consistent with DCD. Twenty-four strength training sessions were completed using a universal exercise unit. Postintervention scores significantly improved on the Bruininks-Oseretsky test of motor proficiency, second edition, and the Canadian occupational performance measure scores and raised the developmental coordination disorder questionnaire, revised 2007, scores above the range where DCD is suspected. Nonsignificant changes in strength were observed. Improved function and significant gains in manual coordination were observed following blocked practice of isolated, simple joint movements during strength training. Improved motor skills may be because of effective use of feedforward control and improved stabilization. Strength training does not rehearse skills using momentum, explaining nonsignificant changes in locomotor or locomotion areas.

Patient Demonstration Videos in Predoctoral Endodontic Education: Aspects Perceived as Beneficial by Students.

PubMed

Edrees, Hadeel Y; Ohlin, Johan; Ahlquist, Michael; Tessma, Mesfin K; Zary, Nabil

2015-08-01

The aim of this study was to assess the perceived benefits of video-mediated demonstrations in learning endodontics. Participants in the study were 75 third-year students enrolled in the undergraduate dentistry program at Karolinska Institute, Stockholm, Sweden. After the endodontic preclinical course, the students were introduced to the treatment protocol in the clinic by watching two live patient-demonstrated videos. The first video demonstrated how to communicate with the patient and perform diagnosis and root canal instrumentation. The second video illustrated how to perform bacterial sampling and root canal filling. After the students watched each video, a questionnaire was used to evaluate their opinions about various steps of the endodontic treatment protocol and the benefit of such educational material for their practice. Of the total 75 students, 72 completed the first questionnaire (96% response rate), and 65 completed the second questionnaire (87% response rate). The results showed that the students perceived high value in the video demonstrations related to treatment procedure. A statistically significant difference was observed between the perceived benefits of the first and second sessions in communication and treatment procedure (p<0.001). Further studies are needed to assess improvement in the design and delivery format for video demonstrations to enhance their effectiveness as a teaching modality for endodontics.

Self-assessment and goal-setting is associated with an improvement in interviewing skills

PubMed Central

Hanley, Kathleen; Zabar, Sondra; Charap, Joseph; Nicholson, Joseph; Disney, Lindsey; Kalet, Adina; Gillespie, Colleen

2014-01-01

Purpose Describe the relationship between medical students’ self-assessment and goal-setting (SAGS) skills and development of interviewing skills during the first-year doctoring course. Method 157 first-year medical students completed three two-case standardized patient (SP) interviews. After each of the first two, students viewed videotapes of their interview, completed a SAGS worksheet, and reviewed a selected tape segment in a seminar. SAGS was categorized into good and poor quality and interviewing skills were rated by trained raters. Results SAGS improved over time (37% good week 1 vs. 61% good week 10). Baseline SAGS and interviewing skills were not associated. Initial SAGS quality was associated with change in interviewing skills – those with poor-quality SAGS demonstrated a decrease and those with good-quality SAGS demonstrated an increase in scores by 17 weeks (ANOVA F=4.16, p=0.024). For students whose SAGS skills were good at both week 1 and 10, interviewing skills declined in weeks 1–10 and then increased significantly at week 17. For those whose SAGS remained ‘poor’ in weeks 1–10, interviewing skills declined in weeks 10–17. Conclusions In general, the quality of students’ SAGS improved over time. Poor baseline SAGS skills and failure to improve were associated with a decrease in interviewing skills at 17 weeks. For students with better SAGS, interviewing skills increased at week 17. Improvement in SAGS skills was not associated with improved interviewing skills. Understanding structured self-assessment skills helps identify student characteristics that influence progressive mastery of communication skills and therefore may inform curriculum and remediation tailoring. PMID:25059835

Optical coherence tomography findings of bilateral foveal leukemic infiltration.

PubMed

Le, John Q; Braich, Puneet S; Brar, Vikram S

2016-01-01

We report a case of a 59-year-old man with a history of atypical chronic myelogenous leukemia who presented with a several-week history of decreased vision in both eyes. His clinical examination revealed bilateral foveal infiltration, which was also demonstrated on optical coherence tomography. After a failed induction with imatinib (Gleevec(®)), he was treated with omacetaxine (Synribo(®)) with an appropriate hematologic response. As his leukemia improved with chemotherapy, his retinal lesions regressed as demonstrated by serial optical coherence tomography and fundus photographs, with near complete restoration of foveal architecture.

Evaluation of a seven state criminal history screening pilot program for long-term care workers.

PubMed

Radcliff, Tiffany A; White, Alan; West, David R; Hurd, Donna; Côté, Murray J

2013-01-01

This article summarizes results from an evaluation of a federally sponsored criminal history screening (CHS) pilot program to improve screening for workers in long-term care settings. The evaluation addressed eight key issues specified through enabling legislation, including efficiency, costs, and outcomes of screening procedures. Of the 204,339 completed screenings, 3.7% were disqualified due to criminal history, and 18.8% were withdrawn prior to completion for reasons that may include relevant criminal history. Lessons learned from the pilot program experiences may inform a new national background check demonstration program.

A complete audit cycle of management of third/fourth degree perineal tears.

PubMed

Panigrahy, R; Welsh, J; MacKenzie, F; Owen, P

2008-04-01

We present a complete audit cycle of the management of third/fourth degree perineal tears in the three Glasgow maternity hospitals measured against the recommendations of the Royal College of Obstetricians and Gynaecologists (RCOG) Guideline No. 29 (www.rcog.org.uk). Following an initial 6-month data collection period, shortcomings in the practice were identified, circulated and an operative proforma was designed and introduced. A re-audit demonstrated improved compliance with the RCOG guidelines. We recommend the introduction of an operative proforma to aid management and documentation of third/fourth degree tear repairs.

Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms.

PubMed

Gerber, G S; Zagaja, G P; Bales, G T; Chodak, G W; Contreras, B A

1998-06-01

To assess the effects of saw palmetto on voiding symptoms and urodynamic parameters in men with lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH). Fifty men with previously untreated LUTS and a minimum International Prostate Symptom Score (IPSS) of 10 or greater were treated with a commercially available form of saw palmetto (160 mg twice per day) for 6 months. The initial evaluation included measurement of peak urinary flow rate, postvoid residual urine volume, pressure-flow study, and serum prostate-specific antigen (PSA) level. Patients completed an IPSS, serum PSA was determined, and flow rate was measured every 2 months during the course of the study. A urodynamic evaluation was repeated at the completion of the 6-month trial. The mean IPSS (+/-SD) improved from 19.5+/-5.5 to 12.5+/-7.0 (P <0.001) among the 46 men who completed the study. Significant improvement in the symptom score was noted after treatment with saw palmetto for 2 months. An improvement in symptom score of 50% or greater after treatment with saw palmetto for 2, 4, and 6 months was noted in 21% (10 of 48), 30% (14 of 47), and 46% (21 of 46) of patients, respectively. There was no significant change in peak urinary flow rate, postvoid residual urine volume, or detrusor pressure at peak flow among patients completing the study. No significant change in mean serum PSA level was noted. Saw palmetto is a well-tolerated agent that may significantly improve lower urinary tract symptoms in men with BPH. However, we were unable to demonstrate any significant improvement in objective measures of bladder outlet obstruction. Placebo-controlled trials of saw palmetto are needed to evaluate the true effectiveness of this compound.

Impact of total hip arthroplasty on pain, walking ability, and cardiovascular fitness.

PubMed

Horstmann, Thomas; Vornholt-Koch, Sandra; Brauner, Torsten; Grau, Stefan; Mündermann, Annegret

2012-12-01

We tested the hypothesis that total hip arthroplasty (THA) patients have less pain and are able to walk longer post-operatively than pre-operatively, and that THA patients before and after have higher heart rates and compromised gas exchange determinants at rest and following exercise compared to healthy subjects with a post-operative improvement. Fifty-two patients completed questionnaires and an incremental walking stress test pre-operatively and 6-months after THA. Twenty-four age-matched control subjects completed the same stress test. Fifty-one patients had less pain 6-months after THA compared to pre-operative levels. Forty-three patients showed an improvement of at least one walking duration category. Patients had compromised cardiovascular fitness compared to the control group with a tendency to improve after THA. Hence, 6-months following THA, deficits exist other than reduced strength as reported in the literature. Prior to THA, the ability to walk longer is compromised by pain and not by poor cardiovascular fitness. Studies on specific rehabilitation programs of varying intensities may demonstrate opportunities to improve the cardiovascular fitness of this population. Copyright © 2012 Orthopaedic Research Society.

Augmenting cognitive processing therapy to improve sleep impairment in PTSD: A randomized controlled trial.

PubMed

Galovski, Tara E; Harik, Juliette M; Blain, Leah M; Elwood, Lisa; Gloth, Chelsea; Fletcher, Thomas D

2016-02-01

Despite the success of empirically supported treatments for posttraumatic stress disorder (PTSD), sleep impairment frequently remains refractory after treatment. This single-site, randomized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD (cognitive processing therapy [CPT]). Participants completed either 3 weeks of hypnosis (n = 52) or a symptom monitoring control condition (n = 56) before beginning standard CPT. Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis resulted in improvements in sleep, PTSD, and depression. An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT. After the initial phase of treatment (hypnosis or symptom monitoring), the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression, but not PTSD. After CPT, both conditions demonstrated significant improvement in sleep and PTSD; however, the hypnosis condition demonstrated greater improvement in depressive symptoms. As sleep improved, there were corresponding improvements in PTSD and depression, with a stronger relationship between sleep and PTSD. Hypnosis was effective in improving sleep impairment, but those improvements did not augment gains in PTSD recovery during the trauma-focused intervention. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Can We Get Faculty Interviewers on the Same Page? An Examination of a Structured Interview Course for Surgeons.

PubMed

Gardner, Aimee K; D'Onofrio, Brenna C; Dunkin, Brian J

Guidance on how to train faculty to conduct structured interviews and implement them into current screening processes is lacking. The goal of this study is to describe a structured interview training program designed specifically for surgeons and examine its effectiveness. Faculty involved in advanced surgical fellowship interviews completed a 20-item knowledge assessment and video-based applicant interview ratings before taking a half-day course on conducting structured interviews. The course consisted of evidence-based strategies and methods for conducting structured interviews, asking questions, and rating applicants in a highly interactive format. After the course, faculty again completed the knowledge assessment and provided ratings for 3 video-based applicant interviews. All faculty members (N = 5) responsible for selecting fellows in minimally invasive and bariatric surgery completed the training. Faculty had an average of 15.8 ± 9.12 years in practice. Average performance on the precourse knowledge assessment was 35% ± 6.12% and the group was unable to achieve acceptable agreement for applicant interview scores for any of the competencies assessed. After the course, faculty demonstrated significant improvements (p < 0.01) on the knowledge assessment, more than doubling their scores on the pretest with average scores of 80% ± 9.35%. Faculty also improved their interrater agreement of applicant competency, with 80% of the applicant interview ratings within 2 points of each other. Implementation of a half-day course designed to teach principles and skills around structured interviewing and assessment demonstrated significant improvements in both interviewing knowledge and interrater agreement. These findings support the time and resources required to develop and implement a structured interview training program for surgeons for the postgraduate admissions process. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Retention of movement pattern changes after a lower extremity injury prevention program is affected by program duration.

PubMed

Padua, Darin A; DiStefano, Lindsay J; Marshall, Stephen W; Beutler, Anthony I; de la Motte, Sarah J; DiStefano, Michael J

2012-02-01

Changes in movement patterns have been repeatedly observed immediately after completing a lower extremity injury prevention program. However, it is not known if movement pattern changes are maintained after discontinuing the training program. The ability to maintain movement pattern changes after training has ceased may be influenced by the program's duration. The authors hypothesized that among individuals who completed either a 3-month or 9-month training program and who demonstrated immediate movement pattern changes, only those who completed the 9-month training program would maintain movement pattern changes after a 3-month period of no longer performing the exercises. Cohort study; Level of evidence, 2. A total of 140 youth soccer athletes from 15 separate teams volunteered to participate. Athletes' movement patterns were assessed using the Landing Error Scoring System (LESS) at pretest, posttest, and 3 months after ceasing the program (retention test). Eighty-four of the original 140 participants demonstrated improvements in their LESS scores between pretest and posttest (change in LESS score >0) and were included in the final analyses for this study (n = 84; 20 boys and 64 girls; mean age, 14 ± 2 years; age range, 11-17 years). Teams performed 3-month (short-duration group) and 9-month (extended-duration group) injury prevention programs. The exercises performed were identical for both groups. Teams performed the programs as part of their normal warm-up routine. Although both groups improved their total LESS scores from pretest to posttest, only the extended-duration training group retained their improvements 3 months after ceasing the injury prevention program (F(2,137) = 3.38; P = .04). Results suggest that training duration may be an important factor to consider when designing injury prevention programs that facilitate long-term changes in movement control.

Incorporating hypertensive patient education on salt intake into an introductory pharmacy practice experience.

PubMed

Garza, Kimberly B; Westrick, Salisa C; Teeter, Benjamin S; Stevenson, T Lynn

2013-11-12

To evaluate the impact of the Salt Education Program for hypertensive adults on student pharmacists' knowledge, behaviors, and attitudes regarding sodium consumption. As part of the introductory pharmacy practice experience program in community pharmacies, student pharmacists assessed patients' sodium intake knowledge and behaviors, taught them how to read nutrition labels, and obtained information about their hypertensive conditions. Students completed pre-and post-intervention questionnaires in April and August 2012, respectively. One hundred thirty student pharmacists (70% female, 78% white) completed pre- and post-intervention questionnaires. Students demonstrated significant improvements in knowledge scores (p<0.001) and perceived benefit of a low-salt diet (p=0.004). Further, there were significant improvements in the self-reported frequency of looking at sodium content of foods when shopping (p<0.001) and purchasing low-salt foods (p=0.004). Changes in students' knowledge, behaviors, and attitudes after participating in the Salt Education program suggested that the program was effective in improving student knowledge, behaviors, and attitudes.

An improved UHPLC-UV method for separation and quantification of carotenoids in vegetable crops.

PubMed

Maurer, Megan M; Mein, Jonathan R; Chaudhuri, Swapan K; Constant, Howard L

2014-12-15

Carotenoid identification and quantitation is critical for the development of improved nutrition plant varieties. Industrial analysis of carotenoids is typically carried out on multiple crops with potentially thousands of samples per crop, placing critical needs on speed and broad utility of the analytical methods. Current chromatographic methods for carotenoid analysis have had limited industrial application due to their low throughput, requiring up to 60 min for complete separation of all compounds. We have developed an improved UHPLC-UV method that resolves all major carotenoids found in broccoli (Brassica oleracea L. var. italica), carrot (Daucus carota), corn (Zea mays), and tomato (Solanum lycopersicum). The chromatographic method is completed in 13.5 min allowing for the resolution of the 11 carotenoids of interest, including the structural isomers lutein/zeaxanthin and α-/β-carotene. Additional minor carotenoids have also been separated and identified with this method, demonstrating the utility of this method across major commercial food crops. Copyright © 2014 Elsevier Ltd. All rights reserved.

Large area silicon sheet by EFG

NASA Technical Reports Server (NTRS)

1981-01-01

Progress was made in improving ribbon flatness and reducing stress, and in raising cell performance for 10 cm wide ribbon grown in single cartridge EFG furnaces. Optimization of growth conditions resulted in improved ribbon thickness uniformity at a thickness of 200 micron, grown at 4 cm/minute, and growth at this target speed is routinely achieved over periods of the order of one hour or more. With the improved ribbon flatness, fabrication of large area (50 cm2) cells is now possible, and 10 to 11% efficiencies were demonstrated on ribbon grown at 3.5 to 4 cm/minute. Factors limiting performance of the existing multiple ribbon furnace were identified, and growth system improvements implemented to help raise throughput rates and the time percentage of simultaneous three-ribbon growth. However, it is evident that major redesign of this furnace would be needed to overcome shortfalls in its ability to achieve the Technical Features Demonstration goals of 1980. It was decided to start construction of a new multiple ribbon furnace and to incorporate the desired improvements into its design. The construction of this furnace is completed.

Reexamining the iconic dihadron correlation measurement demonstrating jet quenching

DOE PAGES

Nattrass, Christine

2018-03-28

We report that early measurements at the BNL Relativistic Heavy Ion Collider (RHIC) demonstrated jet quenching through the suppression of pairs of high momentum hadrons. These dihadron correlations have a large correlated background. As understanding of the background improved, it was recognized in the field that a significant term was omitted from the background and several dihadron correlation results were quantitatively and qualitatively incorrect. The original measurements demonstrating jet quenching have not been revisited. These measurements are repeated in this paper in a kinematic range similar to the original measurement using publicly available data, applying current knowledge about the background.more » Finally, the new results are qualitatively consistent with the previous results, demonstrating complete suppression of the away side within uncertainties.« less

Reexamining the iconic dihadron correlation measurement demonstrating jet quenching

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

Nattrass, Christine

We report that early measurements at the BNL Relativistic Heavy Ion Collider (RHIC) demonstrated jet quenching through the suppression of pairs of high momentum hadrons. These dihadron correlations have a large correlated background. As understanding of the background improved, it was recognized in the field that a significant term was omitted from the background and several dihadron correlation results were quantitatively and qualitatively incorrect. The original measurements demonstrating jet quenching have not been revisited. These measurements are repeated in this paper in a kinematic range similar to the original measurement using publicly available data, applying current knowledge about the background.more » Finally, the new results are qualitatively consistent with the previous results, demonstrating complete suppression of the away side within uncertainties.« less

Eddy current compensation for delta relaxation enhanced MR by dynamic reference phase modulation.

PubMed

Hoelscher, Uvo Christoph; Jakob, Peter M

2013-04-01

Eddy current compensation by dynamic reference phase modulation (eDREAM) is a compensation method for eddy current fields induced by B 0 field-cycling which occur in delta relaxation enhanced MR (dreMR) imaging. The presented method is based on a dynamic frequency adjustment and prevents eddy current related artifacts. It is easy to implement and can be completely realized in software for any imaging sequence. In this paper, the theory of eDREAM is derived and two applications are demonstrated. The theory describes how to model the behavior of the eddy currents and how to implement the compensation. Phantom and in vivo measurements are carried out and demonstrate the benefits of eDREAM. A comparison of images acquired with and without eDREAM shows a significant improvement in dreMR image quality. Images without eDREAM suffer from severe artifacts and do not allow proper interpretation while images with eDREAM are artifact free. In vivo experiments demonstrate that dreMR imaging without eDREAM is not feasible as artifacts completely change the image contrast. eDREAM is a flexible eddy current compensation for dreMR. It is capable of completely removing the influence of eddy currents such that the dreMR images do not suffer from artifacts.

Improved physical fitness correlates with improved cognition in multiple sclerosis.

PubMed

Beier, Meghan; Bombardier, Charles H; Hartoonian, Narineh; Motl, Robert W; Kraft, George H

2014-07-01

To determine whether there is an association between improvements in objective measures of physical fitness and performance on cognitive tests in people with multiple sclerosis (MS). Post hoc correlational analysis in which people demonstrating physical improvement were compared with those not demonstrating physical improvement. Individuals with MS residing in the community. Adults with clinically confirmed MS (N=88) who participated in a controlled trial of a telephone-based health promotion intervention, chose to work on exercise, and completed the pre- and postintervention assessments. Participants were measured for strength (isokinetic dynamometer), aerobic fitness (bicycle ergometer), and cognition (Paced Auditory Serial Addition Test [PASAT], Trail Making Test [TMT]) at baseline and 12 weeks later. Change in fitness was calculated by subtracting each participant's baseline score from the outcome score, and then transforming the difference to a z score. Individuals with a z score ≥1 on any fitness measure were placed in the physically improved group (n=25). All others were in the physically not improved group (n=57). After controlling for covariates (age, sex, ethnicity, education, disease activity, MS type), there was a significant group-by-time interaction, suggesting that cognitive functioning changed over time based on level of fitness. Participants in the physically improved group demonstrated improved performance on measures of executive functioning after 12 weeks of exercise. The results of this study lend support to the hypothesis that change in fitness is associated with improved executive functioning in people with MS. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Using tablet computers to teach evidence-based medicine to pediatrics residents: a prospective study.

PubMed

Soma, David B; Homme, Jason H; Jacobson, Robert M

2013-01-01

We sought to determine if tablet computers-supported by a laboratory experience focused upon skill-development-would improve not only evidence-based medicine (EBM) knowledge but also skills and behavior. We conducted a prospective cohort study where we provided tablet computers to our pediatric residents and then held a series of laboratory sessions focused on speed and efficiency in performing EBM at the bedside. We evaluated the intervention with pre- and postintervention tests and surveys based on a validated tool available for use on MedEdPORTAL. The attending pediatric hospitalists also completed surveys regarding their observations of the residents' behavior. All 38 pediatric residents completed the preintervention test and the pre- and postintervention surveys. All but one completed the posttest. All 7 attending pediatric hospitalists completed their surveys. The testing, targeted to assess EBM knowledge, revealed a median increase of 16 points out of a possible 60 points (P < .0001). We found substantial increases in individual resident's test scores across all 3 years of residency. Resident responses demonstrated statistically significant improvements in self-reported comfort with 6 out of 6 EBM skills and statistically significant increases in self-reported frequencies for 4 out of 7 EBM behaviors. Attending pediatric hospitalists reported improvements in 5 of 7 resident behaviors. This novel approach for teaching EBM to pediatric residents improved knowledge, skills, and behavior through the introduction of a tablet computer and laboratory sessions designed to teach the quick and efficient application of EBM at the bedside. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

On the asymptotic optimality and improved strategies of SPTB heuristic for open-shop scheduling problem

NASA Astrophysics Data System (ADS)

Bai, Danyu; Zhang, Zhihai

2014-08-01

This article investigates the open-shop scheduling problem with the optimal criterion of minimising the sum of quadratic completion times. For this NP-hard problem, the asymptotic optimality of the shortest processing time block (SPTB) heuristic is proven in the sense of limit. Moreover, three different improvements, namely, the job-insert scheme, tabu search and genetic algorithm, are introduced to enhance the quality of the original solution generated by the SPTB heuristic. At the end of the article, a series of numerical experiments demonstrate the convergence of the heuristic, the performance of the improvements and the effectiveness of the quadratic objective.

Laparoscopic and robotic skills are transferable in a simulation setting: a randomized controlled trial.

PubMed

Thomaier, Lauren; Orlando, Megan; Abernethy, Melinda; Paka, Chandhana; Chen, Chi Chiung Grace

2017-08-01

Although surgical simulation provides an effective supplement to traditional training, it is not known whether skills are transferable between minimally invasive surgical modalities. The purpose of this study was to assess the transferability of skills between minimally invasive surgical simulation platforms among simulation-naïve participants. Forty simulation-naïve medical students were enrolled in this randomized single-blinded controlled trial. Participants completed a baseline evaluation on laparoscopic (Fundamentals of Laparoscopic Surgery Program, Los Angeles, CA) and robotic (dV-Trainer, Mimic, Seattle, WA) simulation peg transfer tasks. Participants were then randomized to perform a practice session on either the robotic (N = 20) or laparoscopic (N = 20) simulator. Two blinded, expert minimally invasive surgeons evaluated participants before and after training using a modified previously validated subjective global rating scale. Objective measures including time to task completion and Mimic dV-Trainer motion metrics were also recorded. At baseline, there were no significant differences between the training groups as measured by objective and subjective measures for either simulation task. After training, participants randomized to the laparoscopic practice group completed the laparoscopic task faster (p < 0.003) and with higher global rating scale scores (p < 0.001) than the robotic group. Robotic-trained participants performed the robotic task faster (p < 0.001), with improved economy of motion (p < 0.001), and with higher global rating scale scores (p = 0.006) than the laparoscopic group. The robotic practice group also demonstrated significantly improved performance on the laparoscopic task (p = 0.02). Laparoscopic-trained participants also improved their robotic performance (p = 0.02), though the robotic group had a higher percent improvement on the robotic task (p = 0.037). Skills acquired through practice on either laparoscopic or robotic simulation platforms appear to be transferable between modalities. However, participants demonstrate superior skill in the modality in which they specifically train.

Multiresolution image gathering and restoration

NASA Technical Reports Server (NTRS)

Fales, Carl L.; Huck, Friedrich O.; Alter-Gartenberg, Rachel; Rahman, Zia-Ur

1992-01-01

In this paper we integrate multiresolution decomposition with image gathering and restoration. This integration leads to a Wiener-matrix filter that accounts for the aliasing, blurring, and noise in image gathering, together with the digital filtering and decimation in signal decomposition. Moreover, as implemented here, the Wiener-matrix filter completely suppresses the blurring and raster effects of the image-display device. We demonstrate that this filter can significantly improve the fidelity and visual quality produced by conventional image reconstruction. The extent of this improvement, in turn, depends on the design of the image-gathering device.

Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project.

PubMed

Schiff, Gordon D; Reyes Nieva, Harry; Griswold, Paula; Leydon, Nicholas; Ling, Judy; Federico, Frank; Keohane, Carol; Ellis, Bonnie R; Foskett, Cathy; Orav, E John; Yoon, Catherine; Goldmann, Don; Weissman, Joel S; Bates, David W; Biondolillo, Madeleine; Singer, Sara J

2017-08-01

Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools. Chart reviews conducted at baseline and postintervention for intervention sites. Staff and patient survey data collected at baseline and postintervention for intervention and control sites. Chart reviews demonstrated significant improvements in documentation of abnormal results, patient notification, documentation of an action or treatment plan, and evidence of a completed plan (all P<0.001). Mean days between laboratory test date and evidence of completed action/treatment plan decreased by 19.4 days (P<0.001). Staff surveys showed modest but nonsignificant improvement for intervention practices relative to controls overall and for the 3 high-risk domains that were the focus of PROMISES. A consortium of stakeholders, quality improvement tools, coaches, and learning network decreased selected ambulatory safety risks often seen in malpractice claims.

A Scoping Review of Behavioral Economic Interventions for Prevention and Treatment of Type 2 Diabetes Mellitus.

PubMed

Kullgren, Jeffrey T; Hafez, Dina; Fedewa, Allison; Heisler, Michele

2017-09-01

The purpose of this paper was to review studies of behavioral economic interventions (financial incentives, choice architecture modifications, or commitment devices) to prevent type 2 diabetes mellitus (T2DM) among at-risk patients or improve self-management among patients with T2DM. We found 15 studies that used varied study designs and outcomes to test behavioral economic interventions in clinical, workplace, or health plan settings. Of four studies that focused on prevention of T2DM, two found that financial incentives increased weight loss and completion of a fasting blood glucose test, and two choice architecture modifications had mixed effects in encouraging completion of tests to screen for T2DM. Of 11 studies that focused on improving self-management of T2DM, four of six tests of financial incentives demonstrated increased engagement in recommended care processes or improved biometric measures, and three of five tests of choice architecture modifications found improvements in self-management behaviors. Though few studies have tested behavioral economic interventions for prevention or treatment of T2DM, those that have suggested such approaches have the potential to improve patient behaviors and such approaches should be tested more broadly.

A Multidisciplinary Self-Directed Learning Module Improves Knowledge of a Quality Improvement Instrument: The HEART Pathway.

PubMed

Hartman, Nicholas D; Harper, Erin N; Leppert, Lauren M; Browning, Brittany M; Askew, Kim; Manthey, David E; Mahler, Simon A

We created and tested an educational intervention to support implementation of an institution wide QI project (the HEART Pathway) designed to improve care for patients with acute chest pain. Although online learning modules have been shown effective in imparting knowledge regarding QI projects, it is unknown whether these modules are effective across specialties and healthcare professions. Participants, including nurses, advanced practice clinicians, house staff and attending physicians (N = 486), were enrolled into an online, self-directed learning course exploring the key concepts of the HEART Pathway. The module was completed by 97% of enrollees (469/486) and 90% passed on the first attempt (422/469). Out of 469 learners, 323 completed the pretest, learning module and posttest in the correct order. Mean test scores across learners improved significantly from 74% to 89% from the pretest to the posttest. Following the intervention, the HEART Pathway was used for 88% of patients presenting to our institution with acute chest pain. Our data demonstrate that this online, self-directed learning module can improve knowledge of the HEART Pathway across specialties-paving the way for more efficient and informed care for acute chest pain patients.

A Scoping Review of Behavioral Economic Interventions for Prevention and Treatment of Type 2 Diabetes Mellitus

PubMed Central

Kullgren, Jeffrey T.; Hafez, Dina; Fedewa, Allison; Heisler, Michele

2017-01-01

Purpose of review To review studies of behavioral economic interventions (financial incentives, choice architecture modifications, or commitment devices) to prevent type 2 diabetes mellitus (T2DM) among at-risk patients or improve self-management among patients with T2DM. Recent findings We found 15 studies that used varied study designs and outcomes to test behavioral economic interventions in clinical, workplace, or health plan settings. Of four studies that focused on prevention of T2DM, two found that financial incentives increased weight loss and completion of a fasting blood glucose test, and two choice architecture modifications had mixed effects in encouraging completion of tests to screen for T2DM. Of 11 studies that focused on improving self-management of T2DM, four of six tests of financial incentives demonstrated increased engagement in recommended care processes or improved biometric measures, and three of five tests of choice architecture modifications found improvements in self-management behaviors. Summary Though few studies have tested behavioral economic interventions for prevention or treatment of T2DM, those that have suggest such approaches have potential to improve patient behaviors and should be tested more broadly. PMID:28755061

Rapid and Programmable Protein Mutagenesis Using Plasmid Recombineering.

PubMed

Higgins, Sean A; Ouonkap, Sorel V Y; Savage, David F

2017-10-20

Comprehensive and programmable protein mutagenesis is critical for understanding structure-function relationships and improving protein function. There is thus a need for robust and unbiased molecular biological approaches for the construction of the requisite comprehensive protein libraries. Here we demonstrate that plasmid recombineering is a simple and robust in vivo method for the generation of protein mutants for both comprehensive library generation as well as programmable targeting of sequence space. Using the fluorescent protein iLOV as a model target, we build a complete mutagenesis library and find it to be specific and comprehensive, detecting 99.8% of our intended mutations. We then develop a thermostability screen and utilize our comprehensive mutation data to rapidly construct a targeted and multiplexed library that identifies significantly improved variants, thus demonstrating rapid protein engineering in a simple protocol.

Multipoint Pressure and Temperature Sensing Fiber Optic Cable for Monitoring CO 2 Sequestration

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

Challener, William

2015-02-10

This report describes the work completed on contract DE-FE0010116. The goal of this two year project was to develop and demonstrate in the laboratory a highly accurate multi-point pressure measurement fiber optic cable based on MEMS pressure sensors suitable for downhole deployment in a CO 2 sequestration well. The sensor interrogator was also to be demonstrated in a remote monitoring system and environmental testing was to be completed to indicate its downhole survivability over a lengthy period of time (e.g., 20 years). An interrogator system based on a pulsed laser excitation was shown to be capable of multiple (potentially 100+)more » simultaneous sensor measurements. Two sensors packages were completed and spliced in a cable onto the same fiber and measured. One sensor package was subsequently measured at high temperatures and pressures in supercritical CO 2, while the other package was measured prior and after being subjected to high torque stresses to mimic downhole deployment. The environmental and stress tests indicated areas in which the package design should be further improved.« less

Feasibility and Efficacy of Brief Computerized Training to Improve Emotion Recognition in Premanifest and Early-Symptomatic Huntington's Disease.

PubMed

Kempnich, Clare L; Wong, Dana; Georgiou-Karistianis, Nellie; Stout, Julie C

2017-04-01

Deficits in the recognition of negative emotions emerge before clinical diagnosis in Huntington's disease (HD). To address emotion recognition deficits, which have been shown in schizophrenia to be improved by computerized training, we conducted a study of the feasibility and efficacy of computerized training of emotion recognition in HD. We randomly assigned 22 individuals with premanifest or early symptomatic HD to the training or control group. The training group used a self-guided online training program, MicroExpression Training Tool (METT), twice weekly for 4 weeks. All participants completed measures of emotion recognition at baseline and post-training time-points. Participants in the training group also completed training adherence measures. Participants in the training group completed seven of the eight sessions on average. Results showed a significant group by time interaction, indicating that METT training was associated with improved accuracy in emotion recognition. Although sample size was small, our study demonstrates that emotion recognition remediation using the METT is feasible in terms of training adherence. The evidence also suggests METT may be effective in premanifest or early-symptomatic HD, opening up a potential new avenue for intervention. Further study with a larger sample size is needed to replicate these findings, and to characterize the durability and generalizability of these improvements, and their impact on functional outcomes in HD. (JINS, 2017, 23, 314-321).

The effect of complementary and alternative medicine on quality of life, depression, anxiety, and fatigue levels among cancer patients during active oncology treatment: phase II study.

PubMed

Bar-Sela, Gil; Danos, Sara; Visel, Bella; Mashiach, Tanya; Mitnik, Inbal

2015-07-01

During the past decade, there has been growing interest in complementary and alternative medicine (CAM) among cancer patients and it is being integrated more frequently within conventional cancer centers. The long-term effect of mind-body therapies on quality of life (QoL), depression, anxiety, and fatigue was tested prospectively in this study. Cancer patients who received six weekly sessions of CAM during their oncological treatments participated in the study. The Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI) and QoL-EORTC-C30 were completed during the intervention and follow-up period. Over a two-year period, 163 patients entered the study, 135 of whom completed all six CAM sessions. An improvement was demonstrated in the median of BFI from 4.8 to 3.9 (p < 0.001), HADS-Anxiety from 8 to 7 (p < 0.001) and HADS-Depression from 7 to 6 (p < 0.001) after 12 weeks. In addition, the median of global QoL improved from 50 to 67 (p < 0.001), and a significant improvement was noticed in several parameters on the functioning and symptoms scales of the QoL-EORTC-C30. Cancer patients who completed six weekly sessions of CAM improved significantly on measured outcomes, regardless of their demographic characteristics.

How to improve plastic surgery knowledge, skills and career interest in undergraduates in one day.

PubMed

Davis, C R; O'Donoghue, J M; McPhail, J; Green, A R

2010-10-01

Plastic surgery now occupies a negligible component of many undergraduate curricula. The British Association of Plastic, Reconstructive and Aesthetic Surgeons Undergraduate Course aimed to introduce and improve students' plastic surgery knowledge and skills, as well as develop personal career interests. This research aims to quantify whether this was achieved. Students attending the one-day course were invited to complete a questionnaire before and after the course. Questions were self-reflective and incorporated four key themes: (1) plastic surgery knowledge; (2) awareness of the work of a plastic surgeon; (3) ability to perform basic plastic surgical skills; (4) career interest in plastic surgery. Non-medical students were given an identical questionnaire to quantify public perception of the work of a plastic surgeon. 121 students attended from 17 universities across the UK, with 93 completing the questionnaire (77% response rate). Paired analyses compared mean or median scores of the students' answers before and after the course. After completing the course, medical students significantly improved in all four key themes (p<0.01). 93 non-medical students completed questionnaires. Medical students were significantly more accurate at identifying plastic surgery procedures than non-medical students (P < 0.01), which was further strengthened after completing the course (P < 0.001). This study demonstrates the positive educational impact of a one-day plastic surgery event for medical students and supports the need for plastic surgery education at an undergraduate level. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Recurrent Vestibular Migraine Vertigo Attacks Associated With the Development of Profound Bilateral Vestibulopathy: A Case Series.

PubMed

Wester, Jacob L; Ishiyama, Akira; Ishiyama, Gail

2017-09-01

Bilateral vestibulopathy (BVP) is a debilitating condition characterized by gait ataxia, oscillopsia, and imbalance. Case series of patients with migraine-linked vertigo spells and profound BVP. PATIENT 1:: A 69-year-old man presented with a history of recurrent severe vertigo spells lasting up to 3 days in duration associated with prostrating migraine headaches starting at age 60. His symptoms were misdiagnosed as an anxiety syndrome. At age 68, electronystagmography (ENG) revealed bilaterally absent caloric responses and complete BVP. His hearing was normal. PATIENT 2:: A 51-year-old man presented with a history of "earthquake-like" vertigo, sharp head pain, and phonophobia. These episodes occurred a handful of times over a 7-year period. Previous ENG testing at age 43 was normal. However, his ENG at age 48 revealed complete BVP. He was started on acetazolamide and noted improved balance, although subsequent ENG was unchanged. PATIENT 3:: A 49-year-old woman presented with a history of recurrent migraines with visual aura associated with vertigo lasting 1 hour. ENG at age 50 revealed complete BVP. Subjectively, she noted improved balance with acetazolamide and subsequent ENG demonstrated mild improvement. PATIENT 4:: A 43-year-old man presented with a 5-year history of optical migraines and recurrent vertigo spells, lasting 30 seconds, which was misdiagnosed as positional vertigo. He additionally had a 10-year history of oscillopsia. ENG at age 61 revealed complete BVP. In these cases, vestibular migraine was linked to recurrent vertigo spells that eventually led to complete bilateral vestibulopathy.

Home-based aerobic conditioning for management of symptoms of fibromyalgia: a pilot study.

PubMed

Harden, R Norman; Song, Sharon; Fasen, Jo; Saltz, Samuel L; Nampiaparampil, Devi; Vo, Andrew; Revivo, Gadi

2012-06-01

This pilot study was designed to evaluate the impact of a home-based aerobic conditioning program on symptoms of fibromyalgia and determine if changes in symptoms were related to quantitative changes in aerobic conditioning (VO(2) max). Twenty-six sedentary individuals diagnosed with fibromyalgia syndrome participated in an individualized 12-week home-based aerobic exercise program with the goal of daily aerobic exercise of 30 minutes at 80% of estimated maximum heart rate. The aerobic conditioning took place in the participants' homes, outdoors, or at local fitness clubs at the discretion of the individual under the supervision of a physical therapist. Patients were evaluated at baseline and completion for physiological level of aerobic conditioning (VO(2) max), pain ratings, pain disability, depression, and stress. In this pilot study subjects who successfully completed the 12-week exercise program demonstrated an increase in aerobic conditioning, a trend toward decrease in pain measured by the McGill Pain Questionnaire-Short Form and a weak trend toward improvements in visual analog scale, depression, and perceived stress. Patients who were unable or unwilling to complete this aerobic conditioning program reported significantly greater pain and perceived disability (and a trend toward more depression) at baseline than those who completed the program. Patients suffering from fibromyalgia who can participate in an aerobic conditioning program may experience physiological and psychological benefits, perhaps with improvement in symptoms of fibromyalgia, specifically pain ratings. More definitive trials are needed, and this pilot demonstrates the feasibility of the quantitative VO2 max method. Subjects who experience significant perceived disability and negative affective symptoms are not likely to maintain a home-based conditioning program, and may need a more comprehensive interdisciplinary program offering greater psychological and social support. Wiley Periodicals, Inc.

Effectiveness of Ear Splint Therapy for Ear Deformities

PubMed Central

2017-01-01

Objective To present our experience with ear splint therapy for babies with ear deformities, and thereby demonstrate that this therapy is an effective and safe intervention without significant complications. Methods This was a retrospective study of 54 babies (35 boys and 19 girls; 80 ears; age ≤3 months) with ear deformities who had received ear splint therapy at the Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University Hospital between December 2014 and February 2016. Before the initiation of ear splint therapy, ear deformities were classified with reference to the standard terminology. We compared the severity of ear deformity before and after ear splint therapy by using the physician's ratings. We also compared the physician's ratings and the caregiver's ratings on completion of ear splint therapy. Results Among these 54 babies, 41 children (58 ears, 72.5%) completed the ear splint therapy. The mean age at initiation of therapy was 52.91±18.26 days and the treatment duration was 44.27±32.06 days. Satyr ear, forward-facing ear lobe, Darwinian notch, overfolded ear, and cupped ear were the five most common ear deformities. At the completion of therapy, the final physician's ratings of ear deformities were significantly improved compared to the initial ratings (8.28±1.44 vs. 2.51±0.92; p<0.001). There was no significant difference between the physician's ratings and the caregiver's ratings at the completion of ear splint therapy (8.28±1.44 vs. 8.0±1.61; p=0.297). Conclusion We demonstrated that ear splint therapy significantly improved ear deformities in babies, as measured by quantitative rating scales. Ear splint therapy is an effective and safe intervention for babies with ear deformities. PMID:28289646

Where do Students Go Wrong in Applying the Scientific Method?

NASA Astrophysics Data System (ADS)

Rubbo, Louis; Moore, Christopher

2015-04-01

Non-science majors completing a liberal arts degree are frequently required to take a science course. Ideally with the completion of a required science course, liberal arts students should demonstrate an improved capability in the application of the scientific method. In previous work we have demonstrated that this is possible if explicit instruction is spent on the development of scientific reasoning skills. However, even with explicit instruction, students still struggle to apply the scientific process. Counter to our expectations, the difficulty is not isolated to a single issue such as stating a testable hypothesis, designing an experiment, or arriving at a supported conclusion. Instead students appear to struggle with every step in the process. This talk summarizes our work looking at and identifying where students struggle in the application of the scientific method. This material is based upon work supported by the National Science Foundation under Grant No. 1244801.

Can video games be used to predict or improve laparoscopic skills?

PubMed

Rosenberg, Bradley H; Landsittel, Douglas; Averch, Timothy D

2005-04-01

Performance of laparoscopic surgery requires adequate hand-eye coordination. Video games are an effective way to judge one's hand-eye coordination, and practicing these games may improve one's skills. Our goal was to see if there is a correlation between skill in video games and skill in laparoscopy. Also, we hoped to demonstrate that practicing video games can improve one's laparoscopic skills. Eleven medical students (nine male, two female) volunteered to participate. On day 1, each student played three commercially available video games (Top Spin, XSN Sports; Project Gotham Racing 2, Bizarre Creations; and Amped 2, XSN Sports) for 30 minutes on an X-box (Microsoft, Seattle, WA) and was judged both objectively and subjectively. Next, the students performed four laparoscopic tasks (object transfer, tracing a figure-of-eight, suture placement, and knot-tying) in a swine model and were assessed for time to complete the task, number of errors committed, and hand-eye coordination. The students were then randomized to control (group A) or "training" (i.e., video game practicing; group B) arms. Two weeks later, all students repeated the laparoscopic skills laboratory and were reassessed. Spearman correlation coefficients demonstrated a significant relation between many of the parameters, particularly time to complete each task and hand-eye coordination at the different games. There was a weaker association between video game performance and both laparoscopic errors committed and hand-eye coordination. Group B subjects did not improve significantly over those in group A in any measure (P >0.05 for all). Video game aptitude appears to predict the level of laparoscopic skill in the novice surgeon. In this study, practicing video games did not improve one's laparoscopic skill significantly, but a larger study with more practice time could prove games to be helpful.

Educating restaurant owners and cooks to lower their own sodium intake is a potential strategy for reducing the sodium contents of restaurant foods: a small-scale pilot study in South Korea.

PubMed

Park, Sohyun; Lee, Heeseung; Seo, Dong-Il; Oh, Kwang-Hwan; Hwang, Taik Gun; Choi, Bo Youl

2016-12-01

This study was conducted to evaluate the feasibility of a sodium reduction program at local restaurants through nutrition education and examination of the health of restaurant owners and cooks. The study was a single-arm pilot intervention using a pre-post design in one business district with densely populated restaurants in Seoul, South Korea. The intervention focused on improving nutrition behaviors and psychosocial factors through education, health examination, and counseling of restaurant personnel. Forty-eight restaurant owners and cooks completed the baseline survey and participated in the intervention. Forty participants completed the post-intervention survey. The overweight and obesity prevalences were 25.6% and 39.5%, respectively, and 74.4% of participants had elevated blood pressure. After health examination, counseling, and nutrition education, several nutrition behaviors related to sodium intake showed improvement. In addition, those who consumed less salt in their baseline diet (measured with urine dipsticks) were more likely to agree that providing healthy foods to their customers is necessary. This study demonstrated the potential to reduce the sodium contents of restaurant foods by improving restaurant owners' and cooks' psychological factors and their own health behaviors. This small pilot study demonstrated that working with restaurant owners and cooks to improve their own health and sodium intake may have an effect on participation in restaurant-based sodium reduction initiatives. Future intervention studies with a larger sample size and comparison group can focus on improving the health and perceptions of restaurant personnel in order to increase the feasibility and efficacy of restaurant-based sodium reduction programs and policies.

Educating restaurant owners and cooks to lower their own sodium intake is a potential strategy for reducing the sodium contents of restaurant foods: a small-scale pilot study in South Korea

PubMed Central

Lee, Heeseung; Seo, Dong-il; Oh, Kwang-hwan; Hwang, Taik Gun; Choi, Bo Youl

2016-01-01

BACKGROUND/OBJECTIVES This study was conducted to evaluate the feasibility of a sodium reduction program at local restaurants through nutrition education and examination of the health of restaurant owners and cooks. SUBJECTS/METHODS The study was a single-arm pilot intervention using a pre-post design in one business district with densely populated restaurants in Seoul, South Korea. The intervention focused on improving nutrition behaviors and psychosocial factors through education, health examination, and counseling of restaurant personnel. Forty-eight restaurant owners and cooks completed the baseline survey and participated in the intervention. Forty participants completed the post-intervention survey. RESULTS The overweight and obesity prevalences were 25.6% and 39.5%, respectively, and 74.4% of participants had elevated blood pressure. After health examination, counseling, and nutrition education, several nutrition behaviors related to sodium intake showed improvement. In addition, those who consumed less salt in their baseline diet (measured with urine dipsticks) were more likely to agree that providing healthy foods to their customers is necessary. This study demonstrated the potential to reduce the sodium contents of restaurant foods by improving restaurant owners' and cooks' psychological factors and their own health behaviors. CONCLUSIONS This small pilot study demonstrated that working with restaurant owners and cooks to improve their own health and sodium intake may have an effect on participation in restaurant-based sodium reduction initiatives. Future intervention studies with a larger sample size and comparison group can focus on improving the health and perceptions of restaurant personnel in order to increase the feasibility and efficacy of restaurant-based sodium reduction programs and policies. PMID:27909562

Code Team Training: Demonstrating Adherence to AHA Guidelines During Pediatric Code Blue Activations.

PubMed

Stewart, Claire; Shoemaker, Jamie; Keller-Smith, Rachel; Edmunds, Katherine; Davis, Andrew; Tegtmeyer, Ken

2017-10-16

Pediatric code blue activations are infrequent events with a high mortality rate despite the best effort of code teams. The best method for training these code teams is debatable; however, it is clear that training is needed to assure adherence to American Heart Association (AHA) Resuscitation Guidelines and to prevent the decay that invariably occurs after Pediatric Advanced Life Support training. The objectives of this project were to train a multidisciplinary, multidepartmental code team and to measure this team's adherence to AHA guidelines during code simulation. Multidisciplinary code team training sessions were held using high-fidelity, in situ simulation. Sessions were held several times per month. Each session was filmed and reviewed for adherence to 5 AHA guidelines: chest compression rate, ventilation rate, chest compression fraction, use of a backboard, and use of a team leader. After the first study period, modifications were made to the code team including implementation of just-in-time training and alteration of the compression team. Thirty-eight sessions were completed, with 31 eligible for video analysis. During the first study period, 1 session adhered to all AHA guidelines. During the second study period, after alteration of the code team and implementation of just-in-time training, no sessions adhered to all AHA guidelines; however, there was an improvement in percentage of sessions adhering to ventilation rate and chest compression rate and an improvement in median ventilation rate. We present a method for training a large code team drawn from multiple hospital departments and a method of assessing code team performance. Despite subjective improvement in code team positioning, communication, and role completion and some improvement in ventilation rate and chest compression rate, we failed to consistently demonstrate improvement in adherence to all guidelines.

Feasibility of a novel mHealth management system to capture and improve medication adherence among adolescents with asthma.

PubMed

Cushing, Anna; Manice, Melissa P; Ting, Andrew; Parides, Michael K

2016-01-01

Currently, 7.1 million children in the United States have asthma. Nonadherence to daily controller asthma medication is common, leading to more severe symptoms, overuse of rescue medication, and increased hospitalizations. The purpose of this study was to develop and evaluate the feasibility and acceptability of a novel mHealth management system composed of a sensored device, which is connected to mobile phone app that is designed to monitor and improve asthma medication adherence. The asthma management system was designed using well-established behavioral theory. Seven adolescents aged 11-18 years were enrolled and given an adherence sensor, and four of those also received a mobile phone app with game features and reminders. Five patients completed the study, and one was lost to follow-up in each group. Mobile app users and their parents participated in focus groups to assess patient preferences. Feasibility was assessed by the ability of sensors to capture real-time medication data. Acceptability was assessed by patient questionnaire and focus group analysis. Successful upload of real-time data from six of seven inhaler sensors to the HIPAA-compliant server demonstrates the feasibility of at-home patient monitoring using the sensor device. All three mobile app users who completed the study reported interest in continued use of the management system and would recommend the app to friends. Unstructured interviews and focus groups revealed that patients felt that the intervention helped their sense of asthma control. This study demonstrates the feasibility of using the sensor device to remotely monitor real-time medication usage, and user feedback demonstrates the acceptability of the intervention for patient use. The findings provide guidance for the improvement of study design and technology development. Further research is needed to assess the efficacy of the intervention.

Community-based group exercise for persons with Parkinson disease: a randomized controlled trial.

PubMed

Combs, Stephanie A; Diehl, M Dyer; Chrzastowski, Casey; Didrick, Nora; McCoin, Brittany; Mox, Nicholas; Staples, William H; Wayman, Jessica

2013-01-01

The purpose of this study was to compare group boxing training to traditional group exercise on function and quality of life in persons with Parkinson disease (PD). A convenience sample of adults with PD (n = 31) were randomly assigned to boxing training or traditional exercise for 24-36 sessions, each lasting 90 minutes, over 12 weeks. Boxing training included: stretching, boxing (e.g. lateral foot work, punching bags), resistance exercises, and aerobic training. Traditional exercise included: stretching, resistance exercises, aerobic training, and balance activities. Participants were tested before and after completion of training on balance, balance confidence, mobility, gait velocity, gait endurance, and quality of life. The traditional exercise group demonstrated significantly greater gains in balance confidence than the boxing group (p < 0.025). Only the boxing group demonstrated significant improvements in gait velocity and endurance over time with a medium between-group effect size for the gait endurance (d = 0.65). Both groups demonstrated significant improvements with the balance, mobility, and quality of life with large within-group effect sizes (d ≥ 0.80). While groups significantly differed in balance confidence after training, both groups demonstrated improvements in most outcome measures. Supporting options for long-term community-based group exercise for persons with PD will be an important future consideration for rehabilitation professionals.

The Feasibility and Potential Impact of Brain Training Games on Cognitive and Emotional Functioning in Middle-Aged Adults

PubMed Central

Curtis, Ashley F.; Branscombe-Caird, Laura M.; Comrie, Janna K.; Murtha, Susan J.E.

2018-01-01

Abstract Objectives:To investigate whether a commercially available brain training program is feasible to use with a middle-aged population and has a potential impact on cognition and emotional well-being (proof of concept). Method: Fourteen participants (ages 46–55) completed two 6-week training conditions using a crossover (counterbalanced) design: (1) experimental brain training condition and (2) active control “find answers to trivia questions online” condition. A comprehensive neurocognitive battery and a self-report measure of depression and anxiety were administered at baseline (first time point, before training) and after completing each training condition (second time point at 6 weeks, and third time point at 12 weeks). Cognitive composite scores were calculated for participants at each time point. Results: Study completion and protocol adherence demonstrated good feasibility of this brain training protocol in healthy middle-aged adults. Exploratory analyses suggested that brain training was associated with neurocognitive improvements related to executive attention, as well as improvements in mood. Conclusion: Overall, our findings suggest that brain training programs are feasible in middle-aged cohorts. We propose that brain training games may be linked to improvements in executive attention and affect by promoting cognitive self-efficacy in middle-aged adults. PMID:29189046

The impact of a dedicated research education month for anesthesiology residents.

PubMed

Freundlich, Robert E; Newman, Jessica W; Tremper, Kevin K; Mhyre, Jill M; Kheterpal, Sachin; Sanford, Theodore J; Tait, Alan R

2015-01-01

An educational intervention was implemented at the University of Michigan starting in 2008, in which anesthesiology interns complete a dedicated month-long didactic rotation in evidence-based medicine (EBM) and research methodology. We sought to assess its utility. Scores on a validated EBM test before and after the rotation were compared and assessed for significance of improvement. A survey was also given to gauge satisfaction with the quality of the rotation and self-reported improvement in understanding of EBM topics. Fourteen consecutive interns completed the research rotation during the study period. One hundred percent completed both the pre- and postrotation test. The mean pretest score was 7.78 ± 2.46 (median = 7.5, 0-15 scale, and interquartile range 7.0-10.0) and the mean posttest score was 10.00 ± 2.35 (median = 9.5, interquartile range 8.0-12.3), which represented a statistically significant increase (P = 0.011, Wilcoxon signed-rank test). All fourteen of the residents "agreed" or "strongly agreed" that they would recommend the course to future interns and that the course increased their ability to critically review the literature. Our findings demonstrate that this can be an effective means of improving understanding of EBM topics and anesthesiology research.

Impact of online education on intern behaviour around joint commission national patient safety goals: a randomised trial.

PubMed

Shaw, Tim J; Pernar, Luise I; Peyre, Sarah E; Helfrick, John F; Vogelgesang, Kaitlin R; Graydon-Baker, Erin; Chretien, Yves; Brown, Elizabeth J; Nicholson, James C; Heit, Jeremy J; Co, John Patrick T; Gandhi, Tejal

2012-10-01

To compare the effectiveness of two types of online learning methodologies for improving the patient-safety behaviours mandated in the Joint Commission National Patient Safety Goals (NPSG). This randomised controlled trial was conducted in 2010 at Massachusetts General Hospital and Brigham and Women's Hospital (BWH) in Boston USA. Incoming interns were randomised to either receive an online Spaced Education (SE) programme consisting of cases and questions that reinforce over time, or a programme consisting of an online slide show followed by a quiz (SQ). The outcome measures included NPSG-knowledge improvement, NPSG-compliant behaviours in a simulation scenario, self-reported confidence in safety and quality, programme acceptability and programme relevance. Both online learning programmes improved knowledge retention. On four out of seven survey items measuring satisfaction and self-reported confidence, the proportion of SE interns responding positively was significantly higher (p<0.05) than the fraction of SQ interns. SE interns demonstrated a mean 4.79 (36.6%) NPSG-compliant behaviours (out of 13 total), while SQ interns completed a mean 4.17 (32.0%) (p=0.09). Among those in surgical fields, SE interns demonstrated a mean 5.67 (43.6%) NPSG-compliant behaviours, while SQ interns completed a mean 2.33 (17.9%) (p=0.015). Focus group data indicates that SE was more contextually relevant than SQ, and significantly more engaging. While both online methodologies improved knowledge surrounding the NPSG, SE was more contextually relevant to trainees and was engaging. SE impacted more significantly on both self-reported confidence and the behaviour of surgical residents in a simulated scenario.

Proteogenomics produces comprehensive and highly accurate protein-coding gene annotation in a complete genome assembly of Malassezia sympodialis

PubMed Central

Tellgren-Roth, Christian; Baudo, Charles D.; Kennell, John C.; Sun, Sheng; Billmyre, R. Blake; Schröder, Markus S.; Andersson, Anna; Holm, Tina; Sigurgeirsson, Benjamin; Wu, Guangxi; Sankaranarayanan, Sundar Ram; Siddharthan, Rahul; Sanyal, Kaustuv; Lundeberg, Joakim; Nystedt, Björn; Boekhout, Teun; Dawson, Thomas L.; Heitman, Joseph

2017-01-01

Abstract Complete and accurate genome assembly and annotation is a crucial foundation for comparative and functional genomics. Despite this, few complete eukaryotic genomes are available, and genome annotation remains a major challenge. Here, we present a complete genome assembly of the skin commensal yeast Malassezia sympodialis and demonstrate how proteogenomics can substantially improve gene annotation. Through long-read DNA sequencing, we obtained a gap-free genome assembly for M. sympodialis (ATCC 42132), comprising eight nuclear and one mitochondrial chromosome. We also sequenced and assembled four M. sympodialis clinical isolates, and showed their value for understanding Malassezia reproduction by confirming four alternative allele combinations at the two mating-type loci. Importantly, we demonstrated how proteomics data could be readily integrated with transcriptomics data in standard annotation tools. This increased the number of annotated protein-coding genes by 14% (from 3612 to 4113), compared to using transcriptomics evidence alone. Manual curation further increased the number of protein-coding genes by 9% (to 4493). All of these genes have RNA-seq evidence and 87% were confirmed by proteomics. The M. sympodialis genome assembly and annotation presented here is at a quality yet achieved only for a few eukaryotic organisms, and constitutes an important reference for future host-microbe interaction studies. PMID:28100699

Quality-of-life outcomes in patients who underwent subcutaneous immunotherapy and sublingual immunotherapy in a real-world clinical setting.

PubMed

Schwanke, Theresa; Carragee, Eugene; Bremberg, Maria; Reisacher, William R

2017-09-01

To compare changes in quality of life (QOL) that resulted from sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) in a real-world clinical setting. SLIT is established as a viable alternative to SCIT for the treatment of allergic rhinitis. Although comparative trials are increasingly available, few studies have examined QOL outcomes between these two treatments. One hundred and five participants who underwent immunotherapy for airborne allergies were enrolled in this prospective, single-center study. Forty participants completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) at initiation of therapy, after 6 months, and after 1 year of therapy. Only patients with complete time points were included in the ultimate analysis. Twenty-nine of these participants underwent SCIT and 11 underwent SLIT. The effects of age, sex, and asthma history were also examined. The participants in both groups demonstrated improvements in QOL regarding allergic rhinoconjunctivitis over the study period. However, the change in the RQLQ score from both baseline to 6 months and baseline to 1 year was only statistically significant in the SCIT group (p = 0.002, 6 months and 1 year). The participants in the SCIT group also demonstrated statistically significant improvement from baseline to 1 year in the specific domains of practical and emotional functioning, nasal symptoms, non-nasal/eye symptoms, and sleep. After 1 year, both SCIT and SLIT demonstrated a minimally important difference from baseline in the overall RQLQ score. Age <35 years in the SCIT group had a significant positive impact on QOL improvement (p = 0.038). Although improvements in QOL were noted in both groups, changes in overall scores and the majority of domains only achieved statistical significance in the SCIT group. A small study population and difficulties adhering to immunotherapy dosing schedules in the SLIT group may be contributing factors.

A collaborative approach to lean laboratory workstation design reduces wasted technologist travel.

PubMed

Yerian, Lisa M; Seestadt, Joseph A; Gomez, Erron R; Marchant, Kandice K

2012-08-01

Lean methodologies have been applied in many industries to reduce waste. We applied Lean techniques to redesign laboratory workstations with the aim of reducing the number of times employees must leave their workstations to complete their tasks. At baseline in 68 workflows (aggregates or sequence of process steps) studied, 251 (38%) of 664 tasks required workers to walk away from their workstations. After analysis and redesign, only 59 (9%) of the 664 tasks required technologists to leave their workstations to complete these tasks. On average, 3.4 travel events were removed for each workstation. Time studies in a single laboratory section demonstrated that workers spend 8 to 70 seconds in travel each time they step away from the workstation. The redesigned workstations will allow employees to spend less time travelling around the laboratory. Additional benefits include employee training in waste identification, improved overall laboratory layout, and identification of other process improvement opportunities in our laboratory.

Pilot of the Chronic Disease Self-Management Program (CDSMP) for Adolescents and Young Adults with Sickle Cell Disease

PubMed Central

Crosby, Lori E.; Joffe, Naomi E.; Peugh, James; Ware, Russell E.; Britto, Maria T.

2016-01-01

Purpose This study evaluated the feasibility of a group self-management intervention, the well-established Stanford Chronic Disease Self-Management Program (CDSMP), for adolescents and young adults (AYA) with sickle cell disease (SCD). Methods A total of 22 AYA participants with SCD, ages 16 to 24 years, completed self-efficacy and quality of life (HRQOL) measures before the CDSMP, after, and 3 and 6 months later. Results This AYA cohort showed significant improvements in self-efficacy (primary outcome) after the intervention. Analyses of follow-up data revealed a medium effect of the CDSMP on patient activation 3 months post although this was not sustained. Participants were highly satisfied, but only 64% completed the program. Conclusions This study demonstrates that the CDSMP is acceptable, and has the ability to improve self-efficacy. Additional research is needed to determine feasibility and evaluate health outcomes for AYA with SCD. PMID:27793727

'I Got it off my Chest': An Examination of how Research Participation Improved the Mental Health of Women Engaging in Transactional Sex.

PubMed

Felsher, Marisa; Wiehe, Sarah E; Gunn, Jayleen K L; Roth, Alexis M

2018-02-01

Ecologic momentary assessment (EMA) is a form of close-ended diary writing. While it has been shown that participating in a study that incorporates EMA improves mental health of participants, no study to date has examined the pathways through which benefits may occur. For 4-weeks, twice-daily EMAs and weekly interviews captured mood, daily activities and HIV risk behavior of 25 women who engage in transactional sex. Qualitative analysis of exit interviews was performed to examine how participation impacted women's mental health. The majority of participants felt that EMAs heightened awareness of emotions and behavior. Most reported experiencing catharsis from the interviews; specifically, from having a non-judgmental, trusting listener. Participants felt responsible for completing tasks, a sense of accomplishment for completing the study, and altruism. This study demonstrates there are direct benefits associated with participation in an EMA and interview study.

Training students to detect delirium: An interprofessional pilot study.

PubMed

Chambers, Breah; Meyer, Mary; Peterson, Moya

2018-06-01

The purpose of this paper is to report nursing student knowledge acquisition and attitude after completing and interprofessional simulation with medical students. The IOM has challenged healthcare educators to teach teamwork and communication skills in interprofessional settings. Interprofessional simulation provides a higher fidelity experience than simulation in silos. Simulation may be particularly useful in helping healthcare workers gain the necessary skills to care for psychiatric clients. Specifically, healthcare providers have difficulty differentiating between dementia and delirium. Recognizing this deficit, an interprofessional simulation was created using medical students in their neurology rotation and senior nursing students. Twenty-four volunteer nursing students completed a pre-survey to assess delirium knowledge and then completed an education module about delirium. Twelve of these students participated in a simulation with medicine students. Pre and Post Kid SIM Attitude questionnaires were completed by all students participating in the simulation. After the simulations were complete, all twenty-four students were asked to complete the post-survey regarding delirium knowledge. While delirium knowledge scores improved in both groups, the simulation group scored higher, but the difference did not reach significance. The simulation group demonstrated a statistically significant improvement in attitudes toward simulation, interprofessional education, and teamwork post simulation compared to their pre-simulation scores. Nursing students who participated in an interprofessional simulation developed a heightened appreciation for learning communication, teamwork, situational awareness, and interprofessional roles and responsibilities. These results support the use of interprofessional simulation in healthcare education. Copyright © 2018 Elsevier Ltd. All rights reserved.

Interprofessional, multiple step simulation course improves pediatric resident and nursing staff management of pediatric patients with diabetic ketoacidosis

PubMed Central

Larson-Williams, Linnea M; Youngblood, Amber Q; Peterson, Dawn Taylor; Zinkan, J Lynn; White, Marjorie L; Abdul-Latif, Hussein; Matalka, Leen; Epps, Stephen N; Tofil, Nancy M

2016-01-01

AIM To investigate the use of a multidisciplinary, longitudinal simulation to educate pediatric residents and nurses on management of pediatric diabetic ketoacidosis. METHODS A multidisciplinary, multiple step simulation course was developed by faculty and staff using a modified Delphi method from the Pediatric Simulation Center and pediatric endocrinology department. Effectiveness of the simulation for the residents was measured with a pre- and post-test and a reference group not exposed to simulation. A follow up post-test was completed 3-6 mo after the simulation. Nurses completed a survey regarding the education activity. RESULTS Pediatric and medicine-pediatric residents (n = 20) and pediatric nurses (n = 25) completed the simulation course. Graduating residents (n = 16) were used as reference group. Pretest results were similar in the control and intervention group (74% ± 10% vs 76% ± 15%, P = 0.658). After completing the intervention, participants improved in the immediate post-test in comparison to themselves and the control group (84% ± 12% post study; P < 0.05). The 3-6 mo follow up post-test results demonstrated knowledge decay when compared to their immediate post-test results (78% ± 14%, P = 0.761). Residents and nurses felt the interdisciplinary and longitudinal nature of the simulation helped with learning. CONCLUSION Results suggest a multidisciplinary, longitudinal simulation improves immediate post-intervention knowledge but important knowledge decay occurs, future studies are needed to determine ways to decrease this decay. PMID:27896145

Optical coherence tomography findings of bilateral foveal leukemic infiltration

PubMed Central

Le, John Q; Braich, Puneet S; Brar, Vikram S

2016-01-01

We report a case of a 59-year-old man with a history of atypical chronic myelogenous leukemia who presented with a several-week history of decreased vision in both eyes. His clinical examination revealed bilateral foveal infiltration, which was also demonstrated on optical coherence tomography. After a failed induction with imatinib (Gleevec®), he was treated with omacetaxine (Synribo®) with an appropriate hematologic response. As his leukemia improved with chemotherapy, his retinal lesions regressed as demonstrated by serial optical coherence tomography and fundus photographs, with near complete restoration of foveal architecture. PMID:27540313

Neovascularity in patellar tendinopathy and the response to eccentric training: a case report using Power Doppler ultrasound.

PubMed

McCreesh, Karen M; Riley, Sara J; Crotty, James M

2013-12-01

This report describes the case of an amateur soccer player with chronic patellar tendinopathy who underwent ultrasound imaging before and after engaging in an 8-week programme of eccentric exercise. On initial assessment, greyscale ultrasound imaging demonstrated tendon thickening and reduced echogenicity, while Power Doppler imaging demonstrated a large amount of neovascularity. After 8 weeks of an eccentric loading programme, the patient reported significantly improved symptoms and functional scores, while follow-up imaging demonstrated improvement in the echo appearance of the tendon and complete resolution of the neovascularity. The association between neovascularity and symptoms in tendinopathy research is conflicting, with a paucity of research in the area of patellar tendinopathy. While further research is needed to clarify the significance of greyscale and Power Doppler ultrasound changes in relation to symptoms in patellar tendinopathy, ultrasound imaging was shown to be a useful adjunct to diagnosis and outcome assessment in this case. Copyright © 2012 Elsevier Ltd. All rights reserved.

Combining of ETHOS Operating Ergonomic Platform, Three-dimensional Laparoscopic Camera, and Radius Surgical System Manipulators Improves Ergonomy in Urologic Laparoscopy: Comparison with Conventional Laparoscopy and da Vinci in a Pelvi Trainer.

PubMed

Tokas, Theodoros; Gözen, Ali Serdar; Avgeris, Margaritis; Tschada, Alexandra; Fiedler, Marcel; Klein, Jan; Rassweiler, Jens

2017-10-01

Posture, vision, and instrumentation limitations are the main predicaments of conventional laparoscopy. To combine the ETHOS surgical chair, the three-dimensional laparoscope, and the Radius Surgical System manipulators, and compare the system with conventional laparoscopy and da Vinci in terms of task completion times and discomfort. Fifteen trainees performed the three main laparoscopic suturing tasks of the Heilbronn training program (IV: simulation of dorsal venous complex suturing; V: circular suturing of tubular structure; and VI: urethrovesical anastomosis) in a pelvi trainer. The tasks were performed conventionally, utilizing the three devices, and robotically. Task completion times were recorded and the surgeon discomfort was evaluated using questionnaires. Task completion times were compared using nonparametric Wilcoxon signed rank test and ergonomic scores were compared using Pearson chi-square test. The use of the full laparoscopic set (ETHOS chair, three-dimensional laparoscopic camera, Radius Surgical System needle holders), resulted in a significant improvement of the completion time of the three tested tasks compared with conventional laparoscopy (p<0.001) and similar to da Vinci surgery. After completing Tasks IV, V, and VI conventionally, 12 (80%), 13 (86.7%), and 13 (86.7%) of the 15 trainees, respectively, reported heavy total discomfort. The full laparoscopic system nullified heavy discomfort for Tasks IV and V and minimized it (6.7%) for the most demanding Task VI. Especially for Task VI, all trainees gained benefit, by using the system, in terms of task completion times and discomfort. The limited trainee robotic experience and the questionnaire subjectivity could be a potential limitation. The ergonomic laparoscopic system offers significantly improved task completion times and ergonomy than conventional laparoscopy. Furthermore, it demonstrates comparable results to robotic surgery. The study was conducted in a pelvi trainer and no patients were recruited. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Effectiveness of a School-based Academic Asthma Health Education and Counseling Program on Fostering Acceptance of Asthma in Older School-age Students with Asthma

PubMed Central

Kintner, Eileen K.; Cook, Gwendolyn; Marti, C. Nathan; Gomes, Melissa; Meeder, Linda; Van Egeren, Laurie A.

2014-01-01

Purpose The purpose was to evaluate the effectiveness of the academic asthma education and counseling SHARP program on fostering psychosocial acceptance of asthma. Design and Methods This was a phase III, two-group, cluster randomized, single-blinded, longitudinal study. Students from grades 4 and 5 (N = 205) with asthma and their caregivers completed surveys at pre-intervention and at 1, 12, and 24 months post-intervention. Analysis involved multilevel modeling. Results All students demonstrated significant improvement in aspects of acceptance; students in SHARP demonstrated significant improvement in openness to sharing and connectedness with teachers over students in the control condition. Practice Implications The SHARP program offers a well-tested, effective program for psychosocial acceptance of asthma, which is welcomed by schools. PMID:25443593

Polymer-free carbon nanotube thermoelectrics with improved charge carrier transport and power factor

DOE PAGES

Norton-Baker, Brenna; Ihly, Rachelle; Gould, Isaac E.; ...

2016-11-17

Here, semiconducting single-walled carbon nanotubes (s-SWCNTs) have recently attracted attention for their promise as active components in a variety of optical and electronic applications, including thermoelectricity generation. Here we demonstrate that removing the wrapping polymer from the highly enriched s-SWCNT network leads to substantial improvements in charge carrier transport and thermoelectric power factor. These improvements arise primarily from an increase in charge carrier mobility within the s-SWCNT networks because of removal of the insulating polymer and control of the level of nanotube bundling in the network, which enables higher thin-film conductivity for a given carrier density. Ultimately, these studies demonstratemore » that highly enriched s-SWCNT thin films, in the complete absence of any accompanying semiconducting polymer, can attain thermoelectric power factors in the range of approximately 400 μW m -1K -2, which is on par with that of some of the best single-component organic thermoelectrics demonstrated to date.« less

Immediate improvement of motor function after epilepsy surgery in congenital hemiparesis.

PubMed

Pascoal, Tharick; Paglioli, Eliseu; Palmini, André; Menezes, Rafael; Staudt, Martin

2013-08-01

Hemispherectomy often leads to a loss of contralateral hand function. In some children with congenital hemiparesis, however, paretic hand function remains unchanged. An immediate improvement of hand function has never been reported. A 17-year-old boy with congenital hemiparesis and therapy-refractory seizures due to a large infarction in the territory of the middle cerebral artery underwent epilepsy surgery. Intraoperatively, electrical cortical stimulation of the affected hemisphere demonstrated preserved motor projections from the sensorimotor cortex to the (contralateral) paretic hand. A frontoparietal resection was performed, which included a complete disconnection of all motor projections originating in the sensorimotor cortex of the affected hemisphere. Surprisingly, the paretic hand showed a significant functional improvement immediately after the operation. This observation demonstrates that, in congenital hemiparesis, crossed motor projections from the affected hemisphere are not always beneficial, but can be dysfunctional, interfering with ipsilateral motor control over the paretic hand by the contralesional hemisphere. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples

PubMed Central

Selker, Harry P.; Leslie, Laurel K.

2015-01-01

Abstract There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in‐person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. PMID:26332869

Tri-Clustered Tensor Completion for Social-Aware Image Tag Refinement.

PubMed

Tang, Jinhui; Shu, Xiangbo; Qi, Guo-Jun; Li, Zechao; Wang, Meng; Yan, Shuicheng; Jain, Ramesh

2017-08-01

Social image tag refinement, which aims to improve tag quality by automatically completing the missing tags and rectifying the noise-corrupted ones, is an essential component for social image search. Conventional approaches mainly focus on exploring the visual and tag information, without considering the user information, which often reveals important hints on the (in)correct tags of social images. Towards this end, we propose a novel tri-clustered tensor completion framework to collaboratively explore these three kinds of information to improve the performance of social image tag refinement. Specifically, the inter-relations among users, images and tags are modeled by a tensor, and the intra-relations between users, images and tags are explored by three regularizations respectively. To address the challenges of the super-sparse and large-scale tensor factorization that demands expensive computing and memory cost, we propose a novel tri-clustering method to divide the tensor into a certain number of sub-tensors by simultaneously clustering users, images and tags into a bunch of tri-clusters. And then we investigate two strategies to complete these sub-tensors by considering (in)dependence between the sub-tensors. Experimental results on a real-world social image database demonstrate the superiority of the proposed method compared with the state-of-the-art methods.

Emphasizing the process of science using demonstrations in conceptual chemistry

NASA Astrophysics Data System (ADS)

Lutz, Courtney A.

The purpose of this project was to teach students a method for employing the process of science in a conceptual chemistry classroom when observing a demonstration of a discrepant event. Students observed six demonstrations throughout a trimester study of chemistry and responded to each demonstration by asking as many questions as they could think of, choosing one testable question to answer by making as many hypotheses as possible, and choosing one hypothesis to make predictions about observed results of this hypothesis when tested. Students were evaluated on their curiosity, confidence, knowledge of the process of science, and knowledge of the nature of science before and after the six demonstrations. Many students showed improvement in using or mastery of the process of science within the context of conceptual chemistry after six intensive experiences with it. Results of the study also showed students gained confidence in their scientific abilities after completing one trimester of conceptual chemistry. Curiosity and knowledge of the nature of science did not show statistically significant improvement according to the assessment tool. This may have been due to the scope of the demonstration and response activities, which focused on the process of science methodology instead of knowledge of the nature of science or the constraints of the assessment tool.

Virtual reality-based simulation training for ventriculostomy: an evidence-based approach.

PubMed

Schirmer, Clemens M; Elder, J Bradley; Roitberg, Ben; Lobel, Darlene A

2013-10-01

Virtual reality (VR) simulation-based technologies play an important role in neurosurgical resident training. The Congress of Neurological Surgeons (CNS) Simulation Committee developed a simulation-based curriculum incorporating VR simulators to train residents in the management of common neurosurgical disorders. To enhance neurosurgical resident training for ventriculostomy placement using simulation-based training. A course-based neurosurgical simulation curriculum was introduced at the Neurosurgical Simulation Symposium at the 2011 and 2012 CNS annual meetings. A trauma module was developed to teach ventriculostomy placement as one of the neurosurgical procedures commonly performed in the management of traumatic brain injury. The course offered both didactic and simulator-based instruction, incorporating written and practical pretests and posttests and questionnaires to assess improvement in skill level and to validate the simulators as teaching tools. Fourteen trainees participated in the didactic component of the trauma module. Written scores improved significantly from pretest (75%) to posttest (87.5%; P < .05). Seven participants completed the ventriculostomy simulation. Significant improvements were observed in anatomy (P < .04), burr hole placement (P < .03), final location of the catheter (P = .05), and procedure completion time (P < .004). Senior residents planned a significantly better trajectory (P < .01); junior participants improved most in terms of identifying the relevant anatomy (P < .03) and the time required to complete the procedure (P < .04). VR ventriculostomy placement as part of the CNS simulation trauma module complements standard training techniques for residents in the management of neurosurgical trauma. Improvement in didactic and hands-on knowledge by course participants demonstrates the usefulness of the VR simulator as a training tool.

Microsurgical Resection of Lateral Tuberculum Sellae Meningioma: Operative Video.

PubMed

Cândido, Duarte N C; Nakashima, Paulo E H; de Oliveira, Jean Gonçalves; Borba, Luis A B

2018-02-01

Tuberculum Sellae Meningiomas (TSMs) are lesions dramatically related to the optic apparatus once the principal clinical complain remains on visual alterations. This is the main picture on decision making to evaluate the best time, risk-benefit, and surgical approaches to the patient treatment. In this video, we present a 65 years old female with 30 days complaint of unilateral (right) complete blindness and complete impaired right eye field test. On physical examination, there were normal pupillary function to light tests. The scans demonstrated the presence of a TSM mostly related to the right optic nerve and encasing it altogether with the right internal carotid artery. Promptly, surgery was addressed using a modified one piece cranio-orbital-zygomatic approach with extra-dural anterior clinoidectomy, as this is the procedure of choice of the senior author (LB), with easy access to decompression of the optic canal and nerve. As demonstrated on the video, the optic nerve was encased by the tumor and pushed upwards against the falciform ligament. Complete resection and decompression was established with step by step dissection, starting unroofing the optic canal, opening the ligament and finally with carefully tumor debulking. Pathology demonstrated a grade one meningioma. The patient improved remarkably her visual acuity and visual field tests on the postoperative period, emphasizing the importance of early treatment for nerve function outcome. The link to the video can be found at: https://youtu.be/pALZqDUkltQ .

A Checklist Intervention to Assess Resident Diagnostic Knee and Shoulder Arthroscopic Efficiency.

PubMed

Nwachukwu, Benedict; Gaudiani, Michael; Hammann-Scala, Jennifer; Ranawat, Anil

The purpose of this investigation was to apply an arthroscopic shoulder and knee checklist in the evaluation of orthopedic resident arthroscopic skill efficiency and to demonstrate the use of a surgical checklist for assessing resident surgical efficiency over the course of a surgical rotation. Orthopedic surgery residents rotating on the sports medicine service at our institution between 2011 and 2015 were enrolled in this study. Residents were administered a shoulder and knee arthroscopy assessment tool at the beginning and end of their 6-week rotation. The assessment tools consisted of checklist items for knee and shoulder arthroscopy skills. Residents were timed while performing these checklist tasks. The primary outcome measure was resident improvement as a function of time to completion for the checklist items, and the intervention was participation in a 6-week resident rotation with weekly arthroscopy didactics, cadaver simulator work, and operating room experience. A paired t test was used to compare means. Mean time to checklist completion during week 1 among study participants for the knee checklist was 787.4 seconds for the knee checklist and 484.4 seconds at the end of the rotation. Mean time to checklist completion during week 1 among study participants for the shoulder checklist was 1655.3 seconds and 832.7 seconds for the shoulder checklist at the end of the rotation. Mean improvement in time to completion was 303 seconds (p = 0.0006, SD = 209s) and 822.6 seconds (p = 0.00008, SD = 525.2s) for the arthroscopic knee and shoulder assessments, respectively. An arthroscopic checklist is 1 method to evaluate and assess resident efficiency and improvement during surgical training. Among residents participating in this study, we found statistically significant improvements in time for arthroscopic task completion. II. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Severity of anxiety and work-related outcomes of patients with anxiety disorders.

PubMed

Erickson, Steven R; Guthrie, Sally; Vanetten-Lee, Michelle; Himle, Joseph; Hoffman, Jody; Santos, Susana F; Janeck, Amy S; Zivin, Kara; Abelson, James L

2009-01-01

This study examined associations between anxiety and work-related outcomes in an anxiety disorders clinic population, examining both pretreatment links and the impact of anxiety change over 12 weeks of treatment on work outcomes. Four validated instruments were used to also allow examination of their psychometric properties, with the goal of improving measurement of work-related quality of life in this population. Newly enrolled adult patients seeking treatment in a university-based anxiety clinic were administered four work performance measures: Work Limitations Questionnaire (WLQ), Work Productivity and Activity Impairment Questionnaire (WPAI), Endicott Work Productivity Scale (EWPS), and Functional Status Questionnaire Work Performance Scale (WPS). Anxiety severity was determined using the Beck Anxiety Inventory (BAI). The Clinical Global Impressions, Global Improvement Scale (CGI-I) was completed by patients to evaluate symptom change at a 12-week follow-up. Two severity groups (minimal/mild vs. moderate/severe, based on baseline BAI score) were compared to each other on work measures. Eighty-one patients provided complete baseline data. Anxiety severity groups did not differ in job type, time on job, job satisfaction, or job choice. Patients with greater anxiety generally showed lower work performance on all instruments. Job advancement was impaired for the moderate/severe group. The multi-item performance scales demonstrated better validity and internal consistency. The WLQ and the WPAI detected change with symptom improvement. Level of work performance was generally associated with severity of anxiety. Of the instruments tested, the WLQ and the WPAI questionnaire demonstrated acceptable validity and internal reliability.

Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study

PubMed Central

Ruocco, Anthony C.; Rodrigo, Achala H.; McMain, Shelley F.; Page-Gould, Elizabeth; Ayaz, Hasan; Links, Paul S.

2016-01-01

Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, 29 actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex (PFC) during impulse control prior to beginning DBT and after 7 months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex (DLPFC) prior to beginning treatment, and they showed the greatest increases in activity within this region after 7 months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial PFC and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right DLPFC even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the PFC underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT. PMID:27242484

Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study.

PubMed

Ruocco, Anthony C; Rodrigo, Achala H; McMain, Shelley F; Page-Gould, Elizabeth; Ayaz, Hasan; Links, Paul S

2016-01-01

Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, 29 actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex (PFC) during impulse control prior to beginning DBT and after 7 months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex (DLPFC) prior to beginning treatment, and they showed the greatest increases in activity within this region after 7 months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial PFC and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right DLPFC even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the PFC underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT.

Redesigning a General Education Science Course to Promote Critical Thinking

PubMed Central

Rowe, Matthew P.; Gillespie, B. Marcus; Harris, Kevin R.; Koether, Steven D.; Shannon, Li-Jen Y.; Rose, Lori A.

2015-01-01

Recent studies question the effectiveness of a traditional university curriculum in helping students improve their critical thinking and scientific literacy. We developed an introductory, general education (gen ed) science course to overcome both deficiencies. The course, titled Foundations of Science, differs from most gen ed science offerings in that it is interdisciplinary; emphasizes the nature of science along with, rather than primarily, the findings of science; incorporates case studies, such as the vaccine-autism controversy; teaches the basics of argumentation and logical fallacies; contrasts science with pseudoscience; and addresses psychological factors that might otherwise lead students to reject scientific ideas they find uncomfortable. Using a pretest versus posttest design, we show that students who completed the experimental course significantly improved their critical-thinking skills and were more willing to engage scientific theories the general public finds controversial (e.g., evolution), while students who completed a traditional gen ed science course did not. Our results demonstrate that a gen ed science course emphasizing the process and application of science rather than just scientific facts can lead to improved critical thinking and scientific literacy. PMID:26231561

Labor productivity, perceived effectiveness, and sustainability of innovative projects.

PubMed

Makai, Peter; Cramm, Jane M; van Grotel, Marloes; Nieboer, Anna P

2014-01-01

To assess labor productivity, perceived effectiveness, and sustainability of a national quality program that sought to stimulate efficiency gains through increased labor productivity while maintaining quality through implementing small-scale innovation projects. Longitudinal measures of labor productivity and quality were collected at baseline and after completion of the innovation projects. Perceived effectiveness and sustainability (measured by routinization) were assessed cross-sectionally after project completion. This study was conducted in The Netherlands. Ninety-eight improvement projects in long-term care organizations. A national quality program to stimulate innovative approaches in long-term care. Labor productivity, perceived effectiveness, and sustainability were the main outcome measures. Labor productivity data were available for only 37 (38%) of the 98 projects, 33 (89%) of which demonstrated significantly improved efficiency. Perceived effectiveness was significantly associated with sustainability (0.29; p < .05), but not labor productivity. To achieve sustainability in long-term care, developers of innovative projects must collect better quality information on efficiency gains in terms of labor productivity and focus more on efficiency improvement. More research is necessary to explore relationships between labor productivity, perceived effectiveness, and sustainability. © 2012 National Association for Healthcare Quality.

Lock Wall Expedient Repair Demonstration Monitoring, John T. Myers Locks and Dam, Ohio River

DTIC Science & Technology

2011-10-01

original condition. Complete confinement of the concrete within the armor appears to provide good resistance to impact and abrasion (Figure 29). ERDC... resistance to impact and abrasion . Synopsis General classifications of observed damage were described and, where repairs are considered necessary or...against abrasion , fire , and environmental attacks and to improve the adhesion to other construc- tion materials. For high-weatherproof performance

Surrogate data--a secure way to share corporate data.

PubMed

Tetko, Igor V; Abagyan, Ruben; Oprea, Tudor I

2005-01-01

The privacy of chemical structure is of paramount importance for the industrial sector, in particular for the pharmaceutical industry. At the same time, companies handle large amounts of physico-chemical and biological data that could be shared in order to improve our molecular understanding of pharmacokinetic and toxicological properties, which could lead to improved predictivity and shorten the development time for drugs, in particular in the early phases of drug discovery. The current study provides some theoretical limits on the information required to produce reverse engineering of molecules from generated descriptors and demonstrates that the information content of molecules can be as low as less than one bit per atom. Thus theoretically just one descriptor can be used to completely disclose the molecular structure. Instead of sharing descriptors, we propose to share surrogate data. The sharing of surrogate data is nothing else but sharing of reliably predicted molecules. The use of surrogate data can provide the same information as the original set. We consider the practical application of this idea to predict lipophilicity of chemical compounds and we demonstrate that surrogate and real (original) data provides similar prediction ability. Thus, our proposed strategy makes it possible not only to share descriptors, but also complete collections of surrogate molecules without the danger of disclosing the underlying molecular structures.

Increased oil production and reserves from improved completion techniques in the Bluebell field, Uinta Basin, Utah. Tenth quarterly technical progress report, January 1, 1996--March 31, 1996. Revised

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

Allison, M.L.

1996-05-13

The objective of this project is to increase oil production and reserves in the Uinta Basin by demonstrating improved completion techniques. Low productivity of Uinta Basin will is caused by gross production intervals of several thousand feet that contain perforated thief zones, water-bearing zones, and unperforated oil- bearing intervals. Geologic and engineering characterization and computer simulation of the Green River and Wasatch Formations in the Bluefell field will determine reservoir heterogeneities related to fractures and depositional trends. This will be followed by techniques based on the reservoir characterization. Transfer of the project results will be an ongoing component of themore » project. Data (net pay thickness, porosity, and water saturation) of more than 100 individuals beds in he lower Green River and Wasatch Formations were used to generate geostatistical realization (numerical- representation) of the reservoir properties. The data set was derived from the Michelle Ute and Malnar Pike demonstration wells and 22 other wells in a 20 (52 km{sup 2}) square-mile area. Beds were studied independently of each other. Principles of sequential Gaussian simulations were used to generate geostatistical realizations of the beds.« less

Concentrating Solar Power Central Receiver Panel Component Fabrication and Testing FINAL REPORT

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

McDowell, Michael W; Miner, Kris

The objective of this project is to complete a design of an advanced concentrated solar panel and demonstrate the manufacturability of key components. Then confirm the operation of the key components under prototypic solar flux conditions. This work is an important step in reducing the levelized cost of energy (LCOE) from a central receiver solar power plant. The key technical risk to building larger power towers is building the larger receiver systems. Therefore, this proposed technology project includes the design of an advanced molten salt prototypic sub-scale receiver panel that can be utilized into a large receiver system. Then completemore » the fabrication and testing of key components of the receive design that will be used to validate the design. This project shall have a significant impact on solar thermal power plant design. Receiver panels of suitable size for utility scale plants are a key element to a solar power tower plant. Many subtle and complex manufacturing processes are involved in producing a reliable, robust receiver panel. Given the substantial size difference between receiver panels manufactured in the past and those needed for large plant designs, the manufacture and demonstration on prototype receiver panel components with representative features of a full-sized panel will be important to improving the build process for commercial success. Given the thermal flux limitations of the test facility, the panel components cannot be rendered full size. Significance changes occurred in the projects technical strategies from project initiation to the accomplishments described herein. The initial strategy was to define cost improvements for the receiver, design and build a scale prototype receiver and test, on sun, with a molten salt heat transport system. DOE had committed to constructing a molten salt heat transport loop to support receiver testing at the top of the NSTTF tower. Because of funding constraints this did not happen. A subsequent plan to test scale prototype receiver, off sun but at temperature, at a molten salt loop at ground level adjacent to the tower also had to be abandoned. Thus, no test facility existed for a molten salt receiver test. As a result, PWR completed the prototype receiver design and then fabricated key components for testing instead of fabricating the complete prototype receiver. A number of innovative design ideas have been developed. Key features of the receiver panel have been identified. This evaluation includes input from Solar 2, personal experience of people working on these programs and meetings with Sandia. Key components of the receiver design and key processes used to fabricate a receiver have been selected for further evaluation. The Test Plan, Concentrated Solar Power Receiver In Cooperation with the Department of Energy and Sandia National Laboratory was written to define the scope of the testing to be completed as well as to provide details related to the hardware, instrumentation, and data acquisition. The document contains a list of test objectives, a test matrix, and an associated test box showing the operating points to be tested. Test Objectives: 1. Demonstrate low-cost manufacturability 2. Demonstrate robustness of two different tube base materials 3. Collect temperature data during on sun operation 4. Demonstrate long term repeated daily operation of heat shields 5. Complete pinhole tube weld repairs 6. Anchor thermal models This report discusses the tests performed, the results, and implications for design improvements and LCOE reduction.« less

Improving completion rates for client intake forms through Audio Computer-Assisted Self-Interview (ACASI): results from a pilot study with the Avon Breast Health Outreach Program.

PubMed

Hallum-Montes, Rachel; Senter, Lindsay; D'Souza, Rohan; Gates-Ferris, Kathryn; Hurlbert, Marc; Anastario, Michael

2014-01-01

This study compares rates of completion of client intake forms (CIFs) collected via three interview modes: audio computer-assisted self-interview (ACASI), face-to-face interview (FFI), and self-administered paper-based interview (SAPI). A total of 303 clients served through the Avon Breast Health Outreach Program (BHOP) were sampled from three U.S. sites. Clients were randomly assigned to complete a standard CIF via one of the three interview modes. Logistic regression analyses demonstrated that clients were significantly more likely to complete the entire CIF via ACASI than either FFI or SAPI. The greatest observed differences were between ACASI and SAPI; clients were almost six times more likely to complete the CIF via ACASI as opposed to SAPI (AOR = 5.8, p < .001). We recommend that where feasible, ACASI be utilized as an effective means of collecting client-level data in healthcare settings. Adoption of ACASI in health centers may translate into higher completion rates of intake forms by clients, as well as reduced burden on clinic staff to enter data and review intake forms for completion. © 2013 National Association for Healthcare Quality.

Communication skills training curriculum for pulmonary and critical care fellows.

PubMed

McCallister, Jennifer W; Gustin, Jillian L; Wells-Di Gregorio, Sharla; Way, David P; Mastronarde, John G

2015-04-01

The Accreditation Council for Graduate Medical Education requires physicians training in pulmonary and critical care medicine to demonstrate competency in interpersonal communication. Studies have shown that residency training is often insufficient to prepare physicians to provide end-of-life care and facilitate patient and family decision-making. Poor communication in the intensive care unit (ICU) can adversely affect outcomes for critically ill patients and their family members. Despite this, communication training curricula in pulmonary and critical care medicine are largely absent in the published literature. We evaluated the effectiveness of a communication skills curriculum during the first year of a pulmonary and critical care medicine fellowship using a family meeting checklist to provide formative feedback to fellows during ICU rotations. We hypothesized that fellows would demonstrate increased competence and confidence in the behavioral skills necessary for facilitating family meetings. We evaluated a 12-month communication skills curriculum using a pre-post, quasiexperimental design. Subjects for this study included 11 first-year fellows who participated in the new curriculum (intervention group) and a historical control group of five fellows who had completed no formal communication curriculum. Performance of communication skills and self-confidence in family meetings were assessed for the intervention group before and after the curriculum. The control group was assessed once at the beginning of their second year of fellowship. Fellows in the intervention group demonstrated significantly improved communication skills as evaluated by two psychologists using the Family Meeting Behavioral Skills Checklist, with an increase in total observed skills from 51 to 65% (P ≤ 0.01; Cohen's D effect size [es], 1.13). Their performance was also rated significantly higher when compared with the historical control group, who demonstrated only 49% of observed skills (P ≤ 0.01; es, 1.55). Fellows in the intervention group also showed significantly improved self-confidence scores upon completion of the curriculum, with an increase from 77 to 89% (P ≤ 0.01; es, 0.87) upon completion of the curriculum A structured curriculum that includes abundant opportunities for fellows to practice and receive feedback using a behavioral checklist during their ICU rotations helps to develop physicians with advanced communication skills.

Improving patient-centered communication while using an electronic health record: Report from a curriculum evaluation.

PubMed

Fogarty, Colleen T; Winters, Paul; Farah, Subrina

2016-05-01

Researchers and clinicians are concerned about the impact of electronic health record use and patient-centered communication. Training about patient-centered clinical communication skills with the electronic health record may help clinicians adapt and remain patient-centered. We developed an interactive workshop eliciting challenges and opportunities of working with the electronic health record in clinical practice, introduction of specific patient-centered behaviors and mindful practice techniques, and video demonstrating contrasts in common behavior and "better practices." One hundred thirty-nine resident physicians and faculty supervisors in five residency training programs at the University of Rochester Medical Center participated in the workshops. Participants were asked to complete an 11-item survey of behaviors related to their use of the electronic health record prior to training and after attending training. We used paired t-tests to assess changes in self-reported behavior from pre-intervention to post-intervention. We trained 139 clinicians in the workshops; 110 participants completed the baseline assessment and 39 completed both the baseline and post-intervention assessment. Data from post-curriculum respondents found a statistically significant increase in "I told the patient when turning my attention from the patient to the computer," from 60% of the time prior to the training to 70% of the time after. Data from our program evaluation demonstrated improvement in one communication behavior. Sample size limited the detection of other changes; further research should investigate effective training techniques for patient-centered communication while using the electronic health record. © The Author(s) 2016.

Evaluation of online training for the provision of opioid substitution treatment by community pharmacists in New Zealand.

PubMed

Walters, Carina; Raymont, Antony; Galea, Susanna; Wheeler, Amanda

2012-11-01

The role of community pharmacists in the provision of opioid substitution treatment (OST) is pivotal and integral to addiction treatment. An online training program for pharmacists in OST management was piloted in New Zealand in 2010, following recognition of the difficulty in recruitment and retention of community pharmacists to provide OST services. Our aim was to evaluate the OST online training that was made available for any community pharmacist in New Zealand and to establish the feasibility and acceptability of this format of training for community pharmacists. The evaluation explored participants' attitudes, skills and knowledge both pre- and post-training in OST. All pharmacists registering to participate in the training program were asked to complete an evaluation questionnaire immediately before (pre) and immediately after (post) completing the training. Participants were also invited to participate in a brief 10 min structured telephone interview about their training experience. In the first 4 months 190 pharmacists commenced the training; 101 completed both evaluations. Improvements in the confidence and skills of pharmacists were demonstrated through both the quantitative and qualitative analyses. Statistically significant changes in attitudes were also demonstrated. Overall the OST training was well received and the online format was feasible and highly acceptable. Online training is an appropriate and economical method of improving pharmacists' clinical skills with respect to this client group, and has the potential to reach a wider audience of pharmacists. Further research is required to investigate OST client experiences in community pharmacy. © 2012 Australasian Professional Society on Alcohol and other Drugs.

Improving information management in primary care: the proof is in the pudding.

PubMed

Reed, Virginia A; Schifferdecker, Karen E; Homa, Karen

2008-01-01

Generalists in both the USA and UK have been at the forefront of improving information management skills, defined here as the abilities required to locate and utilise synthesised information for patient care that is accessible, current, relevant and valid. Over the past decade, a variety of interventions designed to improve knowledge and skills relative to information management has been implemented. The goals of training are for learners to demonstrate long-term retention of knowledge and skills gained and to be able to transfer this learning from the context of training into different situations and contexts, such as those encountered in the workplace. Thus, to conclude that learning has taken place, it is essential to study performance after learners have acquired knowledge and skills to see how well those have been retained and generalised. The current study builds on previous work conducted by the authors that described and evaluated an intervention designed to improve information management knowledge, skills and use of Web-based resources by participants from generalist primary care practices. This cross-over study found that both groups of participants--those who received training initially and those who received training later--showed the same improvements when assessed 15 months and three months, respectively, after training. Given the definition of learning as 'relatively permanent', we wondered if these improvements would last. Participants in the original three phases of the study completed questionnaires during each phase; for the current study they were asked to complete a fourth questionnaire administered 27 and 15 months, respectively, after their original training. All variables showed non-significant differences between participants' scores at the end of the original study, where learning was assessed as having occurred, and the current administration of the questionnaire. Demonstrated long-term retention of knowledge and skills and generalisation to the workplace show that the goals of training have been met.

Virtual lab demonstrations improve students' mastery of basic biology laboratory techniques.

PubMed

Maldarelli, Grace A; Hartmann, Erica M; Cummings, Patrick J; Horner, Robert D; Obom, Kristina M; Shingles, Richard; Pearlman, Rebecca S

2009-01-01

Biology laboratory classes are designed to teach concepts and techniques through experiential learning. Students who have never performed a technique must be guided through the process, which is often difficult to standardize across multiple lab sections. Visual demonstration of laboratory procedures is a key element in teaching pedagogy. The main goals of the study were to create videos explaining and demonstrating a variety of lab techniques that would serve as teaching tools for undergraduate and graduate lab courses and to assess the impact of these videos on student learning. Demonstrations of individual laboratory procedures were videotaped and then edited with iMovie. Narration for the videos was edited with Audacity. Undergraduate students were surveyed anonymously prior to and following screening to assess the impact of the videos on student lab performance by completion of two Participant Perception Indicator surveys. A total of 203 and 171 students completed the pre- and posttesting surveys, respectively. Statistical analyses were performed to compare student perceptions of knowledge of, confidence in, and experience with the lab techniques before and after viewing the videos. Eleven demonstrations were recorded. Chi-square analysis revealed a significant increase in the number of students reporting increased knowledge of, confidence in, and experience with the lab techniques after viewing the videos. Incorporation of instructional videos as prelaboratory exercises has the potential to standardize techniques and to promote successful experimental outcomes.

Motor learning characterizes habilitation of children with hemiplegic cerebral palsy.

PubMed

Krebs, Hermano I; Fasoli, Susan E; Dipietro, Laura; Fragala-Pinkham, Maria; Hughes, Richard; Stein, Joel; Hogan, Neville

2012-09-01

This study tested in children with cerebral palsy (CP) whether motor habilitation resembles motor learning. Twelve children with hemiplegic CP ages 5 to 12 years with moderate to severe motor impairments underwent a 16-session robot-mediated planar therapy program to improve upper limb reach, with a focus on shoulder and elbow movements. Participants were trained to execute point-to-point movements (with robot assistance) with the affected arm and were evaluated (without robot assistance) in trained (point-to-point) and untrained (circle-drawing) conditions. Outcomes were measured at baseline, midpoint, immediately after the program, and 1 month postcompletion. Outcome measures were the Fugl-Meyer (FM), Quality of Upper Extremity Skills Test (QUEST), and Modified Ashworth Scale (MAS) scores; parent questionnaire; and robot-based kinematic metrics. To assess whether learning best characterizes motor habilitation in CP, the authors quantified (a) improvement on trained tasks at completion of training (acquisition) and 1 month following completion (retention) and (b) quantified generalization of improvement to untrained tasks. After robotic intervention, the authors found significant gains in the FM, QUEST, and parent questionnaire. Robot-based evaluations demonstrated significant improvement in trained movements and that improvement was sustained at follow-up. Furthermore, children improved their performance in untrained movements indicating generalization. Motor habilitation in CP exhibits some traits of motor learning. Optimal treatment may not require an extensive repertoire of tasks but rather a select set to promote generalization.

Shoulder function and anatomy in complete obstetric brachial plexus palsy: long-term improvement after triangle tilt surgery

PubMed Central

Karicherla, Priyanka; Mahmooduddin, Faiz

2010-01-01

Purpose Untreated complete obstetric brachial plexus injury (COBPI) usually results in limited spontaneous recovery of shoulder function. Older methods used to treat COBPI have had questionable success, with very few studies being published. The purpose of the current study was to examine the results of triangle tilt surgery on shoulder function and development in COBPI individuals. Methods This study was conducted as a retrospective chart review. Inclusion criteria were COBPI patients that had undergone the triangle tilt procedure from 2005 to 2009 and were between the ages of 9 months and 12 years. COBPI was defined as permanent injury to all five nerve roots (C5–T1), with significant degradation in development and function of the hand. Twenty-five patients with a mean age of 5 (0.75–12) years were followed up clinically for more than 2 years. Results The triangle tilt procedure resulted in demonstrable clinical enhancements with appreciable improvements in shoulder function, glenoid version, and humeral head congruity. There was a significant increase in the overall Mallet score (2.4 points, p < 0.0001) following surgical correction in patients that were followed up for more than 2 years. Conclusions The results of this study demonstrate that COBPI patients who develop SHEAR and medial rotation contracture deformities can benefit from the triangle tilt surgery, which improves shoulder function and anatomy across a range of pediatric ages. Despite these patients presenting late for surgery in general (5 years), significant improvements were observed in their glenohumeral (GH) dysplasia and their ability to perform shoulder and arm movements following surgery. PMID:20473676

Using digital multimedia to improve parents' and children's understanding of clinical trials.

PubMed

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

2015-06-01

Data show that many research subjects have difficulty understanding study information using traditional paper consent documents. This study, therefore, was designed to evaluate the effect of an interactive multimedia program on improving parents' and children's understanding of clinical trial concepts and participation. Parents (n=148) and children (n=135) were each randomised to receive information regarding clinical trials using either a traditional paper format (TF) or an interactive iPad program (IP) with inline exercises. Participants' understanding of the information was assessed using semistructured interviews prior to (pretest) and after (post-test) receiving the information. Participants also completed a short survey to assess their perceptions of information delivery and satisfaction with the process. Regardless of the mode of information delivery, all participants demonstrated improved pretest to post-test understanding. While there were no statistical differences in parents' post-test understanding between the TF and IP groups, children in the IP group had significantly greater post-test understanding compared with children in the TF group (11.65 (4.1) vs 8.85 (4.1) (2.8, 1.4, 4.2) 0-18 scale where 18=complete understanding). Furthermore, the IP was found to be significantly 'easier to follow' and 'more effective' in presenting information compared with the TF. Results demonstrated the importance of providing information regarding clinical trial concepts to parents and children. Importantly, the ability of interactive multimedia to improve understanding of clinical trial concepts and satisfaction with information delivery, particularly among children, supports this approach as a novel and effective vehicle for enhancing the informed consent process. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Process of constructing a lightweight x-ray flight mirror assembly

NASA Astrophysics Data System (ADS)

McClelland, Ryan S.; Biskach, Michael P.; Chan, Kai-Wing; Espina, Rebecca A.; Hohl, Bruce R.; Saha, Timo T.; Zhang, William W.

2014-07-01

Lightweight and high resolution optics are needed for future space-based x-ray telescopes to achieve advances in highenergy astrophysics. NASA's Next Generation X-ray Optics (NGXO) project has made significant progress towards building such optics, both in terms of maturing the technology for spaceflight readiness and improving the angular resolution. Technology Development Modules (TDMs) holding three pairs of mirrors have been regularly and repeatedly integrated and tested both for optical performance and mechanical strength. X-ray test results have been improved over the past year from 10.3 arc-seconds Half Power Diameter (HPD) to 8.3 arc-seconds HPD. A vibration test has been completed to NASA standard verification levels showing the optics can survive launch and pointing towards improvements in strengthening the modules through redundant bonds. A Finite Element Analysis (FEA) study was completed which shows the mirror distortion caused by bonding is insensitive to the number of bonds. Next generation TDMs, which will demonstrate a lightweight structure and mount additional pairs of mirrors, have been designed and fabricated. The light weight of the module structure is achieved through the use of E-60 Beryllium Oxide metal matrix composite material. As the angular resolution of the development modules has improved, gravity distortion during horizontal x-ray testing has become a limiting factor. To address this issue, a facility capable of testing in the vertical orientation has been designed and planned. Test boring at the construction site suggest standard caisson construction methods can be utilized to install a subterranean vertical vacuum pipe. This facility will also allow for the testing of kinematically mounted mirror segments, which greatly reduces the effect of bonding displacements. A development platform demonstrating the feasibility of kinematically mounting mirror segments has been designed, fabricated, and successfully tested.

Impact of online education on intern behaviour around Joint Commission National Patient Safety Goals: A randomised trial

PubMed Central

TJ, Shaw; LIM, Pernar; SE, Peyre; JF, Helfrick; K, Vogelgesang; E, Graydon-Baker; Y, Chretien; EJ, Brown; J, Nicholson; JJ, Heit; JP, Co; TK, Gandhi

2014-01-01

Purpose To compare the effectiveness of 2 types of online learning methodologies for improving the patient-safety behaviours mandated in the Joint Commission National Patient Safety Goals (NPSG). Methods This randomized controlled trial was conducted in 2010 at Massachusetts General Hospital (MGH) and Brigham & Women’s Hospital (BWH) in Boston USA. Incoming interns were randomised to either receive an online Spaced Education program (SE) consisting of cases and questions that reinforce over time, or a program consisting of an online slide show followed by a quiz (SQ). The outcome measures included NPSG-knowledge improvement, NPSG-compliant behaviors in a simulation scenario, self reported confidence in safety and quality, program acceptability and program relevance. Results Both online learning programs improved knowledge retention. On four out of seven survey items measuring satisfaction and self reported confidence, the proportion of SE interns responding positively was significantly higher (p<0.05) than the fraction of SQ interns. SE interns demonstrated a mean 4.79 (36.6%) NPSG-compliant behaviors (out of 13 total), while SQ interns completed a mean 4.17 (32.0%) (p=0.09). Among those in surgical fields, SE interns demonstrated a mean 5.67 (43.6%) NPSG-compliant behaviors, while SQ interns completed a mean 2.33 (17.9%) (p=0.015). Focus group data indicates that SE was more contextually relevant than SQ and significantly more engaging. Conclusion While both online methodologies improved knowledge surrounding the NPSG, SE was more contextually relevant to trainees and engaging. SE impacted more significantly on both self reported confidence and the behaviour of surgical residents in a simulated scenario. PMID:22706930

Incorporating robotic-assisted telerehabilitation in a home program to improve arm function following stroke.

PubMed

Linder, Susan M; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Rosenfeldt, Anson B; Clark, Cindy; Wolf, Steven L; Alberts, Jay L

2013-09-01

After stroke, many individuals lack resources to receive the intensive rehabilitation that is thought to improve upper extremity motor function. This case study describes the application of a telerehabilitation intervention using a portable robotic device combined with a home exercise program (HEP) designed to improve upper extremity function. The participant was a 54-year-old man, 22 weeks following right medullary pyramidal ischemic infarct. At baseline, he exhibited residual paresis of the left upper extremity, resulting in impaired motor control consistent with a flexion synergistic pattern, scoring 22 of 66 on the Fugl-Meyer Assessment. The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period. The participant demonstrated an improvement of 26 points on the Action Research Arm Test, 5 points on the Functional Ability Scale portion of the Wolf Motor Function Test, and 20 points on the Fugl-Meyer Assessment, all of which surpassed the minimal clinically important difference. Of the 17 tasks of the Wolf Motor Function Test, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his recovery from stroke on the Stroke Impact Scale quality-of-life questionnaire from 40 of 100 to 65 of 100. His score on the Center for Epidemiologic Studies Depression Scale improved by 19 points. This case demonstrates that robotic-assisted therapy paired with an HEP can be successfully delivered within a home environment to a person with stroke. Robotic-assisted therapy may be a feasible and efficacious adjunct to an HEP program to elicit substantial improvements in upper extremity motor function, especially in those persons with stroke who lack access to stroke rehabilitation centers.

A Six-Month Randomized Controlled Trial of Exercise and Pyridostigmine in the Treatment of Fibromyalgia

PubMed Central

Jones, K. D.; Burckhardt, C. S.; Deodhar, A. A.; Perrin, N. A.; Hanson, G. C.; Bennett, R. M.

2008-01-01

Objective A subset of fibromyalgia (FM) patients have a dysfunctional hypothalamic–pituitary–insulin-like growth factor 1 (IGF-1) axis, as evidenced by low serum levels of IGF-1 and a reduced growth hormone (GH) response to physiologic stimuli. There is evidence that pyridostigmine (PYD) improves the acute response of GH to exercise in FM patients. The purpose of this study was to evaluate the clinical effectiveness of 6 months of PYD and group exercise on FM symptoms. Methods FM patients were randomized to 1 of the following 4 groups: PYD plus exercise, PYD plus diet recall but no exercise, placebo plus exercise, and placebo plus diet recall but no exercise. The primary outcome measures were the visual analog scale (VAS) score for pain, tender point count, and total myalgic score. Secondary outcome measures were the total score on the Fibromyalgia Impact Questionnaire (FIQ) and FIQ VAS scores for individual symptoms (fatigue, poor sleep, stiffness, and anxiety), as well as quality of life (QOL) and physical fitness (lower body strength/endurance, upper and lower body flexibility, balance, and time on the treadmill). Results A total of 165 FM patients completed baseline measurements; 154 (93.3%) completed the study. The combination of PYD and exercise did not improve pain scores. PYD groups showed a significant improvement in sleep and anxiety in those who completed the study and in QOL in those who complied with the therapeutic regimen as compared with the placebo groups. Compared with the nonexercise groups, the 2 exercise groups demonstrated improvement in fatigue and fitness. PYD was generally well tolerated. Conclusion Neither the combination of PYD plus supervised exercise nor either treatment alone yielded improvement in most FM symptoms. However, PYD did improve anxiety and sleep, and exercise improved fatigue and fitness. We speculate that PYD may have improved vagal tone, thus benefiting sleep and anxiety; this notion warrants further study. PMID:18240245

The power of timing: Adding a time-to-completion cutoff to the Word Choice Test and Recognition Memory Test improves classification accuracy.

PubMed

Erdodi, Laszlo A; Tyson, Bradley T; Shahein, Ayman G; Lichtenstein, Jonathan D; Abeare, Christopher A; Pelletier, Chantalle L; Zuccato, Brandon G; Kucharski, Brittany; Roth, Robert M

2017-05-01

The Recognition Memory Test (RMT) and Word Choice Test (WCT) are structurally similar, but psychometrically different. Previous research demonstrated that adding a time-to-completion cutoff improved the classification accuracy of the RMT. However, the contribution of WCT time-cutoffs to improve the detection of invalid responding has not been investigated. The present study was designed to evaluate the classification accuracy of time-to-completion on the WCT compared to the accuracy score and the RMT. Both tests were administered to 202 adults (M age  = 45.3 years, SD = 16.8; 54.5% female) clinically referred for neuropsychological assessment in counterbalanced order as part of a larger battery of cognitive tests. Participants obtained lower and more variable scores on the RMT (M = 44.1, SD = 7.6) than on the WCT (M = 46.9, SD = 5.7). Similarly, they took longer to complete the recognition trial on the RMT (M = 157.2 s,SD = 71.8) than the WCT (M = 137.2 s, SD = 75.7). The optimal cutoff on the RMT (≤43) produced .60 sensitivity at .87 specificity. The optimal cutoff on the WCT (≤47) produced .57 sensitivity at .87 specificity. Time-cutoffs produced comparable classification accuracies for both RMT (≥192 s; .48 sensitivity at .88 specificity) and WCT (≥171 s; .49 sensitivity at .91 specificity). They also identified an additional 6-10% of the invalid profiles missed by accuracy score cutoffs, while maintaining good specificity (.93-.95). Functional equivalence was reached at accuracy scores ≤43 (RMT) and ≤47 (WCT) or time-to-completion ≥192 s (RMT) and ≥171 s (WCT). Time-to-completion cutoffs are valuable additions to both tests. They can function as independent validity indicators or enhance the sensitivity of accuracy scores without requiring additional measures or extending standard administration time.

Extracting renewable energy from a salinity difference using a capacitor.

PubMed

Brogioli, Doriano

2009-07-31

Completely renewable energy can be produced by using water solutions of different salinity, like river water and sea water. Many different methods are already known, but development is still at prototype stage. Here I report a novel method, based on electric double-layer capacitor technology. Two porous electrodes, immersed in the salt solution, constitute a capacitor. It is first charged, then the salt solution is brought into contact with fresh water. The electrostatic energy increases as the salt concentration of the solution is reduced due to diffusion. This device can be used to turn sources of salinity difference into completely renewable sources of energy. An experimental demonstration is given, and performances and possible improvements are discussed.

Bench model surgical skill training improves novice ability to multitask: a randomized controlled study.

PubMed

Grierson, Lawrence; Melnyk, Megan; Jowlett, Nathan; Backstein, David; Dubrowski, Adam

2011-01-01

Skills training in simulation laboratories is becoming increasingly common. However, the educational benefit of these laboratories remains unclear. This study examined whether such training enables better performance on the simultaneous execution of technical skill and knowledge retention. Twenty-four novice trainees completed the elliptical excision on baseline testing. Following baseline testing twelve of the novices completed a technical practice (simulation training group) session, while the other twelve did not (control group). One week later, all participants returned for dual-task follow up testing in which they performed the excision while listening to a didactic lesson on the staging and treatment of cutaneous melanoma. The dual-tasking during the post test was standardized, whereby excision sutures 3 and 5 were performed alone (single), and sutures 4 and 6 were performed concurrently with the didactic lecture (dual). Seven additional trainees also participated as controls that were randomized to listen to the didactic lesson alone (knowledge retention alone group). Knowledge retention was assessed by a multiple choice questionnaire (MCQ). Technical performance was evaluated with computer and expert-based measures. Time to complete the performance improved among both groups completing the elliptical excision on follow-up testing (p<0.01). The simulation training group demonstrated superior hand motion performance on simultaneous didactic lesson testing (p<0.01). Novices from the no-training group performed statistically worse while suturing concurrently with the didactic lesson (p<0.01). The pretraining of novices in surgical skills laboratories leads to improved technical performance during periods of increased attention demands.

Surviving floods: leaf gas films improve O₂ and CO₂ exchange, root aeration, and growth of completely submerged rice.

PubMed

Pedersen, Ole; Rich, Sarah Meghan; Colmer, Timothy David

2009-04-01

When completely submerged, the leaves of some species retain a surface gas film. Leaf gas films on submerged plants have recently been termed 'plant plastrons', analogous with the plastrons of aquatic insects. In aquatic insects, surface gas layers (i.e. plastrons) enlarge the gas-water interface to promote O₂ uptake when under water; however, the function of leaf gas films has rarely been considered. The present study demonstrates that gas films on leaves of completely submerged rice facilitate entry of O₂ from floodwaters when in darkness and CO₂ entry when in light. O₂ microprofiles showed that the improved gas exchange was not caused by differences in diffusive boundary layers adjacent to submerged leaves with or without gas films; instead, reduced resistance to gas exchange was probably due to the enlarged water-gas interface (cf. aquatic insects). When gas films were removed artificially, underwater net photosynthesis declined to only 20% of the rate with gas films present, such that, after 7 days of complete submergence, tissue sugar levels declined, and both shoot and root growth were reduced. Internal aeration of roots in anoxic medium, when shoots were in aerobic floodwater in darkness or when in light, was improved considerably when leaf gas films were present. Thus, leaf gas films contribute to the submergence tolerance of rice, in addition to those traits already recognized, such as the shoot-elongation response, aerenchyma and metabolic adjustments to O₂ deficiency and oxidative stress. © 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd.

A Psychometric Tool for a Virtual Reality Rehabilitation Approach for Dyslexia.

PubMed

Pedroli, Elisa; Padula, Patrizia; Guala, Andrea; Meardi, Maria Teresa; Riva, Giuseppe; Albani, Giovanni

2017-01-01

Dyslexia is a chronic problem that affects the life of subjects and often influences their life choices. The standard rehabilitation methods all use a classic paper and pencil training format but these exercises are boring and demanding for children who may have difficulty in completing the treatments. It is important to develop a new rehabilitation program that would help children in a funny and engaging way. A Wii-based game was developed to demonstrate that a short treatment with an action video game, rather than phonological or orthographic training, may improve the reading abilities in dyslexic children. According to the results, an approach using cues in the context of a virtual environment may represent a promising tool to improve attentional skills. On the other hand, our results do not demonstrate an immediate effect on reading performance, suggesting that a more prolonged protocol may be a future direction.

Split-brain phenomena in anterior communicating artery aneurysm rupture: A case report.

PubMed

Korsakova, Natalya; Liebson, Elizabeth; Moskovich, Lena

2017-06-01

In 1976, a patient with an anterior communicating artery aneurysm (ACoAA) rupture (diagnosed on angiography) and sub-arachnoid hemorrhage (SAH) underwent serial neuropsychological testing revealing a classical anterior cerebral artery (ACA) spasm picture with severe anterograde amnesia of Korsakoff's type and dysexecutive syndrome. In addition, the patient demonstrated impaired hemispheric interaction with alien hand syndrome, dyscopia-dysgraphia, complete left ear neglect, and other, more complex, split-brain phenomena. He was evaluated by A. R. Luria in 1976. Following surgery the patient demonstrated gradual improvement. © 2017 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

Comparative Initial and Sustained Engagement in Web-based Training by Behavioral Healthcare Providers in New York State.

PubMed

Talley, Rachel; Chiang, I-Chin; Covell, Nancy H; Dixon, Lisa

2018-06-01

Improved dissemination is critical to implementation of evidence-based practice in community behavioral healthcare settings. Web-based training modalities are a promising strategy for dissemination of evidence-based practice in community behavioral health settings. Initial and sustained engagement of these modalities in large, multidisciplinary community provider samples is not well understood. This study evaluates comparative engagement and user preferences by provider type in a web-based training platform in a large, multidisciplinary community sample of behavioral health staff in New York State. Workforce make-up among platform registrants was compared to the general NYS behavioral health workforce. Training completion by functional job type was compared to characterize user engagement and preferences. Frequently completed modules were classified by credit and requirement incentives. High initial training engagement across professional role was demonstrated, with significant differences in initial and sustained engagement by professional role. The most frequently completed modules across functional job types contained credit or requirement incentives. The analysis demonstrated that high engagement of a web-based training in a multidisciplinary provider audience can be achieved without tailoring content to specific professional roles. Overlap between frequently completed modules and incentives suggests a role for incentives in promoting engagement of web-based training. These findings further the understanding of strategies to promote large-scale dissemination of evidence-based practice in community behavioral health settings.

Proteogenomics produces comprehensive and highly accurate protein-coding gene annotation in a complete genome assembly of Malassezia sympodialis.

PubMed

Zhu, Yafeng; Engström, Pär G; Tellgren-Roth, Christian; Baudo, Charles D; Kennell, John C; Sun, Sheng; Billmyre, R Blake; Schröder, Markus S; Andersson, Anna; Holm, Tina; Sigurgeirsson, Benjamin; Wu, Guangxi; Sankaranarayanan, Sundar Ram; Siddharthan, Rahul; Sanyal, Kaustuv; Lundeberg, Joakim; Nystedt, Björn; Boekhout, Teun; Dawson, Thomas L; Heitman, Joseph; Scheynius, Annika; Lehtiö, Janne

2017-03-17

Complete and accurate genome assembly and annotation is a crucial foundation for comparative and functional genomics. Despite this, few complete eukaryotic genomes are available, and genome annotation remains a major challenge. Here, we present a complete genome assembly of the skin commensal yeast Malassezia sympodialis and demonstrate how proteogenomics can substantially improve gene annotation. Through long-read DNA sequencing, we obtained a gap-free genome assembly for M. sympodialis (ATCC 42132), comprising eight nuclear and one mitochondrial chromosome. We also sequenced and assembled four M. sympodialis clinical isolates, and showed their value for understanding Malassezia reproduction by confirming four alternative allele combinations at the two mating-type loci. Importantly, we demonstrated how proteomics data could be readily integrated with transcriptomics data in standard annotation tools. This increased the number of annotated protein-coding genes by 14% (from 3612 to 4113), compared to using transcriptomics evidence alone. Manual curation further increased the number of protein-coding genes by 9% (to 4493). All of these genes have RNA-seq evidence and 87% were confirmed by proteomics. The M. sympodialis genome assembly and annotation presented here is at a quality yet achieved only for a few eukaryotic organisms, and constitutes an important reference for future host-microbe interaction studies. © The Author(s) 2017. Published by Oxford University Press on behalf of Nucleic Acids Research.

Performance evaluation of the Personal Mobility and Manipulation Appliance (PerMMA).

PubMed

Wang, Hongwu; Xu, Jijie; Grindle, Garrett; Vazquez, Juan; Salatin, Ben; Kelleher, Annmarie; Ding, Dan; Collins, Diane M; Cooper, Rory A

2013-11-01

The Personal Mobility and Manipulation Appliance (PerMMA) is a recently developed personal assistance robot created to provide people with severe physical disabilities enhanced assistance in both mobility and manipulation. PerMMA aims to improve functional independence when a personal care attendant is not available on site. PerMMA integrates both a smart powered wheelchair and two dexterous robotic arms to assist its users in completing essential mobility and manipulation tasks during basic and instrumental activities of daily living (ADL). Two user interfaces were developed: a local control interface and a remote operator controller. This paper reports on the evaluation of PerMMA with end users completing basic ADL tasks. Participants with both lower and upper extremity impairments (N=15) were recruited to operate PerMMA and complete up to five ADL tasks in a single session of no more than two hours (to avoid fatigue or frustration of the participants). The performance of PerMMA was evaluated by participants completing ADL tasks with two different control modes: local mode and cooperative control. The users' task completion performance and answers on pre/post-evaluation questionnaires demonstrated not only the ease in learning and usefulness of PerMMA, but also their attitudes toward assistance from advanced technology like PerMMA. As a part of the iterative development process, results of this work will serve as supporting evidence to identify design criteria and other areas for improvement of PerMMA. Copyright © 2013 IPEM. All rights reserved.

Curriculum renewal: Alignment of introductory pharmacy practice experiences with didactic course content.

PubMed

Nuffer, Wesley; Botts, Sheila; Franson, Kari; Gilliam, Eric; Knutsen, Randy; Nuffer, Monika; O'Brien, Elizabeth; Saseen, Joseph; Thompson, Megan; Vande Griend, Joseph; Willis, Robert

2017-11-01

The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) used the opportunity of curriculum renewal to integrate knowledge and skills learned from didactic courses into the introductory pharmacy practice experiences (IPPEs) occurring simultaneously. This paper describes and evaluates the meaningful application of course content into IPPEs, and evaluates the success using qualitative feedback. Students entering the renewed curriculum starting in fall 2012 were provided a list of pharmacy skills and activities from didactic course directors that reinforced course content for that semester. The skills and activities were to be completed during the students' IPPE visits in the community or health systems settings, depending on the program year and semester. Students successfully completed course assignments during their IPPE course program. Not all activities could be completed as designed, and many required modification, including simulated experiences. Feedback from faculty and preceptor members of the school's experiential education committee demonstrated that these activities were valuable and improved learning of course material, but were challenging to implement. A renewed curriculum that mapped course assignments for completion in experiential settings was successfully established, after some modifications. The program was modified at regular intervals to improve the ability of preceptors to complete these activities in their individual practice environment. A balance between the school providing guidance on what activities students should perform and allowing unstructured independent learning with the preceptor is needed for an optimal experience. Copyright © 2017 Elsevier Inc. All rights reserved.

Cooking Matters for Adults Improves Food Resource Management Skills and Self-confidence Among Low-Income Participants.

PubMed

Pooler, Jennifer A; Morgan, Ruth E; Wong, Karen; Wilkin, Margaret K; Blitstein, Jonathan L

Determine the impact of Cooking Matters for Adults (CM) on food resource management (FRM) skills and self-confidence 6 months after course completion. Quasi-experimental design with nonequivalent comparison group and 6-month follow-up. Cooking Matters for Adults programs in CA, CO, ME, MA, MI, and OR. Participants in CM attending classes in April to July, 2016 (n = 332); comparison group (n = 336). Cooking Matters for Adults educated low-income adults to shop for and prepare healthy meals economically using hands-on meal preparation, facilitated discussion, and an interactive grocery store tour. Classes met for 2 hours, once a week for 6 weeks. Food resource management practices; FRM self-confidence (ie, in shopping for and preparing healthy foods on a budget); worrying that food might run out. Pearson's chi-square test and t tests identified measures associated with outcomes of interest and between-group differences. Repeated-measures linear mixed models with fixed and random effects were used to examine differences in outcomes between participants in CM and nonequivalent comparison group and to estimate the treatment effect of the program at 3 and 6 months after course completion. Six months after course completion, CM participants demonstrated improvements in all outcome measures of interest: Use of FRM practices improved (P = .002) as did FRM confidence (P < .001). Participants also worried less that food would run out before they had money to buy more (P = .03). This study demonstrated a positive impact of including FRM skills and confidence building in a nutrition education program, the effects of which could be seen for 6 months after participation in the program. Equipping low-income families with FRM skills allowed them to access healthier foods even during times of hardship. Copyright © 2017 Society for Nutrition Education and Behavior. All rights reserved.

Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes.

PubMed

Villatte, Jennifer L; Vilardaga, Roger; Villatte, Matthieu; Plumb Vilardaga, Jennifer C; Atkins, David C; Hayes, Steven C

2016-02-01

A modular, transdiagnostic approach to treatment design and implementation may increase the public health impact of evidence-based psychosocial interventions. Such an approach relies on algorithms for selecting and implementing treatment components intended to have a specific therapeutic effect, yet there is little evidence for how components function independent of their treatment packages when employed in clinical service settings. This study aimed to demonstrate the specificity of treatment effects for two components of Acceptance and Commitment Therapy (ACT), a promising candidate for modularization. A randomized, nonconcurrent, multiple-baseline across participants design was used to examine component effects on treatment processes and outcomes in 15 adults seeking mental health treatment. The ACT OPEN module targeted acceptance and cognitive defusion; the ACT ENGAGED module targeted values-based activation and persistence. According to Tau-U analyses, both modules produced significant improvements in psychiatric symptoms, quality of life, and targeted therapeutic processes. ACT ENGAGED demonstrated greater improvements in quality of life and values-based activation. ACT OPEN showed greater improvements in symptom severity, acceptance, and defusion. Both modules improved awareness and non-reactivity, which were mutually targeted, though using distinct intervention procedures. Both interventions demonstrated high treatment acceptability, completion, and patient satisfaction. Treatment effects were maintained at 3-month follow up. ACT components should be considered for inclusion in a modular approach to implementing evidence-based psychosocial interventions for adults. Copyright © 2015 Elsevier Ltd. All rights reserved.

A novel primary-specialist care collaborative demonstration project to improve the access and health care of medically complex patients.

PubMed

Siu, Henry Yu-Hin; Steward, Nicole; Peter, Jessica; Cooke, Laurel; Arnold, Donald M; Price, David

2017-09-01

Objective Medically complex patients experience fragmented health care compounded by long wait times. The MedREACH program was developed to improve access and overall system experience for medically complex patients. Program description MedREACH is a novel primary-tertiary care collaborative demonstration program that features community nursing outreach, community specialist outreach, and a multi-specialty consultation clinic. Methods All 179 patients, referring primary care clinicians, and specialists involved were eligible to participate. Patient and clinician feedback were elicited by feedback surveys. Process measures were evaluated by participant retrospective chart reviews. Community nursing outreach patients completed the Goal Attainment Scale. Results Forty-eight patients and 22 clinicians consented to the feedback survey. About 75% of patients were seen within 2 weeks of referral. Patients spent an average of 3, 1.63, and 1.2 visits with the nursing outreach, multi-specialty clinic, and specialist outreach, respectively. Patients indicated a better medical experience, health enablement, and goals attainment. Family physicians felt more supported in the community management of medically complex patients and, overall, physicians felt MedREACH could improve collaborative care for medically complex patients. Qualitative analysis of clinician responses identified the need for increased mental health services. Discussion MedREACH demonstrates a patient-centered link between primary and tertiary care that could improve health care access and overall experience.

Enhancements to the FAST-MAC Circulation Control Model and Recent High-Reynolds Number Testing in the National Transonic Facility

NASA Technical Reports Server (NTRS)

Milholen, William E., II; Jones, Gregory S.; Chan, David T.; Goodliff, Scott L.; Anders, Scott G.; Melton, Latunia P.; Carter, Melissa B.; Allan, Brian G.; Capone, Francis J.

2013-01-01

A second wind tunnel test of the FAST-MAC circulation control model was recently completed in the National Transonic Facility at the NASA Langley Research Center. The model was equipped with four onboard flow control valves allowing independent control of the circulation control plenums, which were directed over a 15% chord simple-hinged flap. The model was configured for low-speed high-lift testing with flap deflections of 30 and 60 degrees, along with the transonic cruise configuration with zero degree flap deflection. Testing was again conducted over a wide range of Mach numbers up to 0.88, and Reynolds numbers up to 30 million based on the mean chord. The first wind tunnel test had poor transonic force and moment data repeatability at mild cryogenic conditions due to inadequate thermal conditioning of the balance. The second test demonstrated that an improvement to the balance heating system significantly improved the transonic data repeatability, but also indicated further improvements are still needed. The low-speed highlift performance of the model was improved by testing various blowing slot heights, and the circulation control was again demonstrated to be effective in re-attaching the flow over the wing at off-design transonic conditions. A new tailored spanwise blowing technique was also demonstrated to be effective at transonic conditions with the benefit of reduced mass flow requirements.

The Teachers of Quality Academy: Evaluation of the Effectiveness and Impact of a Health Systems Science Training Program.

PubMed

Walsh, Danielle S; Lazorick, Suzanne; Lawson, Luan; Lake, Donna; Garrison, Herbert G; Higginson, Jason; Vos, Paul; Baxley, Elizabeth

2018-05-01

This project aimed to evaluate the effectiveness of a faculty development program in health systems science (HSS)-the Teachers of Quality Academy (TQA). Participants in TQA and a comparison group were evaluated before, during, and 1 year after the program using self-perception questionnaires, tests of HSS knowledge, and tracking of academic productivity and career advancement. Among program completers (n = 27), the mean self-assessed ratings of knowledge and skills of HSS topics immediately after the program, as compared to baseline, increased significantly compared to controls (n = 30). Participants demonstrated progressive improvement of self-perceived skills and attitudes, and retention of HSS knowledge, from baseline to completion of the program. Participants also demonstrated substantially higher HSS scholarly productivity, leadership, and career advancement compared to the comparison group. The TQA effectively created a faculty cadre able to role model, teach, and create a curriculum in HSS competencies for medical students, resident physicians, and other health professionals.

Long-term complete remission with belinostat in a patient with chemotherapy refractory peripheral T-cell lymphoma.

PubMed

Reimer, Peter; Chawla, Shanta

2013-09-10

Peripheral T/NK-cell lymphomas (PTCL) are rare malignancies with a poor prognosis. Due to the lack of randomised studies, standard therapy has not been established. First-line treatment with anthracycline-based polychemotherapy followed by consolidation with high-dose therapy and autologous stem cell transplant in responding patients has demonstrated good feasibility with low toxicity in prospective studies and is widely used in eligible patients. In relapsed and refractory patients, who are not candidates for transplant approaches, therapeutic options are limited and are usually palliative. Several new agents are currently under investigation to improve the outcome of PTCL in the first line and salvage settings. Belinostat, a histone deacetylase (HDAC) inhibitor, has demonstrated broad antineoplastic activity in preclinical studies, and promising results in advanced relapsed/refractory lymphomas.Here, we report the case of a 73 year old patient with heavily pre-treated refractory PTCL in complete remission with belinostat for 39 months.

Successful Completion of FY18/Q1 ASC L2 Milestone 6355: Electrical Analysis Calibration Workflow Capability Demonstration.

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

Copps, Kevin D.

The Sandia Analysis Workbench (SAW) project has developed and deployed a production capability for SIERRA computational mechanics analysis workflows. However, the electrical analysis workflow capability requirements have only been demonstrated in early prototype states, with no real capability deployed for analysts’ use. This milestone aims to improve the electrical analysis workflow capability (via SAW and related tools) and deploy it for ongoing use. We propose to focus on a QASPR electrical analysis calibration workflow use case. We will include a number of new capabilities (versus today’s SAW), such as: 1) support for the XYCE code workflow component, 2) data managementmore » coupled to electrical workflow, 3) human-in-theloop workflow capability, and 4) electrical analysis workflow capability deployed on the restricted (and possibly classified) network at Sandia. While far from the complete set of capabilities required for electrical analysis workflow over the long term, this is a substantial first step toward full production support for the electrical analysts.« less

Laparoscopic Skills Are Improved With LapMentor™ Training

PubMed Central

Andreatta, Pamela B.; Woodrum, Derek T.; Birkmeyer, John D.; Yellamanchilli, Rajani K.; Doherty, Gerard M.; Gauger, Paul G.; Minter, Rebecca M.

2006-01-01

Objective: To determine if prior training on the LapMentor™ laparoscopic simulator leads to improved performance of basic laparoscopic skills in the animate operating room environment. Summary Background Data: Numerous influences have led to the development of computer-aided laparoscopic simulators: a need for greater efficiency in training, the unique and complex nature of laparoscopic surgery, and the increasing demand that surgeons demonstrate competence before proceeding to the operating room. The LapMentor™ simulator is expensive, however, and its use must be validated and justified prior to implementation into surgical training programs. Methods: Nineteen surgical interns were randomized to training on the LapMentor™ laparoscopic simulator (n = 10) or to a control group (no simulator training, n = 9). Subjects randomized to the LapMentor™ trained to expert criterion levels 2 consecutive times on 6 designated basic skills modules. All subjects then completed a series of laparoscopic exercises in a live porcine model, and performance was assessed independently by 2 blinded reviewers. Time, accuracy rates, and global assessments of performance were recorded with an interrater reliability between reviewers of 0.99. Results: LapMentor™ trained interns completed the 30° camera navigation exercise in significantly less time than control interns (166 ± 52 vs. 220 ± 39 seconds, P < 0.05); they also achieved higher accuracy rates in identifying the required objects with the laparoscope (96% ± 8% vs. 82% ± 15%, P < 0.05). Similarly, on the two-handed object transfer exercise, task completion time for LapMentor™ trained versus control interns was 130 ± 23 versus 184 ± 43 seconds (P < 0.01) with an accuracy rate of 98% ± 5% versus 80% ± 13% (P < 0.001). Additionally, LapMentor™ trained interns outperformed control subjects with regard to camera navigation skills, efficiency of motion, optimal instrument handling, perceptual ability, and performance of safe electrocautery. Conclusions: This study demonstrates that prior training on the LapMentor™ laparoscopic simulator leads to improved resident performance of basic skills in the animate operating room environment. This work marks the first prospective, randomized evaluation of the LapMentor™ simulator, and provides evidence that LapMentor™ training may lead to improved operating room performance. PMID:16772789

Minimal Residual Disease in Acute Myeloid Leukemia

PubMed Central

Hourigan, Christopher S.; Karp, Judith E.

2014-01-01

Technological advances in the laboratory have lead to substantial improvements in clinical decision-making by the use of pre-treatment prognostic risk stratification factors in acute myeloid leukemia (AML). Unfortunately similar progress has not been made in treatment response criteria, with the definition of “complete remission” in AML largely unchanged for over half a century. Several recent clinical trials have demonstrated that higher sensitivity measurements of residual disease burden during or after treatment can be performed, that results are predictive for clinical outcome and can be used to improve outcomes by guiding additional therapeutic intervention to patients in clinical complete remission but at increased relapse risk. We review here these recent trials, the characteristics and challenges of the modalities currently used to detect minimal residual disease (MRD), and outline opportunities to both refine detection and better clinically utilize MRD measurements. MRD measurement is already the standard of care in other myeloid malignancies such as chronic myelogenous leukemia (CML) and acute promyelocytic leukemia (APL). It is our belief that response criteria for non-APL AML should be updated to include assessment for molecular complete remission (mCR) and that recommendations for post-consolidation surveillance should include regular monitoring for molecular relapse as a standard of care. PMID:23799371

PIGSPro: prediction of immunoGlobulin structures v2.

PubMed

Lepore, Rosalba; Olimpieri, Pier P; Messih, Mario A; Tramontano, Anna

2017-07-03

PIGSpro is a significant upgrade of the popular PIGS server for the prediction of the structure of immunoglobulins. The software has been completely rewritten in python following a similar pipeline as in the original method, but including, at various steps, relevant modifications found to improve its prediction accuracy, as demonstrated here. The steps of the pipeline include the selection of the appropriate framework for predicting the conserved regions of the molecule by homology; the target template alignment for this portion of the molecule; the selection of the main chain conformation of the hypervariable loops according to the canonical structure model, the prediction of the third loop of the heavy chain (H3) for which complete canonical structures are not available and the packing of the light and heavy chain if derived from different templates. Each of these steps has been improved including updated methods developed along the years. Last but not least, the user interface has been completely redesigned and an automatic monthly update of the underlying database has been implemented. The method is available as a web server at http://biocomputing.it/pigspro. © The Author(s) 2017. Published by Oxford University Press on behalf of Nucleic Acids Research.

The modified Memorial Symptom Assessment Scale Short Form: a modified response format and rational scoring rules.

PubMed

Sharp, J L; Gough, K; Pascoe, M C; Drosdowsky, A; Chang, V T; Schofield, P

2018-07-01

The Memorial Symptom Assessment Scale Short Form (MSAS-SF) is a widely used symptom assessment instrument. Patients who self-complete the MSAS-SF have difficulty following the two-part response format, resulting in incorrectly completed responses. We describe modifications to the response format to improve useability, and rational scoring rules for incorrectly completed items. The modified MSAS-SF was completed by 311 women in our Peer and Nurse support Trial to Assist women in Gynaecological Oncology; the PeNTAGOn study. Descriptive statistics were used to summarise completion of the modified MSAS-SF, and provide symptom statistics before and after applying the rational scoring rules. Spearman's correlations with the Functional Assessment for Cancer Therapy-General (FACT-G) and Hospital Anxiety and Depression Scale (HADS) were assessed. Correct completion of the modified MSAS-SF items ranged from 91.5 to 98.7%. The rational scoring rules increased the percentage of useable responses on average 4% across all symptoms. MSAS-SF item statistics were similar with and without the scoring rules. The pattern of correlations with FACT-G and HADS was compatible with prior research. The modified MSAS-SF was useable for self-completion and responses demonstrated validity. The rational scoring rules can minimise loss of data from incorrectly completed responses. Further investigation is recommended.

Augmenting CPT to Improve Sleep Impairment in PTSD: A Randomized Clinical Trial

PubMed Central

Galovski, Tara E.; Mott, Juliette; Blain, Leah M.; Elwood, Lisa; Gloth, Chelsea; Fletcher, Thomas

2015-01-01

Objective Despite the success of empirically supported treatments for posttraumatic stress disorder (PTSD), sleep impairment frequently remains refractory following treatment for PTSD. This single-site, randomized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD (cognitive processing therapy; CPT). Method Participants completed either 3 weeks of hypnosis (n = 52) or a symptom monitoring control condition (n = 56) before beginning standard CPT. Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis resulted in improvements in sleep, PTSD, and depression. An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT. Results After the initial phase of treatment (hypnosis or symptom monitoring), the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression, but not PTSD. After CPT, both conditions demonstrated significant improvement in sleep and PTSD; however, the hypnosis condition demonstrated greater improvement in depressive symptoms. As sleep improved, there were corresponding improvements in PTSD and depression, with a stronger relationship between sleep and PTSD. Conclusion Hypnosis was effective in improving sleep impairment, but those improvements did not augment gains in PTSD recovery during the trauma-focused intervention. Public Health Significance: This study suggests that hypnosis may be a viable treatment option in a stepped-care approach for treating sleep impairment in individuals suffering from PTSD. PMID:26689303

An improved K-means clustering method for cDNA microarray image segmentation.

PubMed

Wang, T N; Li, T J; Shao, G F; Wu, S X

2015-07-14

Microarray technology is a powerful tool for human genetic research and other biomedical applications. Numerous improvements to the standard K-means algorithm have been carried out to complete the image segmentation step. However, most of the previous studies classify the image into two clusters. In this paper, we propose a novel K-means algorithm, which first classifies the image into three clusters, and then one of the three clusters is divided as the background region and the other two clusters, as the foreground region. The proposed method was evaluated on six different data sets. The analyses of accuracy, efficiency, expression values, special gene spots, and noise images demonstrate the effectiveness of our method in improving the segmentation quality.

Impact of brief communication training among hospital social workers.

PubMed

Bunting, Morgan; Cagle, John G

2016-01-01

Hospital social workers are often the fulcrum of communication between physicians, patients, and families especially when patients are facing life-threatening illness. This study aims to understand the impact of a brief training for hospital social workers. The training is designed to improve communication skills and self-efficacy, as well as lessen fears of death and dying. Repeated-measures tests were used to assess outcomes across three time points. Twenty-nine university-based hospital social workers participated. Results trended in the desired directions. Communication self-efficacy improved immediately following the training, and this was sustained 1 month following training completion. Although participants were relatively experienced, improvement was still demonstrated and maintained suggesting brief communication training is promising for hospital social workers across the career.

A comparison of self-reported emotional and trauma-related concerns among sexually abused children with and without sexual behavior problems.

PubMed

Allen, Brian; Thorn, Brian L; Gully, Kevin J

2015-05-01

Numerous studies document concomitant features of sexual behavior problems (SBPs) among children 12 years of age or younger, but rarely does research involve child self-report assessments. This study provides the most comprehensive examination to date of self-reported concerns among children with SBP, using a large sample (N = 392) of clinically referred participants who reported sexual abuse histories. Children between the ages of 8 and 12 were categorized as demonstrating SBP (n = 203) or not demonstrating SBP (n = 189) as determined by scores on the Child Sexual Behavior Inventory. Children completed the Trauma Symptom Checklist for Children, and caregivers completed the Child Behavior Checklist. Self-reports of children showed that those with SBP reported significantly greater concerns in all areas, including sexual preoccupation and sexual distress, than their peers not demonstrating SBP. Caregivers of children in the SBP group reported greater concerns of internalizing and externalizing problems than the caregivers of children who did not have SBP. Implications for clinical practice and future research are discussed. Specifically, it is recommended that future research improve on the manner in which sexual abuse and SBPs were defined and assessed. © The Author(s) 2015.

Development of Advanced Fuel Cell System (Phase 4)

NASA Technical Reports Server (NTRS)

Meyer, A. P.; Bell, W. F.

1976-01-01

A multiple-task research and development program was performed to improve the weight, life, and performance characteristics of hydrogen-oxygen alkaline fuel cells for advanced power systems. During Phase 4, the lowest stabilized degradation rate observed in all the testing completed during four phases of the program, 1 microvolt/hour, was demonstrated. This test continues after 5,000 hours of operation. The cell incorporates a PPf anode, a 90Au/10Pt cathode, a hybrid frame, and a Fybex matrix. These elements were developed under this program to extend cell life. The result demonstrated that the 80Au/20Pt cathode is as stable as a 90Au/10Pt cathode of twice the precious metal loading, was confirmed in full-scale cells. A hybrid frame two-cell plaque with dedicated flow fields and manifolds for all fluids was demonstrated to prevent the cell-to cell electrolyte transfer that limited the endurance of multicell plaques. At the conclusion of Phase 4, more than 90,900 hours of testing had been completed and twelve different cell designs had been evaluated. A technology base has been established which is ready for evaluation at the powerplant level.

Outcomes of a Suicide Prevention Gatekeeper Training Program Among School Personnel.

PubMed

Lamis, Dorian A; Underwood, Maureen; D'Amore, Nicole

2017-03-01

Gatekeeper suicide prevention programs train staff to increase the identification and referral of suicidal individuals to the appropriate resources. We evaluated Act on FACTS: Making Educators Partners in Youth Suicide Prevention (MEP), which is an online training program designed to enhance the knowledge of suicide risk factors and warning signs as well as improve participants' attitudes and self-efficacy/confidence. School personnel (N = 700) completed a survey administered before and immediately after the training to assess gains in training outcomes and to evaluate participants' satisfaction with the training. Results indicated that MEP participants demonstrated significant increases in suicide knowledge, attitudes, and self-efficacy. Moreover, exploratory analyses revealed moderating effects of professional role on pre-/posttest changes in self-efficacy, but not suicide knowledge or attitudes. Specifically, guidance counselors demonstrated significantly smaller increases in self-efficacy/confidence compared with teachers and classroom aids, whereas teachers demonstrated significantly larger increases in self-efficacy/confidence compared with administrators. The majority of school personnel who completed the MEP program were satisfied with the training content and experience. Although the current findings are promising, more rigorous evaluations employing randomized controlled research designs are warranted to adequately determine the effectiveness of the MEP program.

Personalized Video Feedback and Repeated Task Practice Improve Laparoscopic Knot-Tying Skills: Two Controlled Trials.

PubMed

Abbott, Eduardo F; Thompson, Whitney; Pandian, T K; Zendejas, Benjamin; Farley, David R; Cook, David A

2017-11-01

Compare the effect of personalized feedback (PF) vs. task demonstration (TD), both delivered via video, on laparoscopic knot-tying skills and perceived workload; and evaluate the effect of repeated practice. General surgery interns and research fellows completed four repetitions of a simulated laparoscopic knot-tying task at one-month intervals. Midway between repetitions, participants received via e-mail either a TD video (demonstration by an expert) or a PF video (video of their own performance with voiceover from a blinded senior surgeon). Each participant received at least one video per format, with sequence randomly assigned. Outcomes included performance scores and NASA Task Load Index (NASA-TLX) scores. To evaluate the effectiveness of repeated practice, scores from these trainees on a separate delayed retention test were compared against historical controls who did not have scheduled repetitions. Twenty-one trainees completed the randomized study. Mean change in performance scores was significantly greater for those receiving PF (difference = 23.1 of 150 [95% confidence interval (CI): 0, 46.2], P = .05). Perceived workload was also significantly reduced (difference = -3.0 of 20 [95% CI: -5.8, -0.3], P = .04). Compared with historical controls (N = 93), the 21 with scheduled repeated practice had higher scores on the laparoscopic knot-tying assessment two weeks after the final repetition (difference = 1.5 of 10 [95% CI: 0.2, 2.8], P = .02). Personalized video feedback improves trainees' procedural performance and perceived workload compared with a task demonstration video. Brief monthly practice sessions support skill acquisition and retention.

Supervised autonomous robotic soft tissue surgery.

PubMed

Shademan, Azad; Decker, Ryan S; Opfermann, Justin D; Leonard, Simon; Krieger, Axel; Kim, Peter C W

2016-05-04

The current paradigm of robot-assisted surgeries (RASs) depends entirely on an individual surgeon's manual capability. Autonomous robotic surgery-removing the surgeon's hands-promises enhanced efficacy, safety, and improved access to optimized surgical techniques. Surgeries involving soft tissue have not been performed autonomously because of technological limitations, including lack of vision systems that can distinguish and track the target tissues in dynamic surgical environments and lack of intelligent algorithms that can execute complex surgical tasks. We demonstrate in vivo supervised autonomous soft tissue surgery in an open surgical setting, enabled by a plenoptic three-dimensional and near-infrared fluorescent (NIRF) imaging system and an autonomous suturing algorithm. Inspired by the best human surgical practices, a computer program generates a plan to complete complex surgical tasks on deformable soft tissue, such as suturing and intestinal anastomosis. We compared metrics of anastomosis-including the consistency of suturing informed by the average suture spacing, the pressure at which the anastomosis leaked, the number of mistakes that required removing the needle from the tissue, completion time, and lumen reduction in intestinal anastomoses-between our supervised autonomous system, manual laparoscopic surgery, and clinically used RAS approaches. Despite dynamic scene changes and tissue movement during surgery, we demonstrate that the outcome of supervised autonomous procedures is superior to surgery performed by expert surgeons and RAS techniques in ex vivo porcine tissues and in living pigs. These results demonstrate the potential for autonomous robots to improve the efficacy, consistency, functional outcome, and accessibility of surgical techniques. Copyright © 2016, American Association for the Advancement of Science.

Implementation of a Hydrotherapy Protocol to Improve Postpartum Pain Management.

PubMed

Batten, Meghann; Stevenson, Eleanor; Zimmermann, Deb; Isaacs, Christine

2017-03-01

A growing number of women are seeking alternatives to traditional pharmacologic pain management during birth. While there has been an extensive array of nonpharmacologic options developed for labor, there are limited offerings in the postpartum period. The purpose of this quality improvement project was to implement a hydrotherapy protocol in the early postpartum period to improve pain management for women choosing a nonmedicated birth. The postpartum hydrotherapy protocol was initiated in a certified nurse-midwife (CNM) practice in an urban academic medical center. All women who met criteria were offered a 30-minute warm water immersion bath at one hour postpartum. Pain scores were assessed prior to the bath, at 15 minutes after onset, and again at the conclusion (30 minutes). Women who completed the bath were also asked to complete a brief survey on their experience with postpartum hydrotherapy. In women who used the bath (N = 45), there was a significant reduction in pain scores (P < .001) between the onset of the bath and scores at both 15 minutes and 30 minutes. There was no significant difference between pain scores at 15 minutes and 30 minutes (P = .97). Of those women who completed a survey (n = 43), 97.7% reported both that the bath reduced their pain and improved their birth experience. One hundred percent reported they would use it again in another birth. This project demonstrated successful implementation of a hydrotherapy protocol as an alternative or adjunct to medication for early postpartum pain management that significantly reduced pain and improved the birth experience for those who used it. It offers a nonpharmacologic alternative where there have traditionally been limited options. © 2017 by the American College of Nurse-Midwives.

Management of onychomycosis and co-existing tinea pedis.

PubMed

Lipner, Shari R; Scher, Richard K

2015-05-01

Onychomycosis is a common nail infection that often co-exists with tinea pedis. Surveys have suggested the diseases co-exist in at least one third of patients, although actual numbers may be a lot higher due to significant under-reporting. The importance of evaluating and treating both diseases is being increasingly recognized, however, data on improved outcomes, and the potential to minimize re-infection are limited. We review a recent post hoc analysis of two large studies treating mild to moderate onychomycosis with efinaconazole topical solution, 10%, demonstrating that complete cure rates of onychomycosis are significantly improved when any co-existing tinea pedis is also treated.

Patient safety, quality of care, and knowledge translation in the intensive care unit.

PubMed

Needham, Dale M

2010-07-01

A large gap exists between the completion of clinical research demonstrating the benefit of new treatment interventions and improved patient outcomes resulting from implementation of these interventions as part of routine clinical practice. This gap clearly affects patient safety and quality of care. Knowledge translation is important for addressing this gap, but evaluation of the most appropriate and effective knowledge translation methods is still ongoing. Through describing one model for knowledge translation and an example of its implementation, insights can be gained into systematic methods for advancing the implementation of evidence-based interventions to improve safety, quality, and patient outcomes.

Space crew radiation exposure analysis system based on a commercial stand-alone CAD system

NASA Technical Reports Server (NTRS)

Appleby, Matthew H.; Golightly, Michael J.; Hardy, Alva C.

1992-01-01

Major improvements have recently been completed in the approach to spacecraft shielding analysis. A Computer-Aided Design (CAD)-based system has been developed for determining the shielding provided to any point within or external to the spacecraft. Shielding analysis is performed using a commercially available stand-alone CAD system and a customized ray-tracing subroutine contained within a standard engineering modeling software package. This improved shielding analysis technique has been used in several vehicle design projects such as a Mars transfer habitat, pressurized lunar rover, and the redesigned Space Station. Results of these analyses are provided to demonstrate the applicability and versatility of the system.

Effecting Change in an Evidence-Based Medicine Curriculum: Librarians' Role in a Pediatric Residency Program.

PubMed

Zeblisky, Kathy; Birr, Rebecca A; Sjursen Guerrero, Anne Marie

2015-01-01

Librarians for the joint Phoenix Children's Hospital/Maricopa Medical Center Pediatric Residency Program were asked to assist on the Evidence-Based Medicine (EBM) Subcommittee for the program. Faculty was open to recommendations for revising and improving the curriculum and desired librarian assistance in completing the task. The annual program review and conference evaluations revealed a gap between the objectives of the EBM curriculum and the residents' perceived abilities to integrate knowledge into meaningful literature searches. This column demonstrates how librarians can collaborate with their residency programs to revise and improve processes to effect change in their program's EBM curriculum.

Preventing alcohol and drug exposed births in Washington state: intervention findings from three parent-child assistance program sites.

PubMed

Grant, Therese M; Ernst, Cara C; Streissguth, Ann; Stark, Kenneth

2005-01-01

Home visitation interventions show promise for helping at-risk mothers, yet few programs have been developed and evaluated specifically for alcohol and drug-abusing pregnant women. This study examines outcomes among 216 women enrolled in the Washington State Parent-Child Assistance Program, a three-year intervention program for women who abuse alcohol and drugs during an index pregnancy. Pretest-posttest comparison was made across three sites: the original demonstration (1991-1995), and the Seattle and Tacoma replications (1996-2003). In the original demonstration, the client group performed significantly better than controls. Compared to the original demonstration, outcomes at replication sites were maintained (for regular use of contraception and use of reliable method; and number of subsequent deliveries), or improved (for alcohol/drug treatment completed; alcohol/ drug abstinence; subsequent delivery unexposed to alcohol/drugs). Improved outcomes at replication sites are not attributable to enrolling lower-risk women. Public policies and programs initiated over the study period may have had a positive effect on outcomes. Study findings suggest that this community-based intervention model is effective over time and across venues.

PROMIS Physical Function Correlation With NDI and mJOA in the Surgical Cervical Myelopathy Patient Population.

PubMed

Owen, Robert J; Zebala, Lukas P; Peters, Colleen; McAnany, Steven

2018-04-15

Retrospective review. To determine the correlation of Patient-Reported Outcomes Measurement Information System (PROMIS) physical function with Neck Disability Index (NDI) and Modified Japanese Orthopedic Association (mJOA) scores in the surgical cervical myelopathy patient population. Outcome measures such as NDI and mJOA are essential for analyzing treatments for cervical myelopathy. Administrative burdens impose limits on completion of these measures. The PROMIS group developed an outcome measure to improve reporting of patient symptoms and function and to reduce administrative burden. Despite early success, NDI and mJOA have not been compared with PROMIS in patients with cervical myelopathy. This study determines the correlation of NDI and mJOA with PROMIS in surgical patients with cervical myelopathy. A total of 60 patients with cervical myelopathy undergoing surgery were included. PROMIS, NDI, and mJOA were collected preoperatively, and in the first 6 months postoperatively. Correlations between NDI, mJOA, and PROMIS were quantified using Pearson correlation coefficients. Students t tests were used to test significance. All 60 (100%) of patients completed preoperative questionnaires. Fifty-five (92%) of patients completed initial follow-up questionnaires within the first 6 months. PROMIS physical function and NDI demonstrated a strong negative correlation at baseline and in initial follow-up (R = -0.69, -0.76). PROMIS and mJOA demonstrated a strong positive correlation at baseline and in initial follow-up (R = 0.61, 0.72). PROMIS physical function has a strong negative correlation with NDI and a strong positive correlation with mJOA at baseline and in the early postoperative course in patients undergoing surgery for cervical myelopathy. Surgeons may factor these outcomes into the delivery and interpretation of patient-reported outcome measures in this population. Use of PROMIS may improve completion of outcome measures in the office and reduce administrative burden while still providing reliable outcomes data. 3.

A service evaluation and improvement project: a three year systematic audit cycle of the physiotherapy treatment for Lateral Epicondylalgia.

PubMed

Barratt, Paul A; Selfe, James

2018-06-01

To improve outcomes of physiotherapy treatment for patients with Lateral Epicondylalgia. A systematic audit and quality improvement project over three phases, each of one year duration. Salford Royal NHS Foundation Trust Teaching Hospital Musculoskeletal Physiotherapy out-patients department. n=182. Phase one - individual discretion; Phase two - strengthening as a core treatment however individual discretion regarding prescription and implementation; Phase three - standardised protocol using high load isometric exercise, progressing on to slow combined concentric & eccentric strengthening. Global Rating of Change Scale, Pain-free grip strength, Patient Rated Tennis Elbow Evaluation, Tampa Scale of Kinesophobia-11. Phase three demonstrated a reduction in the average number of treatments by 42% whilst improving the number of responders to treatment by 8% compared to phase one. Complete cessation of non-evidence based treatments was also observed by phase three. Strengthening should be a core treatment for LE. Load setting needs to be sufficient. In phase three of the audit a standardised tendon loading programme using patient specific high load isometric exercises into discomfort/pain demonstrated a higher percentage of responders compared to previous phases. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Recovery Act--Class 8 Truck Freight Efficiency Improvement Project

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

Trucks, Daimler

2015-07-26

Daimler Trucks North America completed a five year, $79.6M project to develop and demonstrate a concept vehicle with at least 50% freight efficiency improvement over a weighted average of several drive cycles relative to a 2009 best-in-class baseline vehicle. DTNA chose a very fuel efficient baseline vehicle, the 2009 Freightliner Cascadia with a DD15 engine, yet successfully demonstrated a 115% freight efficiency improvement. DTNA learned a great deal about the various technologies that were incorporated into Super Truck and those that, through down-selection, were discarded. Some of the technologies competed with each other for efficiency, and notably some of themore » technologies complemented each other. For example, we found that Super Truck’s improved aerodynamic drag resulted in improved fuel savings from eCoast, relative to a similar vehicle with worse aerodynamic drag. However, some technologies were in direct competition with each other, namely the predictive technologies which use GPS and 3D digital maps to efficiently manage the vehicles kinetic energy through controls and software, versus hybrid which is a much costlier technology that essentially targets the same inefficiency. Furthermore, the benefits of a comprehensive, integrated powertrain/vehicle approach was proven, in which vast improvements in vehicle efficiency (e.g. lower aero drag and driveline losses) enabled engine strategies such as downrating and downspeeding. The joint engine and vehicle developments proved to be a multiplier-effect which resulted in large freight efficiency improvements. Although a large number of technologies made the selection process and were used on the Super Truck demonstrator vehicle, some of the technologies proved not feasible for series production.« less

Complete multipactor suppression in an X-band dielectric-loaded accelerating structure

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

Jing, C.; Gold, S. H.; Fischer, Richard

2016-05-09

Multipactor is a major issue limiting the gradient of rf-driven Dielectric-Loaded Accelerating (DLA) structures. Theoretical models have predicted that an axial magnetic field applied to DLA structures may completely block the multipactor discharge. However, previous attempts to demonstrate this magnetic field effect in an X-band traveling-wave DLA structure were inconclusive, due to the axial variation of the applied magnetic field, and showed only partial suppression of the multipactor loading [Jing et al., Appl. Phys. Lett. 103, 213503 (2013)]. The present experiment has been performed under improved conditions with a uniform axial magnetic field extending along the length of an X-bandmore » standing-wave DLA structure. Multipactor loading began to be continuously reduced starting from 3.5 kG applied magnetic field and was completely suppressed at 8 kG. Dependence of multipactor suppression on the rf gradient inside the DLA structure was also measured.« less

Pilot of the Chronic Disease Self-Management Program for Adolescents and Young Adults With Sickle Cell Disease.

PubMed

Crosby, Lori E; Joffe, Naomi E; Peugh, James; Ware, Russell E; Britto, Maria T

2017-01-01

This study evaluated the feasibility of a group self-management intervention, the well-established Stanford Chronic Disease Self-Management Program (CDSMP), for adolescents and young adults (AYA) with sickle cell disease (SCD). A total of 22 AYA participants with SCD, ages 16-24 years, completed self-efficacy and quality of life measures before the CDSMP, after, and 3 and 6 months later. This AYA cohort showed significant improvements in self-efficacy (primary outcome) after the intervention. Analyses of follow-up data revealed a medium effect of the CDSMP on patient activation 3 months post although this was not sustained. Participants were highly satisfied, but only 64% completed the program. This study demonstrates that the CDSMP is acceptable and has the ability to improve self-efficacy. Additional research is needed to determine feasibility and evaluate health outcomes for AYA with SCD. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

A dissociation of objective and subjective workload measures in assessing the impact of speech controls in advanced helicopters

NASA Technical Reports Server (NTRS)

Vidulich, Michael A.; Bortolussi, Michael R.

1988-01-01

Among the new technologies that are expected to aid helicopter designers are speech controls. Proponents suggest that speech controls could reduce the potential for manual control overloads and improve time-sharing performance in environments that have heavy demands for manual control. This was tested in a simulation of an advanced single-pilot, scout/attack helicopter. Objective performance indicated that the speech controls were effective in decreasing the interference of discrete responses during moments of heavy flight control activity. However, subjective ratings indicated that the use of speech controls required extra effort to speak precisely and to attend to feedback. Although the operational reliability of speech controls must be improved, the present results indicate that reliable speech controls could enhance the time-sharing efficiency of helicopter pilots. Furthermore, the results demonstrated the importance of using multiple assessment techniques to completely assess a task. Neither the objective nor the subjective measures alone provided complete information. It was the contrast between the measures that was most informative.

Success of a Faculty Development Program for Teachers at the Mayo Clinic

PubMed Central

Lee, Staci M.; Lee, Mark C.; Reed, Darcy A.; Halvorsen, Andrew J.; Berbari, Elie F.; McDonald, Furman S.; Beckman, Thomas J.

2014-01-01

Background There has been limited research on the improvement of underperforming clinical teachers. Objective To determine whether a faculty development program could improve the evaluations of clinical teachers in an internal medicine residency program. Methods A total of 123 teachers completed faculty development at the Mayo Clinic from 2009 to 2012. The faculty enhancement and education development program (FEED) consists of 6 interactive, small group, 2-hour sessions taught by experienced Mayo Clinic faculty over 1 year. These sessions address the following competencies: asking questions, diagnosing learners, giving feedback, using teaching frameworks, recognizing learning styles, and providing clinical supervision. Resident-of-faculty Mayo teaching effectiveness (MTE) scores have previously demonstrated content, internal structure, and criterion validity. Teachers were grouped into the top 80% or the bottom 20%, according to baseline MTE scores. Mixed linear models were used to compare these groups regarding changes in MTE scores after completion of FEED. Results were adjusted for teacher age, sex, medical specialty, academic rank, and teaching awards. Results For all participants combined, the adjusted MTE scores (mean; standard error) improved from baseline (3.80; 0.04) to completion of FEED (3.93; 0.04; P < .001). However, the bottom 20% had a significantly greater improvement in scores than the top 80% (score-change difference  =  0.166, P < .001). Conclusions We describe a low-intensity faculty development intervention that benefited all clinical teachers, but was particularly effective for underperforming teachers in internal medicine. The approach may be suitable for adoption or adaptation in other graduate medical education programs. PMID:26140122

Bringing interdisciplinary and multicultural team building to health care education: the downstate team-building initiative.

PubMed

Hope, Joanie Mayer; Lugassy, Daniel; Meyer, Rina; Jeanty, Freida; Myers, Stephanie; Jones, Sadie; Bradley, Joann; Mitchell, Rena; Cramer, Eva

2005-01-01

To evaluate the impact of the Downstate Team-Building Initiative (DTBI), a model multicultural and interdisciplinary health care team-building program for health professions students. A total of 65 students representing seven health disciplines participated in DTBI's first three years (one cohort per year since implementation). During the 18-session curriculum, students self-evaluated their group's progress through Tuckman's four team-development stages (FORMING, STORMING, NORMING, PERFORMING) on an 11-point scale. Students completed matched pre- and postintervention program evaluations assessing five variables: interdisciplinary understanding, interdisciplinary attitudes, teamwork skills, multicultural skills, and team atmosphere. After participation, students completed narrative follow-up questionnaires investigating impact one and two years after program completion. Each year's team development curve followed a similar logarithmic trajectory. Cohort 1 remained in team development stage 3 (NORMING) while Cohorts 2 and 3 advanced into the final stage-PERFORMING. A total of 34 matched pre- and postintervention evaluations showed significant change in all major variables: Team atmosphere and group teamwork skills improved most (48% and 44%, respectively). Interdisciplinary understanding improved 42%. Individual multicultural skills (defined by ability to address racism, homophobia, and sexism) started at the highest baseline and improved the least (13%). Group multicultural skills improved 36%. Of 23 responses to the follow-up surveys, 22 (96%) stated DTBI was a meaningful educational experience applicable to their current clinical surroundings. DTBI successfully united students across health discipline, ethnicity, socioeconomic class, gender, and sexual orientation into functioning teams. The model represents an effective approach to teaching health care team building and demonstrates benefits in both preclinical and clinical years of training.

Prosthetic outcome, patient complaints, and nutritional effects on elderly patients with magnet-retained, implant-supported overdentures--a 1-year report.

PubMed

Khoo, Huan Ding; Chai, John; Chow, Tak Wah

2013-01-01

To study the changes in treatment outcomes of complete dentures and magnet-retained, implant-supported overdentures in a group of elderly patients. In this nonrandomized trial, 43 edentulous patients (14 men and 29 women) were fitted with complete dentures followed by implant-supported mandibular overdenture in a sequential model. Treatment outcomes used for analysis included objective assessment of denture quality (Woelfel's index), patient satisfaction, nutritional status, body mass index (BMI), and serum albumin level. The McNemar test was used to determine if significant differences in the Woelfel's index and nutritional status existed at different treatment phases. Repeated measures ANOVA and multiple pairwise comparison tests were used to analyze patient satisfaction. BMI status and serum albumin level at different treatment phases were analyzed with one-way ANOVA and Tukey post hoc test. At the 1-year follow-up, significant improvements were recorded for the objective assessment of denture quality and patient complaints (P < .05). No subject was found to be malnourished at pretreatment and in subsequent treatment phases. BMI and serum albumin level were not significantly different at different treatment phases (P > .05) CONCLUSIONS: The present study demonstrated that in elderly patients with stable health and nutritional status, complete dentures made in a university clinic brought about overall improvement in denture quality and reduction in denture complaint score. Insertion of mandibular implant-supported overdentures further improved the mandibular denture quality and reduced the mandibular denture complaint score. In this group of patients, no improvement in BMI, serum albumin value, and nutritional status were documented.

Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy

PubMed Central

Brunelli, Steven M.; Meade, Debra; Wang, Weiling; Hymes, Jeffrey; Lacson, Eduardo

2013-01-01

Summary Background and objective Calcific uremic arteriolopathy (CUA) is an often fatal condition with no effective treatment. Multiple case reports and case series have described intravenous sodium thiosulfate (STS) administration in CUA, but no studies have systematically evaluated this treatment. Design, setting, participants, & measurements This study included 172 patients undergoing maintenance hemodialysis who had CUA and were treated with STS between August 2006 and June 2009 at Fresenius Medical Care North America. Of these, 85% completed STS therapy. Clinical, laboratory, and mortality data were abstracted from clinical information systems. Responses to survey questionnaires sent to treating physicians regarding patient-level outcomes were available for 53 patients. Effect on CUA lesions and mortality were summarized as CUA outcomes. Relevant laboratory measures, weight (using pairwise comparisons of values before, during, and after STS), and adverse events were summarized as safety parameters. Results Mean age of the cohort was 55 years, and 74% of patients were women. Median STS dose was 25 g, and median number of doses was 38. Among surveyed patients, CUA completely resolved in 26.4%, markedly improved in 18.9%, improved in 28.3%, and did not improve in 5.7%; in the remaining patients (20.8%), the response was unknown. One-year mortality in patients treated with STS was 35%. Adverse events, laboratory abnormalities, and weight-related changes were mild. Significant reductions in serum phosphorous (P=0.02) and parathyroid hormone (P=0.01) were noted during STS treatment in patients who completed the therapy. Conclusions Although conclusive evidence regarding its efficacy is lacking, a majority of patients who received STS demonstrated clinical improvement in this study. PMID:23520041

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

Kisner, R.; Melin, A.; Burress, T.

The objective of this project is to demonstrate improved reliability and increased performance made possible by deeply embedding instrumentation and controls (I&C) in nuclear power plant (NPP) components and systems. The project is employing a highly instrumented canned rotor, magnetic bearing, fluoride salt pump as its I&C technology demonstration platform. I&C is intimately part of the basic millisecond-by-millisecond functioning of the system; treating I&C as an integral part of the system design is innovative and will allow significant improvement in capabilities and performance. As systems become more complex and greater performance is required, traditional I&C design techniques become inadequate andmore » more advanced I&C needs to be applied. New I&C techniques enable optimal and reliable performance and tolerance of noise and uncertainties in the system rather than merely monitoring quasistable performance. Traditionally, I&C has been incorporated in NPP components after the design is nearly complete; adequate performance was obtained through over-design. By incorporating I&C at the beginning of the design phase, the control system can provide superior performance and reliability and enable designs that are otherwise impossible. This report describes the progress and status of the project and provides a conceptual design overview for the platform to demonstrate the performance and reliability improvements enabled by advanced embedded I&C.« less

Nutritional support in patients with colorectal cancer during chemotherapy: does it work?

PubMed

Dobrila-Dintinjana, Renata; Trivanovic, Dragan; Zelić, Marko; Radić, Mladen; Dintinjana, Marijan; Petranović, Duška; Toni, Valković; Vukelic, Jelena; Matijasic, Nusa

2013-05-01

Early intervention with nutritional supplementation has been shown to halt malnutrition and may improve outcome in some patients with colorectal cancer. The aim of this study was to investigate whether dietary counseling, oral nutrition and megestrol acetate during chemotherapy affected nutritional status and survival in patients with advanced disease. Six hundred and twenty-eight patients with colorectal advanced disease were included in the study from January 2000 through December 2009 and divided into one of two groups. Group I consisted of 315 patients who were monitored prospectively and were given nutritional support. Group II included 313 patients without nutritional counseling and support. After the completion of chemotherapy all patients were evaluated (BMI, NST, Appetite Loss Scale and ECOG). After the completion of chemotherapy, there were lower proportions of patients in Group I with a BMI<20, NST>=5, loss of appetite and decreased weight gain. Nutritional counseling and supplemental feeding temporarily halted weight loss and improved appetite. This improvement may have implications for patient survival. Patients with early nutritional support lived 19.1 months while patients in the control group had a survival of 12.4 months (p=0.022). This study demonstrated that concurrent individualized dietary counseling and nutritional support are effective in improving nutritional status thereby lessening chemotherapy-induced morbidity.

Medical education and the ACGME duty hour requirements: assessing the effect of a day float system on educational activities.

PubMed

Roey, Steve

2006-01-01

In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted new resident work hour mandates, which are being shown to improve resident well-being and patient safety. However, there are limited data on the impact these new mandates may have on educational activities. To assess the impact on educational activities of a day float system created to meet ACGME work hour mandates. The inpatient ward coverage was changed by adding a day float team responsible for new patient admissions in the morning, with the on-call teams starting later and being responsible for new patient admissions thereafter. I surveyed the residents to assess the impact of this new system on educational activities-resident autonomy, attending teaching, conference attendance, resident teaching, self-directed learning, and ability to complete patient care responsibilities. There was no adverse effect of the day float system on educational activities. House staff reported increased autonomy, enhanced teaching from attending physicians, and improved ability to complete patient care responsibilities. Additionally, house staff demonstrated improved compliance with the ACGME mandates. The implementation of a novel day float system for the inpatient medicine ward service improved compliance with ACGME work duty requirements and did not adversely impact educational activities of the residency training program.

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples.

PubMed

Daudelin, Denise H; Selker, Harry P; Leslie, Laurel K

2015-12-01

There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in-person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. © 2015 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc.

Helping doctors in training to STEP-UP: A leadership and quality improvement programme in the Belfast Health and Social Care Trust.

PubMed

Donaghy, Grainne; McKeever, Kris; Flanagan, Catherine; O'Kane, Donal; McQuillan, Bernie; Cash, Johnny; Jack, Cathy; Lundy, Claire

2018-05-01

Medical engagement in healthcare organisations can improve service development and patient experience. Doctors in training have limited opportunities to engage in service improvement work and develop leadership skills. We describe the Specialist Trainees Engaged in Leadership Programme (STEP) , a programme developed to introduce concepts of medical leadership and quality improvement skills in the Belfast Trust. STEP started in 2013 and over 140 trainees have now participated in the programme. Over 42 quality improvement projects have been completed with the support of the programme. Evaluation of STEP has demonstrated an improvement across all domains explored throughout the duration of the programme, with benefits for the individual trainee and the wider organisation. We describe the programme in detail. The STEP curriculum can easily be adapted to meet the needs of NHS trainees, allowing them to understand the objectives and strategy of their employers and improve their ability to plan and deliver safe, effective, patient-centred care.

Improving the quality of outpatient clinic letters using the Sheffield Assessment Instrument for Letters (SAIL).

PubMed

Fox, Adam T; Palmer, Roger D; Crossley, James G M; Sekaran, Devanitha; Trewavas, Eira S; Davies, Helena A

2004-08-01

To improve the quality of outpatient letters used as communication between hospital and primary care doctors. On 2 separate occasions, 15 unselected outpatient letters written by each of 7 hospital practitioners were rated by another hospital doctor and a general practitioner (GP) using the Sheffield Assessment Instrument for Letters (SAIL). Individualised feedback was provided to participants following the rating of the first set of letters. The audit cycle was completed 3 months later without forewarning by repeat assessment by the same hospital and GP assessors using the SAIL tool to see if there was any improvement in correspondence. Single centre: general paediatric outpatient department in a large district general hospital. All 7 doctors available for reassessment completed the audit loop, each providing 15 outpatient letters per assessment. The mean of the quality scores, derived for each letter from the summation of a 20-point checklist and a global score, improved from 23.3 (95% CI 22.1-24.4) to 26.6 (95% CI 25.8-27.4) (P = 0.001). The SAIL provides a feasible and reliable method of assessing the quality and content of outpatient clinic letters. This study demonstrates that it can also provide feedback with a powerful educational impact. This approach holds real potential for appraisal and revalidation, providing an effective means for the quality improvement required by clinical governance.

Effect of Dai-kenchu-to (Da-Jian-Zhong-Tang) on the delayed intestinal propulsion induced by chlorpromazine in mice.

PubMed

Satoh, Kazuko; Kase, Yoshio; Yuzurihara, Mitsutoshi; Mizoguchi, Kazushige; Kurauchi, Kouji; Ishige, Atsushi

2003-05-01

This study was conducted to evaluate the effect of Dai-kenchu-to on chlorpromazine-induced hypoperistalsis in mice. Oral administration of Dai-kenchu-to (30-300 mg/kg) dose-dependently improved small intestinal and distal colonic propulsion decreased by chlorpromazine (3 mg/kg, p.o.). Although the improvement of small intestinal propulsion due to Dai-kenchu-to was partially inhibited by atropine (1 mg/kg, s.c.), this action was completely inhibited by the concomitant administration of lorglumide (10 mg/kg, i.p.), a CCKA receptor antagonist. The distal colonic propulsion-improving effect of Dai-kenchu-to was abolished by atropine (1 mg/kg, s.c.). When the effects of the respective components of Dai-kenchu-to were evaluated, oral administration of Zanthoxylum Fruit improved both delayed small intestinal and distal colonic propulsion caused by chlorpromazine. On the other hand, Malt Sugar was effective against only delayed small intestinal propulsion. The action of Zanthoxylum Fruit was completely inhibited by atropine (1 mg/kg, s.c.), and the effect of Malt Sugar was inhibited by lorglumide (10 mg/kg, i.p.). These results demonstrated that Dai-kenchu-to improves chlorpromazine-induced hypoperistalsis via cholinergic systems and that Zanthoxylum Fruit is the main contributor to this action of Dai-kenchu-to. In addition, endogenous CCK due to Malt Sugar may also contribute to this effect of Dai-kenchu-to.

Feasibility of a novel mHealth management system to capture and improve medication adherence among adolescents with asthma

PubMed Central

Cushing, Anna; Manice, Melissa P; Ting, Andrew; Parides, Michael K

2016-01-01

Purpose Currently, 7.1 million children in the United States have asthma. Nonadherence to daily controller asthma medication is common, leading to more severe symptoms, overuse of rescue medication, and increased hospitalizations. The purpose of this study was to develop and evaluate the feasibility and acceptability of a novel mHealth management system composed of a sensored device, which is connected to mobile phone app that is designed to monitor and improve asthma medication adherence. Patients and methods The asthma management system was designed using well-established behavioral theory. Seven adolescents aged 11–18 years were enrolled and given an adherence sensor, and four of those also received a mobile phone app with game features and reminders. Five patients completed the study, and one was lost to follow-up in each group. Mobile app users and their parents participated in focus groups to assess patient preferences. Feasibility was assessed by the ability of sensors to capture real-time medication data. Acceptability was assessed by patient questionnaire and focus group analysis. Results Successful upload of real-time data from six of seven inhaler sensors to the HIPAA-compliant server demonstrates the feasibility of at-home patient monitoring using the sensor device. All three mobile app users who completed the study reported interest in continued use of the management system and would recommend the app to friends. Unstructured interviews and focus groups revealed that patients felt that the intervention helped their sense of asthma control. Conclusion This study demonstrates the feasibility of using the sensor device to remotely monitor real-time medication usage, and user feedback demonstrates the acceptability of the intervention for patient use. The findings provide guidance for the improvement of study design and technology development. Further research is needed to assess the efficacy of the intervention. PMID:27853357

Advances in Pediatric Cardiology Boot Camp: Boot Camp Training Promotes Fellowship Readiness and Enables Retention of Knowledge.

PubMed

Ceresnak, Scott R; Axelrod, David M; Sacks, Loren D; Motonaga, Kara S; Johnson, Emily R; Krawczeski, Catherine D

2017-03-01

We previously demonstrated that a pediatric cardiology boot camp can improve knowledge acquisition and decrease anxiety for trainees. We sought to determine if boot camp participants entered fellowship with a knowledge advantage over fellows who did not attend and if there was moderate-term retention of that knowledge. A 2-day training program was provided for incoming pediatric cardiology fellows from eight fellowship programs in April 2016. Hands-on, immersive experiences and simulations were provided in all major areas of pediatric cardiology. Knowledge-based examinations were completed by each participant prior to boot camp (PRE), immediately post-training (POST), and prior to the start of fellowship in June 2016 (F/U). A control group of fellows who did not attend boot camp also completed an examination prior to fellowship (CTRL). Comparisons of scores were made for individual participants and between participants and controls. A total of 16 participants and 16 control subjects were included. Baseline exam scores were similar between participants and controls (PRE 47 ± 11% vs. CTRL 52 ± 10%; p = 0.22). Participants' knowledge improved with boot camp training (PRE 47 ± 11% vs. POST 70 ± 8%; p < 0.001) and there was excellent moderate-term retention of the information taught at boot camp (PRE 47 ± 11% vs. F/U 71 ± 8%; p < 0.001). Testing done at the beginning of fellowship demonstrated significantly better scores in participants versus controls (F/U 71 ± 8% vs. CTRL 52 ± 10%; p < 0.001). Boot camp participants demonstrated a significant improvement in basic cardiology knowledge after the training program and had excellent moderate-term retention of that knowledge. Participants began fellowship with a larger fund of knowledge than those fellows who did not attend.

Improved Attitudes to Psychiatry: A Global Mental Health Peer-to-Peer E-Learning Partnership.

PubMed

Keynejad, Roxanne; Garratt, Elisabeth; Adem, Gudon; Finlayson, Alexander; Whitwell, Susannah; Sheriff, Rebecca Syed

2016-08-01

Health links aim to strengthen healthcare systems in low and middle-income countries through mutual exchange of skills, knowledge, and experience. However, student participation remains limited despite growing educational emphasis upon global health. Medical students continue to report negative attitudes to psychiatry in high-income countries, and in Somaliland, the lack of public sector psychiatrists limits medical students' awareness of mental healthcare. The authors describe the design, implementation, and mixed-methods analysis of a peer-to-peer psychiatry e-learning partnership between UK and Somaliland students arising from a global mental health link between the two countries. Medical students at King's College London and Hargeisa and Amoud universities, Somaliland, were grouped into 24 pairs. Participants aimed to complete ten fortnightly meetings to discuss psychiatry topics via the website MedicineAfrica. Students completed initial and final evaluations including Attitudes toward Psychiatry (ATP-30) questions, a stigma questionnaire, and brief evaluations after each meeting. Quantitative findings demonstrated that enjoyment, interest, and academic helpfulness were rated highly by students in Somaliland and moderately by students in the UK. Somaliland students' attitudes to psychiatry were significantly more positive post-participation, whereas UK students' attitudes remained stable. Qualitative findings identified more gains in factual knowledge for Somaliland students, whereas UK students reported more cross-cultural learning. Reasons for non-completion and student-suggested improvements emphasized the need to ensure commitment to the program by participants. This partnership encouraged students to consider global mental health outside the standard medical education environment, through an e-learning format solely utilizing existing resources. This new approach demonstrates potential benefits to students in contrasting locations of brief, focused online peer-to-peer education partnerships, expanding the scope of health links to the medical professionals of the future.

Interferon for the treatment of genital warts: a systematic review

PubMed Central

2009-01-01

Background Interferon has been widely used in the treatment of genital warts for its immunomodulatory, antiproliferative and antiviral properties. Currently, no evidence that interferon improves the complete response rate or reduces the recurrence rate of genital warts has been generally provided. The aim of this review is to assess, from randomized control trials (RCTs), the efficacy and safety of interferon in curing genital warts. Methods We searched Cochrane Sexually Transmitted Diseases Group's Trials Register (January, 2009), Cochrane Central Register of Controlled Trials (2009, issue 1), PubMed (1950-2009), EMBASE (1974-2009), Chinese Biomedical Literature Database (CBM) (1975-2009), China National Knowledge Infrastructure (CNKI) (1979-2009), VIP database (1989-2009), as well as reference lists of relevant studies. Two reviewers independently screened searched studies, extracted data and evaluated their methodological qualities. RevMan 4.2.8 software was used for meta-analysis Results 12 RCTs involving 1445 people were included. Among them, 7 studies demonstrated the complete response rate of locally-used interferon as compared to placebo for treating genital warts. Based on meta-analysis, the rate of Complete response of the two interventions differed significantly (locally-used interferon:44.4%; placebo:16.1%). The difference between the two groups had statistical significance (RR 2.68, 95% CI 1.79 to 4.02, P < 0.00001). 5 studies demonstrated the complete response rate of systemically-used interferon as compared to placebo for treating genital warts. Based on meta-analysis, the rate of Complete response of the two interventions had no perceivable discrepancy (systemically-used interferon:27.4%; placebo:26.4%). The difference between the two groups had no statistical significance (RR1.25, 95% CI 0.80 to 1.95, P > 0.05). 7 studies demonstrated the recurrence rate of interferon as compared to placebo for treating genital warts. Based on meta-analysis, the recurrence rate of the two interventions had no perceivable discrepancy(interferon 21.1%; placebo: 34.2%). The difference between the two groups had no statistical significance (RR0.56, 95% CI 0.27 to 1.18, P > 0.05). However, subgroup analysis showed that HPV-infected patients with locally administered interferon were less likely than those given placebo to relapse, but that no significant difference in relapse rates was observed between systemic and placebo. The reported adverse events of interferon were mostly mild and transient, which could be well tolerated. Conclusion Interferon tends to be a fairly well-tolerated form of therapy. According to different routes of administration, locally-used interferon appears to be much more effective than both systemically-used interferon and placebo in either improving the complete response rate or reducing the recurrence rate for the treatment of genital warts. PMID:19772554

Interferon for the treatment of genital warts: a systematic review.

PubMed

Yang, Jin; Pu, Yu-Guo; Zeng, Zhong-Ming; Yu, Zhi-Jian; Huang, Na; Deng, Qi-Wen

2009-09-21

Interferon has been widely used in the treatment of genital warts for its immunomodulatory, antiproliferative and antiviral properties. Currently, no evidence that interferon improves the complete response rate or reduces the recurrence rate of genital warts has been generally provided. The aim of this review is to assess, from randomized control trials (RCTs), the efficacy and safety of interferon in curing genital warts. We searched Cochrane Sexually Transmitted Diseases Group's Trials Register (January, 2009), Cochrane Central Register of Controlled Trials (2009, issue 1), PubMed (1950-2009), EMBASE (1974-2009), Chinese Biomedical Literature Database (CBM) (1975-2009), China National Knowledge Infrastructure (CNKI) (1979-2009), VIP database (1989-2009), as well as reference lists of relevant studies. Two reviewers independently screened searched studies, extracted data and evaluated their methodological qualities. RevMan 4.2.8 software was used for meta-analysis 12 RCTs involving 1445 people were included. Among them, 7 studies demonstrated the complete response rate of locally-used interferon as compared to placebo for treating genital warts. Based on meta-analysis, the rate of Complete response of the two interventions differed significantly (locally-used interferon:44.4%; placebo:16.1%). The difference between the two groups had statistical significance (RR 2.68, 95% CI 1.79 to 4.02, P < 0.00001). 5 studies demonstrated the complete response rate of systemically-used interferon as compared to placebo for treating genital warts. Based on meta-analysis, the rate of Complete response of the two interventions had no perceivable discrepancy (systemically-used interferon:27.4%; placebo:26.4%). The difference between the two groups had no statistical significance (RR1.25, 95% CI 0.80 to 1.95, P > 0.05). 7 studies demonstrated the recurrence rate of interferon as compared to placebo for treating genital warts. Based on meta-analysis, the recurrence rate of the two interventions had no perceivable discrepancy(interferon 21.1%; placebo: 34.2%). The difference between the two groups had no statistical significance (RR0.56, 95% CI 0.27 to 1.18, P > 0.05). However, subgroup analysis showed that HPV-infected patients with locally administered interferon were less likely than those given placebo to relapse, but that no significant difference in relapse rates was observed between systemic and placebo. The reported adverse events of interferon were mostly mild and transient, which could be well tolerated. Interferon tends to be a fairly well-tolerated form of therapy. According to different routes of administration, locally-used interferon appears to be much more effective than both systemically-used interferon and placebo in either improving the complete response rate or reducing the recurrence rate for the treatment of genital warts.

Can sensory attention focused exercise facilitate the utilization of proprioception for improved balance control in PD?

PubMed

Lefaivre, Shannon C; Almeida, Quincy J

2015-02-01

Impaired sensory processing in Parkinson's disease (PD) has been argued to contribute to balance deficits. Exercises aimed at improving sensory feedback and body awareness have the potential to ameliorate balance deficits in PD. Recently, PD SAFEx™, a sensory and attention focused rehabilitation program, has been shown to improve motor deficits in PD, although balance control has never been evaluated. The objective of this study was to measure the effects of PD SAFEx™ on balance control in PD. Twenty-one participants with mild to moderate idiopathic PD completed 12 weeks of PD SAFEx™ training (three times/week) in a group setting. Prior to training, participants completed a pre-assessment evaluating balance in accordance with an objective, computerized test of balance (modified clinical test of sensory integration and balance (m-CTSIB) and postural stability testing (PST)) protocols. The m-CTSIB was our primary outcome measure, which allowed assessment of balance in both eyes open and closed conditions, thus enabling evaluation of specific sensory contributions to balance improvement. At post-test, a significant interaction between time of assessment and vision condition (p=.014) demonstrated that all participants significantly improved balance control, specifically when eyes were closed. Balance control did not change from pre to post with eyes open. These results provide evidence that PD SAFEx™ is effective at improving the ability to utilize proprioceptive information, resulting in improved balance control in the absence of vision. Enhancing the ability to utilize proprioception for individuals with PD is an important intermediary to improving balance deficits. Copyright © 2015. Published by Elsevier B.V.

Sage Simulation Model for Technology Demonstration Convertor by a Step-by-Step Approach

NASA Technical Reports Server (NTRS)

Demko, Rikako; Penswick, L. Barry

2006-01-01

The development of a Stirling model using the 1-D Saga design code was completed using a step-by-step approach. This is a method of gradually increasing the complexity of the Saga model while observing the energy balance and energy losses at each step of the development. This step-by-step model development and energy-flow analysis can clarify where the losses occur, their impact, and suggest possible opportunities for design improvement.

2011 AFMS Medical Research Symposium Held in National Harbor, Maryland on August 2-4, 2011. Volume 1: Plenary Sessions, Presentation & Poster Abstracts

DTIC Science & Technology

2011-08-01

Each student completed an SCCM standardized and validated pretest and posttest , a survey of 10 five-point Likert scale questions on managing...knowledge improved from a pretest score of 60% to a posttest score of 80%. Pediatric residents reported feelings of preparation increased by an...This research uses a mixed- methods framework (qualitative and quantitative ) to demonstrate the importance of exploring alternative training models

Active Video Gaming for Children with Cerebral Palsy: Does a Clinic-Based Virtual Reality Component Offer an Additive Benefit? A Pilot Study.

PubMed

Levac, Danielle; McCormick, Anna; Levin, Mindy F; Brien, Marie; Mills, Richard; Miller, Elka; Sveistrup, Heidi

2018-02-01

To compare changes in gross motor skills and functional mobility between ambulatory children with cerebral palsy who underwent a 1-week clinic-based virtual reality intervention (VR) followed by a 6-week, therapist-monitored home active video gaming (AVG) program and children who completed only the 6-week home AVG program. Pilot non-randomized controlled trial. Five children received 1 hour of VR training for 5 days followed by a 6-week home AVG program, supervised online by a physical therapist. Six children completed only the 6-week home AVG program. The Gross Motor Function Measure Challenge Module (GMFM-CM) and Six Minute Walk Test (6MWT) evaluated change. There were no significant differences between groups. The home AVG-only group demonstrated a statistically and clinically significant improvement in GMFM-CM scores following the 6-week AVG intervention (median difference 4.5 points, interquartile range [IQR] 4.75, p = 0.042). The VR + AVG group demonstrated a statistically and clinically significant decrease in 6MWT distance following the intervention (median decrease 68.2 m, IQR 39.7 m, p = 0.043). All 6MWT scores returned to baseline at 2 months post-intervention. Neither intervention improved outcomes in this small sample. Online mechanisms to support therapist-child communication for exercise progression were insufficient to individualize exercise challenge.

Implementation Of Fuzzy Approach To Improve Time Estimation [Case Study Of A Thermal Power Plant Is Considered

NASA Astrophysics Data System (ADS)

Pradhan, Moumita; Pradhan, Dinesh; Bandyopadhyay, G.

2010-10-01

Fuzzy System has demonstrated their ability to solve different kinds of problem in various application domains. There is an increasing interest to apply fuzzy concept to improve tasks of any system. Here case study of a thermal power plant is considered. Existing time estimation represents time to complete tasks. Applying fuzzy linear approach it becomes clear that after each confidence level least time is taken to complete tasks. As time schedule is less than less amount of cost is needed. Objective of this paper is to show how one system becomes more efficient in applying Fuzzy Linear approach. In this paper we want to optimize the time estimation to perform all tasks in appropriate time schedules. For the case study, optimistic time (to), pessimistic time (tp), most likely time(tm) is considered as data collected from thermal power plant. These time estimates help to calculate expected time(te) which represents time to complete particular task to considering all happenings. Using project evaluation and review technique (PERT) and critical path method (CPM) concept critical path duration (CPD) of this project is calculated. This tells that the probability of fifty percent of the total tasks can be completed in fifty days. Using critical path duration and standard deviation of the critical path, total completion of project can be completed easily after applying normal distribution. Using trapezoidal rule from four time estimates (to, tm, tp, te), we can calculate defuzzyfied value of time estimates. For range of fuzzy, we consider four confidence interval level say 0.4, 0.6, 0.8,1. From our study, it is seen that time estimates at confidence level between 0.4 and 0.8 gives the better result compared to other confidence levels.

The Use of the Performance Diagnostic Checklist-Human Services to Assess and Improve the Job Performance of Individuals with Intellectual Disabilities.

PubMed

Smith, Madison; Wilder, David A

2018-06-01

The Performance Diagnostic Checklist-Human Services (PDC-HS) is an informant-based tool designed to identify the variables responsible for performance problems. To date, the PDC-HS has not been examined with individuals with intellectual disabilities. In the current study, two supervisors with intellectual disabilities completed the PDC-HS to assess the productivity of two supervisees with disabilities who performed a pricing task in a thrift store. The PDC-HS suggested that performance deficits were due to a lack of training; a PDC-HS-indicated intervention was effective to increase accurate pricing. • The PDC-HS is an informant-based tool designed to identify the variables responsible for employee performance problems in human service settings. • The PDC-HS can be completed by some individuals with intellectual disabilities in a supervisory position to identify the variables responsible for problematic job performance among their supervisees. • A PDC-HS indicated intervention was demonstrated to be effective to improve the job performance of individuals with disabilities. • The PDC-HS may be a useful tool to support performance improvement and job maintenance among individuals with intellectual disabilities.

Comparison of health literacy in privately insured and public hospital orthopaedic patients.

PubMed

Cosic, Filip; Porter, Tabitha; Norsworthy, Cameron; Price, Rohan; Bedi, Harvinder

2018-05-14

Objective The aim of the present study was to quantify and compare patient health literacy between privately insured and public orthopaedic patients. Methods As part of the present cross-sectional study, elective postoperative orthopaedic patients across two sites were recruited and asked to complete a questionnaire at the first postoperative out-patient review. Patients were divided into three groups: (1) a public group (Public); (2) a private group (Private-pre); and (3) a private group that completed the questionnaire immediately after the out-patient review (Private-post). The questionnaire consisted of six questions regarding surgical management, expected recovery time and postoperative instructions. Patients were further asked to grade their satisfaction regarding information received throughout their management. Results In all, 150 patients completed the questionnaire, 50 in each of the three groups. Patients in the Public, Private-pre and Private-post groups answered a mean 2.74, 3.24 and 4.70 of 6 questions correctly respectively. The Private-pre group was 1.46-fold more likely to demonstrate correct health literacy than the Public group, whereas the Private-post group was 2.44-fold more likely to demonstrate improved health literacy than the Private-pre group. Patient satisfaction with information received was not associated with health literacy. Conclusion Limited health literacy in orthopaedic patients continues to be an area of concern. Both private and public orthopaedic patients demonstrated poor health literacy, but private patients demonstrated significant improvement after the out-patient review. What is known about the topic? Limited health literacy is a growing public health issue worldwide, with previous literature demonstrating a prevalence of low health literacy of 26% and marginal health literacy of 20% among all patient populations. Of concern, limited health literacy has been shown to result in a range of adverse health outcomes, including increased mortality and chronic disease morbidity. It has also been associated with an increased rate of hospitalisation and use of healthcare resources. Previous work in the orthopaedic trauma setting has found poor levels of health literacy and poor understanding of diagnosis, management and prognosis in the Australian public health system. Promisingly, it has been shown that simple, targeted interventions can improve patient health literacy. What does this paper add? This study further highlights that health literacy exhibited by orthopaedic patients is poor, particularly among patients in the public healthcare system. The present study is the first to have demonstrated that health literacy is poor among patients in both the public and private healthcare systems, despite these patients having distinctly different demographics. Promisingly, the present study shows that, unlike public orthopaedic out-patient review, private orthopaedic out-patient review appears to be effective in increasing patient health literacy regarding their orthopaedic condition and its management. What are the implications for practitioners? Health literacy is essential for patients to effectively communicate with doctors and achieve good health outcomes. Healthcare professionals need to be aware that a large proportion of patients have poor health literacy and difficulty understanding health-related information, particularly pertaining to that surrounding diagnosis, management and prognosis. This study highlights the need for healthcare professionals to ensure that they communicate with patients at an appropriate level to ensure patient understanding during the pre-, peri- and postoperative stages of management. Further, healthcare professionals should be aware that there is potential to improve patient health literacy at routine out-patient review, provided that this opportunity is used as an educational resource.

Motor Learning Characterizes Habilitation of Children With Hemiplegic Cerebral Palsy

PubMed Central

Krebs, Hermano I.; Fasoli, Susan E.; Dipietro, Laura; Fragala-Pinkham, Maria; Hughes, Richard; Stein, Joel; Hogan, Neville

2015-01-01

Background This study tested in children with cerebral palsy (CP) whether motor habilitation resembles motor learning. Methods Twelve children with hemiplegic CP ages 5 to 12 years with moderate to severe motor impairments underwent a 16-session robot-mediated planar therapy program to improve upper limb reach, with a focus on shoulder and elbow movements. Participants were trained to execute point-to-point movements (with robot assistance) with the affected arm and were evaluated (without robot assistance) in trained (point-to-point) and untrained (circle-drawing) conditions. Outcomes were measured at baseline, midpoint, immediately after the program, and 1 month postcompletion. Outcome measures were the Fugl-Meyer (FM), Quality of Upper Extremity Skills Test (QUEST), and Modified Ashworth Scale (MAS) scores; parent questionnaire; and robot-based kinematic metrics. To assess whether learning best characterizes motor habilitation in CP, the authors quantified (a) improvement on trained tasks at completion of training (acquisition) and 1 month following completion (retention) and (b) quantified generalization of improvement to untrained tasks. Results After robotic intervention, the authors found significant gains in the FM, QUEST, and parent questionnaire. Robot-based evaluations demonstrated significant improvement in trained movements and that improvement was sustained at follow-up. Furthermore, children improved their performance in untrained movements indicating generalization. Conclusions Motor habilitation in CP exhibits some traits of motor learning. Optimal treatment may not require an extensive repertoire of tasks but rather a select set to promote generalization. PMID:22331211

Depression Treatment by Non-Mental-Health Providers: Incremental Evidence for the Effectiveness of Listening Visits

PubMed Central

O’Hara, Michael W.; Segre, Lisa S.

2017-01-01

Maternal depression is a prevalent public health problem, particularly for low-income mothers of young children. Intervention development efforts, which often focus on surmounting instrumental barriers to care, have not successfully engaged and retained women in treatment. Task-sharing approaches like Listening Visits (LV) could overcome key instrumental and psychological barriers by leveraging the access of trusted, community caregivers to deliver treatment. A recent randomized controlled trial (RCT) demonstrated the efficacy of LV delivered by non-mental-health providers as compared to usual care. The present report presents results from a follow-up phase of that RCT during which participants who had completed LV were followed for an additional 8 weeks and completed measures of depression and quality of life. In addition, participants who were initially randomized to the wait-list control group received LV and were assessed. Treatment gains previously observed in participants completing LV were enhanced during the 8-week follow-up period. Participants receiving LV during the follow-up period experienced significant improvement in depressive symptoms. Results demonstrate the sustainability of LV delivered by non-mental-health providers, and provide preliminary evidence for the replicability of this approach in a sample of predominately low-income pregnant women and mothers of young children. PMID:28349604

Topical resiquimod can induce disease regression and enhance T-cell effector functions in cutaneous T-cell lymphoma.

PubMed

Rook, Alain H; Gelfand, Joel M; Gelfand, Joel C; Wysocka, Maria; Troxel, Andrea B; Benoit, Bernice; Surber, Christian; Elenitsas, Rosalie; Buchanan, Marie A; Leahy, Deborah S; Watanabe, Rei; Kirsch, Ilan R; Kim, Ellen J; Clark, Rachael A

2015-09-17

Early-stage cutaneous T-cell lymphoma (CTCL) is a skin-limited lymphoma with no cure aside from stem cell transplantation. Twelve patients with stage IA-IIA CTCL were treated in a phase 1 trial of 0.03% and 0.06% topical resiquimod gel, a Toll-like receptor 7/8 agonist. Treated lesions significantly improved in 75% of patients and 30% had clearing of all treated lesions. Resiquimod also induced regression of untreated lesions. Ninety-two percent of patients had more than a 50% improvement in body surface area involvement by the modified Severity-Weighted Assessment Tool analysis and 2 patients experienced complete clearing of disease. Four of 5 patients with folliculotropic disease also improved significantly. Adverse effects were minor and largely skin limited. T-cell receptor sequencing and flow cytometry studies of T cells from treated lesions demonstrated decreased clonal malignant T cells in 90% of patients and complete eradication of malignant T cells in 30%. High responses were associated with recruitment and expansion of benign T-cell clones in treated skin, increased skin T-cell effector functions, and a trend toward increased natural killer cell functions. In patients with complete or near eradication of malignant T cells, residual clinical inflammation was associated with cytokine production by benign T cells. Fifty percent of patients had increased activation of circulating dendritic cells, consistent with a systemic response to therapy. In summary, topical resiquimod is safe and effective in early-stage CTCL and the first topical therapy to our knowledge that can induce clearance of untreated lesions and complete remissions in some patients. This trial was registered at www.clinicaltrials.gov as #NCT813320. © 2015 by The American Society of Hematology.

An Electronic Asthma Self-Management Intervention for Young African American Adults.

PubMed

Speck, Aimee L; Hess, Michael; Baptist, Alan P

2016-01-01

Health disparities are seen in many chronic conditions including asthma. Young African American adults represent a population at high risk for poor asthma outcomes due to both their minority status and the difficult transition from adolescence to adulthood. Recruitment and retention has been challenging in this demographic stratum, and traditional asthma education is often not feasible. The objective of this study was to develop and assess the feasibility of an electronic asthma self-management program for young African American adults. A total of 44 African American adults (age 18-30 years) with uncontrolled persistent asthma were enrolled in an asthma self-management program. The 6-week Breathe Michigan program (predicated on the social cognitive theory) was tailored specifically to the concerns and preferences of young African American adults. The entire program was completed electronically, without any specialized human support. At 2 weeks and 3 months after program completion, participants were contacted for follow-up. A total of 89% of enrolled subjects completed the 6-week intervention, and 77% were available for evaluation at 3 months. All subjects completing the 2-week postprogram survey reported that the program was helpful, and 97% would recommend it to others. Asthma control as measured by the Asthma Control Test improved from 16.1 to 19.3 (P < .01), and asthma quality of life as measured by the Mini Asthma Quality of Life Questionnaire improved from 4.0 to 5.1 (P < .01). The Breathe Michigan program is feasible for recruitment and retention, and demonstrated an improvement in asthma control and quality of life for young African American adults. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Is there any advantage to the acquisition of 24-hour thallium images, in the presence of persistent perfusion defects at 4 h after reinjection?

PubMed

Bobba, K; Botvinick, E H; Sciammarella, M G; Starsken, N F; Zhu, Y Y; Lapidus, A; Dae, M W

1998-05-01

We determined the incidence of delayed 24-h reversibility post thallium-201 reinjection and imaging at 4 h, as well as the prognostic and significance of such delayed reversibility. We studied 46 consecutive patients with persistent thallium-201 perfusion or incompletely reversible single-photon emission tomography (SPET) perfusion defects acquired within 10 min after reinjection performed 4 h after stress. In 38 of 46 patients (82%) 24-h images showed no further reversibility beyond the post-reinjection 4-h study (group A). Eight of 46 patients (17%) demonstrated reversibility on 24-h imaging (group B). Of these eight, three patients showed no improvement compared with the post-stress images, with a mean perfusion score of the abnormal segments of 1. 25+/-0.50 on the 4-h images, and of 3.00 on the 24-h images, where normal is 4. Four patients presented with nine mixed regions. Four of these regions showed an improvement in the mean perfusion score of 2.50+/-0.58 on 4- and 24-h images. Two of them, with moderate/severe defects, demonstrated complete reversibility at 4-h post-reinjection imaging. In addition, five other regions presented no improvement at 4-h imaging, but showed an improvement in the mean perfusion score from 0.80+/-0.84 at 4-h to 3.30+/-0.89 at 24-h imaging. Two of these regions in one patient showed a severe perfusion score of 0 at 4 h, and complete reversibility at 24 hours, with a mean score improvement of 4. Another patient had three severe perfusion defects; two of them redistributed partially at 4 h and completely at 24 h. The remaining segment with a perfusion score of 0 at 4 h, presented complete reversibility with a score of 4 at 24 h. Two (4%) patients revealed significant reversibility at 24 h in a region that was severely underperfused after post-reinjection imaging at 4 h. Among group B patients, 75% (6/8) had recent acute ischemic syndrome, compared with only 13% (5/38) in group A (P = 0. 001). Among 11 patients with unstable angina, six (55%) had evidence of delayed 24-h reversibility, compared with 2 of 35 (6%) patients without clinically acute ischemia (P = 0.001). On follow-up, there were seven (17%) cardiac deaths among the 38 group A patients but three (38%) among the eight group B patients (P = 0.3). These findings suggest that although the presence of delayed 24-h 201Tl, post-reinjection reversibility is infrequent, it has potential clinical importance. Thus, delayed 24-h imaging should be considered in the context of unstable angina or other acute coronary syndromes.

Fielding An Amphibious UAV: Development, Results, and Lessons Learned

NASA Technical Reports Server (NTRS)

Pisanich, Greg; Morris, Stephen

2002-01-01

This report summarizes the work completed on the design and flight-testing of a small, unmanned, amphibious demonstrator aircraft that flies autonomously. The aircraft named ACAT (Autonomous Cargo Amphibious Transport) is intended to be a large cargo carrying unmanned aircraft that operates from water to avoid airspace and airfield conflict issues between manned and unmanned aircraft. To demonstrate the feasibility of this concept, a demonstrator ACAT was designed, built, and flown that has a six-foot wingspan and can fly autonomously from land or water airfield. The demonstrator was designed for a 1-hour duration and 1-mile telemetry range. A sizing code was used to design the smallest demonstrator UAV to achieve these goals. The final design was a six-foot wingspan, twin hull configuration that distributes the cargo weight across the span, reducing the wing structural weight. The demonstrator airframe was constructed from balsa wood, fiberglass, and plywood. A 4-stroke model airplane engine powered by methanol fuel was mounted in a pylon above the wing and powers the ACAT UAV. Initial flight tests from land and water were conducted under manual radio control and confirmed the amphibious capability of the design. Flight avionics that were developed by MLB for production UAVs were installed in the ACAT demonstrator. The flight software was also enhanced to permit autonomous takeoff and landing from water. A complete autonomous flight from ahard runway was successfully completed on July 5, 2001 and consisted of a take-off, rectangular flight pattern, and landing under complete computer control. A completely autonomous flight that featured a water takeoff and landing was completed on October 4, 2001. This report describes these activities in detail and highlights the challenges encountered and solved during the development of the ACAT demonstrator. hard runway was successfully completed on July 5, 2001 and consisted of a take-off, rectangular flight pattern, and landing under complete computer control. A completely autonomous flight that featured a water takeoff and landing was completed on October 4, 2001. This report describes these activities in detail and highlights the challenges encountered and solved during the development of the ACAT demonstrator.

The more the merrier? Increasing group size may be detrimental to decision-making performance in nominal groups.

PubMed

Amir, Ofra; Amir, Dor; Shahar, Yuval; Hart, Yuval; Gal, Kobi

2018-01-01

Demonstrability-the extent to which group members can recognize a correct solution to a problem-has a significant effect on group performance. However, the interplay between group size, demonstrability and performance is not well understood. This paper addresses these gaps by studying the joint effect of two factors-the difficulty of solving a problem and the difficulty of verifying the correctness of a solution-on the ability of groups of varying sizes to converge to correct solutions. Our empirical investigations use problem instances from different computational complexity classes, NP-Complete (NPC) and PSPACE-complete (PSC), that exhibit similar solution difficulty but differ in verification difficulty. Our study focuses on nominal groups to isolate the effect of problem complexity on performance. We show that NPC problems have higher demonstrability than PSC problems: participants were significantly more likely to recognize correct and incorrect solutions for NPC problems than for PSC problems. We further show that increasing the group size can actually decrease group performance for some problems of low demonstrability. We analytically derive the boundary that distinguishes these problems from others for which group performance monotonically improves with group size. These findings increase our understanding of the mechanisms that underlie group problem-solving processes, and can inform the design of systems and processes that would better facilitate collective decision-making.

Advanced servomanipulator remote maintenance demonstration

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

Bradley, E.C.; Ladd, L.D.

1988-01-01

The Fuel Recycle Division (FRD) of the Oak Ridge National Laboratory (ORNL) is developing remote maintenance systems for the Consolidated Fuel Reprocessing Program for applications in future nuclear fuel cycle facilities. The most recent development is the advanced servomanipulator (ASM), a digitally controlled, force-reflecting, dual-arm, master/slave servomanipulator. A unique feature of ASM is that the slave arms are remotely maintainable. The ASM slave arms are composed of modules, each of which is capable of being removed and replaced by another manipulator system. The intent of this test was to demonstrate that the ASM slave arms could be completely disassembled andmore » reassembled remotely. This remote maintenance demonstration was performed using the Remote Operations and Maintenance Demonstration (ROMD) facility model M-2 servomanipulator maintenance system. Maintenance of ASM was successfully demonstrated using the M-2 servomanipulator and special fixtures. Recommendations, generally applicable to other remotely maintained equipment, have been made for maintainability improvements. 3 refs., 5 figs.« less

Inheriting the Learner's View: A Google Glass-Based Wearable Computing Platform for Improving Surgical Trainee Performance.

PubMed

Brewer, Zachary E; Fann, Hutchinson C; Ogden, W David; Burdon, Thomas A; Sheikh, Ahmad Y

2016-01-01

It is speculated that, in operative environments, real-time visualization of the trainee's viewpoint by the instructor may improve performance and teaching efficacy. We hypothesized that introduction of a wearable surgical visualization system allowing the instructor to visualize otherwise "blind" areas in the operative field could improve trainee performance in a simulated operative setting. A total of 11 surgery residents (4 in general surgery training and 7 in an integrated 6-year cardiothoracic surgery program) participated in the study. Google (Mountain View, CA) Glass hardware running proprietary software from CrowdOptic (San Francisco, CA) was utilized for creation of the wearable surgical visualization system. Both the learner and trainer wore the system, and video was streamed from the learner's system in real time to the trainer, who directed the learner to place needles in a simulated operative field. Subjects placed a total of 5 needles in each of 4 quadrants. A composite error score was calculated based on the accuracy of needle placement in relation to the intended needle trajectories as described by the trainer. Time to task completion (TTC) was also measured and participants completed an exit questionnaire. All residents completed the protocol tasks and the survey. Introduction of the wearable surgical visualization system did not affect mean time to task completion (278 ± 50 vs. 282 ± 69 seconds, p = NS). However, mean composite error score fell significantly once the wearable system was deployed (18 ± 5 vs. 15 ± 4, p < 0.05), demonstrating improved accuracy of needle placement. Most of the participants deemed the device unobtrusive, easy to operate, and useful for communication and instruction. This study suggests that wearable surgical visualization systems allowing for adoption of the learner's perspective may be a useful educational adjunct in the training of surgeons. Further evaluations of the efficacy of wearable technology in the operating room environment are warranted. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Integration of a Clinical Pharmacist into an Interdisciplinary Palliative Care Outpatient Clinic.

PubMed

DiScala, Sandra Lee; Onofrio, Sarah; Miller, Maura; Nazario, Mitchell; Silverman, Michael

2017-11-01

The primary objective of this quality improvement (QI) project was to determine if the Interdisciplinary Palliative Care Outpatient Clinic (IPCOC) at the West Palm Beach Veterans Affairs Medical Center offered improved symptom assessment and palliative care treatment outcomes. Secondary objectives were to identify, classify, and resolve medication problems and calculate the number of pharmacist recommendations accepted by prescribing providers. An IPCOC was created by selecting disciplines for a core group including a nurse practitioner, clinical pharmacist, social worker, chaplain, and physician. Consult referrals were recruited by providing educational sessions. The patient assessments were completed using the Edmonton Symptom Assessment System: (revised version; ESAS-R). The clinical pharmacist classified and resolved drug-related problems. The pharmacy resident telephoned veterans for completion of the "Patient Assessment: Overall Satisfaction with Outpatient Palliative Care Clinic." Seventeen consults were received, 6 patients were excluded, and 11 were seen in clinic. One (9%) of 11 patients met the outcomes measure of system assessment documentation in the past year. At completion, 11 (100%) of 11 patients met the outcomes data measure. The Patient Satisfaction Assessment revealed veterans strongly agree to recommend the IPCOC. The clinical pharmacist identified 20 drug-related problems, made 16 recommendations, had a 93.7% implementation rate, and facilitated implementation of medication changes. This QI project demonstrates that an IPCOC improved symptom assessment and palliative care outcomes in addition to resolution of medication prescribing issues in veterans with advanced cancer by integration of a clinical pharmacist into the core team.

Long-term treatment of epilepsy with everolimus in tuberous sclerosis

PubMed Central

Wilfong, Angus A.; Mays, Maxwell; Talley, Christina M.; Agricola, Karen; Tudor, Cindy; Capal, Jamie; Holland-Bouley, Katherine; Franz, David Neal

2016-01-01

Objective: To evaluate the long-term benefit and safety of everolimus for the treatment of medically refractory epilepsy in patients with tuberous sclerosis complex (TSC). Methods: Everolimus was titrated over 4 weeks and continued an additional 8 weeks in a prospective, open-label, phase I/II clinical trial design. Participants demonstrating initial benefit continued treatment until study completion (48 months). The primary endpoint was percentage of patients with a ≥50% reduction in seizure frequency compared to baseline. Secondary endpoints assessed absolute seizure frequency, adverse events (AEs), behavior, and quality of life. Results: Of the 20 participants who completed the initial study phase, 18 continued extended treatment. Fourteen of 18 (78%) participants completed the study, all but 1 of whom reported ≥50% reduction in seizure frequency at 48 months. All participants reported at least 1 AE, the vast majority (94%) of which were graded mild or moderate severity. Improvements in behavior and quality of life were also observed, but failed to achieve statistical significance at 48 months. Conclusions: Improved seizure control was maintained for 4 years in the majority of patients with TSC with medically refractory epilepsy treated with everolimus. Long-term treatment with everolimus is safe and well-tolerated in this population. Everolimus may be a therapeutic option for refractory epilepsy in TSC. Classification of evidence: This study provides Class IV evidence that for patients with TSC with medically refractory epilepsy everolimus improves seizure control. PMID:27815402

The implementation of computerized cognitive behavioural therapies in a service user-led, third sector self help clinic.

PubMed

Cavanagh, Kate; Seccombe, Nick; Lidbetter, Nicky

2011-07-01

The efficacy and effectiveness of a computerized cognitive behavioural therapy (CCBT) package, Beating the Blues, has been demonstrated in a large randomized controlled trial and several pragmatic studies in the National Health Service (NHS). The current study tests the generalizability of this finding to the implementation of CCBT in a service user-led, third sector Self Help Clinic. 510 referrals for the Beating the Blues program were received over a 16 month period in routine care. The Patient Health Questionnaire Depression (PHQ-9) and Anxiety (GAD-7) Scales were administered pre-treatment and during each treatment session. The 10-item Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), Work and Social Adjustment Scale and Patient Experience Questionnaire were also administered pre-treatment and immediately on completing treatment. More than two-thirds of referrals were suitable for treatment and completed a baseline assessment; 84% of these started the Beating the Blues program. Two-hundred and twenty-six people meeting caseness criteria at baseline completed at least two sessions of CCBT. Of these, 50% met recovery criteria at their final point of measurement. Completer and intention-to-treat analysis also demonstrated statistically and clinically significant improvements on key outcome measures. CCBT can be effectively implemented in a service user-led, third sector Self Help Clinic, increasing access to psychological therapies to meet local needs for tier two interventions for depression and anxiety.

Environmental enrichment improves learning and memory and long-term potentiation in young adult rats through a mechanism requiring mGluR5 signaling and sustained activation of p70s6k.

PubMed

Hullinger, Rikki; O'Riordan, Kenneth; Burger, Corinna

2015-11-01

Previous studies from our lab have demonstrated that mild cognitive impairments identified early in life are predictive of cognitive deficits that develop with age, suggesting that enhancements in cognition at an early age can provide a buffer against age-related cognitive decline. Environmental enrichment has been shown to improve learning and memory in the rodent, but the impact of enrichment on synaptic plasticity and the molecular mechanisms behind enrichment are not completely understood. To address these unresolved issues, we have housed 2-month old rats in environmentally enriched (EE), socially enriched (SE), or standard housing (SC) and conducted tests of learning and memory formation at various time intervals. Here we demonstrate that animals that have been exposed to one month of social or environmental enrichment demonstrate enhanced learning and memory relative to standard housed controls. However, we have found that after 4months EE animals perform better than both SE and SC groups and demonstrate an enhanced hippocampal LTP. Our results demonstrate that this LTP is dependent on mGluR5 signaling, activation of ERK and mTOR signaling cascades, and sustained phosphorylation of p70s6 kinase, thus providing a potential target mechanism for future studies of cognitive enhancement in the rodent. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of singing on voice, respiratory control and quality of life in persons with Parkinson's disease.

PubMed

Stegemöller, Elizabeth L; Radig, Hollie; Hibbing, Paul; Wingate, Judith; Sapienza, Christine

2017-03-01

Purpose Interventions focused on singing may provide additional benefits to established voice and respiratory therapies, due to their greater emphasis on the respiratory muscle control system in those with Parkinson's disease (PD) progresses. The purpose of this study was to examine if singing can improve voice, respiratory pressure and quality of life (QOL) in persons with PD. Methods This pilot study measured the effects of a singing intervention in 27 participants with PD. Participants were assigned to a high (met twice weekly) or low (met once weekly) dosage group. Voice, respiratory and QOL measures were recorded before and after an 8-week singing intervention. Sessions were led by board-certified music therapists and included a series of vocal and articulation exercises and group singing. Results Both groups demonstrated significant improvements in maximum inspiratory and expiratory pressure, as well as phonation time. While other voice measures improved, they did not reach statistical significance. Voice QOL and whole health QOL also significantly improved. Conclusion These results suggest singing may be a beneficial and engaging treatment choice for improving and maintaining vocal function and respiratory pressure in persons with PD. Implications for Rehabilitation In a small sample, group singing proved beneficial for improving voice and respiratory impairment in persons with Parkinson's disease. Completing group singing one time per week for 8 weeks was as effective as completing group singing two times per week for 8 weeks in persons with Parkinson's disease. Group singing is an effective means of improving overall quality of life in persons with Parkinson's disease.

A compound herbal preparation (CHP) in the treatment of children with ADHD: a randomized controlled trial.

PubMed

Katz, M; Levine, A Adar; Kol-Degani, H; Kav-Venaki, L

2010-11-01

Evaluation of the efficacy of a patented, compound herbal preparation (CHP) in improving attention, cognition, and impulse control in children with ADHD. A randomized, double-blind, placebo-controlled trial. University-affiliated tertiary medical center. 120 children newly diagnosed with ADHD, meeting DSM-IV criteria. Random assignment to the herbal treatment group (n = 80) or control group (placebo; n = 40); 73 patients in the treatment group (91%) and 19 in the control group (48%) completed the 4-month trial. Test of Variables of Attention (TOVA) administered before and after the treatment period; overall score and 4 subscales. The treatment group showed substantial, statistically significant improvement in the 4 subscales and overall TOVA scores, compared with no improvement in the control group, which persisted in an intention-to-treat analysis. The well-tolerated CHP demonstrated improved attention, cognition, and impulse control in the intervention group, indicating promise for ADHD treatment in children.

Phosphatidylserine containing omega-3 Fatty acids may improve memory abilities in nondemented elderly individuals with memory complaints: results from an open-label extension study.

PubMed

Vakhapova, Veronika; Cohen, Tzafra; Richter, Yael; Herzog, Yael; Kam, Yossi; Korczyn, Amos D

2014-01-01

The present study is an open-label extension (OLE) aimed at evaluating the effect of 100 mg/day of phosphatidylserine enriched with docosahexaenoic acid (PS-DHA) on cognitive performance in nondemented elderly individuals with memory complaints. From the participants who completed the core study, 122 continued with a 15-week OLE. Efficacy was assessed using a computerized tool and the Clinical Global Impression of Change (CGI-C) rating scale. A significant improvement in sustained attention and memory recognition was observed in the PS-DHA naïve group, while the PS-DHA continuers maintained their cognitive status. Additionally, a significant improvement in CGI-C was observed in the naïve group. The results demonstrate that consumption of 100 mg/day of PS-DHA might be associated with improving or maintaining cognitive status in elderly subjects with memory complaints.

DOT2: Macromolecular Docking With Improved Biophysical Models

PubMed Central

Roberts, Victoria A.; Thompson, Elaine E.; Pique, Michael E.; Perez, Martin S.; Eyck, Lynn Ten

2015-01-01

Computational docking is a useful tool for predicting macromolecular complexes, which are often difficult to determine experimentally. Here we present the DOT2 software suite, an updated version of the DOT intermolecular docking program. DOT2 provides straightforward, automated construction of improved biophysical models based on molecular coordinates, offering checkpoints that guide the user to include critical features. DOT has been updated to run more quickly, allow flexibility in grid size and spacing, and generate a complete list of favorable candidate configu-rations. Output can be filtered by experimental data and rescored by the sum of electrostatic and atomic desolvation energies. We show that this rescoring method improves the ranking of correct complexes for a wide range of macromolecular interactions, and demonstrate that biologically relevant models are essential for biologically relevant results. The flexibility and versatility of DOT2 accommodate realistic models of complex biological systems, improving the likelihood of a successful docking outcome. PMID:23695987

Caffeine Enhances Memory Performance in Young Adults during Their Non-optimal Time of Day

PubMed Central

Sherman, Stephanie M.; Buckley, Timothy P.; Baena, Elsa; Ryan, Lee

2016-01-01

Many college students struggle to perform well on exams in the early morning. Although students drink caffeinated beverages to feel more awake, it is unclear whether these actually improve performance. After consuming coffee (caffeinated or decaffeinated), college-age adults completed implicit and explicit memory tasks in the early morning and late afternoon (Experiment 1). During the morning, participants ingesting caffeine demonstrated a striking improvement in explicit memory, but not implicit memory. Caffeine did not alter memory performance in the afternoon. In Experiment 2, participants engaged in cardiovascular exercise in order to examine whether increases in physiological arousal similarly improved memory. Despite clear increases in physiological arousal, exercise did not improve memory performance compared to a stretching control condition. These results suggest that caffeine has a specific benefit for memory during students’ non-optimal time of day – early morning. These findings have real-world implications for students taking morning exams. PMID:27895607

Prediction of global vapor-liquid equilibria for mixtures containing polar and associating components with improved renormalization group theory.

PubMed

Mi, Jianguo; Tang, Yiping; Zhong, Chongli; Li, Yi-Gui

2005-11-03

Our recently improved renormalization group (RG) theory is further reformulated within the context of density functional theory. To improve the theory for polar and associating fluids, an explicit and complete expression of the theory is derived in which the density fluctuation is expanded up to the third-order term instead of the original second-order term. A new predictive equation of state based on the first-order mean spherical approximation statistical associating fluid theory (FMSA-SAFT) and the newly improved RG theory is proposed for systems containing polar and associating fluids. The calculated results for both pure fluids and mixtures are in good agreement with experimental data both inside and outside the critical region. This work demonstrates that the RG theory incorporated with the solution of FMSA is a promising route for accurately describing the global phase behavior of complex fluids and mixtures.

JT90 thermal barrier coated vanes

NASA Technical Reports Server (NTRS)

Sheffler, K. D.; Graziani, R. A.; Sinko, G. C.

1982-01-01

The technology of plasma sprayed thermal barrier coatings applied to turbine vane platforms in modern high temperature commercial engines was advanced to the point of demonstrated feasibility for application to commercial aircraft engines. The three thermal barrier coatings refined under this program are zirconia stabilized with twenty-one percent magnesia (21% MSZ), six percent yttria (6% YSZ), and twenty percent yttria (20% YSZ). Improvement in thermal cyclic endurance by a factor of 40 times was demonstrated in rig tests. A cooling system evolved during the program which featured air impingement cooling for the vane platforms rather than film cooling. The impingement cooling system, in combination with the thermal barrier coatings, reduced platform cooling air requirements by 44% relative to the current film cooling system. Improved durability and reduced cooling air requirements were demonstrated in rig and engine endurance tests. Two engine tests were conducted, one of 1000 cycles and the other of 1500 cycles. All three coatings applied to vanes fabricated with the final cooling system configuration completed the final 1500 cycle engine endurance test. Results of this test clearly demonstrated the durability of the 6% YSZ coating which was in very good condition after the test. The 21% MSZ and 20% YSZ coatings had numerous occurrences of significant spalling in the test.

Body System Effects of a Multi-Modal Training Program Targeting Chronic, Motor Complete Thoracic Spinal Cord Injury.

PubMed

Gant, Katie L; Nagle, Kathleen G; Cowan, Rachel E; Field-Fote, Edelle C; Nash, Mark S; Kressler, Jochen; Thomas, Christine K; Castellanos, Mabelin; Widerström-Noga, Eva; Anderson, Kimberly D

2018-02-01

The safety and efficacy of pharmacological and cellular transplantation strategies are currently being evaluated in people with spinal cord injury (SCI). In studies of people with chronic SCIs, it is thought that functional recovery will be best achieved when drug or cell therapies are combined with rehabilitation protocols. However, any functional recovery attributed to the therapy may be confounded by the conditioned state of the body and by training-induced effects on neuroplasticity. For this reason, we sought to investigate the effects of a multi-modal training program on several body systems. The training program included body-weight-supported treadmill training for locomotion, circuit resistance training for upper body conditioning, functional electrical stimulation for activation of sublesional muscles, and wheelchair skills training for overall mobility. Eight participants with chronic, thoracic-level, motor-complete SCI completed the 12-week training program. After 12 weeks, upper extremity muscular strength improved significantly for all participants, and some participants experienced improvements in function, which may be explained by increased strength. Neurological function did not change. Changes in pain and spasticity were highly variable between participants. This is the first demonstration of the effect of this combination of four training modalities. However, balancing participant and study-site burden with capturing meaningful outcome measures is also an important consideration.

Social validity of the Social Skills Improvement System-Classwide Intervention Program (SSIS-CIP) in the primary grades.

PubMed

Wollersheim Shervey, Sarah; Sandilos, Lia E; DiPerna, James C; Lei, Pui-Wa

2017-09-01

The purpose of this study was to examine the social validity of the Social Skills Improvement System-Classwide Intervention Program (SSIS-CIP) for teachers in the primary grades. Participants included 45 first and second grade teachers who completed a 16-item social validity questionnaire during each year of the SSIS-CIP efficacy trial. Findings indicated that teachers generally perceived the SSIS-CIP as a socially valid and feasible intervention for primary grades; however, teachers' ratings regarding ease of implementation and relevance and sequence demonstrated differences across grade levels in the second year of implementation. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Direct modeling parameter signature analysis and failure mode prediction of physical systems using hybrid computer optimization

NASA Technical Reports Server (NTRS)

Drake, R. L.; Duvoisin, P. F.; Asthana, A.; Mather, T. W.

1971-01-01

High speed automated identification and design of dynamic systems, both linear and nonlinear, are discussed. Special emphasis is placed on developing hardware and techniques which are applicable to practical problems. The basic modeling experiment and new results are described. Using the improvements developed successful identification of several systems, including a physical example as well as simulated systems, was obtained. The advantages of parameter signature analysis over signal signature analysis in go-no go testing of operational systems were demonstrated. The feasibility of using these ideas in failure mode prediction in operating systems was also investigated. An improved digital controlled nonlinear function generator was developed, de-bugged, and completely documented.

A Data-Driven Solution for Performance Improvement

NASA Technical Reports Server (NTRS)

2002-01-01

Marketed as the "Software of the Future," Optimal Engineering Systems P.I. EXPERT(TM) technology offers statistical process control and optimization techniques that are critical to businesses looking to restructure or accelerate operations in order to gain a competitive edge. Kennedy Space Center granted Optimal Engineering Systems the funding and aid necessary to develop a prototype of the process monitoring and improvement software. Completion of this prototype demonstrated that it was possible to integrate traditional statistical quality assurance tools with robust optimization techniques in a user- friendly format that is visually compelling. Using an expert system knowledge base, the software allows the user to determine objectives, capture constraints and out-of-control processes, predict results, and compute optimal process settings.

The group dynamics of women's self-defense training.

PubMed

Brecklin, Leanne R; Middendorf, Rena K

2014-03-01

The current study examines the role of group interaction in a women's self-defense class. Study methods included individual interviews with women who had completed a college-based women-only self-defense course as well as supplemental observation of group behavior during a mock "attack" simulation class. The unique relationship that develops among women's self-defense classmates seems to improve overall learning and performance due to the group collaboration and vicarious experiences. Results demonstrated that women's self-defense courses offer participants a beneficial and supportive group atmosphere.

MIT ASTROMAG 1.7 meter disk magnet design report

NASA Technical Reports Server (NTRS)

Marston, P. G.; Hale, J. R.; Vieira, R.; Zhukovsky, A.; Titus, P. H.; Sullivan, J. D.; Dawson, A. M.

1990-01-01

MIT has proposed a magnet design for ASTROMAG, which has demonstrated substantial improvement in performance as compared with the present HEAO baseline design. Several advantages of the MIT disk design are listed along with design characteristics. Details of field contours and active field regions are shown along with comparisons with other designs. Three alternative design configurations for the ASTROMAG disk coils are summarized. The parameters of the conductors are listed and basic parameters for each of the complete systems are shown.

Application of process improvement principles to increase the frequency of complete airway management documentation.

PubMed

McCarty, L Kelsey; Saddawi-Konefka, Daniel; Gargan, Lauren M; Driscoll, William D; Walsh, John L; Peterfreund, Robert A

2014-12-01

Process improvement in healthcare delivery settings can be difficult, even when there is consensus among clinicians about a clinical practice or desired outcome. Airway management is a medical intervention fundamental to the delivery of anesthesia care. Like other medical interventions, a detailed description of the management methods should be documented. Despite this expectation, airway documentation is often insufficient. The authors hypothesized that formal adoption of process improvement methods could be used to increase the rate of "complete" airway management documentation. The authors defined a set of criteria as a local practice standard of "complete" airway management documentation. The authors then employed selected process improvement methodologies over 13 months in three iterative and escalating phases to increase the percentage of records with complete documentation. The criteria were applied retrospectively to determine the baseline frequency of complete records, and prospectively to measure the impact of process improvements efforts over the three phases of implementation. Immediately before the initial intervention, a retrospective review of 23,011 general anesthesia cases over 6 months showed that 13.2% of patient records included complete documentation. At the conclusion of the 13-month improvement effort, documentation improved to a completion rate of 91.6% (P<0.0001). During the subsequent 21 months, the completion rate was sustained at an average of 90.7% (SD, 0.9%) across 82,571 general anesthetic records. Systematic application of process improvement methodologies can improve airway documentation and may be similarly effective in improving other areas of anesthesia clinical practice.

Improvements in Unmarried African American Parents' Rapport, Communication, and Problem-Solving Following a Prenatal Coparenting Intervention.

PubMed

McHale, James P; Salman-Engin, Selin; Coovert, Michael D

2015-12-01

This report examines effects of a coparenting intervention designed for and delivered to expectant unmarried African American mothers and fathers on observed interaction dynamics known to predict relationship adjustment. Twenty families took part in the six-session "Figuring It Out for the Child" (FIOC) dyadic intervention offered in a faith-based human services agency during the third trimester of the mother's pregnancy, and completed a postpartum booster session 1 month after the baby's arrival. Parent referrals for the FIOC program were received from a county Health Department and from OBGYNs and Pregnancy Centers in the targeted community. All intervention sessions were delivered by a trained male-female paraprofessional team whose fidelity to the FIOC manualized curriculum was independently evaluated by a team of trained analysts. At both the point of intake ("PRE") and again at an exit evaluation completed 3 months postpartum ("POST"), the mothers and fathers were videotaped as they completed two standardized "revealed differences" conflict discussions. Blinded videotapes of these sessions were evaluated using the System for Coding Interactions in Dyads. Analyses documented statistically significant improvements on 8 of 12 variables examined, with effect sizes ranging from moderate to large. Overall, 14 families demonstrated beneficial outcomes, 3 did not improve, and 3 showed some signs of decline from the point of intake. For most interaction processes, PRE to POST improvements were unrelated to degree of adherence the paraprofessional interventionists showed to the curriculum. However, better interventionist competence was related to decreases in partners' Coerciveness and Negativity and Conflict, and to smaller increases in partner Withdrawal. Implications of the work for development and delivery of community-based coparenting interventions for unmarried parents are discussed. © 2015 Family Process Institute.

Multivalent Binding and Biomimetic Cell Rolling Improves the Sensitivity and Specificity of Circulating Tumor Cell Capture.

PubMed

Myung, Ja Hye; Eblan, Michael J; Caster, Joseph M; Park, Sin-Jung; Poellmann, Michael J; Wang, Kyle; Tam, Kevin A; Miller, Seth M; Shen, Colette; Chen, Ronald C; Zhang, Tian; Tepper, Joel E; Chera, Bhishamjit S; Wang, Andrew Z; Hong, Seungpyo

2018-06-01

Purpose: We aimed to examine the effects of multivalent binding and biomimetic cell rolling on the sensitivity and specificity of circulating tumor cell (CTC) capture. We also investigated the clinical significance of CTCs and their kinetic profiles in patients with cancer undergoing radiotherapy treatment. Experimental Design: Patients with histologically confirmed primary carcinoma undergoing radiotherapy, with or without chemotherapy, were eligible for enrollment. Peripheral blood was collected prospectively at up to five time points, including before radiotherapy, at the first week, mid-point and final week of treatment, as well as 4 to 12 weeks after completion of radiotherapy. CTC capture was accomplished using a nanotechnology-based assay (CapioCyte) functionalized with aEpCAM, aHER-2, and aEGFR. Results: CapioCyte was able to detect CTCs in all 24 cancer patients enrolled. Multivalent binding via poly(amidoamine) dendrimers further improved capture sensitivity. We also showed that cell rolling effect can improve CTC capture specificity (% of captured cells that are CK + /CD45 - /DAPI + ) up to 38%. Among the 18 patients with sequential CTC measurements, the median CTC decreased from 113 CTCs/mL before radiotherapy to 32 CTCs/mL at completion of radiotherapy ( P = 0.001). CTCs declined throughout radiotherapy in patients with complete clinical and/or radiographic response, in contrast with an elevation in CTCs at mid or post-radiotherapy in the two patients with known pathologic residual disease. Conclusions: Our study demonstrated that multivalent binding and cell rolling can improve the sensitivity and specificity of CTC capture compared with multivalent binding alone, allowing reliable monitoring of CTC changes during and after treatment. Clin Cancer Res; 24(11); 2539-47. ©2018 AACR . ©2018 American Association for Cancer Research.

Improving the impact of didactic resident training with online spaced education.

PubMed

Gyorki, David E; Shaw, Tim; Nicholson, James; Baker, Caroline; Pitcher, Meron; Skandarajah, Anita; Segelov, Eva; Mann, G Bruce

2013-06-01

Educational programmes are frequently developed to improve the knowledge of medical trainees. The impact of a programme may be limited if there is no follow-up to reinforce the message. Online Spaced Education (SE) has been developed to address this limitation. This study was performed to assess whether an SE programme would improve the impact of a didactic seminar. A randomized trial of an online SE programme occurred as part of the 2010 Clinical Oncology Society of Australia Breast Cancer Trainee Workshop. Consenting participants were randomized to undertake SE or not and were then invited to undertake a 22-question knowledge test. A questionnaire was administered relating to the perceived value of the SE programme. Participants consisted largely of surgical and medical oncology trainees. Two hundred people attended the workshop and 97 consented to randomization. Thirty-eight of 49 randomized to the SE group commenced the SE course. Seventy-one percent of participants answered each question at least once and 55% of participants completed the entire programme. Fifty-nine participants completed the post-test. The SE participants performed significantly better than the control group (P < 0.05). The questionnaire was completed by 26 of the SE group. Ninety-two percent strongly agreed or agreed that SE would improve their practice and 96% agreed that SE effectively reinforced key aspects of workshop. This study demonstrates the utility of SE to increase knowledge retention following a face-to-face workshop. The programme was very well received by the participants and may be an appropriate reinforcing methodology for other similar seminars. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

Prospective Randomized Study of the Effect of Music on the Efficiency of Surgical Closures.

PubMed

Lies, Shelby R; Zhang, Andrew Y

2015-09-01

Music is commonly played in operating theaters. Some surgeons believe music reduces stress and operative time, while others think music is a distraction and should be avoided. There is limited published evidence evaluating the effects of music on surgical performance. The goal of this study is to evaluate the effect of music on simple wound closure. Plastic surgery residents were asked to perform layered closures on pigs' feet with and without their preferred music playing. Simple randomization was used to assign residents to the music playing first or music playing second group. The time to complete the repair was measured and repairs were graded by blinded faculty. Results were analyzed to determine significant differences in time to complete the task and quality of repair. Participants were retested in a second session with music played in the opposite order to evaluate consistency. Listening to preferred music decreased repair time by 8% for all plastic surgery residents (p = 0.009). Subgroup analysis demonstrated even more significant improvement in speed for senior residents (PGY 4-6), resulting in a 10% decrease in repair time (p = 0.006). The quality of repair was also better in the music group, at 3.3 versus 3.1 (p = 0.047). Retesting revealed results remained significant whether music was played first or second. Playing preferred music made plastic surgery residents faster in completing wound closure with a 10% improvement in senior residents. Music also improved quality of repair as judged by blinded faculty. Our study showed that music improves efficiency of wound closure, which may translate to healthcare cost savings. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Biomass power for rural development: Phase 2. Technical progress report, April 1--June 30, 1998

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

Neuhauser, E.

1998-11-01

The project undertaken by the Salix Consortium is a multi-phased, multi-partner endeavor. Phase-1 focused on initial development and testing of the technology and agreements necessary to demonstrate commercial willow production in Phase-2. The Phase-1 objectives have been successfully completed: preparing final design plans for two utility pulverized coal boilers, developing fuel supply plans for the project, obtaining power production commitments from the power companies for Phase-2, obtaining construction and environmental permits, and developing an experimental strategy for crop production and power generation improvements needed to assure commercial success. The R and D effort also addresses environmental issues pertaining to introductionmore » of the willow energy system. Beyond those Phase-1 requirements the Consortium has already successfully demonstrated cofiring at Greenidge Station and developed the required nursery capacity for acreage scale-up. This past summer 105 acres were prepared in advance for the spring planting in 1998. Having completed the above tasks, the Consortium is well positioned to begin Phase-2. In phase-2 every aspect of willow production and power generation from willow will be demonstrated. The ultimate objective of Phase-2 is to transition the work performed under the Rural Energy for the Future project into a thriving, self-supported energy crop enterprise.« less

Decolourization and biodegradation of azo dye methyl red by Rhodococcus strain UCC 0016.

PubMed

Maniyam, Maegala Nallapan; Ibrahim, Abdul Latif; Cass, Anthony E G

2018-06-20

In the present study, locally isolated Rhodococcus strains were attempted as biological tools for methyl red removal, a mutagenic azo dye posing threat to the environment if left untreated. Rhodococcus strain UCC 0016 demonstrated superior methyl red-decolourizing activity of 100% after 24 hours at static condition in comparison to Rhodococcus strain UCC 0008 which recorded 65% decolourization after 72 hours. Optimization of physicochemical parameters at 30 °C, pH 7 and supplementing glucose as the carbon source resulted in improved methyl red-decolourizing activity at static condition and reduced the time taken to achieve complete decolourization by 80%. Higher concentration of methyl red (5 g/L) was able to be decolourized completely within 10 hours by adopting the technology of immobilization. The encapsulated cells of Rhodococcus strain UCC 0016 demonstrated higher substrate affinity (K m =0.6995 g/L) and accelerated rate of disappearance of methyl red (V max = 0.3203 g/L/h) compared to the free cells. Furthermore, the gellan gum beads could be reused up to 9 batches without substantial loss in the catalytic activity indicating the economic importance of this protocol. Analysis of methyl red degradation products revealed no germination inhibition on Triticum aestivum and Vigna radiata demonstrating complete toxicity removal of the parent dye after biological treatment. The occurrence of new and altered peaks (UV-Vis and FTIR) further supported the notion that the removal of methyl red by Rhodococcus strain UCC 0016 was indeed through biodegradation. Therefore, this strain has a huge potential as a candidate for efficient bioremediation of wastewater containing methyl red.

An analysis of observer-rated functional vision in patients implanted with the Argus II Retinal Prosthesis System at three years.

PubMed

Geruschat, Duane R; Richards, Thomas P; Arditi, Aries; da Cruz, Lyndon; Dagnelie, Gislin; Dorn, Jessy D; Duncan, Jacque L; Ho, Allen C; Olmos de Koo, Lisa C; Sahel, José-Alain; Stanga, Paulo E; Thumann, Gabriele; Wang, Vizhong; Greenberg, Robert J

2016-05-01

The purpose of this analysis was to compare observer-rated tasks in patients implanted with the Argus II Retinal Prosthesis System, when the device is ON versus OFF. The Functional Low-Vision Observer Rated Assessment (FLORA) instrument was administered to 26 blind patients implanted with the Argus II Retinal Prosthesis System at a mean follow-up of 36 months. FLORA is a multi-component instrument that consists in part of observer-rated assessment of 35 tasks completed with the device ON versus OFF. The ease with which a patient completes a task is scored using a four-point scale, ranging from easy (score of 1) to impossible (score of 4). The tasks are evaluated individually and organised into four discrete domains, including 'Visual orientation', 'Visual mobility', 'Daily life and 'Interaction with others'. Twenty-six patients completed each of the 35 tasks. Overall, 24 out of 35 tasks (69 per cent) were statistically significantly easier to achieve with the device ON versus OFF. In each of the four domains, patients' performances were significantly better (p < 0.05) with the device ON versus OFF, ranging from 19 to 38 per cent improvement. Patients with an Argus II Retinal Prosthesis implanted for 18 to 44 months (mean 36 months), demonstrated significantly improved completion of vision-related tasks with the device ON versus OFF. © 2016 The Authors Clinical and Experimental Optometry published by John Wiley & Sons Australia, Ltd on behalf of Optometry Australia.

An analysis of observer‐rated functional vision in patients implanted with the Argus II Retinal Prosthesis System at three years

PubMed Central

Richards, Thomas P; Arditi, Aries; da Cruz, Lyndon; Dagnelie, Gislin; Dorn, Jessy D; Duncan, Jacque L; Ho, Allen C; Olmos de Koo, Lisa C; Sahel, José‐Alain; Stanga, Paulo E; Thumann, Gabriele; Wang, Vizhong; Greenberg, Robert J

2016-01-01

Abstract Objective The purpose of this analysis was to compare observer‐rated tasks in patients implanted with the Argus II Retinal Prosthesis System, when the device is ON versus OFF. Methods The Functional Low‐Vision Observer Rated Assessment (FLORA) instrument was administered to 26 blind patients implanted with the Argus II Retinal Prosthesis System at a mean follow‐up of 36 months. FLORA is a multi‐component instrument that consists in part of observer‐rated assessment of 35 tasks completed with the device ON versus OFF. The ease with which a patient completes a task is scored using a four‐point scale, ranging from easy (score of 1) to impossible (score of 4). The tasks are evaluated individually and organised into four discrete domains, including ‘Visual orientation’, ‘Visual mobility’, ‘Daily life and ‘Interaction with others’. Results Twenty‐six patients completed each of the 35 tasks. Overall, 24 out of 35 tasks (69 per cent) were statistically significantly easier to achieve with the device ON versus OFF. In each of the four domains, patients’ performances were significantly better (p < 0.05) with the device ON versus OFF, ranging from 19 to 38 per cent improvement. Conclusion Patients with an Argus II Retinal Prosthesis implanted for 18 to 44 months (mean 36 months), demonstrated significantly improved completion of vision‐related tasks with the device ON versus OFF. PMID:26804484

Dexpanthenol: An Overview of its Contribution to Symptom Relief in Acute Rhinitis Treated with Decongestant Nasal Sprays.

PubMed

Mösges, Ralph; Shah-Hosseini, Kija; Hucke, Hans-Peter; Joisten, Marie-Josefine

2017-08-01

Nasal blockage is the most bothersome symptom of acute rhinitis. Nasal decongestant sprays containing alpha-sympathomimetics, such as oxymetazoline and xylometazoline, have a rapid onset of action. However, this effect decreases with repeated application and, furthermore, the ciliary function of the nasal mucosa is practically paralyzed. Dexpanthenol promotes cell proliferation and protects the epithelium. Combining these two agents has demonstrated beneficial synergetic effects on the symptoms of acute rhinitis. In a post hoc analysis of a large-scale double-blind, active-controlled study including 152 patients, we could demonstrate that the benefit of added dexpanthenol appears as early as on the third day of the combined application of xylometazoline and dexpanthenol in terms of complete or near-to-complete freedom from symptoms. After 5 days, 47% of the patients were cured under the combined treatment compared with only 1% under xylometazoline monotherapy. These data show that the addition of dexpanthenol to an alpha-sympathomimetic nasal spray not only improves its tolerability but also further increases its effectiveness and leads to expedited cure. Klosterfrau Healthcare Group.

Phrenic nerve decompression for the management of unilateral diaphragmatic paralysis – preoperative evaluation and operative technique

PubMed Central

Hoshide, Reid; Brown, Justin

2017-01-01

Background: Unilateral diaphragmatic paralysis (UDP) can be a very disabling, typically causing shortness of breath and reduced exercise tolerance. We present a case of a surgical decompression of the phrenic nerve of a patient who presented with UDP, which occurred following cervical spine surgery. Methods: The workup for the etiology of UDP demonstrated paradoxical movement on “sniff test” and notably impaired pulmonary function tests. Seven months following the onset of the UDP, he underwent a surgical decompression of the phrenic nerve at the level of the anterior scalene. Results: He noted rapid symptomatic improvement following surgery and reversal of the above noted objective findings was documented. At his 4-year follow-up, he had complete resolution of his clinical symptoms. Repeated physiologic testing of his respiratory function had shown a complete reversal of his UDP. Conclusions: Anatomical compression of the phrenic nerve by redundant neck vasculature should be considered in the differential diagnosis of UDP. Here we demonstrated the techniques in workup and surgical management, with both subjective and objective evidence of success. PMID:29184705

Phrenic nerve decompression for the management of unilateral diaphragmatic paralysis - preoperative evaluation and operative technique.

PubMed

Hoshide, Reid; Brown, Justin

2017-01-01

Unilateral diaphragmatic paralysis (UDP) can be a very disabling, typically causing shortness of breath and reduced exercise tolerance. We present a case of a surgical decompression of the phrenic nerve of a patient who presented with UDP, which occurred following cervical spine surgery. The workup for the etiology of UDP demonstrated paradoxical movement on "sniff test" and notably impaired pulmonary function tests. Seven months following the onset of the UDP, he underwent a surgical decompression of the phrenic nerve at the level of the anterior scalene. He noted rapid symptomatic improvement following surgery and reversal of the above noted objective findings was documented. At his 4-year follow-up, he had complete resolution of his clinical symptoms. Repeated physiologic testing of his respiratory function had shown a complete reversal of his UDP. Anatomical compression of the phrenic nerve by redundant neck vasculature should be considered in the differential diagnosis of UDP. Here we demonstrated the techniques in workup and surgical management, with both subjective and objective evidence of success.

Low resistivity ZnO-GO electron transport layer based CH{sub 3}NH{sub 3}PbI{sub 3} solar cells

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

Ahmed, Muhammad Imran, E-mail: imranrahbar@scme.nust.edu.pk, E-mail: amirhabib@scme.nust.edu.pk; Hussain, Zakir; Mujahid, Mohammad

Perovskite based solar cells have demonstrated impressive performances. Controlled environment synthesis and expensive hole transport material impede their potential commercialization. We report ambient air synthesis of hole transport layer free devices using ZnO-GO as electron selective contacts. Solar cells fabricated with hole transport layer free architecture under ambient air conditions with ZnO as electron selective contact achieved an efficiency of 3.02%. We have demonstrated that by incorporating GO in ZnO matrix, low resistivity electron selective contacts, critical to improve the performance, can be achieved. We could achieve max efficiency of 4.52% with our completed devices for ZnO: GO composite. Impedancemore » spectroscopy confirmed the decrease in series resistance and an increase in recombination resistance with inclusion of GO in ZnO matrix. Effect of temperature on completed devices was investigated by recording impedance spectra at 40 and 60 {sup o}C, providing indirect evidence of the performance of solar cells at elevated temperatures.« less

Monitoring iCCM referral systems: Bugoye Integrated Community Case Management Initiative (BIMI) in Uganda.

PubMed

English, Lacey; Miller, James S; Mbusa, Rapheal; Matte, Michael; Kenney, Jessica; Bwambale, Shem; Ntaro, Moses; Patel, Palka; Mulogo, Edgar; Stone, Geren S

2016-04-29

In Uganda, over half of under-five child mortality is attributed to three infectious diseases: malaria, pneumonia and diarrhoea. Integrated community case management (iCCM) trains village health workers (VHWs) to provide in-home diagnosis and treatment of these common childhood illnesses. For severely ill children, iCCM relies on a functioning referral system to ensure timely treatment at a health facility. However, referral completion rates vary widely among iCCM programmes and are difficult to monitor. The Bugoye Integrated Community Case Management Initiative (BIMI) is an iCCM programme operating in Bugoye sub-county, Uganda. This case study describes BIMI's experience with monitoring referral completion at Bugoye Health Centre III (BHC), and outlines improvements to be made within iCCM referral systems. This study triangulated multiple data sources to evaluate the strengths and gaps in the BIMI referral system. Three quantitative data sources were reviewed: (1) VHW report of referred patients, (2) referral forms found at BHC, and (3) BHC patient records. These data sources were collated and triangulated from January-December 2014. The goal was to determine if patients were completing their referrals and if referrals were adequately documented using routine data sources. From January-December 2014, there were 268 patients referred to BHC, as documented by VHWs. However, only 52 of these patients had referral forms stored at BHC. Of the 52 referral forms found, 22 of these patients were also found in BHC register books recorded by clinic staff. Thus, the study found a mismatch between VHW reports of patient referrals and the referral visits documented at BHC. This discrepancy may indicate several gaps: (1) referred patients may not be completing their referral, (2) referral forms may be getting lost at BHC, and, (3) referred patients may be going to other health facilities or drug shops, rather than BHC, for their referral. This study demonstrates the challenges of effectively monitoring iCCM referral completion, given identified limitations such as discordant data sources, incomplete record keeping and lack of unique identifiers. There is a need to innovate and improve the ways by which referral compliance is monitored using routine data, in order to improve the percentage of referrals completed. Through research and field experience, this study proposes programmatic and technological solutions to rectify these gaps within iCCM programmes facing similar challenges. With improved monitoring, VHWs will be empowered to increase referral completion, allowing critically ill children to access needed health services.

A Review of the American Recovery and Reinvestment Act Smart Grid Projects and Their Implications for China

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

Liu, Xu; Marnay, Chris; Feng, Wei

The Chinese government has paid growing attention to renewable energy development and has set ambitious goals for carbon dioxide (CO2) emissions reduction and energy savings. Smart grid (SG) technologies have been regarded as emerging ways to integrate renewable energy and to help achieve these climate and energy goals. This report first reviews completed SG demonstrations under the U.S. American Recovery and Reinvestment Act (ARRA); especially two key programs: the SG Investment Grant (SGIG) and the SG Demonstration Project (SGDP). Under the SGIG, the larger of the two programs, over $3.4 billion was used to help industry deploy existing advanced SGmore » technologies and tools to improve grid performance and reduce costs. Including industry investment, a total of $8 billion was spent on 99 cost-shared projects, which involved more than 200 participating electric utilities and other organizations. These projects aimed to modernize the electric grid, strengthen cyber security, improve interoperability, and collect comprehensive data on SG operations and benefits.« less

The influence of an audience response system on knowledge retention: an application to resident education.

PubMed

Pradhan, Archana; Sparano, Dina; Ananth, Cande V

2005-11-01

The purpose of the study was to compare delivery methods of lecture material regarding contraceptive options by either traditional or interactive lecture style with the use of an audience response system with obstetrics and gynecology residents. A prospective, randomized controlled trial that included 17 obstetrics and gynecology residents was conducted. Group differences and comparison of pre/posttest scores to evaluate efficacy of lecture styles were performed with the Student t test. Each participant completed an evaluation to assess usefulness of the audience response system. Residents who received audience response system interactive lectures showed a 21% improvement between pretest and posttest scores; residents who received the standard lecture demonstrated a 2% improvement (P = .018). The evaluation survey showed that 82% of residents thought that the audience response system was a helpful learning aid. The results of this randomized controlled trial demonstrate the effectiveness of audience response system for knowledge retention, which suggests that it may be an efficient teaching tool for residency education.

Brief submaximal isometric exercise improves cold pressor pain tolerance.

PubMed

Foxen-Craft, Emily; Dahlquist, Lynnda M

2017-10-01

Exercise-induced hypoalgesia (EIH), or the inhibition of pain following physical exercise, has been demonstrated in adults, but its mechanisms have remained unclear due to variations in methodology. This study aimed to address methodological imitations of past studies and contribute to the literature demonstrating the generalizability of EIH to brief submaximal isometric exercise and cold pressor pain. Young adults (n = 134) completed a baseline cold pressor trial, maximal voluntary contraction (hand grip strength) assessment, 10-min rest, and either a 2-min submaximal isometric handgrip exercise or a sham exercise in which no force was exerted, followed by a cold pressor posttest. Results indicated that cold pressor pain tolerance significantly increased during the exercise condition, but not during the sham exercise condition. Exercise did not affect pain intensity and marginally affected pain unpleasantness ratings. These findings suggest that submaximal isometric exercise can improve cold pressor pain tolerance but may have an inconsistent analgesic effect on ratings of cold pressor pain.

Single shot trajectory design for region-specific imaging using linear and nonlinear magnetic encoding fields.

PubMed

Layton, Kelvin J; Gallichan, Daniel; Testud, Frederik; Cocosco, Chris A; Welz, Anna M; Barmet, Christoph; Pruessmann, Klaas P; Hennig, Jürgen; Zaitsev, Maxim

2013-09-01

It has recently been demonstrated that nonlinear encoding fields result in a spatially varying resolution. This work develops an automated procedure to design single-shot trajectories that create a local resolution improvement in a region of interest. The technique is based on the design of optimized local k-space trajectories and can be applied to arbitrary hardware configurations that employ any number of linear and nonlinear encoding fields. The trajectories designed in this work are tested with the currently available hardware setup consisting of three standard linear gradients and two quadrupolar encoding fields generated from a custom-built gradient insert. A field camera is used to measure the actual encoding trajectories up to third-order terms, enabling accurate reconstructions of these demanding single-shot trajectories, although the eddy current and concomitant field terms of the gradient insert have not been completely characterized. The local resolution improvement is demonstrated in phantom and in vivo experiments. Copyright © 2012 Wiley Periodicals, Inc.

The European Medicines Agency's approval of new medicines for type 2 diabetes.

PubMed

Blind, Eberhard; Janssen, Heidi; Dunder, Kristina; de Graeff, Pieter A

2018-05-08

Since 2005, more than 40 new medicines for the treatment of type 2 diabetes have been introduced on the market. These consist of 15 new active substances establishing three new classes of non-insulin products, and several new or modified insulin products and combinations. The approval of these products in Europe is regulated via the centralized procedure at the European Medicines Agency. Demonstration of benefit with regard to improved glucose control remains the principal outcome required from confirmatory studies to demonstrate efficacy. For the majority of these new medicines approved since 2005, cardiovascular outcome trials have now been completed, and have invariably supported the cardiovascular safety of these products. In some of these trials additional important benefits have been observed, for instance, a reduction in major adverse cardiovascular events and improvement of renal outcome. The existing regulatory framework and the continuous adaption of regulatory requirements to emerging developments will continue to guide the approval of new products in the future. © 2018 John Wiley & Sons Ltd.

Enhanced chemoprophylactic and clinical efficacy of albendazole formulated as solid dispersions in experimental cystic echinococcosis.

PubMed

Pensel, Patricia E; Castro, Silvina; Allemandi, Daniel; Bruni, Sergio Sánchez; Palma, Santiago D; Elissondo, María Celina

2014-06-16

Cystic echinococcosis is a chronic, complex, and still neglected disease. Although albendazole has demonstrated efficacy, only about one-third of patients experience complete remission or cure and 30-50% of treated patients develop some evidence of a therapeutic response. Different strategies have been developed in order to improve the albendazole water solubility and dissolution rate. The aim of the current work was to investigate the chemoprophylactic and clinical efficacy of an albendazole:poloxamer 188 solid dispersion formulation on mice infected with Echinococcus granulosus metacestodes. Albendazole formulated as solid dispersion had greater chemoprophylactic and clinical efficacy than albendazole alone. The improved in therapeutic efficacy could be a consequence of the increase in the systemic availability of albendazole sulfoxide. The work reported here demonstrates that in vivo treatment with albendazole:poloxamer 188 impairs the development of the hydatid cysts. This new pharmacotechnically based strategy could be a suitable alternative for treating cystic echinococcosis in humans. Copyright © 2014 Elsevier B.V. All rights reserved.

A Public Health Opportunity Found in Food Waste

PubMed Central

Upadhyaya, Mudita; Bounds, Gregory; Markham, Christine

2017-01-01

A food waste problem coexists with food insecurity and obesity. Brighter Bites, a school-based food cooperative program, successfully channels primarily donated produce to low-income communities and provides nutrition education, creating an increased demand for and intake of fruits and vegetables. We present the framework used in Brighter Bites and results of operationalizing this framework during 3 years of implementation in Houston, Texas. Results demonstrated that, during 2013 through 2016, more than 12,500 families enrolled in Brighter Bites for 16 weeks in the school year. More than 90% of the produce was donated. Each week, families received on average 54 to 61 servings of fresh produce with the average cost of produce being $2.53 per family per week. Of those parents who completed the process surveys, more than 80% reported the produce to be effective in improving their children’s diet. Brighter Bites demonstrates a successful model to address food waste and improve dietary habits of underserved families. PMID:29101766

Pseudo-dynamic tests on masonry residential buildings seismically retrofitted by precast steel reinforced concrete walls

NASA Astrophysics Data System (ADS)

Li, Wenfeng; Wang, Tao; Chen, Xi; Zhong, Xiang; Pan, Peng

2017-07-01

A retrofitting technology using precast steel reinforced concrete (PSRC) panels is developed to improve the seismic performance of old masonry buildings. The PSRC panels are built up as an external PSRC wall system surrounding the existing masonry building. The PSRC walls are well connected to the existing masonry building, which provides enough confinement to effectively improve the ductility, strength, and stiffenss of old masonry structures. The PSRC panels are prefabricated in a factory, significantly reducing the situ work and associated construction time. To demonstrate the feasibility and mechanical effectivenss of the proposed retrofitting system, a full-scale five-story specimen was constructed. The retrofitting process was completed within five weeks with very limited indoor operation. The specimen was then tested in the lateral direction, which could potentially suffer sigifnicant damage in a large earthquake. The technical feasibility, construction workability, and seismic performance were thoroughly demonstrated by a full-scale specimen construction and pseudo-dynamic tests.

Neurology resident learning in an end-of-life/palliative care course.

PubMed

Schuh, Lori A; Biondo, Andrew; An, Andrea; Newman, Dan; Ryczko, Stephanie; Remer, Sandra; Bricker, Leslie

2007-02-01

The Accreditation Council for Graduate Medical Education (ACGME) requires neurology residents receive instruction in End-of-Life Care/Palliative Care (EOLPC), but survey data from 24 neurology programs in the National Residency End-of-Life Physician Education Project (NRELEP) demonstrated faculty and residents tend to rate themselves as able to perform EOLPC despite significant knowledge gaps. We participated in the NRELEP to develop an EOLPC course and assess resident learning following this new curriculum. Fifteen residents and 8 nonparticipant faculty completed a content validated knowledge pretest and precourse EOLPC confidence self-assessment tool. The course plan developed during a NRELEP conference consisted of 14 weekly 1-hour sessions covering a variety of topics pertinent to EOLPC care in neurology. Sessions included lectures, role-play, and group problem-solving formats. Residents attended sessions while faculty did not. The postcourse assessment included a posttest and the EOLPC self-assessment, and was completed by 14 residents and 5 comparison faculty. The mean pretest score was 48.1% +/- 16.9% for residents and 59.0% +/-8.2% for faculty. Posttest scores improved to 67.2% +/- 10.6% for residents (t test, p +/- 0.001), but not for the faculty group (52.4% +/- 9.9%, p = 0.2). Resident EOLPC confidence self-assessment significantly improved after the course (precourse mean, 3.09 +/- 1.01; postcourse mean, 3.40 +/- 0.93, p < 0.001), while there was no change in faculty confidence (precourse mean, 3.48 +/- 0.82; postcourse mean, 3.41 +/- 0.82, p = 0.5). Residents performed significantly better than faculty on the posttest (p = 0.01). An EOLPC course was developed and implemented in this program. Residents exhibited demonstrable learning and improved self-assessment of confidence in providing EOLPC following introduction of the course.

Complete replication-competent adenovirus 11p vectors with E1 or E3 insertions show improved heat stability

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

Mei, Ya-Fang, E-mail: ya-fang.mei@umu.se

2016-10-15

Conventional adenovirus vectors harboring E1 or E3 deletions followed by the insertion of an exogenous gene show considerably reduced virion stability. Here, we report strategies to generate complete replication-competent Ad11p(RCAd11p) vectors that overcome the above disadvantage. A GFP cassette was successfully introduced either upstream of E1A or in the E3A region. The resulting vectors showed high expression levels of the hexon and E1genes and also strongly induced the cytopathic effect in targeted cells. When harboring oversized genomes, the RCAd11pE1 and RCAd11pE3 vectors showed significantly improved heat stability in comparison to Ad11pwt;of the three, RCAd11pE3 was the most tolerant to heatmore » treatment. Electron microscopy showed that RCAd11pE3, RCAd11pE1, Ad11pwt, and Ad11pE1 Delmanifested dominant, moderate, minimum, or no full virus particles after heat treatment at 47 °C for 5 h. Our results demonstrated that both genome size and the insertion site in the viral genome affect virion stability. -- Highlights: •Replicating adenovirus 11p GFP vectors at the E1 or E3 region were generated. •RCAd11pE3 and RCAd11pE1 vectors manifested significantly improved heat stability. •RCAd11pE3 and RCAd11pE1 showed more full viral particles than Ad11pwt after heating. •We demonstrated that both genome size and the insertion site affect virion stability.« less

The effectiveness of a staff education program on the use of continuous EEG with patients in neuroscience intensive care units.

PubMed

Seiler, Lisa; Fields, Jennifer; Peach, Elizabeth; Zwerin, Suzanne; Savage, Christine

2012-04-01

Approximately a third of patients in neuroscience intensive care units (ICUs) experience subclinical seizures and, as a result, are at higher risk for poor outcomes. The use of continuous electroencephalography (cEEG) monitoring can help nurses detect seizure activity and initiate early prevention. Nurse competency in the use of cEEG is important to facilitate effective bedside monitoring. The objective of this study was to evaluate the effectiveness of a staff educational program aimed at improving the knowledge of nurses in the use of cEEG monitoring in adults. A quasi-experimental pretest/posttest 1-group design was utilized. Neuroscience ICU registered nurses, whose experience ranged from 2 months to 24 years, participated in the study. Participants completed a pretest on seizure knowledge and the use of cEEG monitoring. Participants received a 4-hour educational session on the use of cEEG monitoring. Immediately after the program and again 1 month later, they completed a posttest. Test scores improved significantly from pretest to the first posttest (t = -15.093, p < .001). Although there was a slight decline in the mean score from the posttest to the 1-month follow-up, posttest scores were significantly better than the pretest score (t = -12.42, df = 44, p < .001). Whereas years of experience correlated positively to the pretest score, after the intervention, no such correlation was evident. The results demonstrated that an educational program improved the competency of nurses in the use of cEEG with adult patients in a neuroscience ICU and that this knowledge was sustained over time. Further research is needed to demonstrate the effectiveness of this intervention in other settings.

Feasibility and acceptability of a cancer symptom awareness intervention for adults living in socioeconomically deprived communities.

PubMed

Smith, Pamela; Smits, Stephanie; Owen, Sioned; Wood, Fiona; McCutchan, Grace; Carter, Ben; Edwards, Adrian; Robling, Michael; Townson, Julia; Brain, Kate

2018-06-05

Cancer survival rates in the UK are lower in comparison with similar countries in Europe and this may be linked to socioeconomic inequalities in stage of cancer diagnosis and survival. Targeted cancer awareness interventions have the potential to improve earlier symptomatic diagnosis and reduce socioeconomic inequalities in cancer outcomes. The health check is an innovative, theory-based intervention designed to increase awareness of cancer symptoms and risk factors, and encourage timely help seeking among adults living in deprived communities. A prospective, non-randomised evaluation was undertaken to test the feasibility and acceptability of the health check for adults aged 40 years and over living in deprived areas of Wales. Primary outcomes included recruitment and retention of approximately 100 adults, reach to participants in the lowest deprivation quartile, and intervention acceptability. Secondary outcomes included self-reported cancer symptom recognition, help-seeking behaviours and state anxiety pre/post intervention. Of 185 individuals approached, 98 (53%) completed the intervention. Sixty-six of 98 participants were recruited from community settings (67%) and 32 from healthcare settings (33%), with 56 (57%) from the lowest deprivation quartile. Eighty-three (85%) participants completed follow-up assessment. Participants recognised on average one extra cancer symptom post intervention, with improved recognition of and anticipated presentation for non-specific symptoms. State anxiety scores remained stable. Qualitative interviews (n = 25) demonstrated that the intervention was well received and motivated change. Recruitment was feasible in community and healthcare settings, with good reach to adults from low socioeconomic groups. The health check intervention was acceptable and demonstrated potential for improved cancer awareness and symptom presentation, especially for non-specific symptoms, in communities most affected by cancer.

Solid-liquid staged combustion space boosters

NASA Technical Reports Server (NTRS)

Culver, D. W.

1990-01-01

NASA has begun to evaluate solid-liquid hybrid propulsion for launch vehicle booster. A three-phase program was outlined to identify, acquire, and demonstrate technology needed to approximate solid and liquid propulsion state of the art. Aerojet has completed a Phase 1 study and recommends a solid-liquid staged combustion concept in which turbopump fed LO2 is burned with fuel-rich solid propellant effluent in aft-mounted thrust chambers.These reasonably sized thrust chambers are LO2 regeneratively cooled, supplemented with fuel-rich barrier cooling. Turbopumps are driven by the resulting GO2 coolant in an expander-bleed-burnoff cycle. Turbine exhaust pressurizes the LO2 tankage directly, and the excess is bled into supersonic nozzle splitlines, where it combusts with the fuel rich boundary layer. Thrust vector control is enhanced by supersonic nozzle movement on flexseal mounts. Every hybrid solid-liquid concept examined improves booster energy management and launch propellant safety compared to current solid boosters. Solid-liquid staged combustion improves hybrid performance by improving both combustion efficiency and combustion stability, especially important for large boosters. These improvements result from careful fluid management and use of smaller combustors. The study shows NASA safety, reliability, cost, and performance criteria are best met with this concept, wherein simple hardware relies on several separate emerging technologies, all of which have been demonstrated successfully.

Effects of dance-based movement therapy on balance, gait, and psychological functions in severe cerebellar ataxia: A case study.

PubMed

Song, Yong-Gwan; Ryu, Young-Uk; Im, Seung-Jin; Lee, Ye-Seung; Park, Jin-Hoon

2018-03-30

Individuals in the later stages of cerebellar ataxia usually experience serious balance and immobility problems. Currently, there is a lack of adequate rehabilitative programs for individuals with severe cerebellar ataxia that can help improve ataxia-related motor impairment. The purpose of the present study was to explore the potential physiotherapeutic benefits of partnered dance on balance, motor functions, and psychological well-being in an individual demonstrating severe cerebellar ataxia symptoms. The individual was a 39-year-old male diagnosed with cerebellar atrophy. He had the disease for more than 15 years prior to the study. The individual attended 24 intervention sessions over an 8-week period of dance-based movement training that aimed to improve his balance and postural stability by facilitating the perception and control of static and dynamic balance movements and body alignment. The individual demonstrated improvements in independent standing balance, gait characteristics, and functional mobility. In addition, improvements in self-reported depression and quality of life scores were observed after completion of the intervention. Although interpreting the findings of this study is limited to a single participant, partnered dance could be a suitable alternative physiotherapeutic intervention method for people with severely impaired mobility due to cerebellar dysfunction.

The Application of Observational Practice and Educational Networking in Simulation-Based and Distributed Medical Education Contexts.

PubMed

Welsher, Arthur; Rojas, David; Khan, Zain; VanderBeek, Laura; Kapralos, Bill; Grierson, Lawrence E M

2018-02-01

Research has revealed that individuals can improve technical skill performance by viewing demonstrations modeled by either expert or novice performers. These findings support the development of video-based observational practice communities that augment simulation-based skill education and connect geographically distributed learners. This study explores the experimental replicability of the observational learning effect when demonstrations are sampled from a community of distributed learners and serves as a context for understanding learner experiences within this type of training protocol. Participants from 3 distributed medical campuses engaged in a simulation-based learning study of the elliptical excision in which they completed a video-recorded performance before being assigned to 1 of 3 groups for a 2-week observational practice intervention. One group observed expert demonstrations, another observed novice demonstrations, and the third observed a combination of both. Participants returned for posttesting immediately and 1 month after the intervention. Participants also engaged in interviews regarding their perceptions of the usability and relevance of video-based observational practice to clinical education. Checklist (P < 0.0001) and global rating (P < 0.0001) measures indicate that participants, regardless of group assignment, improved after the intervention and after a 1-month retention period. Analyses revealed no significant differences between groups. Qualitative analyses indicate that participants perceived the observational practice platform to be usable, relevant, and potentially improved with enhanced feedback delivery. Video-based observational practice involving expert and/or novice demonstrations enhances simulation-based skill learning in a group of geographically distributed trainees. These findings support the use of Internet-mediated observational learning communities in distributed and simulation-based medical education contexts.

Short term (14 days) consumption of insoluble wheat bran fibre-containing breakfast cereals improves subjective digestive feelings, general wellbeing and bowel function in a dose dependent manner.

PubMed

Lawton, Clare L; Walton, Jenny; Hoyland, Alexa; Howarth, Elaine; Allan, Peter; Chesters, David; Dye, Louise

2013-04-22

This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29) completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption.

Short Term (14 Days) Consumption of Insoluble Wheat Bran Fibre-Containing Breakfast Cereals Improves Subjective Digestive Feelings, General Wellbeing and Bowel Function in a Dose Dependent Manner

PubMed Central

Lawton, Clare L.; Walton, Jenny; Hoyland, Alexa; Howarth, Elaine; Allan, Peter; Chesters, David; Dye, Louise

2013-01-01

This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29) completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption. PMID:23609776

A checklist is associated with increased quality of reporting preclinical biomedical research: A systematic review

PubMed Central

Olonisakin, Tolani F.; Pribis, John P.; Zupetic, Jill; Yoon, Joo Heung; Holleran, Kyle M.; Jeong, Kwonho; Shaikh, Nader; Rubio, Doris M.; Lee, Janet S.

2017-01-01

Irreproducibility of preclinical biomedical research has gained recent attention. It is suggested that requiring authors to complete a checklist at the time of manuscript submission would improve the quality and transparency of scientific reporting, and ultimately enhance reproducibility. Whether a checklist enhances quality and transparency in reporting preclinical animal studies, however, has not been empirically studied. Here we searched two highly cited life science journals, one that requires a checklist at submission (Nature) and one that does not (Cell), to identify in vivo animal studies. After screening 943 articles, a total of 80 articles were identified in 2013 (pre-checklist) and 2015 (post-checklist), and included for the detailed evaluation of reporting methodological and analytical information. We compared the quality of reporting preclinical animal studies between the two journals, accounting for differences between journals and changes over time in reporting. We find that reporting of randomization, blinding, and sample-size estimation significantly improved when comparing Nature to Cell from 2013 to 2015, likely due to implementation of a checklist. Specifically, improvement in reporting of the three methodological information was at least three times greater when a mandatory checklist was implemented than when it was not. Reporting the sex of animals and the number of independent experiments performed also improved from 2013 to 2015, likely from factors not related to a checklist. Our study demonstrates that completing a checklist at manuscript submission is associated with improved reporting of key methodological information in preclinical animal studies. PMID:28902887

A hospital discharge summary quality improvement program featuring individual and team-based feedback and academic detailing.

PubMed

Axon, Robert N; Penney, Fletcher T; Kyle, Thomas R; Zapka, Jane; Marsden, Justin; Zhao, Yumin; Mauldin, Patrick D; Moran, William P

2014-06-01

Discharge summaries are an important component of hospital care transitions typically completed by interns in teaching hospitals. However, these documents are often not completed in a timely fashion or do not include pertinent details of hospitalization. This report outlines the development and impact of a curriculum intervention to improve the quality of discharge summaries by interns and residents in Internal Medicine. A previous study demonstrated that a discharge summary curriculum featuring individualized feedback was associated with improved summary quality, but few subsequent studies have described implementation of similar curricula. No information exists on the utility of other strategies such as team-based feedback or academic detailing. Study participants were 96 Internal Medicine intern and resident physicians at an academic medical center-based training program. A comprehensive evidence-based discharge summary quality improvement program was developed and implemented that featured a discharge summary template to facilitate summary preparation, individual feedback, team-based feedback, academic detailing and an objective discharge summary evaluation instrument. The discharge summary evaluation instrument had moderate interrater reliability (κ = 0.72). Discharge summary scores improved from mean score of 70% to 82% (P = 0.05). Interns and residents participating in this program also reported increased confidence in producing and critiquing summaries. A comprehensive discharge summary curriculum can be feasibly implemented within the context of a residency program. Team-based feedback and academic detailing may serve to reinforce individual feedback and extend program reach.

Mobile Assessment and Treatment for Schizophrenia (MATS): A Pilot Trial of An Interactive Text-Messaging Intervention for Medication Adherence, Socialization, and Auditory Hallucinations

PubMed Central

Granholm, Eric; Ben-Zeev, Dror; Bradshaw, Kristen R.; Holden, Jason L.

2012-01-01

Mobile Assessment and Treatment for Schizophrenia (MATS) employs ambulatory monitoring methods and cognitive behavioral therapy interventions to assess and improve outcomes in consumers with schizophrenia through mobile phone text messaging. Three MATS interventions were developed to target medication adherence, socialization, and auditory hallucinations. Participants received up to 840 text messages over a 12-week intervention period. Fifty-five consumers with schizophrenia or schizoaffective disorder were enrolled, but 13 consumers with more severe negative symptoms, lower functioning, and lower premorbid IQ did not complete the intervention, despite repeated prompting and training. For completers, the average valid response rate for 216 outcome assessment questions over the 12-week period was 86%, and 86% of phones were returned undamaged. Medication adherence improved significantly, but only for individuals who were living independently. Number of social interactions increased significantly and a significant reduction in severity of hallucinations was found. In addition, the probability of endorsing attitudes that could interfere with improvement in these outcomes was also significantly reduced in MATS. Lab-based assessments of more general symptoms and functioning did not change significantly. This pilot study demonstrated that low-intensity text-messaging interventions like MATS are feasible and effective interventions to improve several important outcomes, especially for higher functioning consumers with schizophrenia. PMID:22080492

Modernization and Activation of the NASA Ames 11- by 11-Foot Transonic Wind Tunnel

NASA Technical Reports Server (NTRS)

Kmak, Frank J.

2000-01-01

The Unitary Plan Wind Tunnel (UPWT) was modernized to improve performance, capability, productivity, and reliability. Automation systems were installed in all three UPWT tunnel legs and the Auxiliaries facility. Major improvements were made to the four control rooms, model support systems, main drive motors, and main drive speed control. Pressure vessel repairs and refurbishment to the electrical distribution system were also completed. Significant changes were made to improve test section flow quality in the 11-by 11-Foot Transonic leg. After the completion of the construction phase of the project, acceptance and checkout testing was performed to demonstrate the capabilities of the modernized facility. A pneumatic test of the tunnel circuit was performed to verify the structural integrity of the pressure vessel before wind-on operations. Test section turbulence, flow angularity, and acoustic parameters were measured throughout the tunnel envelope to determine the effects of the tunnel flow quality improvements. The new control system processes were thoroughly checked during wind-off and wind-on operations. Manual subsystem modes and automated supervisory modes of tunnel operation were validated. The aerodynamic and structural performance of both the new composite compressor rotor blades and the old aluminum rotor blades was measured. The entire subsonic and supersonic envelope of the 11-by 11-Foot Transonic leg was defined up to the maximum total pressure.

Dangerous gas detection based on infrared video

NASA Astrophysics Data System (ADS)

Ding, Kang; Hong, Hanyu; Huang, Likun

2018-03-01

As the gas leak infrared imaging detection technology has significant advantages of high efficiency and remote imaging detection, in order to enhance the detail perception of observers and equivalently improve the detection limit, we propose a new type of gas leak infrared image detection method, which combines background difference methods and multi-frame interval difference method. Compared to the traditional frame methods, the multi-frame interval difference method we proposed can extract a more complete target image. By fusing the background difference image and the multi-frame interval difference image, we can accumulate the information of infrared target image of the gas leak in many aspect. The experiment demonstrate that the completeness of the gas leakage trace information is enhanced significantly, and the real-time detection effect can be achieved.

The use of picture cues to establish self-control in the preparation of complex meals by mentally retarded adults.

PubMed

Martin, J E; Rusch, F R; James, V L; Decker, P J; Trtol, K A

1982-01-01

This investigation examined the effectiveness of picture cues in establishing self-control in the completion of complex meals by mildly and moderately retarded adults. Three participants, who lived in nonsheltered residential settings, were trained to prepare five complex meals. Following a training baseline comprised of pre-instruction, instructional feedback, and trainers' presence, picture recipe cards were introduced in a multiple-baseline fashion. Rapid improvement in the ability of each participant to independently complete each meal when the picture recipe cards were used occurred. A return to baseline for one of the participants demonstrated further self-directed antecedent stimulus control of the picture recipe cards as an effective treatment procedure. A discussion of future areas of research is included.

Hallermann-Streiff syndrome with hypopituitarism contributing to growth failure.

PubMed

Pivnick, E K; Burstein, S; Wilroy, R S; Kaufman, R A; Ward, J C

1991-12-15

A 35-month-old black boy with Hallermann-Streiff syndrome (HSS) was evaluated for anterior hypopituitarism when he presented with ketotic hypoglycemia, microgenitalia, and short stature. Endocrine evaluation showed a low T4 and TSH levels, suggesting hypothalamic hypothyroidism; this was confirmed by TRH stimulation. Metyrapone test confirmed ACTH deficiency as a contributing factor to the ketotic hypoglycemia. A superagonist GnRH test suggested hypothalamic GnRH deficiency. Growth hormone provocative testing conclusively demonstrated complete growth hormone deficiency. MRI investigation of the brain suggested hypopituitarism. Although facial findings were not completely classical of the HSS, we suggest these may be somewhat altered due to his racial back-ground. We recommend endocrine evaluation of HSS patients with manifestations suggesting hypopituitarism since treatment of this condition will improve the quality of life of these patients.

Capabilities to improve corrosion resistance of fuel claddings by using powerful laser and plasma sources

NASA Astrophysics Data System (ADS)

Borisov, V. M.; Trofimov, V. N.; Sapozhkov, A. Yu.; Kuzmenko, V. A.; Mikhaylov, V. B.; Cherkovets, V. Ye.; Yakushkin, A. A.; Yakushin, V. L.; Dzhumayev, P. S.

2016-12-01

The treatment conditions of fuel claddings of the E110 alloy by using powerful UV or IR laser radiation, which lead to the increase in the corrosion resistance at the high-temperature ( T = 1100°C) oxidation simulating a loss-of-coolant accident, are determined. The possibility of the complete suppression of corrosion under these conditions by using pulsed laser deposition of a Cr layer is demonstrated. The behavior of protective coatings of Al, Al2O3, and Cr planted on steel EP823 by pulsed laser deposition, which is planned to be used in the BREST-OD-300, is studied. The methods of the almost complete suppression of corrosion in liquid lead to the temperature of 720°C are shown.

Analyses of Public Utility Building - Students Designs, Aimed at their Energy Efficiency Improvement

NASA Astrophysics Data System (ADS)

Wołoszyn, Marek Adam

2017-10-01

Public utility buildings are formally, structurally and functionally complex entities. Frequently, the process of their design involves the retroactive reconsideration of energy engineering issues, once a building concept has already been completed. At that stage, minor formal corrections are made along with the design of the external layer of the building in order to satisfy applicable standards. Architecture students do the same when designing assigned public utility buildings. In order to demonstrate energy-related defects of building designs developed by students, the conduct of analyses was proposed. The completed designs of public utility buildings were examined with regard to energy efficiency of the solutions they feature through the application of the following programs: Ecotect, Vasari, and in case of simpler analyses ArchiCad program extensions were sufficient.

Resilience Training for Work-related Stress Among Health Care Workers: Results of a Randomized Clinical Trial Comparing In-person and Smartphone-delivered Interventions.

PubMed

Mistretta, Erin G; Davis, Mary C; Temkit, M'hamed; Lorenz, Christopher; Darby, Betty; Stonnington, Cynthia M

2018-01-24

The aim of this study was to assess whether an in-person mindfulness-based resilience training (MBRT) program or a smartphone-delivered resiliency-based intervention improved stress, well-being, and burnout in employees at a major tertiary health care institution. Sixty participants were randomized to a 6-week MBRT, a resiliency-based smartphone intervention, or an active control group. Stress, well-being, and burnout were assessed at baseline, at program completion, and 3 months postintervention. Both the MBRT and the smartphone groups showed improvements in well-being, whereas only the MBRT group showed improvements in stress and emotional burnout over time. The control group did not demonstrate sustained improvement on any outcome. Findings suggest that brief, targeted interventions improve psychological outcomes and point to the need for larger scale studies comparing the individual and combined treatments that can inform development of tailored, effective, and low-cost programs for health care workers.

Teacher coaching supported by formative assessment for improving classroom practices.

PubMed

Fabiano, Gregory A; Reddy, Linda A; Dudek, Christopher M

2018-06-01

The present study is a wait-list controlled, randomized study investigating a teacher coaching approach that emphasizes formative assessment and visual performance feedback to enhance elementary school teachers' classroom practices. The coaching model targeted instructional and behavioral management practices as measured by the Classroom Strategies Assessment System (CSAS) Observer and Teacher Forms. The sample included 89 general education teachers, stratified by grade level, and randomly assigned to 1 of 2 conditions: (a) immediate coaching, or (b) waitlist control. Results indicated that, relative to the waitlist control, teachers in immediate coaching demonstrated significantly greater improvements in observations of behavior management strategy use but not for observations of instructional strategy use. Observer- and teacher-completed ratings of behavioral management strategy use at postassessment were significantly improved by both raters; ratings of instructional strategy use were significantly improved for teacher but not observer ratings. A brief coaching intervention improved teachers' use of observed behavior management strategies and self-reported use of behavior management and instructional strategies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A collaborative approach to improve the assessment of physical health in adult consumers with schizophrenia in Queensland mental health services.

PubMed

Plever, Sally; McCarthy, Irene; Anzolin, Melissa; Emmerson, Brett; Khatun, Mohsina

2016-02-01

The objective of this study was to apply a quality improvement collaborative to increase the number of physical health assessments conducted with consumers diagnosed with schizophrenia in adult community mental health services across Queensland. Sixteen adult mental health service organisations voluntarily took part in the statewide collaborative initiative to increase the number of physical health assessments completed on persons with a diagnosis of schizophrenia spectrum disorders managed through the community mental health service. Improvement in the physical health assessment clinical indicator was demonstrated across the state over a 3-year period with an increase in the number of physical health assessments recorded from 12% to 58%. Significant improvements were made over a 3-year period by all mental health services involved in the collaborative, supporting the application of a quality improvement methodology to drive change across mental health services. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Enzymatic treatment to improve extraction of capsaicinoids and carotenoids from chili (Capsicum annuum) fruits.

PubMed

Salgado-Roman, Manuel; Botello-Alvarez, Enrique; Rico-Martínez, Ramiro; Jiménez-Islas, Hugo; Cárdenas-Manríquez, Marcela; Navarrete-Bolaños, José Luis

2008-11-12

Enzymatic treatments using noncommercial enzymes as a means to the improve the extraction of carotenoids and capsaicinoids from chili fruits are explored in this study. The results show that it is possible to obtain chili fruit powder with a higher concentration of both capsaicinoids and carotenoids than previously reported for similar processes. Furthermore, extraction yields above 96% for carotenoids and 85% for capsaicinoids as separate fractions can be achieved using a sequential and selective two-stage extraction. Evidence is presented demonstrating that the content and extraction yield depend directly on the extent of the enzymatic hydrolysis of chili cell walls, and higher yields are obtained when the sample is completely hydrolyzed. The enzymatic treatment described here is a promising alternative to current industrial practices, and it improves the extraction of carotenoids and capsaicinoids from chili fruits.

Counterbalancing risks and gains from extended resections in malignant glioma surgery: a supplemental analysis from the randomized 5-aminolevulinic acid glioma resection study. Clinical article.

PubMed

Stummer, Walter; Tonn, Jörg-Christian; Mehdorn, Hubertus Maximilian; Nestler, Ulf; Franz, Kea; Goetz, Claudia; Bink, Andrea; Pichlmeier, Uwe

2011-03-01

Accumulating data suggest more aggressive surgery in patients with malignant glioma to improve outcome. However, extended surgery may increase morbidity. The randomized Phase III 5-aminolevulinic acid (ALA) study investigated 5-ALA-induced fluorescence as a tool for improving resections. An interim analysis demonstrated more frequent complete resections with longer progression-free survival (PFS). However, marginal differences were found regarding neurological deterioration and the frequency of additional therapies. Presently, the authors focus on the latter aspects in the final study population, and attempt to determine how safety might be affected by cytoreductive surgery. Patients with malignant gliomas were randomized for fluorescence-guided (ALA group) or conventional white light (WL) (WL group) microsurgery. The final intent-to-treat population consisted of 176 patients in the ALA and 173 in the WL group. Primary efficacy variables were contrast-enhancing tumor on early MR imaging and 6-month PFS. Among secondary outcome measures, the National Institutes of Health Stroke Scale (NIH-SS) score and the Karnofsky Performance Scale (KPS) score were used for assessing neurological function. More frequent complete resections and improved PFS were confirmed, with higher median residual tumor volumes in the WL group (0.5 vs 0 cm(3), p = 0.001). Patients in the ALA group had more frequent deterioration on the NIH-SS at 48 hours. Patients at risk were those with deficits unresponsive to steroids. No differences were found in the KPS score. Regarding outcome, a combined end point of risks and neurological deficits was attempted, which demonstrated results in patients in the ALA group to be superior to those in participants in the WL group. Interestingly, the cumulative incidence of repeat surgery was significantly reduced in ALA patients. When stratified by completeness of resection, patients with incomplete resections were quicker to deteriorate neurologically (p = 0.0036). Extended resections performed using a tool such as 5-ALA-derived tumor fluorescence, carries the risk of temporary impairment of neurological function. However, risks are higher in patients with deficits unresponsive to steroids.

Ceramic applications in turbine engines

NASA Technical Reports Server (NTRS)

Helms, H. E.; Heitman, P. W.; Lindgren, L. C.; Thrasher, S. R.

1984-01-01

The application of ceramic components to demonstrate improved cycle efficiency by raising the operating temperature of the existing Allison IGI 404 vehicular gas turbine engine is discussed. This effort was called the Ceramic Applications in Turbine Engines (CATE) program and has successfully demonstrated ceramic components. Among these components are two design configurations featuring stationary and rotating caramic components in the IGT 404 engine. A complete discussion of all phases of the program, design, materials development, fabrication of ceramic components, and testing-including rig, engine, and vehicle demonstation test are presented. During the CATE program, a ceramic technology base was established that is now being applied to automotive and other gas turbine engine programs. This technology base is outlined and also provides a description of the CATE program accomplishments.

Working memory training to improve speech perception in noise across languages

PubMed Central

Ingvalson, Erin M.; Dhar, Sumitrajit; Wong, Patrick C. M.; Liu, Hanjun

2015-01-01

Working memory capacity has been linked to performance on many higher cognitive tasks, including the ability to perceive speech in noise. Current efforts to train working memory have demonstrated that working memory performance can be improved, suggesting that working memory training may lead to improved speech perception in noise. A further advantage of working memory training to improve speech perception in noise is that working memory training materials are often simple, such as letters or digits, making them easily translatable across languages. The current effort tested the hypothesis that working memory training would be associated with improved speech perception in noise and that materials would easily translate across languages. Native Mandarin Chinese and native English speakers completed ten days of reversed digit span training. Reading span and speech perception in noise both significantly improved following training, whereas untrained controls showed no gains. These data suggest that working memory training may be used to improve listeners' speech perception in noise and that the materials may be quickly adapted to a wide variety of listeners. PMID:26093435

Working memory training to improve speech perception in noise across languages.

PubMed

Ingvalson, Erin M; Dhar, Sumitrajit; Wong, Patrick C M; Liu, Hanjun

2015-06-01

Working memory capacity has been linked to performance on many higher cognitive tasks, including the ability to perceive speech in noise. Current efforts to train working memory have demonstrated that working memory performance can be improved, suggesting that working memory training may lead to improved speech perception in noise. A further advantage of working memory training to improve speech perception in noise is that working memory training materials are often simple, such as letters or digits, making them easily translatable across languages. The current effort tested the hypothesis that working memory training would be associated with improved speech perception in noise and that materials would easily translate across languages. Native Mandarin Chinese and native English speakers completed ten days of reversed digit span training. Reading span and speech perception in noise both significantly improved following training, whereas untrained controls showed no gains. These data suggest that working memory training may be used to improve listeners' speech perception in noise and that the materials may be quickly adapted to a wide variety of listeners.

Transcutaneous electrical nerve stimulation reduces exercise-induced perceived pain and improves endurance exercise performance.

PubMed

Astokorki, Ali H Y; Mauger, Alexis R

2017-03-01

Muscle pain is a natural consequence of intense and prolonged exercise and has been suggested to be a limiter of performance. Transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) have been shown to reduce both chronic and acute pain in a variety of conditions. This study sought to ascertain whether TENS and IFC could reduce exercise-induced pain (EIP) and whether this would affect exercise performance. It was hypothesised that TENS and IFC would reduce EIP and result in an improved exercise performance. In two parts, 18 (Part I) and 22 (Part II) healthy male and female participants completed an isometric contraction of the dominant bicep until exhaustion (Part I) and a 16.1 km cycling time trial as quickly as they could (Part II) whilst receiving TENS, IFC, and a SHAM placebo in a repeated measures, randomised cross-over, and placebo-controlled design. Perceived EIP was recorded in both tasks using a validated subjective scale. In Part I, TENS significantly reduced perceived EIP (mean reduction of 12%) during the isometric contraction (P = 0.006) and significantly improved participants' time to exhaustion by a mean of 38% (P = 0.02). In Part II, TENS significantly improved (P = 0.003) participants' time trial completion time (~2% improvement) through an increased mean power output. These findings demonstrate that TENS can attenuate perceived EIP in a healthy population and that doing so significantly improves endurance performance in both submaximal isometric single limb exercise and whole-body dynamic exercise.

Partial maintenance of auditory-based cognitive training benefits in older adults

PubMed Central

Anderson, Samira; White-Schwoch, Travis; Choi, Hee Jae; Kraus, Nina

2014-01-01

The potential for short-term training to improve cognitive and sensory function in older adults has captured the public’s interest. Initial results have been promising. For example, eight weeks of auditory-based cognitive training decreases peak latencies and peak variability in neural responses to speech presented in a background of noise and instills gains in speed of processing, speech-in-noise recognition, and short-term memory in older adults. But while previous studies have demonstrated short-term plasticity in older adults, we must consider the long-term maintenance of training gains. To evaluate training maintenance, we invited participants from an earlier training study to return for follow-up testing six months after the completion of training. We found that improvements in response peak timing to speech in noise and speed of processing were maintained, but the participants did not maintain speech-in-noise recognition or memory gains. Future studies should consider factors that are important for training maintenance, including the nature of the training, compliance with the training schedule, and the need for booster sessions after the completion of primary training. PMID:25111032

Effect of a clinic-wide social marketing campaign to improve adherence to antiretroviral therapy for HIV infection

PubMed Central

Giordano, Thomas P.; Rodriguez, Sonia; Zhang, Hong; Kallen, Michael A.; Jibaja-Weiss, Maria; Buscher, April L.; Arya, Monisha; Suarez-Almazor, Maria E.; Ross, Michael

2012-01-01

This demonstration study tested the impact of a 5-month clinic-wide social marketing campaign at improving adherence to antiretroviral therapy (ART). The intervention included a video, posters, pens, mugs, and lapel buttons with the campaign slogan “Live the Solution: Take Your Pills Every Day.” Participants self-reported adherence over a 4-week interval, the primary outcome, with a visual analogue scale. Pre- and post-intervention surveys were completed by 141 participants. Adherence did not change over time (absolute mean change −2.02%, paired t-test p=0.39). Among the 39.7% of participants who correctly identified the campaign slogan on the post-intervention survey, adherence increased by 3.3%, while it decreased in the other participants by 5.5% (paired t-test p=0.07). The well-received campaign did not increase short-term adherence to ART, but adherence tended to increase in participants who were more engaged with the intervention. Future interventions should engage patients more completely and have a more potent effect on adherence. PMID:22983536

Applying usability testing techniques to improve a health promotion website.

PubMed

Hinchliffe, Anetta; Mummery, W Kerry

2008-04-01

Use of the Internet for health promotion is increasing; however, the lack of published research regarding website usability suggests that health promotion websites are being developed without consultation with their users or formal evaluation. This study conducted usability testing of an existing health promotion website to inform modifications and to identify common usability themes that should be addressed by organisations developing or maintaining a health promotion website. A combination of qualitative and quantitative techniques were implemented during the usability testing sessions to gather data from users while completing tasks on the website. Techniques included performance measures (time taken), direct observation (participant observation) and subjective user preferences (questionnaire and interview). Improvements to the website were measured in terms of reduced problems reported, reduced time taken to complete tasks and increased subjective reports. Seven usability themes emerged from the data: design, feedback, format, instructions, navigation, terminology and learnability. This study demonstrates the application of usability testing to the design and modification of a health promotion website and illustrates the areas or themes that can be used as a framework for testing and modification.

Effect of a clinic-wide social marketing campaign to improve adherence to antiretroviral therapy for HIV infection.

PubMed

Giordano, Thomas P; Rodriguez, Sonia; Zhang, Hong; Kallen, Michael A; Jibaja-Weiss, Maria; Buscher, April L; Arya, Monisha; Suarez-Almazor, Maria E; Ross, Michael

2013-01-01

This demonstration study tested the impact of a 5-month clinic-wide social marketing campaign at improving adherence to antiretroviral therapy (ART). The intervention included a video, posters, pens, mugs, and lapel buttons with the campaign slogan "Live the Solution: Take Your Pills Every Day." Participants self-reported adherence over a 4-week interval, the primary outcome, with a visual analogue scale. Pre- and post-intervention surveys were completed by 141 participants. Adherence did not change over time (absolute mean change -2.02 %, paired t test P = 0.39). Among the 39.7 % of participants who correctly identified the campaign slogan on the post-intervention survey, adherence increased by 3.3 %, while it decreased in the other participants by 5.5 % (paired t test P = 0.07). The well-received campaign did not increase short-term adherence to ART, but adherence tended to increase in participants who were more engaged with the intervention. Future interventions should engage patients more completely and have a more potent effect on adherence.

Enhancing memory and imagination improves problem solving among individuals with depression.

PubMed

McFarland, Craig P; Primosch, Mark; Maxson, Chelsey M; Stewart, Brandon T

2017-08-01

Recent work has revealed links between memory, imagination, and problem solving, and suggests that increasing access to detailed memories can lead to improved imagination and problem-solving performance. Depression is often associated with overgeneral memory and imagination, along with problem-solving deficits. In this study, we tested the hypothesis that an interview designed to elicit detailed recollections would enhance imagination and problem solving among both depressed and nondepressed participants. In a within-subjects design, participants completed a control interview or an episodic specificity induction prior to completing memory, imagination, and problem-solving tasks. Results revealed that compared to the control interview, the episodic specificity induction fostered increased detail generation in memory and imagination and more relevant steps on the problem-solving task among depressed and nondepressed participants. This study builds on previous work by demonstrating that a brief interview can enhance problem solving among individuals with depression and supports the notion that episodic memory plays a key role in problem solving. It should be noted, however, that the results of the interview are relatively short-lived.

The Annotated Bibliography and Citation Behavior: Enhancing Student Scholarship in an Undergraduate Biology Course

PubMed Central

Rux, Erika M.; Flaspohler, John A.

2007-01-01

Contemporary undergraduates in the biological sciences have unprecedented access to scientific information. Although many of these students may be savvy technologists, studies from the field of library and information science consistently show that undergraduates often struggle to locate, evaluate, and use high-quality, reputable sources of information. This study demonstrates the efficacy and pedagogical value of a collaborative teaching approach designed to enhance information literacy competencies among undergraduate biology majors who must write a formal scientific research paper. We rely on the triangulation of assessment data to determine the effectiveness of a substantial research paper project completed by students enrolled in an upper-level biology course. After enhancing library-based instruction, adding an annotated bibliography requirement, and using multiple assessment techniques, we show fundamental improvements in students' library research abilities. Ultimately, these improvements make it possible for students to more independently and effectively complete this challenging science-based writing assignment. We document critical information literacy advances in several key areas: student source-type use, annotated bibliography enhancement, plagiarism reduction, as well as student and faculty/librarian satisfaction. PMID:18056306

Cone-beam x-ray luminescence computed tomography based on x-ray absorption dosage

NASA Astrophysics Data System (ADS)

Liu, Tianshuai; Rong, Junyan; Gao, Peng; Zhang, Wenli; Liu, Wenlei; Zhang, Yuanke; Lu, Hongbing

2018-02-01

With the advances of x-ray excitable nanophosphors, x-ray luminescence computed tomography (XLCT) has become a promising hybrid imaging modality. In particular, a cone-beam XLCT (CB-XLCT) system has demonstrated its potential in in vivo imaging with the advantage of fast imaging speed over other XLCT systems. Currently, the imaging models of most XLCT systems assume that nanophosphors emit light based on the intensity distribution of x-ray within the object, not completely reflecting the nature of the x-ray excitation process. To improve the imaging quality of CB-XLCT, an imaging model that adopts an excitation model of nanophosphors based on x-ray absorption dosage is proposed in this study. To solve the ill-posed inverse problem, a reconstruction algorithm that combines the adaptive Tikhonov regularization method with the imaging model is implemented for CB-XLCT reconstruction. Numerical simulations and phantom experiments indicate that compared with the traditional forward model based on x-ray intensity, the proposed dose-based model could improve the image quality of CB-XLCT significantly in terms of target shape, localization accuracy, and image contrast. In addition, the proposed model behaves better in distinguishing closer targets, demonstrating its advantage in improving spatial resolution.

Improvement in motor performance of Weaver mutant mice following lesions of the cerebellum.

PubMed

Grüsser, C; Grüsser-Cornehls, U

1998-12-01

In Weaver mutants (B6CBA wv/wv) cerebellar granule cells degenerate almost completely postnatally. A partial loss of Purkinje cells (PC) and a degeneration of dopaminergic cells in the substantia nigra have also been found. Weaver mice suffer from striking motor symptoms, including difficulty in walking without toppling over. In an attempt to influence the poor motor performance, the cerebellum in young animals was removed, thus eliminating the faulty output of surviving PCs, demonstrated electrophysiologically. Unoperated Weaver, lesioned wildtypes and one sham mouse were used as controls. Before and after operation, a battery of behavioural tests was performed. In Weaver mice, tumbling to the side (t) and the relation of t to the motor activity (k) while traversing an open-field matrix, (t/k), improved considerably, as did manoeuvring on a slanted wire mesh, but keeping balance on a wooden bench did not to the same degree. Locomotor activity alone improved in some animals. In wildtypes no significant changes occurred after operation, with the exception of a strong reduction in locomotor activity. The experiments demonstrate that the motor performance in Weaver mutant mice benefits from removal of their cerebellum.

An Improved Framework for Confound Regression and Filtering for Control of Motion Artifact in the Preprocessing of Resting-State Functional Connectivity Data

PubMed Central

Satterthwaite, Theodore D.; Elliott, Mark A.; Gerraty, Raphael T.; Ruparel, Kosha; Loughead, James; Calkins, Monica E.; Eickhoff, Simon B.; Hakonarson, Hakon; Gur, Ruben C.; Gur, Raquel E.; Wolf, Daniel H.

2013-01-01

Several recent reports in large, independent samples have demonstrated the influence of motion artifact on resting-state functional connectivity MRI (rsfc-MRI). Standard rsfc-MRI preprocessing typically includes regression of confounding signals and band-pass filtering. However, substantial heterogeneity exists in how these techniques are implemented across studies, and no prior study has examined the effect of differing approaches for the control of motion-induced artifacts. To better understand how in-scanner head motion affects rsfc-MRI data, we describe the spatial, temporal, and spectral characteristics of motion artifacts in a sample of 348 adolescents. Analyses utilize a novel approach for describing head motion on a voxelwise basis. Next, we systematically evaluate the efficacy of a range of confound regression and filtering techniques for the control of motion-induced artifacts. Results reveal that the effectiveness of preprocessing procedures on the control of motion is heterogeneous, and that improved preprocessing provides a substantial benefit beyond typical procedures. These results demonstrate that the effect of motion on rsfc-MRI can be substantially attenuated through improved preprocessing procedures, but not completely removed. PMID:22926292

Usability Testing of Two Ambulatory EHR Navigators.

PubMed

Hultman, Gretchen; Marquard, Jenna; Arsoniadis, Elliot; Mink, Pamela; Rizvi, Rubina; Ramer, Tim; Khairat, Saif; Fickau, Keri; Melton, Genevieve B

2016-01-01

Despite widespread electronic health record (EHR) adoption, poor EHR system usability continues to be a significant barrier to effective system use for end users. One key to addressing usability problems is to employ user testing and user-centered design. To understand if redesigning an EHR-based navigation tool with clinician input improved user performance and satisfaction. A usability evaluation was conducted to compare two versions of a redesigned ambulatory navigator. Participants completed tasks for five patient cases using the navigators, while employing a think-aloud protocol. The tasks were based on Meaningful Use (MU) requirements. The version of navigator did not affect perceived workload, and time to complete tasks was longer in the redesigned navigator. A relatively small portion of navigator content was used to complete the MU-related tasks, though navigation patterns were highly variable across participants for both navigators. Preferences for EHR navigation structures appeared to be individualized. This study demonstrates the importance of EHR usability assessments to evaluate group and individual performance of different interfaces and preferences for each design.

Examining the links between therapeutic jurisprudence and mental health court completion.

PubMed

Redlich, Allison D; Han, Woojae

2014-04-01

Research demonstrates that mental health courts (MHCs) lead to improved outcomes compared to traditional criminal court processes. An underlying premise of MHCs is therapeutic jurisprudence (TJ). However, no research, to our knowledge, has examined whether MHC outcomes are predicted by TJ principles as theorized. In the present study, we examined whether principles measured at the onset of MHC enrollment (knowledge, perceived voluntariness, and procedural justice) predicted MHC completion (graduation). Using structural equation modeling with MHC participants from four courts, a significant, direct relationship between TJ and MHC completion was found, such that higher levels of TJ were associated with higher rates of success. Although this direct effect became nonsignificant when mediator variables were included, a significant indirect path remained, such that increased levels of initial perceived voluntariness and procedural justice, and MHC knowledge, led to decreased rates of new arrests, prison, MHC bench warrants, and increased court compliance, which, in turn, led to a higher likelihood of MHC graduation. PsycINFO Database Record (c) 2014 APA, all rights reserved.

The effects of ergonomics training on the knowledge, attitudes, and practices of teleworkers.

PubMed

Harrington, Susan S; Walker, Bonnie L

2004-01-01

The rapid growth of teleworking has raised several social and legal issues regarding an employer's responsibility for the safety of an employee's home office. In this paper, researchers discuss the need for safety training for teleworkers and the effectiveness of a home office ergonomics training program. Study participants (N = 50) were randomly assigned into a treatment or control group. The treatment group completed the ergonomics training and a pre- and posttest. The control group completed the pre- and posttests without training. The study demonstrated the need for teleworker ergonomics training. More than 85% of participants had not received teleworker training before, and 44% had experienced pain or discomfort while teleworking. Participants who completed the training significantly improved their scores on knowledge, attitude, and practices subtests. In a follow-up survey, participants indicated that they had made ergonomic changes to their offices based on the training. Several participants indicated that the pain or discomfort that they had been experiencing was eliminated or reduced as a result of the training.

Improved sexual and urinary function in women with sacral nerve stimulation.

PubMed

Gill, Bradley C; Swartz, Mia A; Firoozi, Farzeen; Rackley, Raymond R; Moore, Courtenay K; Goldman, Howard B; Vasavada, Sandip P

2011-01-01

  Urinary and sexual function improve following sacral nerve stimulation (SNS) for refractory overactive bladder. No significant associations between these changes have been found. Whether improvements in sexual function are independent of or secondary to improvements in urinary function remains unclear. The aim of this study was to analyze changes in urinary and sexual function in a homogeneous sample of patients undergoing SNS for urge urinary incontinence and subsequently identify associations between the two.   A prospective database was created. Enrollees underwent a full history and physical examination at the first office visit. Multiple-day voiding diaries with validated and investigator-designed questionnaires were administered at baseline and follow-up as standard implantation procedures and to assess changes in urinary and sexual function, respectively. Analyses were completed using data from patients who were sexually active at baseline and follow-up.   Statistically significant improvements in urinary and sexual function occurred according to multiple metrics. Patient global impression scales categorized all patients' urinary conditions as improved, with most being less severe. Validated urinary symptom and quality of life scores improved significantly. After treatment, most patients were incontinent less often with sexual activity and felt less restricted from sexual activity by fear of incontinence. Validated quantification of sexual function demonstrated significant improvements in overall sexual function, arousal, and satisfaction. No significant associations between changes in urinary and sexual function were noted; however, trends appeared to exist between the two.   Improved sexual function was not significantly associated with improved urinary function after SNS despite apparent trends between the two. Larger samples are required to definitively demonstrate this conclusion. © 2011 International Neuromodulation Society.

First validation of the PASSPORT training environment for arthroscopic skills.

PubMed

Tuijthof, Gabriëlle J M; van Sterkenburg, Maayke N; Sierevelt, Inger N; van Oldenrijk, Jakob; Van Dijk, C Niek; Kerkhoffs, Gino M M J

2010-02-01

The demand for high quality care is in contrast to reduced training time for residents to develop arthroscopic skills. Thereto, simulators are introduced to train skills away from the operating room. In our clinic, a physical simulation environment to Practice Arthroscopic Surgical Skills for Perfect Operative Real-life Treatment (PASSPORT) is being developed. The PASSPORT concept consists of maintaining the normal arthroscopic equipment, replacing the human knee joint by a phantom, and integrating registration devices to provide performance feedback. The first prototype of the knee phantom allows inspection, treatment of menisci, irrigation, and limb stressing. PASSPORT was evaluated for face and construct validity. Construct validity was assessed by measuring the performance of two groups with different levels of arthroscopic experience (20 surgeons and 8 residents). Participants performed a navigation task five times on PASSPORT. Task times were recorded. Face validity was assessed by completion of a short questionnaire on the participants' impressions and comments for improvements. Construct validity was demonstrated as the surgeons (median task time 19.7 s [8.0-37.6]) were more efficient than the residents (55.2 s [27.9-96.6]) in task completion for each repetition (Mann-Whitney U test, P < 0.05). The prototype of the knee phantom sufficiently imitated limb outer appearance (79%), portal resistance (82%), and arthroscopic view (81%). Improvements are required for the stressing device and the material of cruciate ligaments. Our physical simulation environment (PASSPORT) demonstrates its potential to evolve as a training modality. In future, automated performance feedback is aimed for.

Discrepancies between adolescents' attributed relevance and experiences regarding communication are associated with poorer client participation and learning processes in psychosocial care.

PubMed

Jager, Margot; Reijneveld, Sijmen A; Metselaar, Janneke; Knorth, Erik J; De Winter, Andrea F

2014-12-01

To examine adolescents' attributed relevance and experiences regarding communication, and whether discrepancies in these are associated with clients' participation and learning processes in psychosocial care. Adolescents receiving psychosocial care (n=211) completed measures of communication in three domains: affective communication, information provision, and shared decision-making. Participation involved clients' attendance and adherence (professional-reported). Learning processes involved clients' improved understanding and improved confidence (client and professional-reported). Important but less often experienced affective communication was associated with low adherence (odds ratio, 95% confidence interval: 2.8, 1.1-6.8), less improvement in understanding (3.7, 1.5-9.0), and less improvement in confidence (4.5, 1.8-11.6). If information provision or shared decision-making was important but less often experienced, adolescents were more likely to demonstrate less improvement in understanding (3.1, 1.1-8.5; 4.2, 1.7-10.8). The combination "less important but experienced" only had an effect regarding affective communication; these adolescents were more likely to demonstrate less improvement in confidence (6.0, 2.3-15.4). Discrepancies between attributed relevance and experiences frequently occur. These discrepancies negatively affect adolescents' participation and their learning processes, although the pattern differs across communication domains. Care professionals should pay considerable attention to their clients' communication preferences and adapt their communication style when necessary. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Quality improvement in childhood obesity management through the maintenance of certification process.

PubMed

Huang, Jeannie S; Chun, Stanford; Sandhu, Amanpreet; Terrones, Laura

2013-11-01

To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics. Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses. The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time. Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth. Copyright © 2013 Mosby, Inc. All rights reserved.

Role of Google Glass in improving patient satisfaction for otolaryngology residents: a pilot study.

PubMed

Son, E; Halbert, A; Abreu, S; Hester, R; Jefferson, G; Jennings, K; Pine, H; Watts, T

2017-04-01

To demonstrate the feasibility and efficacy of the Google Glass as a tool to improve patient satisfaction and patient-physician communication for otolaryngology residents in the outpatient clinic setting. The primary outcome of the study was to improve patient satisfaction scores based on physician communication-related questions from Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Prospective randomised trial. Tertiary care hospital. To evaluate the effect on patient satisfaction, five residents were recorded using the Google Glass in an outpatient clinic setting by 50 randomised patients. Modified surveys based on the CG-CAHPS survey were completed by patients at the conclusion of each clinic encounter. The recorded videos were evaluated by two independent faculties. Summarised data and video were distributed to each resident for review as the intervention. The residents were recorded again by 45 additional patients with evaluation by patients and faculties. After intervention, the scores from faculty surveys regarding patient satisfaction including the subject of better explanations (P > 0.001), listening carefully (P > 0.001), addressing patient questions (P > 0.001), displaying respect (P > 0.001) and spending adequate time (P = 0.0005) all significantly improved, as well as overall performance (P = 0.014). The scores from patient surveys did significantly improve. This study demonstrates the improvements in patient satisfaction and patient-physician communication can be achieved with the use of Google Glass as a first-person recording device in the outpatient otolaryngology clinic setting. © 2016 John Wiley & Sons Ltd.

Miniature surgical robot for laparoendoscopic single-incision colectomy.

PubMed

Wortman, Tyler D; Meyer, Avishai; Dolghi, Oleg; Lehman, Amy C; McCormick, Ryan L; Farritor, Shane M; Oleynikov, Dmitry

2012-03-01

This study aimed to demonstrate the effectiveness of using a multifunctional miniature in vivo robotic platform to perform a single-incision colectomy. Standard laparoscopic techniques require multiple ports. A miniature robotic platform to be inserted completely into the peritoneal cavity through a single incision has been designed and built. The robot can be quickly repositioned, thus enabling multiquadrant access to the abdominal cavity. The miniature in vivo robotic platform used in this study consists of a multifunctional robot and a remote surgeon interface. The robot is composed of two arms with shoulder and elbow joints. Each forearm is equipped with specialized interchangeable end effectors (i.e., graspers and monopolar electrocautery). Five robotic colectomies were performed in a porcine model. For each procedure, the robot was completely inserted into the peritoneal cavity, and the surgeon manipulated the user interface to control the robot to perform the colectomy. The robot mobilized the colon from its lateral retroperitoneal attachments and assisted in the placement of a standard stapler to transect the sigmoid colon. This objective was completed for all five colectomies without any complications. The adoption of both laparoscopic and single-incision colectomies currently is constrained by the inadequacies of existing instruments. The described multifunctional robot provides a platform that overcomes existing limitations by operating completely within one incision in the peritoneal cavity and by improving visualization and dexterity. By repositioning the small robot to the area of the colon to be mobilized, the ability of the surgeon to perform complex surgical tasks is improved. Furthermore, the success of the robot in performing a completely in vivo colectomy suggests the feasibility of using this robotic platform to perform other complex surgeries through a single incision.

Multicenter clinical trial of a home-use nonablative fractional laser device for wrinkle reduction.

PubMed

Leyden, James; Stephens, Thomas J; Herndon, James H

2012-11-01

Until now, nonablative fractional treatments could only be delivered in an office setting by trained professionals. The goal of this work was to perform clinical testing of a nonablative fractional laser device designed for home-use. This multicenter trial consisted of two clinical studies with slightly varying treatment protocols in which subjects performed at-home treatments of periorbital wrinkles using a handheld nonablative fractional laser. Both studies included an active treatment phase (daily treatments) and a maintenance phase (twice-weekly treatments). In all, 36 subjects were followed up for as long as 5 months after completion of the maintenance phase and 90 subjects were followed up until the completion of the maintenance phase. Evaluations included in-person investigator assessment, independent blinded review of high-resolution images using the Fitzpatrick Wrinkle Scale, and subject self-assessment. All 124 subjects who completed the study were able to use the device following written instructions for use. Treatments were well tolerated with good protocol compliance. Independent blinded evaluations by a panel of physicians showed Fitzpatrick Wrinkle Scale score improvement by one or more grades in 90% of subjects at the completion of the active phase and in 79% of subjects at the completion of the maintenance phase. The most prevalent side effect was transient posttreatment erythema. Lack of a control group and single-blinded study groups were limitations. Safety testing with self-applications by users demonstrated the utility of the device for home use. Independent blinded review of clinical images confirmed the device's proficiency for improving periorbital wrinkles. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

A workflow learning model to improve geovisual analytics utility

PubMed Central

Roth, Robert E; MacEachren, Alan M; McCabe, Craig A

2011-01-01

Introduction This paper describes the design and implementation of the G-EX Portal Learn Module, a web-based, geocollaborative application for organizing and distributing digital learning artifacts. G-EX falls into the broader context of geovisual analytics, a new research area with the goal of supporting visually-mediated reasoning about large, multivariate, spatiotemporal information. Because this information is unprecedented in amount and complexity, GIScientists are tasked with the development of new tools and techniques to make sense of it. Our research addresses the challenge of implementing these geovisual analytics tools and techniques in a useful manner. Objectives The objective of this paper is to develop and implement a method for improving the utility of geovisual analytics software. The success of software is measured by its usability (i.e., how easy the software is to use?) and utility (i.e., how useful the software is). The usability and utility of software can be improved by refining the software, increasing user knowledge about the software, or both. It is difficult to achieve transparent usability (i.e., software that is immediately usable without training) of geovisual analytics software because of the inherent complexity of the included tools and techniques. In these situations, improving user knowledge about the software through the provision of learning artifacts is as important, if not more so, than iterative refinement of the software itself. Therefore, our approach to improving utility is focused on educating the user. Methodology The research reported here was completed in two steps. First, we developed a model for learning about geovisual analytics software. Many existing digital learning models assist only with use of the software to complete a specific task and provide limited assistance with its actual application. To move beyond task-oriented learning about software use, we propose a process-oriented approach to learning based on the concept of scientific workflows. Second, we implemented an interface in the G-EX Portal Learn Module to demonstrate the workflow learning model. The workflow interface allows users to drag learning artifacts uploaded to the G-EX Portal onto a central whiteboard and then annotate the workflow using text and drawing tools. Once completed, users can visit the assembled workflow to get an idea of the kind, number, and scale of analysis steps, view individual learning artifacts associated with each node in the workflow, and ask questions about the overall workflow or individual learning artifacts through the associated forums. An example learning workflow in the domain of epidemiology is provided to demonstrate the effectiveness of the approach. Results/Conclusions In the context of geovisual analytics, GIScientists are not only responsible for developing software to facilitate visually-mediated reasoning about large and complex spatiotemporal information, but also for ensuring that this software works. The workflow learning model discussed in this paper and demonstrated in the G-EX Portal Learn Module is one approach to improving the utility of geovisual analytics software. While development of the G-EX Portal Learn Module is ongoing, we expect to release the G-EX Portal Learn Module by Summer 2009. PMID:21983545

A workflow learning model to improve geovisual analytics utility.

PubMed

Roth, Robert E; Maceachren, Alan M; McCabe, Craig A

2009-01-01

INTRODUCTION: This paper describes the design and implementation of the G-EX Portal Learn Module, a web-based, geocollaborative application for organizing and distributing digital learning artifacts. G-EX falls into the broader context of geovisual analytics, a new research area with the goal of supporting visually-mediated reasoning about large, multivariate, spatiotemporal information. Because this information is unprecedented in amount and complexity, GIScientists are tasked with the development of new tools and techniques to make sense of it. Our research addresses the challenge of implementing these geovisual analytics tools and techniques in a useful manner. OBJECTIVES: The objective of this paper is to develop and implement a method for improving the utility of geovisual analytics software. The success of software is measured by its usability (i.e., how easy the software is to use?) and utility (i.e., how useful the software is). The usability and utility of software can be improved by refining the software, increasing user knowledge about the software, or both. It is difficult to achieve transparent usability (i.e., software that is immediately usable without training) of geovisual analytics software because of the inherent complexity of the included tools and techniques. In these situations, improving user knowledge about the software through the provision of learning artifacts is as important, if not more so, than iterative refinement of the software itself. Therefore, our approach to improving utility is focused on educating the user. METHODOLOGY: The research reported here was completed in two steps. First, we developed a model for learning about geovisual analytics software. Many existing digital learning models assist only with use of the software to complete a specific task and provide limited assistance with its actual application. To move beyond task-oriented learning about software use, we propose a process-oriented approach to learning based on the concept of scientific workflows. Second, we implemented an interface in the G-EX Portal Learn Module to demonstrate the workflow learning model. The workflow interface allows users to drag learning artifacts uploaded to the G-EX Portal onto a central whiteboard and then annotate the workflow using text and drawing tools. Once completed, users can visit the assembled workflow to get an idea of the kind, number, and scale of analysis steps, view individual learning artifacts associated with each node in the workflow, and ask questions about the overall workflow or individual learning artifacts through the associated forums. An example learning workflow in the domain of epidemiology is provided to demonstrate the effectiveness of the approach. RESULTS/CONCLUSIONS: In the context of geovisual analytics, GIScientists are not only responsible for developing software to facilitate visually-mediated reasoning about large and complex spatiotemporal information, but also for ensuring that this software works. The workflow learning model discussed in this paper and demonstrated in the G-EX Portal Learn Module is one approach to improving the utility of geovisual analytics software. While development of the G-EX Portal Learn Module is ongoing, we expect to release the G-EX Portal Learn Module by Summer 2009.

AF-M315E Propulsion System Advances and Improvements

NASA Technical Reports Server (NTRS)

Masse, Robert K.; Allen, May; Driscoll, Elizabeth; Spores, Ronald A.; Arrington, Lynn A.; Schneider, Steven J.; Vasek, Thomas E.

2016-01-01

Even as for the GR-1 awaits its first on-orbit demonstration on the planned 2017 launch of NASA's Green Propulsion Infusion Mission (GPIM) program, ongoing efforts continue to advance the technical state-of-the-art through improvements in the performance, life capability, and affordability of both Aerojet Rocketdyne's 1-N-class GR-1 and 20-N-class GR-22 green monopropellant thrusters. Hot-fire testing of a design upgrade of the GR-22 thruster successfully demonstrated resolution of a life-limiting thermo-structural issue encountered during prototype testing on the GPIM program, yielding both an approximately 2x increase in demonstrating life capability, as well as fundamental insights relating to how ionic liquid thrusters operate, thruster scaling, and operational factors affecting catalyst bed life. Further, a number of producibility improvements, related to both materials and processes and promising up to 50% unit cost reduction, have been identified through a comprehensive Design for Manufacturing and Assembly (DFMA) assessment activity recently completed at Aerojet Rocketdyne. Focused specifically on the GR-1 but applicable to the common-core architecture of both thrusters, ongoing laboratory (heavyweight) thruster testing being conducted under a Space Act Agreement at NASA Glenn Research Center has already validated a number of these proposed manufacturability upgrades, additionally achieving a greater than 40% increase in thruster life. In parallel with technical advancements relevant to conventional large spacecraft, a joint effort between NASA and Aerojet Rocketdyne is underway to prepare 1-U CubeSat AF-M315E propulsion module for first flight demonstration in 2018.

Fast Whole-Engine Stirling Analysis

NASA Technical Reports Server (NTRS)

Dyson, Rodger W.; Wilson, Scott D.; Tew, Roy C.; Demko, Rikako

2005-01-01

An experimentally validated approach is described for fast axisymmetric Stirling engine simulations. These simulations include the entire displacer interior and demonstrate it is possible to model a complete engine cycle in less than an hour. The focus of this effort was to demonstrate it is possible to produce useful Stirling engine performance results in a time-frame short enough to impact design decisions. The combination of utilizing the latest 64-bit Opteron computer processors, fiber-optical Myrinet communications, dynamic meshing, and across zone partitioning has enabled solution times at least 240 times faster than previous attempts at simulating the axisymmetric Stirling engine. A comparison of the multidimensional results, calibrated one-dimensional results, and known experimental results is shown. This preliminary comparison demonstrates that axisymmetric simulations can be very accurate, but more work remains to improve the simulations through such means as modifying the thermal equilibrium regenerator models, adding fluid-structure interactions, including radiation effects, and incorporating mechanodynamics.

Development and Testing of a High Stability Engine Control (HISTEC) System

NASA Technical Reports Server (NTRS)

Orme, John S.; DeLaat, John C.; Southwick, Robert D.; Gallops, George W.; Doane, Paul M.

1998-01-01

Flight tests were recently completed to demonstrate an inlet-distortion-tolerant engine control system. These flight tests were part of NASA's High Stability Engine Control (HISTEC) program. The objective of the HISTEC program was to design, develop, and flight demonstrate an advanced integrated engine control system that uses measurement-based, real-time estimates of inlet airflow distortion to enhance engine stability. With improved stability and tolerance of inlet airflow distortion, future engine designs may benefit from a reduction in design stall-margin requirements and enhanced reliability, with a corresponding increase in performance and decrease in fuel consumption. This paper describes the HISTEC methodology, presents an aircraft test bed description (including HISTEC-specific modifications) and verification and validation ground tests. Additionally, flight test safety considerations, test plan and technique design and approach, and flight operations are addressed. Some illustrative results are presented to demonstrate the type of analysis and results produced from the flight test program.

Fast Whole-Engine Stirling Analysis

NASA Technical Reports Server (NTRS)

Dyson, Rodger W.; Wilson, Scott D.; Tew, Roy C.; Demko, Rikako

2007-01-01

An experimentally validated approach is described for fast axisymmetric Stirling engine simulations. These simulations include the entire displacer interior and demonstrate it is possible to model a complete engine cycle in less than an hour. The focus of this effort was to demonstrate it is possible to produce useful Stirling engine performance results in a time-frame short enough to impact design decisions. The combination of utilizing the latest 64-bit Opteron computer processors, fiber-optical Myrinet communications, dynamic meshing, and across zone partitioning has enabled solution times at least 240 times faster than previous attempts at simulating the axisymmetric Stirling engine. A comparison of the multidimensional results, calibrated one-dimensional results, and known experimental results is shown. This preliminary comparison demonstrates that axisymmetric simulations can be very accurate, but more work remains to improve the simulations through such means as modifying the thermal equilibrium regenerator models, adding fluid-structure interactions, including radiation effects, and incorporating mechanodynamics.

UV lifetime demonstrator for space-based applications

NASA Astrophysics Data System (ADS)

Albert, Michael; Puffenburger, Kent; Schum, Tom; Fitzpatrick, Fran; Litvinovitch, Slava; Jones, Darrell; Rudd, Joseph; Hovis, Floyd

2016-05-01

A long-lived UV laser is an enabling technology for a number of high-priority, space-based lidar instruments. These include next generation cloud and aerosol lidars that incorporates a UV channel, direct detection 3-D wind lidars, and ozone DIAL (differential absorption lidar) systems. In previous SBIR funded work we developed techniques for increasing the survivability of components in high power UV lasers and demonstrated improved operational lifetimes. In this Phase III ESTO funded effort we are designing and building a TRL (Technology Readiness Level) 6 demonstrator that will have increased output power and a space-qualifiable package that is mechanically robust and thermally-stable. For full space compatibility, thermal control will be through pure conductive cooling. Contamination control processes and optical coatings will be chosen that are compatible with lifetimes in excess of 1 billion shots. The 1064nm output will be frequency tripled to provide greater than 100 mJ pulses of 355 nm light at 150 Hz. The laser module build was completed in the third quarter of 2015 at which time a series of life tests were initiated. The first phase of the lifetime testing is a 532 nm only test that is expected to complete in April 2016. The 532 nm lifetest will be followed by a 4 month half power UV life test and then a four month full power UV life test. The lifetime tests will be followed by thermal/vacuum (TVAC) and vibration testing to demonstrate that the laser optics module design is at TRL 6.

Improving Culture, One Quality Improvement Project at a Time.

PubMed

Vander Schaaf, Emily B; Cornett, Amanda C; Randolph, Greg D

A culture of quality improvement (QI) values collaboration, transparency, and staff empowerment. Organizations exhibiting a culture of QI are more likely to engage in QI. We examined whether local health departments' (LHDs') participation in a longitudinal, experiential QI training program changes QI culture. Prior to and following participation in a QI training program, all employees of participating LHDs were asked to complete an 8-item survey assessing components of QI culture on a 5-point scale. From 2010 to 2015, multidisciplinary teams from North Carolina LHDs participated in sequential cohorts of a 6-month QI training program, during which the teams completed a QI project. We dichotomized culture survey responses, with 4 or 5 being "Supportive." We compared adjusted proportions, using linear regression, clustering at LHD, and controlling for cohort. Data from 42 LHDs were included. At baseline, 7.8% responded that their LHD had a supportive culture for all 8 components, compared with 12% at follow-up (P < .001), adjusted for cohort and clustering by LHD. At follow-up, the percentage of employees responding that their LHDs had supportive cultures increased for all components of culture including communication by 4.1% (95% CI: 2.0%-6.2%), problem solving by 2.9% (95% CI: 1.6%-5.5%), team work by 5.2% (95% CI: 2.5%-7.8%), vision by 4.3% (95% CI: 1.1%-7.5%), performance measures by 5.6% (95% CI: 1.6%-9.6%), recognition by 4.7% (95% CI: 1.4%-8.0%), for conflict by 5.5% (95% CI: 1.7%-9.4%), and alignment by 5.8% (95% CI: 2.3%-9.2%). Engagement with structured QI training programs-and perhaps simply completing QI projects-can cause small, but important changes in organizations' cultures, thus increasing engagement in future QI and improving overall care and services. The article demonstrates that when LHDs participate in a longitudinal, experiential QI training program, their cultures of QI improve. Local health departments participating in similar training programs might experience similar improvements in culture, increasing subsequent participation in QI projects and improving related health outcomes.

The Use of 2 Conditioning Programs and the Fitness Characteristics of Police Academy Cadets.

PubMed

Cocke, Charles; Dawes, Jay; Orr, Robin Marc

2016-11-01

 Police academy training must physically prepare cadets for the rigors of their occupational tasks to prevent injury and allow them to adequately perform their duties.  To compare the effects of 2 physical training programs on multiple fitness measures in police cadets.  Cohort study.  Police training academy.  We collected data from 70 male (age = 27.4 ± 5.9 years, body weight = 85.4 ± 11.8 kg) and 20 female (age = 30.5 ± 5.8 years, body weight = 62.8 ± 11.0 kg) police cadets and analyzed data from 61 male cadets (age = 27.5 ± 5.5 years, body weight = 87.7 ± 13.2 kg).  Participants completed one of two 6-month training programs. The randomized training group (RTG; n = 50), comprising 4 separate and sequential groups (n = 13, n = 11, n = 13, n = 13), completed a randomized training program that incorporated various strength and endurance exercises chosen on the day of training. The periodized group (PG; n = 11) completed a periodized training program that alternated specific phases of training.  Anthropometric fitness measures were body weight, fat mass, and lean body mass. Muscular and metabolic fitness measures were 1-repetition maximum bench press, push-up and sit-up repetitions performed in 1 minute, vertical jump, 300-m sprint, and 2.4-km run.  The RTG demonstrated improvements in all outcome measures between pretraining and posttraining; however, the improvements varied among the 4 individual RTGs. Conversely, the PG displayed improvements in only 3 outcome measures (push-ups, sit-ups, and 300-m sprint) but approached the level of significance set for this study (P < .01) in body weight, fat mass, and 1-repetition maximum bench press.  Regardless of format, physical training programs can improve the fitness of tactical athletes. In general, physical fitness measures appeared to improve more in the RTG than in the PG. However, this observation varied among groups, and injury rates were not compared.

1990 Activity report for 1986-1992

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

Cantwell, K.

1996-01-01

As discussed in last year`s Activity Report, a fairly complete analysis of SPEAR problems was performed in concert with SLAC, and a major maintenance/improvement process was initiated in the spring of 1989. This run made it apparent that SPEAR will remain a very useful and impressive synchrotron radiation storage ring for at least a decade, given a steady maintenance and improvement program. More details about SPEAR functioning during the run, as well as SPEAR improvements, are contained in Chapter I. The formal SPEAR injector construction project was completed in November, 1990, on-time and on-budget. Although DOE was not able tomore » provide anticipated FY90 commissioning funds, preliminary commissioning was performed and 2.3 GeV injection to SPEAR was demonstrated. A discussion of the Injector project is contained in Chapter II. Commissioning of the injector and the injector/SPEAR complex is continuing in 1991 with Users participating during the May-September period. This user participation allowed normal experimentation, so that systems could be tested critically, but with the commissioning process having higher priority than data acquisition. Another major event in 1990 was the full dedication of SPEAR to the synchrotron radiation program. Previously SPEAR was considered a high energy physics machine that was partially dedicated to synchrotron radiation. The full dedication means that the accelerator can be modified and improved for synchrotron radiation research. Despite the heavy emphasis on completing the Injector, many beam line improvements were achieved, as described in Chapter IV. Among these was the optimization of stations 6-2 and 10-2, the provision of a considerably larger hutch for Station 1-5, which contains the area detector diffractometer, and the introduction of white light capability on 10-2. The provision of good beam during the month of April made an appreciable amount of experimentation possible. These and other runs are described in Chapter VI.« less

Engineering Development Program of a Closed Aluminum-Oxygen Semi-cell System for an Unmanned Underwater Vehicle: An Update

NASA Technical Reports Server (NTRS)

Gregg, Dane W.; Hall, Susan E.

1996-01-01

Most emerging unmanned undersea vehicle (UUV) missions require significantly longer range and endurance than is achievable with existing battery technology. The Aluminum-Oxygen (Al-O2) semi-cell is a candidate technology capable of providing a significant improvement in endurance compared to the silver-zinc battery technology currently in use in UUVs and compares favorably to other proposed UUV power systems not only in performance, but also in safety and logistics. An Al-O2 semi-cell system is under development, consisting of a cell stack, gas management, oxygen storage, electrolyte management coolant and controller subsystems. It is designed to replace the existing silver-zinc battery and meet existing weight, volume, electrical and thermal requirements, therefore minimizing modification to the UUV. A detailed system design is complete. A component and material endurance test to evaluate compatibility and reliability of various materials and components is complete. Sub=scale (short stack) system testing is complete. A full-scale demonstration unit is now under construction for testing in the second half of 1995. The full scale demonstration test will simulate environmental conditions of the operational system. This paper summarizes the results of the extensive short stack and endurance test programs, describes the plan for full-scale testing, and concludes with a brief discussion of future directions for this technology.

Complete Decomposition of Li 2 CO 3 in Li–O 2 Batteries Using Ir/B 4 C as Noncarbon-Based Oxygen Electrode

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

Song, Shidong; Xu, Wu; Zheng, Jianming

Incomplete decomposition of Li2CO3 during charge process is a critical barrier for rechargeable Li-O2 batteries. Here we report complete decomposition of Li2CO3 in Li-O2 batteries using ultrafine iridium-decorated boron carbide (Ir/B4C) nanocomposite as oxygen electrode. The systematic investigation on charging the Li2CO3 preloaded Ir/B4C electrode in an ether-based electrolyte demonstrates that Ir/B4C electrode can decompose Li2CO3 with an efficiency close to 100% at below 4.37 V. In contrast, the bare B4C without Ir electrocatalyst can only decompose 4.7% of preloaded Li2CO3. The reaction mechanism of Li2CO3 decomposition in the presence of Ir/B4C electrocatalyst has been further investigated. A Li-O2 batterymore » using Ir/B4C as oxygen electrode material shows highly enhanced cycling stability than that using bare B4C oxygen electrode. These results clearly demonstrate that Ir/B4C is an effecitive oxygen electrode amterial to completely decompose Li2CO3 at relatively low charge voltages and is of significant importance in improving the cycle performanc of aprotic Li-O2 batteries.« less

Estimating crustal thickness and Vp/Vs ratio with joint constraints of receiver function and gravity data

NASA Astrophysics Data System (ADS)

Shi, Lei; Guo, Lianghui; Ma, Yawei; Li, Yonghua; Wang, Weilai

2018-05-01

The technique of teleseismic receiver function H-κ stacking is popular for estimating the crustal thickness and Vp/Vs ratio. However, it has large uncertainty or ambiguity when the Moho multiples in receiver function are not easy to be identified. We present an improved technique to estimate the crustal thickness and Vp/Vs ratio by joint constraints of receiver function and gravity data. The complete Bouguer gravity anomalies, composed of the anomalies due to the relief of the Moho interface and the heterogeneous density distribution within the crust, are associated with the crustal thickness, density and Vp/Vs ratio. According to their relationship formulae presented by Lowry and Pérez-Gussinyé, we invert the complete Bouguer gravity anomalies by using a common algorithm of likelihood estimation to obtain the crustal thickness and Vp/Vs ratio, and then utilize them to constrain the receiver function H-κ stacking result. We verified the improved technique on three synthetic crustal models and evaluated the influence of selected parameters, the results of which demonstrated that the novel technique could reduce the ambiguity and enhance the accuracy of estimation. Real data test at two given stations in the NE margin of Tibetan Plateau illustrated that the improved technique provided reliable estimations of crustal thickness and Vp/Vs ratio.

Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician's management of cardiac arrest.

PubMed

Taira, Breena R; Orue, Aristides; Stapleton, Edward; Lovato, Luis; Vangala, Sitaram; Tinoco, Lucia Solorzano; Morales, Orlando

2016-01-01

Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician's management of simulated code scenarios. Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest), a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, P<0.001). Statistically significant improvement was also seen on the number of critical items completed (OR=3.75, 95% CI 2.71-5.19), total items completed (OR=4.55, 95% CI 3.4-6.11), and number of "excellent" scores on a Likert scale (OR=2.66, 95% CI 1.85-3.81). Nicaraguan resident physicians demonstrate improved ability to manage simulated cardiac arrest scenarios after participation in the Project SEMILLA resuscitation course and retain these skills.

Online weight training.

PubMed

McNamara, John M; Swalm, Ricky L; Stearne, David J; Covassin, Tracey M

2008-07-01

The purpose of this study was to determine how a traditional weight training class compared to nontraditional classes that were heavily laden with technology. Could students learn resistance exercises by watching video demonstrations over the Internet? Three university weight training classes, each lasting 16 weeks, were compared. Each class had the same curriculum and workout requirements but different attendance requirements. The online group made extensive use of the Internet and was allowed to complete the workouts on their own at any gym that was convenient for them. Seventy-nine college-aged students were randomized into 3 groups: traditional (n = 27), hybrid (n = 25), and online (n = 27). They completed pretest and posttest measures on upper-body strength (i.e., bench press), lower-body strength (i.e., back squat), and knowledge (i.e., written exam). The results indicated that all 3 groups showed significant improvement in knowledge (p < 0.05). The online group did not require the students to attend class and may have resulted in significantly lower scores on the bench press (p < 0.05) and squats (p < 0.05). This study indicates that an online weight training course may improve knowledge but not strength. Possible reasons for a lack of improvement in the online group included lack of motivation, low accountability, and the possibility that the self-reported workouts were not accurate. These results suggest that there is a limit to how much technology can be used in a weight training class. If this limit is exceeded, some type of monitoring system appears necessary to ensure that students are actually completing their workouts.

The effects of implementing synoptic pathology reporting in cancer diagnosis: a systematic review.

PubMed

Sluijter, Caro E; van Lonkhuijzen, Luc R C W; van Slooten, Henk-Jan; Nagtegaal, Iris D; Overbeek, Lucy I H

2016-06-01

Pathology reporting is evolving from a traditional narrative report to a more structured synoptic report. Narrative reporting can cause misinterpretation due to lack of information and structure. In this systematic review, we evaluate the impact of synoptic reporting on completeness of pathology reports and quality of pathology evaluation for solid tumours. Pubmed, Embase and Cochrane databases were systematically searched to identify studies describing the effect of synoptic reporting implementation on completeness of reporting and quality of pathology evaluation of solid malignant tumours. Thirty-three studies met the inclusion criteria. All studies, except one, reported an increased overall completeness of pathology reports after introduction of synoptic reporting (SR). Most frequently studied cancers were breast (n = 9) and colorectal cancer (n = 16). For breast cancer, narrative reports adequately described 'tumour type' and 'nodal status'. Synoptic reporting resulted in improved description of 'resection margins', 'DCIS size', 'location' and 'presence of calcifications'. For colorectal cancer, narrative reports adequately reported 'tumour type', 'invasion depth', 'lymph node counts' and 'nodal status'. Synoptic reporting resulted in increased reporting of 'circumferential margin', 'resection margin', 'perineural invasion' and 'lymphovascular invasion'. In addition, increased numbers of reported lymph nodes were found in synoptic reports. Narrative reports of other cancer types described the traditional parameters adequately, whereas for 'resection margins' and '(lympho)vascular/perineural invasion', implementation of synoptic reporting was necessary. Synoptic reporting results in improved reporting of clinical relevant data. Demonstration of clinical impact of this improved method of pathology reporting is required for successful introduction and implementation in daily pathology practice.

Eyes-on training and radiological expertise: an examination of expertise development and its effects on visual working memory.

PubMed

Beck, Melissa R; Martin, Benjamin A; Smitherman, Emily; Gaschen, Lorrie

2013-08-01

Our aim was to examine the specificity of the effects of acquiring expertise on visual working memory (VWM) and the degree to which higher levels of experience within the domain of expertise are associated with more efficient use of VWM. Previous research is inconsistent on whether expertise effects are specific to the area of expertise or generalize to other tasks that also involve the same cognitive processes. It is also unclear whether more training and/or experience will lead to continued improvement on domain-relevant tasks or whether a plateau could be reached. In Experiment I, veterinary medicine students completed a one-shot visual change detection task. In Experiment 2, veterinarians completed a flicker change detection task. Both experiments involved stimuli specific to the domain of radiology and general stimuli. In Experiment I, veterinary medicine students who had completed an "eyes-on" radiological training demonstrated a domain-specific effect in which performance was better on the domain-specific stimuli than on the domain-general stimuli. In Experiment 2, veterinarians again showed a domain-specific effect, but performance was unrelated to the amount of experience veterinarians had accumulated. The effect of experience is domain specific and occurs during the first few years of training, after which a plateau is reached. VWM training in one domain may not lead to improved performance on other VWM tasks. In acquiring expertise, eyes-on training is important initially, but continued experience may not be associated with further improvements in the efficiency of VWM.

Safety and efficacy evaluation of tretinoin cream 0.02% for the reduction of photodamage: a pilot study.

PubMed

Kircik, Leon H

2012-01-01

Clinical studies as well as histologic data maintain that tretinoin improves the appearance of photodamage; however, the long-term benefits of tretinoin 0.02% in moderate to severe photodamage have not been established. We performed independent assessments to demonstrate the long-term safety and efficacy of tretinoin emollient cream 0.02% for moderate to severe facial photodamage. A single-center, open-label, single-group observational study followed 19 patients over 52 weeks. Efficacy assessments consisted of the Glogau Photodamage Classification Scale and severity grading of photodamage signs and symptoms. Facial photography and biopsies were taken from three subjects at baseline and final visits. Tolerability was assessed by the investigator. Twelve patients completed 52 weeks of treatment. Mean change in Glogau photodamage demonstrated statistically significant differences at 3, 6, 9, and 12 months (P<.0005). All patients with moderate to severe photodamage had improved to mild photodamage status by 9 months. Statistically significant improvements (P<.05) were observed at all time points for fine wrinkling, tactile roughness, and mottled hyperpigmentation as well as for lentigines at 6, 9, and 12 months and telangiectasia at 12 months. Biopsy samples revealed microscopic improvement in photodamage. Tretinoin cream 0.02% was generally well-tolerated, with few subjects experiencing adverse events. Our pilot study is limited by lack of control and the small study sample. Tretinoin cream 0.02% was safe and effective for moderate to severe photodamage of facial skin and demonstrated sustainable benefits over an entire year based on the clinically validated Glogau classification system and expert visual grading analysis.

Improving tinnitus with mechanical treatment of the cervical spine and jaw.

PubMed

Cherian, Kay; Cherian, Neil; Cook, Chad; Kaltenbach, James A

2013-01-01

Tinnitus affects approximately 30-50 million Americans. In approximately 0.5-1.0% of the population, tinnitus has a moderate to severe impact on their quality of life. Musculature and joint pathologies of the head and neck are frequently associated with tinnitus and have been hypothesized to play a contributing role in its etiology. However, specific physical therapy interventions to assist in improving tinnitus have not yet been reported. To describe the examination and treatment intervention of a patient with subjective tinnitus. The patient was a 42-yr-old male experiencing intermittent bilateral tinnitus, headaches, blurred vision, and neck tightness. His occupation required long-term positioning into neck protraction. Examination found limitations in cervical extension, bilateral rotation, and side bending. Asymmetry was also noted with temporomandibular joint (TMJ) movements. Upon initial evaluation the patient demonstrated functional, physical, and emotional deficits per neck, headache, and dizziness self-report scales and a score on the Tinnitus Handicap Inventory (THI) of 62. Resisted muscle contractions of the cervical spine in flexion, extension, and rotation increased his tinnitus. Treatment focused on normalizing cervical spine mobility through repetitive movements, joint mobilization, and soft tissue massage. At 2.5 mo, the patient demonstrated a complete reversal of his tinnitus after 10 physical therapy sessions as noted by his score of 0 on the THI upon discharge. He also demonstrated objective improvements in his cervical motion. This case reflected treatment targeted at cervical and TMJ impairments and notable improvements to tinnitus. Future studies should further explore the direct and indirect treatment of tinnitus by physical therapists through clinical trials. American Academy of Audiology.

Present Status and Prospects of FIREX Project

NASA Astrophysics Data System (ADS)

Mima, K.

2008-07-01

The goal of the first phase of Fast Ignition Realization EXperiment (FIREX) project (FIREX-I) is to demonstrate ignition temperature of 5-10 keV, followed by the second phase to demonstrate ignition and burn. Since starting FIREX-I project, plasma physics study in ILE has been devoted to increase the coupling efficiency and to improve compression performance. The heating efficiency can be increased by the following two ways. 1) A previous experiments indicate that the coupling of heating laser to imploded plasmas increases with coating a low-density. foam used in the experiment, low-Z plastic foam is desired for efficient electron transport. (Lei et al. 2006). 2) Electrons generated in the inner surface of the double cone will return by sheathe potential generated between two cones. A 2-D PIC simulation indicates that hot electron confinement is improved by a factor of 1.7 (Nakamura et al. 2007). Further optimization of cone geometry by 2-D simulation will be presented in the workshop. The implosion performance can be improved by three ways. 1) Low-Z plastic layer coating on the outer surface of the cone: The 2D hydro-simulation PINOCO predicts that the target areal density increases by a factor of 2. 2) Br doped plastic layer on a fuel pellet may significantly moderate the Rayleigh-Taylor instability (Fujioka et al. 2004), making implosion more stable. 3) Reducing vapor gas pressure in a pellet is necessary to suppress strength of a jet that will destroy the cone tip. (Stephens et al. 2005). As for the cryogenic target fabrication, R&D of fabricating foam cryogenic cine shell target are under development by the joint group between Osaka Univ. and NIFS. The amplifier system of the heating laser LFEX is completed in March 2008. The amplification test has demonstrated laser energy of 3 kJ/beam at 3nm bandwidth. The equivalent 12 kJ in 4 beams meets the specification of LFEX. The large tiled gratings for pulse compressor are completed and installed. The short pulse laser will be delivered on a target in September, 2008. The fully integrated fast ignition experiments is scheduled on February 2009 until the end of 2010. If subsequent FIREX-II will start as proposed, the ignition and burn will be demonstrated in parallel to that at NIF and LMJ, providing a scientific database of both central and fast ignition.

Neural processes underlying cultural differences in cognitive persistence.

PubMed

Telzer, Eva H; Qu, Yang; Lin, Lynda C

2017-08-01

Self-improvement motivation, which occurs when individuals seek to improve upon their competence by gaining new knowledge and improving upon their skills, is critical for cognitive, social, and educational adjustment. While many studies have delineated the neural mechanisms supporting extrinsic motivation induced by monetary rewards, less work has examined the neural processes that support intrinsically motivated behaviors, such as self-improvement motivation. Because cultural groups traditionally vary in terms of their self-improvement motivation, we examined cultural differences in the behavioral and neural processes underlying motivated behaviors during cognitive persistence in the absence of extrinsic rewards. In Study 1, 71 American (47 females, M=19.68 years) and 68 Chinese (38 females, M=19.37 years) students completed a behavioral cognitive control task that required cognitive persistence across time. In Study 2, 14 American and 15 Chinese students completed the same cognitive persistence task during an fMRI scan. Across both studies, American students showed significant declines in cognitive performance across time, whereas Chinese participants demonstrated effective cognitive persistence. These behavioral effects were explained by cultural differences in self-improvement motivation and paralleled by increasing activation and functional coupling between the inferior frontal gyrus (IFG) and ventral striatum (VS) across the task among Chinese participants, neural activation and coupling that remained low in American participants. These findings suggest a potential neural mechanism by which the VS and IFG work in concert to promote cognitive persistence in the absence of extrinsic rewards. Thus, frontostriatal circuitry may be a neurobiological signal representing intrinsic motivation for self-improvement that serves an adaptive function, increasing Chinese students' motivation to engage in cognitive persistence. Copyright © 2017 Elsevier Inc. All rights reserved.

Assess the feasibility of the high-speed railway construction in China by measuring the traffic demand elastic

NASA Astrophysics Data System (ADS)

Yu, Nan; Cao, Yu

2017-05-01

The traffic demand elastic is proposed as a new indicator in this study to measure the feasibility of the high-speed railway construction in a more intuitive way. The Matrix Completion (MC) and Semi-Supervised Support Vector Machine (S3VM) are used to realize the measurement and prediction of this index on the basis of the satisfaction investigation on the 326 inter-city railways in china. It is demonstrated that instead of calculating the economic benefits brought by the construction of high-speed railway, this indicator can find the most urgent railways to be improved by directly evaluate the existing railway facilities from the perspective of transportation service improvement requirements.

Development and application of GASP 2.0

NASA Technical Reports Server (NTRS)

Mcgrory, W. D.; Huebner, L. D.; Slack, D. C.; Walters, R. W.

1992-01-01

GASP 2.0 represents a major new release of the computational fluid dynamics code in wide use by the aerospace community. The authors have spent the last two years analyzing the strengths and weaknesses of the previous version of the finite-rate chemistry, Navier Stokes solution algorithm. What has resulted is a completely redesigned computer code that offers two to four times the performance of previous versions while requiring as little as one quarter of the memory requirements. In addition to the improvements in efficiency over the original code, Version 2.0 contains many new features. A brief discussion of the improvements made to GASP, and an application using GASP 2.0 which demonstrates some of the new features are presented.

Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards

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

Manley, Stephen, E-mail: stephen.manley@ncahs.health.nsw.gov.au; Last, Andrew; Fu, Kenneth

Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of ourmore » conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients.« less

Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards

PubMed Central

Manley, Stephen; Last, Andrew; Fu, Kenneth; Greenham, Stuart; Kovendy, Andrew; Shakespeare, Thomas P

2015-01-01

Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of our conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients. PMID:26229680

Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards.

PubMed

Manley, Stephen; Last, Andrew; Fu, Kenneth; Greenham, Stuart; Kovendy, Andrew; Shakespeare, Thomas P

2015-06-01

Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of our conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients.

Bilateral improvements in lower extremity function after unilateral balance training in individuals with chronic ankle instability.

PubMed

Hale, Sheri A; Fergus, Andrea; Axmacher, Rachel; Kiser, Kimberly

2014-01-01

Bilateral improvements in postural control have been reported among individuals with acute lateral ankle sprains and individuals with chronic ankle instability (CAI) when only the unstable ankle is rehabilitated. We do not know if training the stable ankle will improve function on the unstable side. To explore the effects of a unilateral balance-training program on bilateral lower extremity balance and function in individuals with CAI when only the stable limb is trained. Cohort study. University clinical research laboratory. A total of 34 volunteers (8 men, 26 women; age = 24.32 ± 4.95 years, height = 167.01 ± 9.45 cm, mass = 77.54 ± 23.76 kg) with CAI were assigned to the rehabilitation (n = 17) or control (n = 17) group. Of those, 27 (13 rehabilitation group, 14 control group) completed the study. Balance training twice weekly for 4 weeks. Foot and Ankle Disability Index (FADI), FADI Sport (FADI-S), Star Excursion Balance Test, and Balance Error Scoring System. The rehabilitation and control groups differed in changes in FADI-S and Star Excursion Balance Test scores over time. Only the rehabilitation group improved in the FADI-S and in the posteromedial and anterior reaches of the Star Excursion Balance Test. Both groups demonstrated improvements in posterolateral reach; however, the rehabilitation group demonstrated greater improvement than the control group. When the groups were combined, participants reported improvements in FADI and FADI-S scores for the unstable ankle but not the stable ankle. Our data suggest training the stable ankle may result in improvements in balance and lower extremity function in the unstable ankle. This further supports the existence of a centrally mediated mechanism in the development of postural-control deficits after injury, as well as improved postural control after rehabilitation.

40 CFR 63.9634 - How do I demonstrate continuous compliance with the emission limitations that apply to me?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 14 2011-07-01 2011-07-01 false How do I demonstrate continuous... demonstrate continuous compliance by completing the requirements in paragraphs (d)(1) and (2) of this section... rate in § 63.9590(b)(1), you must demonstrate continuous compliance by completing the requirements of...

40 CFR 63.9634 - How do I demonstrate continuous compliance with the emission limitations that apply to me?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 14 2010-07-01 2010-07-01 false How do I demonstrate continuous... demonstrate continuous compliance by completing the requirements in paragraphs (d)(1) and (2) of this section... rate in § 63.9590(b)(1), you must demonstrate continuous compliance by completing the requirements of...

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

Melton, Ron

The Pacific Northwest Smart Grid Demonstration (PNWSGD), a $179 million project that was co-funded by the U.S. Department of Energy (DOE) in late 2009, was one of the largest and most comprehensive demonstrations of electricity grid modernization ever completed. The project was one of 16 regional smart grid demonstrations funded by the American Recovery and Reinvestment Act. It was the only demonstration that included multiple states and cooperation from multiple electric utilities, including rural electric co-ops, investor-owned, municipal, and other public utilities. No fewer than 55 unique instantiations of distinct smart grid systems were demonstrated at the projects’ sites. Themore » local objectives for these systems included improved reliability, energy conservation, improved efficiency, and demand responsiveness. The demonstration developed and deployed an innovative transactive system, unique in the world, that coordinated many of the project’s distributed energy resources and demand-responsive components. With the transactive system, additional regional objectives were also addressed, including the mitigation of renewable energy intermittency and the flattening of system load. Using the transactive system, the project coordinated a regional response across the 11 utilities. This region-wide connection from the transmission system down to individual premises equipment was one of the major successes of the project. The project showed that this can be done and assets at the end points can respond dynamically on a wide scale. In principle, a transactive system of this type might eventually help coordinate electricity supply, transmission, distribution, and end uses by distributing mostly automated control responsibilities among the many distributed smart grid domain members and their smart devices.« less

Direct position determination for digital modulation signals based on improved particle swarm optimization algorithm

NASA Astrophysics Data System (ADS)

Yu, Wan-Ting; Yu, Hong-yi; Du, Jian-Ping; Wang, Ding

2018-04-01

The Direct Position Determination (DPD) algorithm has been demonstrated to achieve a better accuracy with known signal waveforms. However, the signal waveform is difficult to be completely known in the actual positioning process. To solve the problem, we proposed a DPD method for digital modulation signals based on improved particle swarm optimization algorithm. First, a DPD model is established for known modulation signals and a cost function is obtained on symbol estimation. Second, as the optimization of the cost function is a nonlinear integer optimization problem, an improved Particle Swarm Optimization (PSO) algorithm is considered for the optimal symbol search. Simulations are carried out to show the higher position accuracy of the proposed DPD method and the convergence of the fitness function under different inertia weight and population size. On the one hand, the proposed algorithm can take full advantage of the signal feature to improve the positioning accuracy. On the other hand, the improved PSO algorithm can improve the efficiency of symbol search by nearly one hundred times to achieve a global optimal solution.

Performance excellence: using Lean Six Sigma tools to improve the US Army behavioral health surveillance process, boost team morale, and maximize value to customers and stakeholders.

PubMed

Watkins, Eren Youmans; Kemeter, Dave M; Spiess, Anita; Corrigan, Elizabeth; Kateley, Keri; Wills, John V; Mancha, Brent Edward; Nichols, Jerrica; Bell, Amy Millikan

2014-01-01

Lean Six Sigma (LSS) is a process improvement, problem-solving methodology used in business and manufacturing to improve the speed, quality, and cost of products. LSS can also be used to improve knowledge-based products integral to public health surveillance. An LSS project by the Behavioral Social Health Outcomes Program of the Army Institute of Public Health reduced the number of labor hours spent producing the routine surveillance of suicidal behavior publication. At baseline, the total number of labor hours was 448; after project completion, total labor hours were 199. Based on customer feedback, publication production was reduced from quarterly to annually. Process improvements enhanced group morale and established best practices in the form of standard operating procedures and business rules to ensure solutions are sustained. LSS project participation also fostered a change in the conceptualization of tasks and projects. These results demonstrate that LSS can be used to inform the public health process and should be considered a viable method of improving knowledge-based products and processes.

Engaging homeless persons in end of life preparations.

PubMed

Song, John; Wall, Melanie M; Ratner, Edward R; Bartels, Dianne M; Ulvestad, Nancy; Gelberg, Lillian

2008-12-01

There are no prospective studies that have investigated the effects of an intervention to improve end of life (EOL) care in an underserved population. To determine whether homeless persons will complete an advance directive (AD). Randomized trial comparing two modes of providing an opportunity for homeless persons to complete an AD. Half of the subjects were randomized to a self-guided group (SG) who were given an AD and written instructions; the other half were given the same material but, in addition, were offered the opportunity to receive guidance to complete the AD (CG). Fifty-nine homeless persons recruited from a drop-in center. Rate of AD completion and baseline and 3-month follow-up EOL-related knowledge, attitudes, and behaviors. The overall AD completion rate was 44%, with a statistically significant higher completion rate of 59% in the CG group compared to 30% in the self-guided only group. Frequency of worry about death decreased among those who filled out an AD from 50% to 12.5%, and also among those who did not (25% to 12.5%) (p < .05). Among those who filled out an AD, there were increases in plans to write down EOL wishes (56% to 100%; p < .05) and plans to talk about these wishes with someone (63% to 94%; p < .05). This study demonstrates that people living in dire economic and social situations will complete an AD when offered the opportunity. While offering guidance resulted in higher rates of completion; even a simple self-guided AD process can achieve completion of ADs in this population.

Quality improvement training for core medical and general practice trainees: a pilot study of project participation, completion and journal publication.

PubMed

McNab, Duncan; McKay, John; Bowie, Paul

2015-11-01

Small-scale quality improvement projects are expected to make a significant contribution towards improving the quality of healthcare. Enabling doctors-in-training to design and lead quality improvement projects is important preparation for independent practice. Participation is mandatory in speciality training curricula. However, provision of training and ongoing support in quality improvement methods and practice is variable. We aimed to design and deliver a quality improvement training package to core medical and general practice specialty trainees and evaluate impact in terms of project participation, completion and publication in a healthcare journal. A quality improvement training package was developed and delivered to core medical trainees and general practice specialty trainees in the west of Scotland encompassing a 1-day workshop and mentoring during completion of a quality improvement project over 3 months. A mixed methods evaluation was undertaken and data collected via questionnaire surveys, knowledge assessment, and formative assessment of project proposals, completed quality improvement projects and publication success. Twenty-three participants attended the training day with 20 submitting a project proposal (87%). Ten completed quality improvement projects (43%), eight were judged as satisfactory (35%), and four were submitted and accepted for journal publication (17%). Knowledge and confidence in aspects of quality improvement improved during the pilot, while early feedback on project proposals was valued (85.7%). This small study reports modest success in training core medical trainees and general practice specialty trainees in quality improvement. Many gained knowledge of, confidence in and experience of quality improvement, while journal publication was shown to be possible. The development of educational resources to aid quality improvement project completion and mentoring support is necessary if expectations for quality improvement are to be realised. © The Author(s) 2015.

Validation of a modified FRAX® tool for improving outpatient efficiency--part of the "Catch Before a Fall" initiative.

PubMed

Parker, Simon; Ciaccio, Maria; Cook, Erica; Davenport, Graham; Cooper, Alun; Grange, Simon; Smitham, Peter

2015-01-01

We have validated our touch-screen-modified FRAX® tool against the traditional healthcare professional-led questionnaire, demonstrating strong concordance between doctor- and patient-derived results. We will use this in outpatient clinics and general practice to increase our capture rate of at-risk patients, making valuable use of otherwise wasted patient waiting times. Outpatient clinics offer an opportunity to collect valuable health information from a captive population. We have previously developed a modified fracture risk assessment (FRAX®) tool, enabling patients to self-assess their osteoporotic fracture risk in a touch-screen computer format and demonstrated its acceptability with patients. We aim to validate the accuracy of our tool against the traditional questionnaire. Fifty patients over 50 years of age within the fracture clinic independently completed a paper equivalent of our touch-screen-modified FRAX® questionnaire. Responses were analysed against the traditional healthcare professional (HCP)-led questionnaire which was carried out afterwards. Correlation was assessed by sensitivity, specificity, Cohen's kappa statistic and Fisher's exact test for each potential FRAX® outcome of "treat", "measure BMD" and "lifestyle advice". Age range was 51-98 years. The FRAX® tool was completed by 88 % of patients; six patients lacked confidence in estimating either their height or weight. Following question adjustment according to patient response and feedback, our tool achieved >95 % sensitivity and specificity for the "treat" and "lifestyle advice" groups, and 79 % sensitivity and 100 % specificity in the "measure BMD" group. Cohen's kappa value ranged from 0.823 to 0.995 across all groups, demonstrating "very good" agreement for all. Fisher's exact test demonstrated significant concordance between doctor and patient decisions. Our modified tool provides a simple, accurate and reliable method for patients to self-report their own FRAX® score outside the clinical contact period, thus releasing the HCP from the time required to complete the questionnaire and potentially increasing our capture rate of at-risk patients.

Health Literacy in Transitions of Care: An Innovative Objective Structured Clinical Examination for Fourth-Year Medical Students in an Internship Preparation Course.

PubMed

Bloom-Feshbach, Kimberly; Casey, Dana; Schulson, Lucy; Gliatto, Peter; Giftos, Jonathan; Karani, Reena

2016-02-01

Low health literacy is associated with adverse health outcomes, especially during transitions of care. Competency-based assessments may improve communication during this time. To develop an Objective Structured Clinical Examination (OSCE) for medical students to demonstrate communication skills to be used during the hospital discharge process with patients of low health literacy. The OSCE was integrated into the curriculum of an internship preparatory clerkship. One hundred and one fourth-year medical students participated. Students received a skills-based health literacy workshop. In the OSCE, learners counseled standardized patients regarding initiation of anticoagulation at discharge and wrote discharge instructions. Fifty-seven students completed the workshop prior to the OSCE, and 44 participated in the workshop after the completing the OSCE. Participants who completed the workshop first outperformed their peers on the checklist (15.1 vs. 13.4, p < 0.0001) and on the reading level of their written instructions (9.9 vs. 10.6, p = 0.01); 82% felt confident communicating with patients of low health literacy after the workshop and OSCE. This OSCE is a tool to train and evaluate future interns' ability to communicate with patients of limited health literacy levels at hospital discharge. Such innovations may make this period of time safer for patients, improving health outcomes.

Efficient fabrication of high-capacity immobilized metal ion affinity chromatographic media: The role of the dextran-grafting process and its manipulation.

PubMed

Zhao, Lan; Zhang, Jingfei; Huang, Yongdong; Li, Qiang; Zhang, Rongyue; Zhu, Kai; Suo, Jia; Su, Zhiguo; Zhang, Zhigang; Ma, Guanghui

2016-03-01

Novel high-capacity Ni(2+) immobilized metal ion affinity chromatographic media were prepared through the dextran-grafting process. Dextran was grafted to an allyl-activated agarose-based matrix followed by functionalization for the immobilized metal ion affinity chromatographic media. With elaborate regulation of the allylation degree, dextran was completely or partly grafted to agarose microspheres, namely, completely dextran-grafted agarose microspheres and partly dextran-grafted ones, respectively. Confocal laser scanning microscope results demonstrated that a good adjustment of dextran-grafting degree was achieved, and dextran was distributed uniformly in whole completely dextran-grafted microspheres, while just distributed around the outside of the partly dextran-grafted ones. Flow hydrodynamic properties were improved greatly after the dextran-grafting process, and the flow velocity increased by about 30% compared with that of a commercial chromatographic medium (Ni Sepharose FF). A significant improvement of protein binding performance was also achieved by the dextran-grafting process, and partly dextran-grafted Ni(2+) chelating medium had a maximum binding capacity for His-tagged lactate dehydrogenase about 2.5 times higher than that of Ni Sepharose FF. The results indicated that this novel chromatographic medium is promising for applications in high-efficiency and large-scale protein purification. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Nursing students' knowledge and beliefs about care of older adults in a shifting context of nursing education.

PubMed

Baumbusch, Jennifer; Dahlke, Sherry; Phinney, Alison

2012-11-01

  To a report a study of improvements in students' knowledge and beliefs about nursing care of older adults following completion of an introductory course with integrated adult/older adult content. Background.  Nursing schools are under pressure to provide accelerated programmes to meet growing workforce demands and provide students with the knowledge they require to care for an ageing population. Thus, stand-alone courses in gerontological nursing are being eliminated and integrated with general adult content. The effect of this approach remains poorly understood.   A one-group pretest-post-test design was used.   Data were collected between September-December 2010. Students completed the Palmore Facts on Aging Quiz, the Perceptions of Caring for Older People Scale, and open-ended questions about their experiences before and after completing a course with integrated adult/older content.   Students' knowledge and beliefs about nursing care of older adults demonstrated an important improvement following completion of the course. Qualitative findings reflected three themes: relating to older people; neglect by the system; having time to learn.   Findings from this study suggest that even when integrated with general adult content, students' knowledge and beliefs about older adult care can be positively influenced. Furthermore research is needed to examine long-term integration of students' learning about older adult care. Nursing faculty with expertise in nursing care of older adults must develop resources and supports for their colleagues to build capacity among nurse educators and integrate older adult content throughout nursing programmes to enhance nursing practice with an ageing population. © 2012 Blackwell Publishing Ltd.

A trial of a reproductive ethics and law curriculum for obstetrics and gynaecology residents.

PubMed

Arora, Kavita Shah

2014-12-01

Prior ethics educational interventions for residents have shown improvement in confidence and knowledge scores strictly in an internal medical resident population. Baseline knowledge and attitudes regarding reproductive ethics and law of obstetrics and gynaecology (ob/gyn) residents were assessed via a survey. Then, after completion of a 20-h curriculum for the residents, the residents were resurveyed in order to assess impact of the curriculum. An online survey with both multiple-choice and open-ended questions was administered to residents both prior to and after curriculum completion. A total of 39 residents (85% of the total ob/gyn residents) completed the survey. 67% of respondents thought ethics was very important in clinical practice, but only 3% considered themselves very familiar with medical ethics. Respondents were asked five case-based questions to assess baseline knowledge and only 10% answered all questions correctly prior to the curriculum. After the residents completed the curriculum, 31 subjects (79% of the original 39 resident respondents) responded to the same survey. 52% of respondents answered all five questions correctly and 31% considered themselves very familiar with medical ethics. Despite the importance placed on reproductive ethics and law by survey respondents including its impact on their clinical practices, there continues to be a deficiency in formal ethics education in ob/gyn. Our curriculum demonstrated both improvement in confidence as well as knowledge of residents towards issues of reproductive ethics and law. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The effects of a 5-week therapeutic horseback riding program on gross motor function in a child with cerebral palsy: a case study.

PubMed

Drnach, Mark; O'Brien, Patricia A; Kreger, Alison

2010-09-01

The purpose of this study was to determine the outcome of a short-term therapeutic horseback riding intervention on the gross motor function in a child with cerebral palsy. This study employed a repeated-measures design with a pretest, a post-test, and a post post-test conducted 5 weeks apart using the Gross Motor Function Measure (GMFM) as an outcome measure. The three sets of test scores from the GMFM were compared upon completion of the intervention. The subject participated in a 5-week therapeutic horseback riding program consisting of 1 hour of riding per week. Each riding session consisted of stretching, strengthening, and balance activities. The child's level of motor function was tested prior to the intervention, upon completion of the intervention, and 5 weeks postintervention. The GMFM, a criterion-referenced observational measure designed to measure change in the gross motor function in children with cerebral palsy, was chosen as the assessment tool. Upon completion of the 5-week intervention, the child was observed to have improved scores on the GMFM in two of the five dimensions measured and scored for a total of eight items. The post post-test was completed 5 weeks after the final riding session and the results demonstrated successful maintenance of the improved scores in seven of eight items. The result of this case study suggest that 5 weeks of therapeutic riding are sufficient to produce positive changes in the gross motor function of a child with cerebral palsy.

Improving health care proxy documentation using a web-based interview through a patient portal

PubMed Central

Crotty, Bradley H; Kowaloff, Hollis B; Safran, Charles; Slack, Warner V

2016-01-01

Objective Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and documentation, we sought to develop and evaluate a web-based interview to guide patients in their selection, and to capture their choices in their electronic health record (EHR). Methods We developed and implemented a HCP interview within the patient portal of a large academic health system. We analyzed the experience, together with demographic and clinical factors, of the first 200 patients who used the portal to complete the interview. We invited users to comment about their experience and analyzed their comments using established qualitative methods. Results From January 20, 2015 to March 13, 2015, 139 of the 200 patients who completed the interview submitted their HCP information for their clinician to review in the EHR. These patients had a median age of 57 years (Inter Quartile Range (IQR) 45–67) and most were healthy. The 99 patients who did not previously have HCP information in their EHR were more likely to complete and then submit their information than the 101 patients who previously had a proxy in their health record (odds ratio 2.4, P = .005). Qualitative analysis identified several ways in which the portal-based interview reminded, encouraged, and facilitated patients to complete their HCP. Conclusions Patients found our online interview convenient and helpful in facilitating selection and documentation of an HCP. Our study demonstrates that a web-based interview to collect and share a patient’s HCP information is both feasible and useful. PMID:26568608

Assessing Academic Self-Efficacy, Knowledge, and Attitudes in Undergraduate Physiology Students

PubMed Central

Woolcock, Andrew D.; Creevy, Kate E.; Coleman, Amanda E.; Moore, James N.; Brown, Scott A.

2016-01-01

Academic self-efficacy affects the success of students in the sciences. Our goals were to develop an instrument to assess the self-efficacy and attitudes toward science of students in an undergraduate physiology course. We hypothesized 1) that our instrument would demonstrate that students taking this course would exhibit greater self-efficacy and more positive attitudes toward science than students in a non-science undergraduate course, and 2) that the physiology students’ self-efficacy and attitudes would improve after completing the course. A 25-question survey instrument was developed with items investigating demographic information, self-efficacy, content knowledge, confidence, and attitudes regarding science. Students in either an undergraduate physiology course (Group P) or a history course (Group H) completed the survey. Forty-eight students in Group P completed both PRE- and POST-class surveys, while 50 students in Group H completed the pre-class survey. The academic self-efficacy of Group P as assessed by the PRE-survey was significantly higher than Group H (p=0.0003). Interestingly, there was no significant difference between groups in content knowledge in the PRE-survey. The self-efficacy of Group P was significantly higher as assessed by the POST-survey, when compared to the PRE-survey (p<0.0001) coincident with an improvement (p<0.001) in content knowledge for Group P in the POST-survey. This study established a survey instrument with utility in assessing self-efficacy, attitudes, and content knowledge. Our approach has applicability to studies designed to determine the impact of instructional variables on academic self-efficacy, attitudes, and confidence of students in the sciences. PMID:27713903

Oral health-related quality of life after prosthetic rehabilitation: a longitudinal study with the OHIP questionnaire.

PubMed

Jenei, Ágnes; Sándor, János; Hegedűs, Csaba; Bágyi, Kinga; Nagy, László; Kiss, Csongor; Szabó, Gyula; Márton, Ildikó J

2015-07-10

Aspects of oral health related quality of life (OHRQoL) attracted an increased attention recently. The aim of the study was to assess self-reported oral health related quality of life (OHRQoL) among patients requiring prosthetic rehabilitation and to determine the rate of improvement 1 month and 6-12 months after therapy. In addition, effect of age, gender, oral health indicators and denture types before treatment were assessed on OHRQoL as evaluated and reported by the patients. Hungarian version of OHIP-49 (OHIP-49-H) questionnaire was completed before oral rehabilitation (T0-phase) by 389 patients undergoing prosthetic replacement. After 1 month (T1-phase) and 6-12 months (T2-phase) recall periods 235 and 92 patients completed the questionnaire. The median interquartile range (IQR) values of the total OHIP-49-H score were calculated for T0-, T1- and T2-phases. Reliability of the questionnaire was checked by Cronbach's statistics. Age, gender, oral health indicators and denture types of patients before and after treatment were recorded and treatment-associated changes in OHRQoL were evaluated. The study demonstrated the excellent reliability and internal consistency of OHIP-49-H by a high and narrow range of Cronbach's alpha value (0.81-0.93). A median OHIP-49-H score of 52; IQR = 25-83 demonstrated a poor OHRQoL on first admission. Decreasing median total OHIP-49-H scores 1 month (24; IQR = 9-51; p < 0.001) and 6-12 months (20; IQR = 7-37; p = 0,055) after therapy indicated an improvement of OHRQoL. Patients' age and CPI value assessed before treatment proved to be significant factors of OHRQoL. Here we presented representative data about self-assessed OHRQoL of patients requiring prosthetic treatment from Hungary using OHIP-49-H questionnaire. The results demonstrated that the restoration of oral health was associated with an improvement in patients' OHRQoL. According to the demographical and T0 phase clinical status, the treatment was more effective in the respect of OHIP-49-H score improvement among females (than among males), among younger (than among more aged), and among patients with more serious CPI assessed at T0. The type of prosthetic interventions did not exert a significant effect on total OHIP-49-H score, suggesting that the improvement in OHRQoL is independent from the type of denture applied.

Bio-based polycarbonate as synthetic toolbox

NASA Astrophysics Data System (ADS)

Hauenstein, O.; Agarwal, S.; Greiner, A.

2016-06-01

Completely bio-based poly(limonene carbonate) is a thermoplastic polymer, which can be synthesized by copolymerization of limonene oxide (derived from limonene, which is found in orange peel) and CO2. Poly(limonene carbonate) has one double bond per repeating unit that can be exploited for further chemical modifications. These chemical modifications allow the tuning of the properties of the aliphatic polycarbonate in nearly any direction. Here we show synthetic routes to demonstrate that poly(limonene carbonate) is the perfect green platform polymer, from which many functional materials can be derived. The relevant examples presented in this study are the transformation from an engineering thermoplastic into a rubber, addition of permanent antibacterial activity, hydrophilization and even pH-dependent water solubility of the polycarbonate. Finally, we show a synthetic route to yield the completely saturated counterpart that exhibits improved heat processability due to lower reactivity.

Capabilities to improve corrosion resistance of fuel claddings by using powerful laser and plasma sources

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

Borisov, V. M., E-mail: borisov@triniti.ru; Trofimov, V. N.; Sapozhkov, A. Yu.

2016-12-15

The treatment conditions of fuel claddings of the E110 alloy by using powerful UV or IR laser radiation, which lead to the increase in the corrosion resistance at the high-temperature (T = 1100°C) oxidation simulating a loss-of-coolant accident, are determined. The possibility of the complete suppression of corrosion under these conditions by using pulsed laser deposition of a Cr layer is demonstrated. The behavior of protective coatings of Al, Al{sub 2}O{sub 3}, and Cr planted on steel EP823 by pulsed laser deposition, which is planned to be used in the BREST-OD-300, is studied. The methods of the almost complete suppressionmore » of corrosion in liquid lead to the temperature of 720°C are shown.« less

Benefits of a 'dental hygiene chew' on the periodontal health of cats.

PubMed

Gorrel, C; Inskeep, G; Inskeep, T

1998-09-01

A study was undertaken to determine the clinical efficacy of a chew designed to improve dental hygiene in the cat. The accumulation of dental deposits (plaque and calculus) and the effect on gingival inflammation were assessed in 15 client-owned cats while on two different regimens. In the first leg of the study, the cats were fed a nutritionally complete dry diet supplemented with one dental hygiene chew. In the second leg of the study, the same cats were fed only the nutritionally complete diet. This study demonstrated that the daily addition of the chew to the dry diet resulted in significantly less plaque and calculus accumulation on tooth surfaces. It was our experience that daily feeding of the chew helped maintain dental hygiene in cats; however, regular professional therapy is still indicated.

Does playing video games improve laparoscopic skills?

PubMed

Ou, Yanwen; McGlone, Emma Rose; Camm, Christian Fielder; Khan, Omar A

2013-01-01

A best evidence topic in surgery was written according to a structured protocol. The question addressed was whether playing video games improves surgical performance in laparoscopic procedures. Altogether 142 papers were found using the reported search, of which seven represented the best evidence to answer the clinical question. The details of the papers were tabulated including relevant outcomes and study weaknesses. We conclude that medical students and experienced laparoscopic surgeons with ongoing video game experience have superior laparoscopic skills for simulated tasks in terms of time to completion, improved efficiency and fewer errors when compared to non-gaming counterparts. There is some evidence that this may be due to better psycho-motor skills in gamers, however further research would be useful to demonstrate whether there is a direct transfer of skills from laparoscopic simulators to the operating table. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Edge enhancement and noise suppression for infrared image based on feature analysis

NASA Astrophysics Data System (ADS)

Jiang, Meng

2018-06-01

Infrared images are often suffering from background noise, blurred edges, few details and low signal-to-noise ratios. To improve infrared image quality, it is essential to suppress noise and enhance edges simultaneously. To realize it in this paper, we propose a novel algorithm based on feature analysis in shearlet domain. Firstly, as one of multi-scale geometric analysis (MGA), we introduce the theory and superiority of shearlet transform. Secondly, after analyzing the defects of traditional thresholding technique to suppress noise, we propose a novel feature extraction distinguishing image structures from noise well and use it to improve the traditional thresholding technique. Thirdly, with computing the correlations between neighboring shearlet coefficients, the feature attribute maps identifying the weak detail and strong edges are completed to improve the generalized unsharped masking (GUM). At last, experiment results with infrared images captured in different scenes demonstrate that the proposed algorithm suppresses noise efficiently and enhances image edges adaptively.

Microfluidics for rapid cytokeratin immunohistochemical staining in frozen sections.

PubMed

Brajkovic, Saska; Dupouy, Diego G; de Leval, Laurence; Gijs, Martin Am

2017-08-01

Frozen sections (FS) of tumor samples represent a cornerstone of pathological intraoperative consultation and have an important role in the microscopic analysis of specimens during surgery. So far, immunohistochemical (IHC) stainings on FS have been demonstrated for a few markers using manual methods. Microfluidic technologies have proven to bring substantial improvement in many fields of diagnostics, though only a few microfluidic devices have been designed to improve the performance of IHC assays. In this work, we show optimization of a complete pan-cytokeratin chromogenic immunostaining protocol on FS using a microfluidic tissue processor into a protocol taking <12 min. Our results showed specificity and low levels of background. The dimensions of the microfluidic prototype device are compatible with the space constraints of an intraoperative pathology laboratory. We therefore anticipate that the adoption of microfluidic technologies in the field of surgical pathology can significantly improve the way FSs influence surgical procedures.

Just-in-Time Training: A Novel Approach to Quality Improvement Education.

PubMed

Knutson, Allison; Park, Nesha D; Smith, Denise; Tracy, Kelly; Reed, Danielle J W; Olsen, Steven L

2015-01-01

Just-in-time training (JITT) is accepted in medical education as a training method for newer concepts or seldom-performed procedures. Providing JITT to a large nursing staff may be an effective method to teach quality improvement (QI) initiatives. We sought to determine if JITT could increase knowledge of a specific nutrition QI initiative. Members of the nutrition QI team interviewed staff using the Frontline Contextual Inquiry to assess knowledge regarding the specific QI project. The inquiry was completed pre- and post-JITT. A JITT educational cart was created, which allowed trainers to bring the educational information to the bedside for a short, small group educational session. The results demonstrated a marked improvement in the knowledge of the frontline staff regarding our Vermont Oxford Network involvement and the specifics of the nutrition QI project. Just-in-time training can be a valuable and effective method to disseminate QI principles to a large audience of staff members.

Doing better by getting worse: posthypnotic amnesia improves random number generation.

PubMed

Terhune, Devin Blair; Brugger, Peter

2011-01-01

Although forgetting is often regarded as a deficit that we need to control to optimize cognitive functioning, it can have beneficial effects in a number of contexts. We examined whether disrupting memory for previous numerical responses would attenuate repetition avoidance (the tendency to avoid repeating the same number) during random number generation and thereby improve the randomness of responses. Low suggestible and low dissociative and high dissociative highly suggestible individuals completed a random number generation task in a control condition, following a posthypnotic amnesia suggestion to forget previous numerical responses, and in a second control condition following the cancellation of the suggestion. High dissociative highly suggestible participants displayed a selective increase in repetitions during posthypnotic amnesia, with equivalent repetition frequency to a random system, whereas the other two groups exhibited repetition avoidance across conditions. Our results demonstrate that temporarily disrupting memory for previous numerical responses improves random number generation.

Doing Better by Getting Worse: Posthypnotic Amnesia Improves Random Number Generation

PubMed Central

Terhune, Devin Blair; Brugger, Peter

2011-01-01

Although forgetting is often regarded as a deficit that we need to control to optimize cognitive functioning, it can have beneficial effects in a number of contexts. We examined whether disrupting memory for previous numerical responses would attenuate repetition avoidance (the tendency to avoid repeating the same number) during random number generation and thereby improve the randomness of responses. Low suggestible and low dissociative and high dissociative highly suggestible individuals completed a random number generation task in a control condition, following a posthypnotic amnesia suggestion to forget previous numerical responses, and in a second control condition following the cancellation of the suggestion. High dissociative highly suggestible participants displayed a selective increase in repetitions during posthypnotic amnesia, with equivalent repetition frequency to a random system, whereas the other two groups exhibited repetition avoidance across conditions. Our results demonstrate that temporarily disrupting memory for previous numerical responses improves random number generation. PMID:22195022

Microfluidics for rapid cytokeratin immunohistochemical staining in frozen sections

PubMed Central

Brajkovic, Saska; Dupouy, Diego G.; de Leval, Laurence; Gijs, Martin A. M.

2017-01-01

Frozen sections (FS) of tumor samples represent a cornerstone of pathological intraoperative consultation and play an important role in the microscopic analysis of specimens during surgery. So far, immunohistochemical (IHC) stainings on FS have been demonstrated for a few markers using manual methods. Microfluidic technologies have proven to bring substantial improvement in many fields of diagnostics, though only a few microfluidic devices have been designed to improve the performance of IHC assays. In this work, we show optimization of a complete pan-cytokeratin chromogenic immunostaining protocol on FS using a microfluidic tissue processor, into a protocol taking less than 12 minutes. Our results showed specificity and low levels of background. The dimensions of the microfluidic prototype device are compatible with the space constraints of an intraoperative pathology laboratory. We therefore anticipate that the adoption of microfluidic technologies in the field of surgical pathology can significantly improve the way FSs influence surgical procedures. PMID:28553936

How people on social assistance perceive, experience, and improve oral health.

PubMed

Bedos, C; Levine, A; Brodeur, J-M

2009-07-01

Oral diseases are highly prevalent among people on social assistance. Despite benefiting from public dental coverage in North America, these people rarely consult the dentist. One possible reason is rooted in their perception of oral health and the means to improve it. To respond to this question, largely unexplored, we conducted qualitative research through 8 focus groups and 15 individual interviews in Montreal (Canada). Thematic analysis revealed that people on social assistance: (a) define oral health in a social manner, placing tremendous value on dental appearance; (b) complain about the decline of their dental appearance and its devastating impact on self-esteem, social interaction, and employability; and (c) feel powerless to improve their oral health and therefore contemplate extractions and complete dentures. Our research demonstrates that perception of oral health strongly influences treatment preference and explains low and selective use of dental services in this disadvantaged population.

The Tarrytown Chief Residents Leadership Conference: a long-term follow-up.

PubMed

Schwartz, Bruce J; Blackmore, Michelle A; Weiss, Andrea

2014-02-01

Creating training opportunities for the development of effective leaders is an increasingly important goal in psychiatry residency training programs. This article examines the long-term perceived impact of the Tarrytown Chief Residents Leadership Conference on preparing psychiatric residents for future leadership positions. Self-report surveys from attendees who participated in the conference between 1998 and 2011 were examined. Five hundred and forty-one completed surveys were returned (43 % response rate). Eighty-six percent of respondents reported moderate to extreme improvement in leadership confidence post-conference. Most respondents indicated at least moderate improvement in self-awareness (93 %), understanding of group process (92 %), and willingness to address conflict (89 %). Ninety percent felt the conference was important to their residency training, and 80 % indicated increased interest in leadership post-conference. Responders reported lasting improvements in their confidence in and perceived ability to utilize skills necessary for effective leadership, demonstrating the value of this experiential learning opportunity.

Improved silicon nitride for advanced heat engines

NASA Technical Reports Server (NTRS)

Yeh, H. C.; Wimmer, J. M.

1986-01-01

Silicon nitride is a high temperature material currently under consideration for heat engine and other applications. The objective is to improve the net shape fabrication technology of Si3N4 by injection molding. This is to be accomplished by optimizing the process through a series of statistically designed matrix experiments. To provide input to the matrix experiments, a wide range of alternate materials and processing parameters was investigated throughout the whole program. The improvement in the processing is to be demonstrated by a 20 percent increase in strength and a 100 percent increase in the Weibull modulus over that of the baseline material. A full characterization of the baseline process was completed. Material properties were found to be highly dependent on each step of the process. Several important parameters identified thus far are the starting raw materials, sinter/hot isostatic pressing cycle, powder bed, mixing methods, and sintering aid levels.

Enhancing sequential time perception and storytelling ability of deaf and hard of hearing children.

PubMed

Ingber, Sara; Eden, Sigal

2011-01-01

A 3-month intervention was conducted to enhance the sequential time perception and storytelling ability of young children with hearing loss. The children were trained to arrange pictorial episodes of temporal scripts and tell the stories they created. Participants (N = 34, aged 4-7 years) were divided into 2 groups based on whether their spoken-language gap was more or less than 1 year compared to age norms. They completed A. Kaufman and N. Kaufman's (1983) picture series subtest and Guralnik's (1982) storytelling test at pretest and posttest. Measures demonstrated significant improvement in sequential time and storytelling achievement postintervention. Three of the examined demographic variables revealed correlations: Participants with genetic etiology showed greater improvement in time sequencing and storytelling than participants with unknown etiology; early onset of treatment correlated with better achievement in time sequencing; cochlear implant users showed greater storytelling improvement than hearing aid users.

Orthopaedic resident preparedness for closed reduction and pinning of pediatric supracondylar fractures is improved by e-learning: a multisite randomized controlled study.

PubMed

Hearty, Thomas; Maizels, Max; Pring, Maya; Mazur, John; Liu, Raymond; Sarwark, John; Janicki, Joseph

2013-09-04

There is a need to provide more efficient surgical training methods for orthopaedic residents. E-learning could possibly increase resident surgical preparedness, confidence, and comfort for surgery. Using closed reduction and pinning of pediatric supracondylar humeral fractures as the index case, we hypothesized that e-learning could increase resident knowledge acquisition for case preparation in the operating room. An e-learning surgical training module was created on the Computer Enhanced Visual Learning platform. The module provides a detailed and focused road map of the procedure utilizing a multimedia format. A multisite prospective randomized controlled study design compared residents who used a textbook for case preparation (control group) with residents who used the same textbook plus completed the e-learning module (test group). All subjects completed a sixty-question test on the theory and methods of the case. After completion of the test, the control group then completed the module as well. All subjects were surveyed on their opinion regarding the effectiveness of the module after performing an actual surgical case. Twenty-eight subjects with no previous experience in this surgery were enrolled at four academic centers. Subjects were randomized into two equal groups. The test group scored significantly better (p < 0.001) and demonstrated competence on the test compared with the control group; the mean correct test score (and standard deviation) was 90.9% ± 6.8% for the test group and 73.5% ± 6.4% for the control group. All residents surveyed (n = 27) agreed that the module is a useful supplement to traditional methods for case preparation and twenty-two of twenty-seven residents agreed that it reduced their anxiety during the case and improved their attention to surgical detail. E-learning using the Computer Enhanced Visual Learning platform significantly improved preparedness, confidence, and comfort with percutaneous closed reduction and pinning of a pediatric supracondylar humeral fracture. We believe that adapting such methods into residency training programs will improve efficiency in surgical training.

Multidisciplinary pain facility treatment outcome for pain-associated fatigue.

PubMed

Fishbain, David A; Lewis, John; Cole, Brandly; Cutler, Brian; Smets, Eve; Rosomoff, Hubert; Rosomoff, Rennee Steele

2005-01-01

Fatigue is frequently found in chronic pain patients (CPPs) and may be etiologically related to the presence of pain. Fishbain et al. have recently demonstrated that chronic low back pain (LBP) and chronic neck pain patients are more fatigued than controls. The purpose of this study was to determine whether chronic LBP- and chronic neck pain-associated fatigue responded to multidisciplinary multimodal treatment not specifically targeted to the treatment of fatigue. A total of 85 chronic LBP and 33 chronic neck pain patients completed the Multidimensional Fatigue Inventory (MFI), Neuropathic Pain Scale (NPS), and Beck Depression Inventory on admission. In addition, an information tool was completed on each CPP by the senior author. This tool listed demographic information, primary and secondary pain diagnoses, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric diagnoses assigned, pain location, pain precipitating event, type of injury, years in pain, number of surgeries, type of surgery, type of pain pattern, opioids consumed per day in morphine equivalents, worker compensation status, and whether, according to the clinical examination, the CPP had a neuropathic pain component. At completion of the multidisciplinary multimodal treatment, each CPP again completed the MFI. Student's t-test was utilized to test for statistical changes on the MFI five scales from pre- to post-treatment. Pearson and point-biserial correlations were utilized to determine which variables significantly correlated with MFI change scores. Variables found significant at less than or equal to 0.01 were utilized in a stepwise aggression analysis to find variables predictive of change in MFI scores. Multidisciplinary pain facility. Chronic LBP and chronic neck pain patients. Multidisciplinary multimodal treatment significantly improved CPP fatigue as measured by the MFI. The available variables utilized to predict fatigue best explained only a small percentage (28.9%) of the variance. Improvement in fatigue was related to NPS-10 scale scores (neuropathic pain) and a previous diagnosis of fibromyalgia. Multidisciplinary multimodal pain facility treatment improves chronic LBP- and neck pain-associated fatigue. At the present time we cannot predict this improvement with significant accuracy.

Hand Robotic Therapy in Children with Hemiparesis: A Pilot Study.

PubMed

Bishop, Lauri; Gordon, Andrew M; Kim, Heakyung

2017-01-01

The aim of this study was to understand the impact of training with a hand robotic device on hand paresis and function in a population of children with hemiparesis. Twelve children with hemiparesis (mean age, 9 [SD, 3.64] years) completed participation in this prospective, experimental, pilot study. Participants underwent clinical assessments at baseline and again 6 weeks later with instructions to not initiate new therapies. After these assessments, participants received 6 weeks of training with a hand robotic device, consisting of 1-hour sessions, 3 times weekly. Assessments were repeated on completion of training. Results showed significant improvements after training on the Assisting Hand Assessment (mean difference, 2.0 Assisting Hand Assessment units; P = 0.011) and on the upper-extremity component of the Fugl-Meyer scale (raw score mean difference, 4.334; P = 0.001). No significant improvements between pretest and posttest were noted on the Jebsen-Taylor Test of Hand Function, the Quality of Upper Extremity Skills Test, or the Pediatric Evaluation of Disability Inventory after intervention. Total active mobility of digits and grip strength also failed to demonstrate significant changes after training. Participants tolerated training with the hand robotic device, and significant improvements in bimanual hand use, as well as impairment-based scales, were noted. Improvements were carried over into bimanual skills during play. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand key components of neuroplasticity; (2) Discuss the benefits of robotic therapy in the recovery of hand function in pediatric patients with hemiplegia; and (3) Appropriately incorporate robotic therapy into the treatment plan of pediatric patients with hemiplegia. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

[Development of X-ray Reflection Grating Technology for the Constellation-X Mission

NASA Technical Reports Server (NTRS)

Schattenburg, Mark L.

2005-01-01

This Grant supports MIT technology development of x-ray reflection gratings for the Constellation-X Reflection Grating Spectrometer (RGS). Since the start of the Grant MIT has extended its previously-developed patterning and super-smooth, blazed grating fabrication technology to ten-times smaller grating periods and ten-times larger blaze angles to demonstrate feasibility and performance in the off-plane grating geometry. In the past year we have focused our efforts on extending our Nanoruler grating fabrication tool to enable it to perform variable-period scanning-beam interference lithography (VP-SBIL). This new capability required extensive optical and mechanical improvements to the system. The design phase of this work is largely completed and key components are now on order and assembly has begun. Over the next several months the new VP-SBIL Nanoruler system will be completed and testing begun. We have also demonstrated a new technique for patterning gratings using the Nanoruler called Doppler mode, which will be important for patterning the radial groove gratings for the RGS using the new VP-SBIL system. Flat and thin grating substrates will be critical for the RGS. In the last year we demonstrated a new technique for flattening thin substrates using magneto-rheologic fluid polishing (MRF) and achieved 2 arcsecond flatness with a 0.5 mm-thick substrate-a world's record. This meets the Con X requirement for grating substrate flatness.

Measuring performance improvement: total organizational commitment or clinical specialization.

PubMed

Caron, Aleece; Jones, Paul; Neuhauser, Duncan; Aron, David C

2004-01-01

Resources for hospitals are limited when they are faced with multiple publicly reported performance measures as tools to assess quality. The leadership in these organizations may choose to focus on 1 or 2 of these outcomes. An alternative approach is that the leadership may commit resources or create conditions that result in improved quality over a broad range of measures. We used aggregated data on mortality, length of stay, and obstetrical outcomes from Greater Cleveland Health Quality Choice data to test these theories. We used Pearson correlation analysis to determine of outcomes were correlated with one another. We used repeated-measures ANOVA to determine if an association existed between outcome and time and outcome and hospital. All of the outcomes across all hospitals demonstrate a trend of overall improvement. Both the Pearson and ANOVA result support the hypothesis for the organization-wide approach to quality improvement. Hospital that make improvements in one clinical area trend to make improvements in others. Hospitals that produce improvements in limited clinical or administrative areas may not have completely adopted CQI into their culture or may not have yet realized the benefits of their organizational commitments, but use some of the concepts to improve quality outcomes.

Improving the psychometric properties of dot-probe attention measures using response-based computation.

PubMed

Evans, Travis C; Britton, Jennifer C

2018-09-01

Abnormal threat-related attention in anxiety disorders is most commonly assessed and modified using the dot-probe paradigm; however, poor psychometric properties of reaction-time measures may contribute to inconsistencies across studies. Typically, standard attention measures are derived using average reaction-times obtained in experimentally-defined conditions. However, current approaches based on experimentally-defined conditions are limited. In this study, the psychometric properties of a novel response-based computation approach to analyze dot-probe data are compared to standard measures of attention. 148 adults (19.19 ± 1.42 years, 84 women) completed a standardized dot-probe task including threatening and neutral faces. We generated both standard and response-based measures of attention bias, attentional orientation, and attentional disengagement. We compared overall internal consistency, number of trials necessary to reach internal consistency, test-retest reliability (n = 72), and criterion validity obtained using each approach. Compared to standard attention measures, response-based measures demonstrated uniformly high levels of internal consistency with relatively few trials and varying improvements in test-retest reliability. Additionally, response-based measures demonstrated specific evidence of anxiety-related associations above and beyond both standard attention measures and other confounds. Future studies are necessary to validate this approach in clinical samples. Response-based attention measures demonstrate superior psychometric properties compared to standard attention measures, which may improve the detection of anxiety-related associations and treatment-related changes in clinical samples. Copyright © 2018 Elsevier Ltd. All rights reserved.

Influence of learning style on instructional multimedia effects on graduate student cognitive and psychomotor performance.

PubMed

Smith, A Russell; Cavanaugh, Catherine; Jones, Joyce; Venn, John; Wilson, William

2006-01-01

Learning outcomes may improve in graduate healthcare students when attention is given to individual learning styles. Interactive multimedia is one tool shown to increase success in meeting the needs of diverse learners. The purpose of this study was to examine the effect of learning style and type of instruction on physical therapy students' cognitive and psychomotor performance. Participants were obtained by a sample of convenience with students recruited from two physical therapy programs. Twenty-seven students volunteered to participate from Program 1. Twenty-three students volunteered to participate from Program 2. Gregorc learning styles were identified through completion of the Gregorc Style Delineator. Students were randomly assigned to one of two instructional strategies: 1) instructional CD or 2) live demonstration. Differences in cognitive or psychomotor performance following instructional multimedia based on learning style were not demonstrated in this study. Written examination scores improved with both instructional strategies demonstrating no differences between the strategies. Practical examination ankle scores were significantly higher in participants receiving CD instruction than in participants receiving live presentation. Learning style did not significantly affect this improvement. Program 2 performed significantly better on written knee and practical knee and ankle examinations. Learning style had no significant effect on student performance following instruction in clinical skills via interactive multimedia. Future research may include additional measurement instruments assessing other models of learning styles and possible interaction of learning style and instructional strategy on students over longer periods of time, such as a semester or an entire curriculum.

Can pelvic floor muscle training improve sexual function in women with pelvic organ prolapse? A randomized controlled trial.

PubMed

Braekken, Ingeborg H; Majida, Memona; Ellström Engh, Marie; Bø, Kari

2015-02-01

Pelvic floor muscle training (PFMT) has level 1 evidence of reducing the size and symptoms associated with pelvic organ prolapse (POP). There is scant knowledge, however, regarding whether PFMT has an effect on sexual function. The aim of the trial was to evaluate the effect of PFMT on sexual function in women with POP. In this randomized controlled trial, 50 women were randomized to an intervention group (6 months of PFMT and lifestyle advice) and 59 women were randomized to a control group (lifestyle advice only). Participants completed a validated POP-specific questionnaire to describe frequency and bother of prolapse, bladder, bowel, and sexual symptoms and answered a semi-structured interview. No significant change in number of women being sexually active was reported. There were no significant differences between groups regarding change in satisfaction with frequency of intercourse. Interview data revealed that 19 (39%) of women in the PFMT group experienced improved sexual function vs. two (5%) in the control group (P<0.01). Specific improvements reported by some of the women were increased control, strength and awareness of the pelvic floor, improved self-confidence, sensation of a "tighter" vagina, improved libido and orgasms, resolution of pain with intercourse, and heightened sexual gratification for partners. Women who described improved sexual function demonstrated the greatest increases in pelvic floor muscle (PFM) strength (mean 16 ± 10 cmH2 0) and endurance (mean 150 ± 140 cmH2 0s) (P<0.01). PFMT can improve sexual function in some women. Women reporting improvement in sexual function demonstrated the greatest increase in PFM strength and endurance. © 2014 International Society for Sexual Medicine.

A Pilot Study of the Effects of Mindfulness-Based Cognitive Therapy on Positive Affect and Social Anxiety Symptoms.

PubMed

Strege, Marlene V; Swain, Deanna; Bochicchio, Lauren; Valdespino, Andrew; Richey, John A

2018-01-01

Randomized controlled trials have demonstrated that mindfulness-based cognitive therapy (MBCT) is efficacious in reducing residual depressive symptoms and preventing future depressive episodes (Kuyken et al., 2016). One potential treatment effect of MBCT may be improvement of positive affect (PA), due to improved awareness of daily positive events (Geschwind et al., 2011). Considering social anxiety disorder (SAD) is characterized by diminished PA (Brown et al., 1998; Kashdan, 2007), we sought to determine whether MBCT would reduce social anxiety symptoms, and whether this reduction would be associated with improvement of PA deficits. Adults ( N = 22) who met criteria for varied anxiety disorders participated in a small, open-label trial of an 8-week manualized MBCT intervention. Most participants presented with either a diagnosis (primary, secondary, or tertiary) of generalized anxiety disorder (GAD) ( N = 15) and/or SAD ( N = 14) prior to treatment, with eight individuals meeting diagnostic criteria for both GAD and SAD. We hypothesized participants would demonstrate improvements in social anxiety symptoms, which would be predicted by improvements in PA, not reductions in negative affect (NA). Results of several hierarchical linear regression analyses (completed in both full and disorder-specific samples) indicated that improvements in PA but not reductions in NA predicted social anxiety improvement. This effect was not observed for symptoms of worry, which were instead predicted by decreased NA for individuals diagnosed with GAD and both decreased NA and increased PA in the entire sample. Results suggest that MBCT may be efficacious in mitigating social anxiety symptoms, and this therapeutic effect may be linked to improvements in PA. However, further work is necessary considering the small, heterogeneous sample, uncontrolled study design, and exploratory nature of the study.

A Pilot Study of the Effects of Mindfulness-Based Cognitive Therapy on Positive Affect and Social Anxiety Symptoms

PubMed Central

Strege, Marlene V.; Swain, Deanna; Bochicchio, Lauren; Valdespino, Andrew; Richey, John A.

2018-01-01

Randomized controlled trials have demonstrated that mindfulness-based cognitive therapy (MBCT) is efficacious in reducing residual depressive symptoms and preventing future depressive episodes (Kuyken et al., 2016). One potential treatment effect of MBCT may be improvement of positive affect (PA), due to improved awareness of daily positive events (Geschwind et al., 2011). Considering social anxiety disorder (SAD) is characterized by diminished PA (Brown et al., 1998; Kashdan, 2007), we sought to determine whether MBCT would reduce social anxiety symptoms, and whether this reduction would be associated with improvement of PA deficits. Adults (N = 22) who met criteria for varied anxiety disorders participated in a small, open-label trial of an 8-week manualized MBCT intervention. Most participants presented with either a diagnosis (primary, secondary, or tertiary) of generalized anxiety disorder (GAD) (N = 15) and/or SAD (N = 14) prior to treatment, with eight individuals meeting diagnostic criteria for both GAD and SAD. We hypothesized participants would demonstrate improvements in social anxiety symptoms, which would be predicted by improvements in PA, not reductions in negative affect (NA). Results of several hierarchical linear regression analyses (completed in both full and disorder-specific samples) indicated that improvements in PA but not reductions in NA predicted social anxiety improvement. This effect was not observed for symptoms of worry, which were instead predicted by decreased NA for individuals diagnosed with GAD and both decreased NA and increased PA in the entire sample. Results suggest that MBCT may be efficacious in mitigating social anxiety symptoms, and this therapeutic effect may be linked to improvements in PA. However, further work is necessary considering the small, heterogeneous sample, uncontrolled study design, and exploratory nature of the study.

Treatment of Dysphagia with Pyridostigmine Bromide in a Patient with the Pharyngeal-Cervical-Brachial Variant of Guillain-Barré Syndrome

PubMed Central

Lee, Kwang Lae; Lim, Oh Kyung; Park, Ki Deok

2012-01-01

A 24-year-old male developed bulbar palsy, ophthalmoplegia, ptosis, and shoulder weakness bilaterally 2 weeks after he had experienced an upper respiratory infection. The electrodiagnostic study demonstrated axonal polyradiculoneuropathy. The repetitive nerve stimulation study (RNS) showed no significant decrement of the compound muscle action potentials (CMAPs). The videofluoroscopic swallowing study (VFSS) showed severe impairment of the pharyngeal phase of swallowing. He was diagnosed as having the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. The patient's dysphagia was not improved for 3 months. A follow up RNS showed a significant decrement of the CMAPs. Pyridostigmine bromide was tried to improve the dysphagia. The patient showed immediate improvement of his dysphagia on the VFSS after the trial with pyridostigmine bromide. Pyridostigmine bromide was given before each meal for 8 days and he showed continuous improvement of his dysphagia. The follow up VFSS after 3 months showed complete recovery of dysphagia. PMID:22506249

Treatment of Dysphagia with pyridostigmine bromide in a patient with the pharyngeal-cervical-brachial variant of guillain-barré syndrome.

PubMed

Lee, Kwang Lae; Lim, Oh Kyung; Lee, Ju Kang; Park, Ki Deok

2012-02-01

A 24-year-old male developed bulbar palsy, ophthalmoplegia, ptosis, and shoulder weakness bilaterally 2 weeks after he had experienced an upper respiratory infection. The electrodiagnostic study demonstrated axonal polyradiculoneuropathy. The repetitive nerve stimulation study (RNS) showed no significant decrement of the compound muscle action potentials (CMAPs). The videofluoroscopic swallowing study (VFSS) showed severe impairment of the pharyngeal phase of swallowing. He was diagnosed as having the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. The patient's dysphagia was not improved for 3 months. A follow up RNS showed a significant decrement of the CMAPs. Pyridostigmine bromide was tried to improve the dysphagia. The patient showed immediate improvement of his dysphagia on the VFSS after the trial with pyridostigmine bromide. Pyridostigmine bromide was given before each meal for 8 days and he showed continuous improvement of his dysphagia. The follow up VFSS after 3 months showed complete recovery of dysphagia.

The Chevron Foil Thrust Bearing: Improved Performance Through Passive Thermal Management and Effective Lubricant Mixing

NASA Technical Reports Server (NTRS)

Bruckner, Robert

2013-01-01

An improved foil thrust bearing is described that eliminates or reduces the need for forced cooling of the bearing foils while at the same time improves the load capacity of the bearing, enhances damping, provides overload tolerance, and eliminates the high speed load capacity drop-off that plagues the current state of the art. The performance improvement demonstrated by the chevron foil thrust bearing stems from a novel trailing edge shape that splays the hot lubricant in the thin film radially, thus preventing hot lubricant carry-over into the ensuing bearing sector. Additionally, the chevron shaped trailing edge induces vortical mixing of the hot lubricant with the gas that is naturally resident within the inter-pad region of a foil thrust bearing. The elimination of hot gas carry-over in combination with the enhanced mixing has enabled a completely passive thermally managed foil bearing design. Laboratory testing at NASA has confirmed the original analysis and reduced this concept to practice.

The Taylor saddle effacement: a new technique for correction of saddle nose deformity.

PubMed

Taylor, S Mark; Rigby, Matthew H

2008-02-01

To describe a novel technique, the Taylor saddle effacement (TSE), for correction of saddle nose deformity using autologous grafts from the lower lateral cartilages. A prospective evaluation of six patients, all of whom had the TSE performed. Photographs were taken in combination with completion of a rhinoplasty outcomes questionnaire preoperatively and at 6 months. The questionnaire included a visual analogue scale (VAS) of nasal breathing and a rhinoplasty outcomes evaluation (ROE) of nasal function and esthetics. All six patients had improvement in both their global nasal airflow on the VAS and on their ROE that was statistically significant. The mean preoperative VAS score was 5.8 compared with our postoperative mean of 8.5 of a possible 10. Mean ROE scores improved from 34.7 to 85.5. At 6 months, all patients felt that their nasal appearance had improved. The TSE is a simple and reliable technique for correction of saddle nose deformity. This prospective study has demonstrated improvement in both nasal function and esthetics when it is employed.

Preparing Future Leaders: An Integrated Quality Improvement Residency Curriculum.

PubMed

Potts, Stacy; Shields, Sara; Upshur, Carole

2016-06-01

The Accreditation Council for Graduate Medical Education (ACGME) has recognized the importance of quality improvement (QI) training and requires that accredited residencies in all specialties demonstrate that residents are "integrated and actively participate in interdisciplinary clinical quality improvement and patient safety activities." However, competing demands in residency training may make this difficult to accomplish. The study's objective is to develop and evaluate a longitudinal curriculum that meets the ACGME requirement for QI and patient safety training and links to patient-centered medical home (PCMH) practices. Residents in the Worcester Family Medicine Residency (WFMR) participated in a faculty-developed quality improvement curriculum that included web-based tutorials, quality improvement projects, and small-group sessions across all 3 years of residency. They completed self-evaluations of knowledge and use of curricular activities annually and at graduation, and comparisons were made between two graduating classes, as well as comparison of end of PGY2 to end of PGY3 for one class. Graduating residents who completed the full 3 years of the curriculum rated themselves as significantly more skilled in nine of 15 areas assessed at end of residency compared to after PGY2 and reported confidence in providing future leadership in a focus group. Five areas were also rated significantly higher than prior-year residents. Involving family medicine residents in a longitudinal curriculum with hands-on practice in implementing QI, patient safety, and chronic illness management activities that are inclusive of PCMH goals increased their self-perceived skills and leadership ability to implement these new and emerging evidence-based practices in primary care.

Changing conversations: teaching safety and quality in residency training.

PubMed

Voss, John D; May, Natalie B; Schorling, John B; Lyman, Jason A; Schectman, Joel M; Wolf, Andrew M D; Nadkarni, Mohan M; Plews-Ogan, Margaret

2008-11-01

Improving patient safety and quality in health care is one of medicine's most pressing challenges. Residency training programs have a unique opportunity to meet this challenge by training physicians in the science and methods of patient safety and quality improvement (QI).With support from the Health Resources and Services Administration, the authors developed an innovative, longitudinal, experiential curriculum in patient safety and QI for internal medicine residents at the University of Virginia. This two-year curriculum teaches the critical concepts and skills of patient safety and QI: systems thinking and human factors analysis, root cause analysis (RCA), and process mapping. Residents apply these skills in a series of QI and patient safety projects. The constructivist educational model creates a learning environment that actively engages residents in improving the quality and safety of their medical practice.Between 2003 and 2005, 38 residents completed RCAs of adverse events. The RCAs identified causes and proposed useful interventions that have produced important care improvements. Qualitative analysis demonstrates that the curriculum shifted residents' thinking about patient safety to a systems-based approach. Residents completed 237 outcome assessments during three years. Results indicate that seminars met predefined learning objectives and were interactive and enjoyable. Residents strongly believe they gained important skills in all domains.The challenge to improve quality and safety in health care requires physicians to learn new knowledge and skills. Graduate medical education can equip new physicians with the skills necessary to lead the movement to safer and better quality of care for all patients.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Improving Nurses' Peripheral Intravenous Catheter Insertion Knowledge, Confidence, and Skills Using a Simulation-Based Blended Learning Program: A Randomized Trial.

PubMed

Keleekai, Nowai L; Schuster, Catherine A; Murray, Connie L; King, Mary Anne; Stahl, Brian R; Labrozzi, Laura J; Gallucci, Susan; LeClair, Matthew W; Glover, Kevin R

2016-12-01

Peripheral intravenous catheter (PIVC) insertion is one of the most common invasive procedures performed in a hospital, but most nurses receive little formal training in this area. Blended PIVC insertion training programs that incorporate deliberate simulated practice have the potential to improve clinical practice and patient care. The study was a randomized, wait-list control group with crossover using nurses on three medical/surgical units. Baseline PIVC knowledge, confidence, and skills assessments were completed for both groups. The intervention group then received a 2-hour PIVC online course, followed by an 8-hour live training course using a synergistic mix of three simulation tools. Both groups were then reassessed. After crossover, the wait-list group received the same intervention and both groups were reassessed. At baseline, both groups were similar for knowledge, confidence, and skills. Compared with the wait-list group, the intervention group had significantly higher scores for knowledge, confidence, and skills upon completing the training program. After crossover, the wait-list group had similarly higher scores for knowledge, confidence, and skills than the intervention group. Between the immediate preintervention and postintervention periods, the intervention group improved scores for knowledge by 31%, skills by 24%, and decreased confidence by 0.5%, whereas the wait-list group improved scores for knowledge by 28%, confidence by 16%, and skills by 15%. Results demonstrate significant improvements in nurses' knowledge, confidence, and skills with the use of a simulation-based blended learning program for PIVC insertion. Transferability of these findings from a simulated environment into clinical practice should be further explored.

Invited review: Recommendations for reporting intervention studies on reproductive performance in dairy cattle: Improving design, analysis, and interpretation of research on reproduction.

PubMed

Lean, Ian J; Lucy, Matthew C; McNamara, John P; Bradford, Barry J; Block, Elliot; Thomson, Jennifer M; Morton, John M; Celi, Pietro; Rabiee, Ahmad R; Santos, José E P; Thatcher, William W; LeBlanc, Stephen J

2016-01-01

Abundant evidence from the medical, veterinary, and animal science literature demonstrates that there is substantial room for improvement of the clarity, completeness, and accuracy of reporting of intervention studies. More rigorous reporting guidelines are needed to improve the quality of data available for use in comparisons of outcomes (or meta-analyses) of multiple studies. Because of the diversity of factors that affect reproduction and the complexity of interactions between these, a systematic approach is required to design, conduct, and analyze basic and applied studies of dairy cattle reproduction. Greater consistency, clarity, completeness, and correctness of design and reporting will improve the value of each report and allow for greater depth of evaluation in meta-analyses. Each of these benefits will improve understanding and application of current knowledge and better identify questions that require additional modeling or primary research. The proposed guidelines and checklist will aid in the design, conduct, analysis, and reporting of intervention studies. We propose an adaptation of the REFLECT (Reporting Guidelines for Randomized Controlled Trials for Livestock and Food Safety) statement to provide guidelines and a checklist specific to reporting intervention studies in dairy cattle reproduction. Furthermore, we provide recommendations that will assist investigators to produce studies with greater internal and external validity that can more often be included in systematic reviews and global meta-analyses. Such studies will also assist the development of models to describe the physiology of reproduction. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Using health technology assessment to identify gaps in evidence and inform study design for comparative effectiveness research.

PubMed

Tunis, Sean R; Turkelson, Charles

2012-12-01

Health technology assessment (HTA) is primarily used as a tool to ensure that clinical and policy decisions are made with the benefit of a systematic analysis of all completed research. This article describes the progress and potential for HTA reports to improve the quality and relevance of future research and to better serve the information needs of patients, clinicians, payers, and other decision makers. We conducted a review of the current published literature and working papers describing past, ongoing, and future initiatives that rely on HTA reports to identify gaps in evidence and improve the design of future research. Although still in a developmental stage, significant progress is under way to improve methods for using HTA reports for the systematic identification of research gaps, prioritization of future research, and improvement of study designs. Several well-defined frameworks have been developed to assist those who produce HTA to become more effective in these additional domains of work. A recurring element of this work is the importance of meaningfully involving stakeholders in the process of defining future research needs and designing studies to address them. Patients, clinicians, and payers are important audiences for completed research and are now recognized as serving an important role in determining what future research is needed. There are substantial opportunities to improve the quality, relevance, and efficiency of clinical research. Recent efforts are beginning to demonstrate the potential to build on the work invested in developing HTA reports to provide a roadmap toward these objectives.

Improving the Isotretinoin Photostability by Incorporating in Microemulsion Matrix

PubMed Central

Patel, Mrunali R.; Patel, Rashmin B.; Parikh, Jolly R.; Patel, Bharat G.

2011-01-01

The present paper demonstrates the increased photostability of isotretinoin when loaded in microemulsion. The photodegradation of isotretinoin, in methanol and microemulsion formulation was studied under direct sun light. The photodegradation process was monitored by UV spectrophotometry. In methanol solution, isotretinoin undergoes complete photodegradation just within a few minutes of light exposure. Isotretinoin incorporated in microemulsion formulation showed an increased stability in comparison to the methanol solutions. In particular for isotretinoin, a residual concentration of 75% was still present after a light irradiance versus a residual value of just 16% measured at the same time in methanol solution. Further, degradation kinetic parameters of isotretinoin-loaded microemulsion formulation were demonstrated increase isotretinoin half-life about five-times in comparison with a methanol solution under a direct sun light. PMID:22389863

Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial.

PubMed

Troche, M S; Okun, M S; Rosenbek, J C; Musson, N; Fernandez, H H; Rodriguez, R; Romrell, J; Pitts, T; Wheeler-Hegland, K M; Sapienza, C M

2010-11-23

Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement. This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images. No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group. EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement. This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST.

An Evidence-Based Medicine Curriculum Improves General Surgery Residents' Standardized Test Scores in Research and Statistics.

PubMed

Trickey, Amber W; Crosby, Moira E; Singh, Monika; Dort, Jonathan M

2014-12-01

The application of evidence-based medicine to patient care requires unique skills of the physician. Advancing residents' abilities to accurately evaluate the quality of evidence is built on understanding of fundamental research concepts. The American Board of Surgery In-Training Examination (ABSITE) provides a relevant measure of surgical residents' knowledge of research design and statistics. We implemented a research education curriculum in an independent academic medical center general residency program, and assessed the effect on ABSITE scores. The curriculum consisted of five 1-hour monthly research and statistics lectures. The lectures were presented before the 2012 and 2013 examinations. Forty residents completing ABSITE examinations from 2007 to 2013 were included in the study. Two investigators independently identified research-related item topics from examination summary reports. Correct and incorrect responses were compared precurriculum and postcurriculum. Regression models were calculated to estimate improvement in postcurriculum scores, adjusted for individuals' scores over time and postgraduate year level. Residents demonstrated significant improvement in postcurriculum examination scores for research and statistics items. Correct responses increased 27% (P < .001). Residents were 5 times more likely to achieve a perfect score on research and statistics items postcurriculum (P < .001). Residents at all levels demonstrated improved research and statistics scores after receiving the curriculum. Because the ABSITE includes a wide spectrum of research topics, sustained improvements suggest a genuine level of understanding that will promote lifelong evaluation and clinical application of the surgical literature.

Impact of nurse-led behavioural counselling to improve metabolic health and physical activity among adults with mental illness.

PubMed

Fraser, Sarah J; Brown, Wendy J; Whiteford, Harvey A; Burton, Nicola W

2018-04-01

The life expectancy of adults with mental illness is significantly less than that of the general population, and this is largely due to poor physical health. Behavioural counselling can improve physical health indicators among people with non-communicable disease. This repeated-measures, single-group intervention trial evaluated the effects of a 19-week behavioural counselling programme on metabolic health indicators and physical activity levels of outpatient adults with mental illness. Sixteen participants completed the intervention that comprised individual face-to-face counselling sessions with a registered nurse every 3 weeks, and progress reviews with a medical practitioner every 6 weeks. Assessment included self-report and objective measurement of physical activity, and measures of blood pressure and anthropometry. Statistically-significant changes were demonstrated between baseline and post intervention for participants' waist circumference (P = 0.035) and waist-to-height ratio (P = 0.037). Non-significant improvements were demonstrated in weight and physical activity. The findings indicated that adults with mental illness can engage in a nurse-led behavioural counselling intervention, with improvements in some metabolic health measures after 19 weeks. It is recommended that behavioural counselling programmes for adults with mental illness be sustained over time and have an 'open door' policy to allow for attendance interruptions, such as hospitalization. © 2017 Australian College of Mental Health Nurses Inc.

Using multifaceted education to improve management in acute viral bronchiolitis.

PubMed

Murch, Hannah; Oakley, Juliette; Pierrepoint, Marcus; Powell, Colin

2015-07-01

To establish current bronchiolitis management across hospitals in Wales, improve compliance with national guidelines and standardise evidence-based clinical practice. A complete audit cycle with implementation of a multifaceted education bundle prior to the follow-up audit. Twelve acute paediatric departments between 1 November and 31 December in 2012 and 2013. All infants under 12 months with a clinical diagnosis of bronchiolitis. The first audit assessed management of bronchiolitis with reference to both the Scottish Intercollegiate Guideline Network (SIGN) guidelines and local hospital guidelines. Following analysis and dissemination of these results, an education bundle was implemented nationwide, with completion of the audit cycle to assess change. Compliance with SIGN recommendations for investigation, treatment and discharge. Compliance with the education bundle requirements also assessed in 2013. Data were collected for 1599 infants. The education bundle was delivered in all hospitals. The level of severity, defined by oxygen saturations in air at presentation, length of stay and paediatric intensive care unit transfers, was equivalent for both years. Mean compliance percentage (95% CI) across Wales significantly improved between 2012 and 2013, with compliance with investigations increasing from 50% (46% to 53%) to 71% (68% to 74%), with management increasing from 65% (61% to 68%) to 74% (71% to 77%), and overall compliance improving from 38% (37% to 39%) to 59% (56% to 62%) in 2013. This audit demonstrated a significant improvement in compliance following implementation of our educational bundle. This has enabled improvement in standardised and evidence-based patient care across Wales. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Evaluation of TEAM dynamics before and after remote simulation training utilizing CERTAIN platform.

PubMed

Pennington, Kelly M; Dong, Yue; Coville, Hongchuan H; Wang, Bo; Gajic, Ognjen; Kelm, Diana J

2018-12-01

The current study examines the feasibility and potential effects of long distance, remote simulation training on team dynamics. The study design was a prospective study evaluating team dynamics before and after remote simulation. Study subjects consisted of interdisciplinary teams (attending physicians, physicians in training, advanced care practitioners, and/or nurses). The study was conducted at nine training sites in eight countries. Study subjects completed 2-3 simulation scenarios of acute crises before and after training with the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN). Pre- and post-CERTAIN training simulations were evaluated by two independent reviewers utilizing the Team Emergency Assessment Measure (TEAM), which is a 11-item questionnaire that has been validated for assessing teamwork in the intensive care unit. Any discrepancies of greater than 1 point between the two reviewers on any question on the TEAM assessment were sent to a third reviewer to judge. The score that was deemed discordant by the third judge was eliminated. Pre- and post-CERTAIN training TEAM scores were averaged and compared. Of the nine teams evaluated, six teams demonstrated an overall improvement in global team performance following CERTAIN virtual training. For each of the 11 TEAM assessments, a trend toward improvement following CERTAIN training was noted; however, no assessment had universal improvement. 'Team composure and control' had the least absolute score improvement following CERTAIN training. The greatest improvement in the TEAM assessment scores was in the 'team's ability to complete tasks in a timely manner' and in the 'team leader's communication to the team'. The assessment of team dynamics using long distance, virtual simulation training appears to be feasible and may result in improved team performance during simulated patient crises; however, language and video quality were the two largest barriers noted during the review process.

Improving children's affective decision making in the Children's Gambling Task.

PubMed

Andrews, Glenda; Moussaumai, Jennifer

2015-11-01

Affective decision making was examined in 108 children (3-, 4-, and 5-year-olds) using the Children's Gambling Task (CGT). Children completed the CGT and then responded to awareness questions. Children in the binary_experience and binary_experience+awareness (not control) conditions first completed two simpler versions. Children in the binary_experience+awareness condition also responded to questions about relational components of the simpler versions. Experience with simpler versions facilitated decision making in 4- and 5-year-olds, but 3-year-olds' advantageous choices declined across trial blocks in the binary_experience and control conditions. Responding to questions about relational components further benefited the 4- and 5-year-olds. The 3-year-olds' advantageous choices on the final block were at chance level in the binary_experience+awareness condition but were below chance level in the other conditions. Awareness following the CGT was strongly correlated with advantageous choices and with age. Awareness was demonstrated by 5-year-olds (all conditions) and 4-year-olds (binary_experience and binary_experience+awareness) but not by 3-year-olds. The findings demonstrate the importance of complexity and conscious awareness in cognitive development. Copyright © 2015 Elsevier Inc. All rights reserved.

Rapid extraction and assay of uranium from environmental surface samples

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

Barrett, Christopher A.; Chouyyok, Wilaiwan; Speakman, Robert J.

Extraction methods enabling faster removal and concentration of uranium compounds for improved trace and low-level assay are demonstrated for standard surface sampling material in support of nuclear safeguards efforts, health monitoring, and other nuclear analysis applications. A key problem with the existing surface sampling swipes is the requirement for complete digestion of sample and sampling matrix. This is a time-consuming and labour-intensive process that limits laboratory throughput, elevates costs, and increases background levels. Various extraction methods are explored for their potential to quickly and efficiently remove different chemical forms of uranium from standard surface sampling material. A combination of carbonatemore » and peroxide solutions is shown to give the most rapid and complete form of uranyl compound extraction and dissolution. This rapid extraction process is demonstrated to be compatible with standard inductive coupled plasma mass spectrometry methods for uranium isotopic assay as well as screening techniques such as x-ray fluorescence. The general approach described has application beyond uranium to other analytes of nuclear forensic interest (e.g., rare earth elements and plutonium) as well as heavy metals for environmental and industrial hygiene monitoring.« less

Teaching binocular indirect ophthalmoscopy to novice residents using an augmented reality simulator.

PubMed

Rai, Amandeep S; Rai, Amrit S; Mavrikakis, Emmanouil; Lam, Wai Ching

2017-10-01

To compare the traditional teaching approach of binocular indirect ophthalmoscopy (BIO) to the EyeSI augmented reality (AR) BIO simulator. Prospective randomized control trial. 28 post-graduate year one (PGY1) ophthalmology residents. Residents were recruited at the 2012 Toronto Ophthalmology Residents Introductory Course (TORIC). 15 were randomized to conventional teaching (Group 1), and 13 to augmented reality simulator training (Group 2). 3 vitreoretinal fellows were enrolled to serve as experts. Evaluations were completed on the simulator, with 3 tasks, and outcome measures were total raw score, total time elapsed, and performance. Following conventional training, Group 1 residents were outperformed by vitreoretinal fellows with respect to all 3 outcome measures. Following AR training, Group 2 residents demonstrated superior total scores and performance compared to Group 1 residents. Once the Group 1 residents also completed the AR BIO training, there was a significant improvement compared to their baseline scores, and were now on par with Group 2 residents. This study provides construct validity for the EyeSI AR BIO simulator and demonstrates that it may be superior to conventional BIO teaching for novice ophthalmology residents. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

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

Rhinefrank, Kenneth; Lamb, Bradford; Prudell, Joseph

This Project aims to satisfy objectives of the DOE’s Water Power Program by completing a system detailed design (SDD) and other important activities in the first phase of a utility-scale grid-connected ocean wave energy demonstration. In early 2012, Columbia Power (CPwr) had determined that further cost and performance optimization was necessary in order to commercialize its StingRAY wave energy converter (WEC). CPwr’s progress toward commercialization, and the requisite technology development path, were focused on transitioning toward a commercial-scale demonstration. This path required significant investment to be successful, and the justification for this investment required improved annual energy production (AEP) andmore » lower capital costs. Engineering solutions were developed to address these technical and cost challenges, incorporated into a proposal to the US Department of Energy (DOE), and then adapted to form the technical content and statement of project objectives of the resulting Project (DE-EE0005930). Through Project cost-sharing and technical collaboration between DOE and CPwr, and technical collaboration with Oregon State University (OSU), National Renewable Energy Lab (NREL) and other Project partners, we have demonstrated experimentally that these conceptual improvements have merit and made significant progress towards a certified WEC system design at a selected and contracted deployment site at the Wave Energy Test Site (WETS) at the Marine Corps Base in Oahu, HI (MCBH).« less

Effectiveness of a Mindfulness-Based Childbirth Education pilot study on maternal self-efficacy and fear of childbirth.

PubMed

Byrne, Jean; Hauck, Yvonne; Fisher, Colleen; Bayes, Sara; Schutze, Robert

2014-01-01

This pilot study tested the feasibility and effectiveness of using Mindfulness-Based Childbirth Education (MBCE), a novel integration of mindfulness meditation and skills-based childbirth education, for mental health promotion with pregnant women. The MBCE protocol aimed to reduce fear of birth, anxiety, and stress and improve maternal self-efficacy. This pilot study also aimed to determine the acceptability and feasibility of the MBCE protocol. A single-arm pilot study of the MBCE intervention using a repeated-measures design was used to analyze data before and after the MBCE intervention to determine change trends with key outcome variables: mindfulness; depression, anxiety, and stress; childbirth self-efficacy; and fear of childbirth. Pregnant women (18-28 weeks' gestation) and their support companions attended weekly MBCE group sessions over 8 weeks in an Australian community setting. Of the 18 women who began and completed the intervention, missing data allowed for complete data from 12 participants to be analyzed. Statistically significant improvements and large effect sizes were observed for childbirth self-efficacy and fear of childbirth. Improvements in depression, mindfulness, and birth outcome expectations were underpowered. At postnatal follow-up significant improvements were found in anxiety, whereas improvements in mindfulness, stress, and fear of birth were significant at a less conservative alpha level. This pilot study demonstrated that a blended mindfulness and skills-based childbirth education intervention was acceptable to women and was associated with improvements in women's sense of control and confidence in giving birth. Previous findings that low self-efficacy and high childbirth fear are linked to greater labor pain, stress reactivity, and trauma suggest the observed improvements in these variables have important implications for improving maternal mental health and associated child health outcomes. Ways in which these outcomes can be achieved through improved childbirth education are discussed. © 2013 by the American College of Nurse-Midwives.

Outcomes From Pediatric Gastroenterology Maintenance of Certification Using Web-based Modules.

PubMed

Sheu, Josephine; Chun, Stanford; O'Day, Emily; Cheung, Sara; Cruz, Rusvelda; Lightdale, Jenifer R; Fishman, Douglas S; Bousvaros, Athos; Huang, Jeannie S

2017-05-01

Beginning in 2013, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) sponsored and developed subspecialty field-specific quality improvement (QI) activities to provide Part 4 Maintenance of Certification (MOC) credit for ongoing certification of pediatric gastroenterologists by the American Board of Pediatrics. Each activity was a Web-based module that measured clinical practice data repeatedly over at least 3 months as participants implemented rapid cycle change. Here, we examine existing variations in clinical practice among participating pediatric gastroenterologists and determine whether completion of Web-based MOC activities improves patient care processes and outcomes. We performed a cross-sectional and prospective analysis of physician and parent-reported clinical practice data abstracted from Web-based MOC modules on the topics of upper endoscopy, colonoscopy, and informed consent collected from pediatric gastroenterologists from North America from 2013 to 2016. Among 134 participating pediatric gastroenterologists, 56% practitioners practiced at an academic institution and most (94%) were NASPGHAN members. Participating physicians reported data from 6300 procedures. At baseline, notable practice variation across measured activities was demonstrated. Much of the rapid cycle changes implemented by participants involved individual behaviors, rather than system/team-based improvement activities. Participants demonstrated significant improvements on most targeted process and quality care outcomes. Pediatric gastroenterologists and parents reported baseline practice variation, and improvement in care processes and outcomes measured during NASPGHAN-sponsored Web-based MOC QI activities. Subspecialty-oriented Web-based MOC QI activities can reveal targets for reducing unwarranted variation in clinical pediatric practice, and can effectively improve care and patient outcomes.

The effect of normal aging and age-related macular degeneration on perceptual learning.

PubMed

Astle, Andrew T; Blighe, Alan J; Webb, Ben S; McGraw, Paul V

2015-01-01

We investigated whether perceptual learning could be used to improve peripheral word identification speed. The relationship between the magnitude of learning and age was established in normal participants to determine whether perceptual learning effects are age invariant. We then investigated whether training could lead to improvements in patients with age-related macular degeneration (AMD). Twenty-eight participants with normal vision and five participants with AMD trained on a word identification task. They were required to identify three-letter words, presented 10° from fixation. To standardize crowding across each of the letters that made up the word, words were flanked laterally by randomly chosen letters. Word identification performance was measured psychophysically using a staircase procedure. Significant improvements in peripheral word identification speed were demonstrated following training (71% ± 18%). Initial task performance was correlated with age, with older participants having poorer performance. However, older adults learned more rapidly such that, following training, they reached the same level of performance as their younger counterparts. As a function of number of trials completed, patients with AMD learned at an equivalent rate as age-matched participants with normal vision. Improvements in word identification speed were maintained at least 6 months after training. We have demonstrated that temporal aspects of word recognition can be improved in peripheral vision with training across a range of ages and these learned improvements are relatively enduring. However, training targeted at other bottlenecks to peripheral reading ability, such as visual crowding, may need to be incorporated to optimize this approach.

The effect of normal aging and age-related macular degeneration on perceptual learning

PubMed Central

Astle, Andrew T.; Blighe, Alan J.; Webb, Ben S.; McGraw, Paul V.

2015-01-01

We investigated whether perceptual learning could be used to improve peripheral word identification speed. The relationship between the magnitude of learning and age was established in normal participants to determine whether perceptual learning effects are age invariant. We then investigated whether training could lead to improvements in patients with age-related macular degeneration (AMD). Twenty-eight participants with normal vision and five participants with AMD trained on a word identification task. They were required to identify three-letter words, presented 10° from fixation. To standardize crowding across each of the letters that made up the word, words were flanked laterally by randomly chosen letters. Word identification performance was measured psychophysically using a staircase procedure. Significant improvements in peripheral word identification speed were demonstrated following training (71% ± 18%). Initial task performance was correlated with age, with older participants having poorer performance. However, older adults learned more rapidly such that, following training, they reached the same level of performance as their younger counterparts. As a function of number of trials completed, patients with AMD learned at an equivalent rate as age-matched participants with normal vision. Improvements in word identification speed were maintained at least 6 months after training. We have demonstrated that temporal aspects of word recognition can be improved in peripheral vision with training across a range of ages and these learned improvements are relatively enduring. However, training targeted at other bottlenecks to peripheral reading ability, such as visual crowding, may need to be incorporated to optimize this approach. PMID:26605694

Evaluating Practice-Based Learning and Improvement: Efforts to Improve Acceptance of Portfolios

PubMed Central

Fragneto, Regina Y.; DiLorenzo, Amy Noel; Schell, Randall M.; Bowe, Edwin A.

2010-01-01

Introduction The Accreditation Council for Graduate Medical Education (ACGME) recommends resident portfolios as 1 method for assessing competence in practice-based learning and improvement. In July 2005, when anesthesiology residents in our department were required to start a portfolio, the residents and their faculty advisors did not readily accept this new requirement. Intensive education efforts addressing the goals and importance of portfolios were undertaken. We hypothesized that these educational efforts improved acceptance of the portfolio and retrospectively audited the portfolio evaluation forms completed by faculty advisors. Methods Intensive education about the goals and importance of portfolios began in January 2006, including presentations at departmental conferences and one-on-one education sessions. Faculty advisors were instructed to evaluate each resident's portfolio and complete a review form. We retrospectively collected data to determine the percentage of review forms completed by faculty. The portfolio reviews also assessed the percentage of 10 required portfolio components residents had completed. Results Portfolio review forms were completed by faculty advisors for 13% (5/38) of residents during the first advisor-advisee meeting in December 2005. Initiation of intensive education efforts significantly improved compliance, with review forms completed for 68% (26/38) of residents in May 2006 (P < .0001) and 95% (36/38) in December 2006 (P < .0001). Residents also significantly improved the completeness of portfolios between May and December of 2006. Discussion Portfolios are considered a best methods technique by the ACGME for evaluation of practice-based learning and improvment. We have found that intensive education about the goals and importance of portfolios can enhance acceptance of this evaluation tool, resulting in improved compliance in completion and evaluation of portfolios. PMID:22132291

Evaluating practice-based learning and improvement: efforts to improve acceptance of portfolios.

PubMed

Fragneto, Regina Y; Dilorenzo, Amy Noel; Schell, Randall M; Bowe, Edwin A

2010-12-01

The Accreditation Council for Graduate Medical Education (ACGME) recommends resident portfolios as 1 method for assessing competence in practice-based learning and improvement. In July 2005, when anesthesiology residents in our department were required to start a portfolio, the residents and their faculty advisors did not readily accept this new requirement. Intensive education efforts addressing the goals and importance of portfolios were undertaken. We hypothesized that these educational efforts improved acceptance of the portfolio and retrospectively audited the portfolio evaluation forms completed by faculty advisors. Intensive education about the goals and importance of portfolios began in January 2006, including presentations at departmental conferences and one-on-one education sessions. Faculty advisors were instructed to evaluate each resident's portfolio and complete a review form. We retrospectively collected data to determine the percentage of review forms completed by faculty. The portfolio reviews also assessed the percentage of 10 required portfolio components residents had completed. Portfolio review forms were completed by faculty advisors for 13% (5/38) of residents during the first advisor-advisee meeting in December 2005. Initiation of intensive education efforts significantly improved compliance, with review forms completed for 68% (26/38) of residents in May 2006 (P < .0001) and 95% (36/38) in December 2006 (P < .0001). Residents also significantly improved the completeness of portfolios between May and December of 2006. Portfolios are considered a best methods technique by the ACGME for evaluation of practice-based learning and improvment. We have found that intensive education about the goals and importance of portfolios can enhance acceptance of this evaluation tool, resulting in improved compliance in completion and evaluation of portfolios.

A Lean Six Sigma quality improvement project to increase discharge paperwork completeness for admission to a comprehensive integrated inpatient rehabilitation program.

PubMed

Neufeld, Nathan J; Hoyer, Erik H; Cabahug, Philippines; González-Fernández, Marlís; Mehta, Megha; Walker, N Colbey; Powers, Richard L; Mayer, R Samuel

2013-01-01

Lean Six Sigma (LSS) process analysis can be used to increase completeness of discharge summary reports used as a critical communication tool when a patient transitions between levels of care. The authors used the LSS methodology as an intervention to improve systems process. Over the course of the project, 8 required elements were analyzed in the discharge paperwork. The authors analyzed the discharge paperwork of patients (42 patients preintervention and 143 patients postintervention) of a comprehensive integrated inpatient rehabilitation program (CIIRP). Prior to this LSS project, 61.8% of required discharge elements were present. The intervention improved the completeness to 94.2% of the required elements. The percentage of charts that were 100% complete increased from 11.9% to 67.8%. LSS is a well-established process improvement methodology that can be used to make significant improvements in complex health care workflow issues. Specifically, the completeness of discharge documentation required for transition of care to CIIRP can be improved.

Self-calibrated multiple-echo acquisition with radial trajectories using the conjugate gradient method (SMART-CG).

PubMed

Jung, Youngkyoo; Samsonov, Alexey A; Bydder, Mark; Block, Walter F

2011-04-01

To remove phase inconsistencies between multiple echoes, an algorithm using a radial acquisition to provide inherent phase and magnitude information for self correction was developed. The information also allows simultaneous support for parallel imaging for multiple coil acquisitions. Without a separate field map acquisition, a phase estimate from each echo in multiple echo train was generated. When using a multiple channel coil, magnitude and phase estimates from each echo provide in vivo coil sensitivities. An algorithm based on the conjugate gradient method uses these estimates to simultaneously remove phase inconsistencies between echoes, and in the case of multiple coil acquisition, simultaneously provides parallel imaging benefits. The algorithm is demonstrated on single channel, multiple channel, and undersampled data. Substantial image quality improvements were demonstrated. Signal dropouts were completely removed and undersampling artifacts were well suppressed. The suggested algorithm is able to remove phase cancellation and undersampling artifacts simultaneously and to improve image quality of multiecho radial imaging, the important technique for fast three-dimensional MRI data acquisition. Copyright © 2011 Wiley-Liss, Inc.

Self-calibrated Multiple-echo Acquisition with Radial Trajectories using the Conjugate Gradient Method (SMART-CG)

PubMed Central

Jung, Youngkyoo; Samsonov, Alexey A; Bydder, Mark; Block, Walter F.

2011-01-01

Purpose To remove phase inconsistencies between multiple echoes, an algorithm using a radial acquisition to provide inherent phase and magnitude information for self correction was developed. The information also allows simultaneous support for parallel imaging for multiple coil acquisitions. Materials and Methods Without a separate field map acquisition, a phase estimate from each echo in multiple echo train was generated. When using a multiple channel coil, magnitude and phase estimates from each echo provide in-vivo coil sensitivities. An algorithm based on the conjugate gradient method uses these estimates to simultaneously remove phase inconsistencies between echoes, and in the case of multiple coil acquisition, simultaneously provides parallel imaging benefits. The algorithm is demonstrated on single channel, multiple channel, and undersampled data. Results Substantial image quality improvements were demonstrated. Signal dropouts were completely removed and undersampling artifacts were well suppressed. Conclusion The suggested algorithm is able to remove phase cancellation and undersampling artifacts simultaneously and to improve image quality of multiecho radial imaging, the important technique for fast 3D MRI data acquisition. PMID:21448967

Current controversies in pediatric urologic robotic surgery.

PubMed

Trevisani, Lorenzo F M; Nguyen, Hiep T

2013-01-01

Minimally invasive surgeries such as conventional laparoscopic surgery and robotic assisted laparoscopic surgery (RALS) have significant advantages over the traditional open surgical approach including lower pain medication requirements and decreased length of hospitalization. However, open surgery has demonstrated better success rates and shorter surgery time when compared to the other modalities. Currently, it is unclear which approach has better long-term clinical outcomes, greater benefits and less cost. There are limited studies in the literature comparing these three different surgical approaches. In this review, we will evaluate the advantages and disadvantages of RALS compared to conventional laparoscopic surgery and open surgery for commonly performed pediatric urological procedures such as pyeloplasty, ureteral reimplantation, complete and partial nephrectomy, bladder augmentation and creation of continent catheterizable channels. Although it is not yet possible to demonstrate the superiority of one single surgical modality over another, RALS has been shown to be feasible, well tolerated and advantageous in reconstructive urological procedures. With experience, the outcomes of RALS are improving, justifying its usage. However, cost remains a significant issue, limiting the accessibility of RALS, which in the future may improve with market competition and device innovation.

Demonstration of transoral robotic supraglottic laryngectomy and total laryngectomy in cadaveric specimens using the Medrobotics Flex System.

PubMed

Funk, Emily; Goldenberg, David; Goyal, Neerav

2017-06-01

Current management of laryngeal malignancies is associated with significant morbidity. Application of minimally invasive transoral techniques may reduce the morbidity associated with traditional procedures. The purpose of this study was to present our investigation of the utility of a novel flexible robotic system for transoral supraglottic laryngectomy and total laryngectomy. Transoral total laryngectomy and transoral supraglottic laryngectomy were performed in cadaveric specimens using the Flex Robotic System (Medrobotics, Raynham, MA). All procedures were completed successfully in the cadaveric models. The articulated endoscope allowed for access to the desired surgical site. Flexible instruments enabled an atraumatic approach and allowed for precise surgical technique. Access to deep anatomic structures remains problematic using current minimally invasive robotic approaches. Improvements in visualization and access to the laryngopharyngeal complex offered by this system may improve surgical applications to the larynx. This study demonstrates the technical feasibility using the Flex Robotic System for transoral robotic supraglottic laryngectomy and total laryngectomy. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1218-1225, 2017. © 2017 Wiley Periodicals, Inc.

Room-Temperature Chemical Welding and Sintering of Metallic Nanostructures by Capillary Condensation.

PubMed

Yoon, Sung-Soo; Khang, Dahl-Young

2016-06-08

Room-temperature welding and sintering of metal nanostructures, nanoparticles and nanowires, by capillary condensation of chemical vapors have successfully been demonstrated. Nanoscale gaps or capillaries that are abundant in layers of metal nanostructures have been found to be the preferred sites for the condensation of chemically oxidizing vapor, H2O2 in this work. The partial dissolution and resolidification at such nanogaps completes the welding/sintering of metal nanostructures within ∼10 min at room-temperature, while other parts of nanostructures remain almost intact due to negligible amount of condensation on there. The welded networks of Ag nanowires have shown much improved performances, such as high electrical conductivity, mechanical flexibility, optical transparency, and chemical stability. Chemically sintered layers of metal nanoparticles, such as Ag, Cu, Fe, Ni, and Co, have also shown orders of magnitude increase in electrical conductivity and improved environmental stability, compared to nontreated ones. Pertinent mechanisms involved in the chemical welding/sintering process have been discussed. Room-temperature welding and sintering of metal nanostructures demonstrated here may find widespread application in diverse fields, such as displays, deformable electronics, wearable heaters, and so forth.

Strategy Guideline. Demonstration Home

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

Hunt, A.; Savage, C.

2012-12-01

This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

Strategy Guideline: Demonstration Home

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

Savage, C.; Hunt, A.

2012-12-01

This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

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

Wu, Amanda S.; Brosha, Eric

This is a progress report for the demonstration of a prototype hydrogen sensor and electronics package. There are five tasks associated with this, and four have been completed as of August 2016: Station Demonstration and Site Recommendation, Order Sensor Equipment, Build Sensors, and Install Sensors. The final task to be completed is Sensor Demonstration and Data Analysis, and expected completion date is January 26, 2017. This progress report details each of the tasks and goes into detail about what is currently being worked on, along with the budget and planned work for July 27, 2016 to January 26, 2017.

Effectiveness of the Simultaneous Stretching of the Achilles Tendon and Plantar Fascia in Individuals With Plantar Fasciitis.

PubMed

Engkananuwat, Phoomchai; Kanlayanaphotporn, Rotsalai; Purepong, Nithima

2018-01-01

Since the plantar fascia and the Achilles tendon are anatomically connected, it is plausible that stretching of both structures simultaneously will result in a better outcome for plantar fasciitis. Fifty participants aged 40 to 60 years with a history of plantar fasciitis greater than 1 month were recruited. They were prospectively randomized into 2 groups. Group 1 was instructed to stretch the Achilles tendon while group 2 simultaneously stretched the Achilles tendon and plantar fascia. After 4 weeks of both stretching protocols, participants in group 2 demonstrated a significantly greater pressure pain threshold than participants in group 1 ( P = .040) with post hoc analysis. No significant differences between groups were demonstrated in other variables ( P > .05). Concerning within-group comparisons, both interventions resulted in significant reductions in pain at first step in the morning and average pain at the medial plantar calcaneal region over the past 24 hours, while there were increases in the pressure pain threshold, visual analog scale-foot and ankle score, and range of motion in ankle dorsiflexion ( P < .001). More participants in group 2 described their symptoms as being much improved to being completely improved than those in group 1. The simultaneous stretching of the Achilles tendon and plantar fascia for 4 weeks was a more effective intervention for plantar fasciitis. Patients who reported complete relief from symptoms at the end of the 4-week intervention in the simultaneous stretching group (n = 14; 56%) were double that of the stretching of the Achilles tendon-only group (n = 7; 28%). II, lesser quality RCT or prospective comparative study.

Translating and testing the ENABLE: CHF-PC concurrent palliative care model for older adults with heart failure and their family caregivers.

PubMed

Dionne-Odom, J Nicholas; Kono, Alan; Frost, Jennifer; Jackson, Lisa; Ellis, Daphne; Ahmed, Ali; Azuero, Andres; Bakitas, Marie

2014-09-01

Heart failure (HF) and palliative care (PC) organizations recommend early PC to improve the quality of life of patients living with HF. We conducted a two-phase formative evaluation study to translate a cancer-focused concurrent PC intervention into one that would be appropriate for rural-dwelling adults with New York Heart Association Class III-IV HF and their primary caregivers. Phase I: We tailored the intervention for an HF population via literature review, expert consultation, and clinician (N=15) small group interviews. Phase II: We enrolled 11 patient/caregiver dyads to assess intervention feasibility and satisfaction. We assessed participants' experiences and satisfaction after session/week three and session/week six via digitally recorded interviews. Clinician and participant interviews were transcribed and content analyzed. Outcome measures were evaluated for completion rates and effect sizes. Phase I: Clinicians described barriers to initiating PC in HF, triggers for initiating PC, and suggestions for intervention improvement. Phase II: Participants were able to complete the majority of study sessions, measures, and interviews. Satisfaction interviews revealed the content to be relevant and comprehensive in addressing HF patient and caregiver primary concerns; however, participants unanimously suggested making the intervention available earlier in the illness trajectory. Efficacy measures demonstrated small to medium effect sizes. We tailored and demonstrated feasibility of providing an early, concurrent palliative care intervention to patients with advanced HF and their caregivers. Based on this experience we are now conducting an efficacy trial in a racially diverse sample.

The Effectiveness of Hands-on Health Informatics Skills Exercises in the Multidisciplinary Smart Home Healthcare and Health Informatics Training Laboratories.

PubMed

Sapci, A H; Sapci, H A

2017-10-01

This article aimed to evaluate the effectiveness of newly established innovative smart home healthcare and health informatics laboratories, and a novel laboratory course that focuses on experiential health informatics training, and determine students' self-confidence to operate wireless home health monitoring devices before and after the hands-on laboratory course. Two web-based pretraining and posttraining questionnaires were sent to 64 students who received hands-on training with wireless remote patient monitoring devices in smart home healthcare and health informatics laboratories. All 64 students completed the pretraining survey (100% response rate), and 49 students completed the posttraining survey (76% response rate). The quantitative data analysis showed that 95% of students had an interest in taking more hands-on laboratory courses. Sixty-seven percent of students had no prior experience with medical image, physiological data acquisition, storage, and transmission protocols. After the hands-on training session, 75.51% of students expressed improved confidence about training patients to measure blood pressure monitor using wireless devices. Ninety percent of students preferred to use a similar experiential approach in their future learning experience. Additionally, the qualitative data analysis demonstrated that students were expecting to have more courses with hands-on exercises and integration of technology-enabled delivery and patient monitoring concepts into the curriculum. This study demonstrated that the multidisciplinary smart home healthcare and health informatics training laboratories and the hands-on exercises improved students' technology adoption rates and their self-confidence in using wireless patient monitoring devices. Schattauer GmbH Stuttgart.

The Efficacy of Stuttering Measurement Training: Evaluating Two Training Programs

PubMed Central

Bainbridge, Lauren A.; Stavros, Candace; Ebrahimian, Mineh; Wang, Yuedong

2015-01-01

Purpose Two stuttering measurement training programs currently used for training clinicians were evaluated for their efficacy in improving the accuracy of total stuttering event counting. Method Four groups, each with 12 randomly allocated participants, completed a pretest–posttest design training study. They were evaluated by their counts of stuttering events on eight 3-min audiovisual speech samples from adults and children who stutter. Stuttering judgment training involved use of either the Stuttering Measurement System (SMS), Stuttering Measurement Assessment and Training (SMAAT) programs, or no training. To test for the reliability of any training effect, SMS training was repeated with the 4th group. Results Both SMS-trained groups produced approximately 34% improvement, significantly better than no training or the SMAAT program. The SMAAT program produced a mixed result. Conclusions The SMS program was shown to produce a “medium” effect size improvement in the accuracy of stuttering event counts, and this improvement was almost perfectly replicated in a 2nd group. Half of the SMAAT judges produced a 36% improvement in accuracy, but the other half showed no improvement. Additional studies are needed to demonstrate the durability of the reported improvements, but these positive effects justify the importance of stuttering measurement training. PMID:25629956

The efficacy of stuttering measurement training: evaluating two training programs.

PubMed

Bainbridge, Lauren A; Stavros, Candace; Ebrahimian, Mineh; Wang, Yuedong; Ingham, Roger J

2015-04-01

Two stuttering measurement training programs currently used for training clinicians were evaluated for their efficacy in improving the accuracy of total stuttering event counting. Four groups, each with 12 randomly allocated participants, completed a pretest-posttest design training study. They were evaluated by their counts of stuttering events on eight 3-min audiovisual speech samples from adults and children who stutter. Stuttering judgment training involved use of either the Stuttering Measurement System (SMS), Stuttering Measurement Assessment and Training (SMAAT) programs, or no training. To test for the reliability of any training effect, SMS training was repeated with the 4th group. Both SMS-trained groups produced approximately 34% improvement, significantly better than no training or the SMAAT program. The SMAAT program produced a mixed result. The SMS program was shown to produce a "medium" effect size improvement in the accuracy of stuttering event counts, and this improvement was almost perfectly replicated in a 2nd group. Half of the SMAAT judges produced a 36% improvement in accuracy, but the other half showed no improvement. Additional studies are needed to demonstrate the durability of the reported improvements, but these positive effects justify the importance of stuttering measurement training.

Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician’s management of cardiac arrest

PubMed Central

2016-01-01

Purpose: Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician’s management of simulated code scenarios. Methods: Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest), a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. Results: On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, P<0.001). Statistically significant improvement was also seen on the number of critical items completed (OR=3.75, 95% CI 2.71-5.19), total items completed (OR=4.55, 95% CI 3.4-6.11), and number of “excellent” scores on a Likert scale (OR=2.66, 95% CI 1.85-3.81). Conclusions: Nicaraguan resident physicians demonstrate improved ability to manage simulated cardiac arrest scenarios after participation in the Project SEMILLA resuscitation course and retain these skills. PMID:27378010

Using Lean Six Sigma Methodology to Improve a Mass Immunizations Process at the United States Naval Academy.

PubMed

Ha, Chrysanthy; McCoy, Donald A; Taylor, Christopher B; Kirk, Kayla D; Fry, Robert S; Modi, Jitendrakumar R

2016-06-01

Lean Six Sigma (LSS) is a process improvement methodology developed in the manufacturing industry to increase process efficiency while maintaining product quality. The efficacy of LSS application to the health care setting has not been adequately studied. This article presents a quality improvement project at the U.S. Naval Academy that uses LSS to improve the mass immunizations process for Midshipmen during in-processing. The process was standardized to give all vaccinations at one station instead of giving a different vaccination at each station. After project implementation, the average immunizations lead time decreased by 79% and staffing decreased by 10%. The process was shown to be in control with a capability index of 1.18 and performance index of 1.10, resulting in a defect rate of 0.04%. This project demonstrates that the LSS methodology can be applied successfully to the health care setting to make sustainable process improvements if used correctly and completely. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Brachypodium distachyon genomics for sustainable food and fuel production.

PubMed

Bevan, Michael W; Garvin, David F; Vogel, John P

2010-04-01

Grass crops are the most important sources of human nutrition, and their improvement is centrally important for meeting the challenges of sustainable agriculture, for feeding the world's population and for developing renewable supplies of fuel and industrial products. We describe the complete sequence of the compact genome of Brachypodium distachyon (Brachypodium) the first pooid grass to be sequenced. We demonstrate the many favorable characteristics of Brachypodium as an experimental system and show how it can be used to navigate the large and complex genomes of closely related grasses. The functional genomics and other experimental resources that are being developed will provide a key resource for improving food and forage crops, in particular wheat, barley and forage grasses, and for establishing new grass crops for sustainable energy production. Copyright 2010 Elsevier Ltd. All rights reserved.

Step to improve neural cryptography against flipping attacks.

PubMed

Zhou, Jiantao; Xu, Qinzhen; Pei, Wenjiang; He, Zhenya; Szu, Harold

2004-12-01

Synchronization of neural networks by mutual learning has been demonstrated to be possible for constructing key exchange protocol over public channel. However, the neural cryptography schemes presented so far are not the securest under regular flipping attack (RFA) and are completely insecure under majority flipping attack (MFA). We propose a scheme by splitting the mutual information and the training process to improve the security of neural cryptosystem against flipping attacks. Both analytical and simulation results show that the success probability of RFA on the proposed scheme can be decreased to the level of brute force attack (BFA) and the success probability of MFA still decays exponentially with the weights' level L. The synchronization time of the parties also remains polynomial with L. Moreover, we analyze the security under an advanced flipping attack.

Interdisciplinary treatment for an adult patient with anterior open bite, severe periodontitis, and intellectual disability.

PubMed

Kang, Da-Young; Choi, Sung-Hwan; Jung, Young-Soo; Hwang, Chung-Ju

2015-05-01

This case report describes the beneficial effects of the interdisciplinary treatment of an adult patient with severe skeletal periodontal problems. A 30-year-old female patient presented with anterior open bite, gummy smile, and facial asymmetry. The patient had chronic generalized severe periodontitis with pathologic maxillary anterior teeth migration and mild intellectual disability. Treatment included 6 months of periodontal treatment, followed by presurgical orthodontic treatment, a Le Fort I osteotomy with anterior segmental osteotomy, a bilateral sagittal split ramus osteotomy, and postsurgical orthodontic treatment. After treatment completion, the patient exhibited functional and aesthetic improvements. Her periodontal condition improved and was maintained after the treatment. Here, we demonstrate a successful treatment outcome in a complicated case following a systematic interdisciplinary approach performed with the correct diagnosis and treatment planning.

Branch-pipe-routing approach for ships using improved genetic algorithm

NASA Astrophysics Data System (ADS)

Sui, Haiteng; Niu, Wentie

2016-09-01

Branch-pipe routing plays fundamental and critical roles in ship-pipe design. The branch-pipe-routing problem is a complex combinatorial optimization problem and is thus difficult to solve when depending only on human experts. A modified genetic-algorithm-based approach is proposed in this paper to solve this problem. The simplified layout space is first divided into threedimensional (3D) grids to build its mathematical model. Branch pipes in layout space are regarded as a combination of several two-point pipes, and the pipe route between two connection points is generated using an improved maze algorithm. The coding of branch pipes is then defined, and the genetic operators are devised, especially the complete crossover strategy that greatly accelerates the convergence speed. Finally, simulation tests demonstrate the performance of proposed method.

Efficacy of the Social Skills Improvement System Classwide Intervention Program (SSIS-CIP) primary version.

PubMed

DiPerna, James Clyde; Lei, Puiwa; Bellinger, Jillian; Cheng, Weiyi

2015-03-01

A multisite cluster randomized trial was conducted to examine the effects of the Social Skills Improvement System Classwide Intervention Program (SSIS-CIP; Elliott & Gresham, 2007) on students' classroom social behavior. The final sample included 432 students across 38 second grade classrooms. Social skills and problem behaviors were measured via the SSIS rating scale for all participants, and direct observations were completed for a subsample of participants within each classroom. Results indicated that the SSIS-CIP demonstrated positive effects on teacher ratings of participants' social skills and internalizing behaviors, with the greatest changes occurring in classrooms with students who exhibited lower skill proficiency prior to implementation. Statistically significant differences were not observed between treatment and control participants on teacher ratings of externalizing problem behaviors or direct observation.

High Performance Computing Software Applications for Space Situational Awareness

NASA Astrophysics Data System (ADS)

Giuliano, C.; Schumacher, P.; Matson, C.; Chun, F.; Duncan, B.; Borelli, K.; Desonia, R.; Gusciora, G.; Roe, K.

The High Performance Computing Software Applications Institute for Space Situational Awareness (HSAI-SSA) has completed its first full year of applications development. The emphasis of our work in this first year was in improving space surveillance sensor models and image enhancement software. These applications are the Space Surveillance Network Analysis Model (SSNAM), the Air Force Space Fence simulation (SimFence), and physically constrained iterative de-convolution (PCID) image enhancement software tool. Specifically, we have demonstrated order of magnitude speed-up in those codes running on the latest Cray XD-1 Linux supercomputer (Hoku) at the Maui High Performance Computing Center. The software applications improvements that HSAI-SSA has made, has had significant impact to the warfighter and has fundamentally changed the role of high performance computing in SSA.

Seismic fiber optic multiplexed sensors for exploration and reservoir management

NASA Astrophysics Data System (ADS)

Houston, Mark H.

2000-12-01

Reliable downhole communications, control and sensor networks will dramatically improve oil reservoir management practices and will enable the construction of intelligent or smart-well completions. Fiber optic technology will play a key role in the implementation of these communication, control and sensing systems because of inherent advantages of power, weight and reliability over more conventional electronic-based systems. Field test data, acquired using an array of fiber optic seismic hydrophones within a steam-flood, heavy oil- production filed, showed a significant improvement (10X in this specific case) in subsurface resolution as compared to conventional surface seismic acquisition. These results demonstrate the viability of using multiplexed fiber optic sensors for exploration and reservoir management in 3D vertical seismic profiling (VSP) surveys and in permanent sensor arrays for 4D surveys.

A tool and index to assess surgical capacity in low income countries: an initial implementation in Sierra Leone.

PubMed

Groen, Reinou S; Kamara, Thaim B; Dixon-Cole, Richmond; Kwon, Steven; Kingham, T Peter; Kushner, Adam L

2012-08-01

A first step toward improving surgical care in many low and middle income countries is to document the need. To facilitate the collection and analysis of surgical capacity data and measure changes over time, Surgeons OverSeas (SOS) developed a tool and index based on personnel, infrastructure, procedures, equipment, and supplies (PIPES). A follow-up assessment of 10 government hospitals in Sierra Leone was completed 42 months after an initial survey in 2008 using the PIPES tool. An index based on number of operating rooms, personnel, infrastructure, procedures, equipment, and supplies was calculated. An index was also calculated, using the 2008 data for comparison. Most hospitals demonstrated an increased index that correlated with site visits that verified improved conditions. Connaught Hospital in Sierra Leone had the highest score (9.2), consistent with its being the best equipped and staffed Ministry of Health and Sanitation facility. Makeni District Hospital had the greatest increase, from 3.8 to 7.5, consistent with a newly constructed facility. The PIPES tool was easily administered at hospitals in Sierra Leone and an index was found useful. Surgical capacity in Sierra Leone improved between 2008 and 2011, as demonstrated by an increase in the overall PIPES indices.

Alternative Surfactants for Improved Efficiency of In Situ Tryptic Proteolysis of Fingermarks

NASA Astrophysics Data System (ADS)

Patel, Ekta; Clench, Malcolm R.; West, Andy; Marshall, Peter S.; Marshall, Nathan; Francese, Simona

2015-06-01

Despite recent improvements to in situ proteolysis strategies, a higher efficiency is still needed to increase both the number of peptides detected and the associated ion intensity, leading to a complete and reliable set of biomarkers for diagnostic or prognostic purposes. In the study presented here, an extract of a systematic study is illustrated investigating a range of surfactants assisting trypsin proteolytic activity. Method development was trialled on fingermarks; this specimen results from a transfer of sweat from an individual's fingertip to a surface upon contact. As sweat carries a plethora of biomolecules, including peptides and proteins, fingermarks are, potentially, a very valuable specimen for non-invasive prognostic or diagnostic screening. A recent study has demonstrated the opportunity to quickly detect peptides and small proteins in fingermarks using Matrix Assisted Laser Desorption Ionization Mass Spectrometry Profiling (MALDI MSP). However, intact detection bears low sensitivity and does not allow species identification; therefore, a shotgun proteomic approach was employed involving in situ proteolysis. Data demonstrate that in fingermarks, further improvements to the existing method can be achieved using MEGA-8 as surfactant in higher percentages as well as combinations of different detergents. Also, for the first time, Rapigest SF, normally used in solution digestions, has been shown to successfully work also for in situ proteolysis.

Improved representation of situational awareness within a dismounted small combat unit constructive simulation

NASA Astrophysics Data System (ADS)

Lee, K. David; Colony, Mike

2011-06-01

Modeling and simulation has been established as a cost-effective means of supporting the development of requirements, exploring doctrinal alternatives, assessing system performance, and performing design trade-off analysis. The Army's constructive simulation for the evaluation of equipment effectiveness in small combat unit operations is currently limited to representation of situation awareness without inclusion of the many uncertainties associated with real world combat environments. The goal of this research is to provide an ability to model situation awareness and decision process uncertainties in order to improve evaluation of the impact of battlefield equipment on ground soldier and small combat unit decision processes. Our Army Probabilistic Inference and Decision Engine (Army-PRIDE) system provides this required uncertainty modeling through the application of two critical techniques that allow Bayesian network technology to be applied to real-time applications. (Object-Oriented Bayesian Network methodology and Object-Oriented Inference technique). In this research, we implement decision process and situation awareness models for a reference scenario using Army-PRIDE and demonstrate its ability to model a variety of uncertainty elements, including: confidence of source, information completeness, and information loss. We also demonstrate that Army-PRIDE improves the realism of the current constructive simulation's decision processes through Monte Carlo simulation.

Cone-beam x-ray luminescence computed tomography based on x-ray absorption dosage.

PubMed

Liu, Tianshuai; Rong, Junyan; Gao, Peng; Zhang, Wenli; Liu, Wenlei; Zhang, Yuanke; Lu, Hongbing

2018-02-01

With the advances of x-ray excitable nanophosphors, x-ray luminescence computed tomography (XLCT) has become a promising hybrid imaging modality. In particular, a cone-beam XLCT (CB-XLCT) system has demonstrated its potential in in vivo imaging with the advantage of fast imaging speed over other XLCT systems. Currently, the imaging models of most XLCT systems assume that nanophosphors emit light based on the intensity distribution of x-ray within the object, not completely reflecting the nature of the x-ray excitation process. To improve the imaging quality of CB-XLCT, an imaging model that adopts an excitation model of nanophosphors based on x-ray absorption dosage is proposed in this study. To solve the ill-posed inverse problem, a reconstruction algorithm that combines the adaptive Tikhonov regularization method with the imaging model is implemented for CB-XLCT reconstruction. Numerical simulations and phantom experiments indicate that compared with the traditional forward model based on x-ray intensity, the proposed dose-based model could improve the image quality of CB-XLCT significantly in terms of target shape, localization accuracy, and image contrast. In addition, the proposed model behaves better in distinguishing closer targets, demonstrating its advantage in improving spatial resolution. (2018) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE).

Novel Card Games for Learning Radiographic Image Quality and Urologic Imaging in Veterinary Medicine.

PubMed

Ober, Christopher P

Second-year veterinary students are often challenged by concepts in veterinary radiology, including the fundamentals of image quality and generation of differential lists. Four card games were developed to provide veterinary students with a supplemental means of learning about radiographic image quality and differential diagnoses in urogenital imaging. Students played these games and completed assessments of their subject knowledge before and after playing. The hypothesis was that playing each game would improve students' understanding of the topic area. For each game, students who played the game performed better on the post-test than students who did not play that game (all p<.01). For three of the four games, students who played each respective game demonstrated significant improvement in scores between the pre-test and the post-test (p<.002). The majority of students expressed that the games were both helpful and enjoyable. Educationally focused games can help students learn classroom and laboratory material. However, game design is important, as the game using the most passive learning process also demonstrated the weakest results. In addition, based on participants' comments, the games were very useful in improving student engagement in the learning process. Thus, use of games in the classroom and laboratory setting seems to benefit the learning process.

Comparison of vocal outcomes after angiolytic laser surgery and microflap surgery for vocal polyps.

PubMed

Mizuta, Masanobu; Hiwatashi, Nao; Kobayashi, Toshiki; Kaneko, Mami; Tateya, Ichiro; Hirano, Shigeru

2015-12-01

The microflap technique is a standard procedure for the treatment of vocal fold polyps. Angiolytic laser surgery carried out under topical anesthesia is an alternative method for vocal polyp removal. However, it is not clear whether angiolytic laser surgery has the same effects on vocal outcomes as the microflap technique because of a lack of studies comparing both procedures. In the current study, vocal outcomes after both procedures were compared to clarify the effects of angiolytic laser surgery for vocal polyp removal. Vocal outcomes were reviewed for patients who underwent angiolytic laser surgery (n=20, laser group) or microflap surgery (n=34, microflap group) for vocal polyp removal. The data analyzed included patient and lesion characteristics, number of surgeries required for complete resolution, and aerodynamic and acoustic examinations before and after surgery. In the laser surgery group, complete resolution of the lesion was achieved with a single procedure in 17 cases (85%) and with two procedures in 3 cases (15%). Postoperative aerodynamic and acoustic parameters demonstrated significant improvement compared to preoperative parameters in both the laser surgery group and the microflap surgery group. There were no significant differences in any postoperative aerodynamic and acoustic parameters between the two groups. The current retrospective study demonstrated that angiolytic laser surgery achieved complete resolution of vocal polyps within two procedures. Postoperative effects on aerodynamic and acoustic functions were similar to those after microflap surgery. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Complete biodegradation of chlorpyrifos by engineered Pseudomonas putida cells expressing surface-immobilized laccases.

PubMed

Liu, Jin; Tan, Luming; Wang, Jing; Wang, Zhiyong; Ni, Hong; Li, Lin

2016-08-01

The long-term abuse use of chlorpyrifos-like pesticides in agriculture and horticulture has resulted in significant soil or water contamination and a worldwide ecosystem threat. In this study, the ability of a solvent-tolerant bacterium, Pseudomonas putida MB285, with surface-displayed bacterial laccase, to biodegrade chlorpyrifos was investigated. The results of compositional analyses of the degraded products demonstrate that the engineered MB285 was capable of completely eliminating chlorpyrifos via direct biodegradation, as determined by high-performance liquid chromatography and gas chromatography-mass spectrometry assays. Two intermediate metabolites, namely 3,5,6-trichloro-2-pyridinol (TCP) and diethyl phosphate, were temporarily detectable, verifying the joint and stepwise degradation of chlorpyrifos by surface laccases and certain cellular enzymes, whereas the purified free laccase incompletely degraded chlorpyrifos into TCP. The degradation reaction can be conducted over a wide range of pH values (2-7) and temperatures (5-55 °C) without the need for Cu(2+). Bioassays using Caenorhabditis elegans as an indicator organism demonstrated that the medium was completely detoxified of chlorpyrifos by degradation. Moreover, the engineered cells exhibited a high capacity of repeated degradation and good performance in continuous degradation cycles, as well as a high capacity to degrade real effluents containing chlorpyrifos. Therefore, the developed system exhibited a high degradation capacity and performance and constitutes an improved approach to address chlorpyrifos contamination in chlorpyrifos-remediation practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Demonstration of an Ice Contamination Effects Flight Training Device

NASA Technical Reports Server (NTRS)

Ratvasky, Thomas P.; Ranaudo, Richard J.; Blankenship, Kurt S.; Lee, Sam

2006-01-01

The development of a piloted flight simulator called the Ice Contamination Effects Flight Training Device (ICEFTD) was recently completed. This device demonstrates the ability to accurately represent an iced airplane s flight characteristics and is utilized to train pilots in recognizing and recovering from aircraft handling anomalies that result from airframe ice formations. The ICEFTD was demonstrated at three recent short courses hosted by the University of Tennessee Space Institute. It was also demonstrated to a group of pilots at the National Test Pilot School. In total, eighty-four pilots and flight test engineers from industry and the regulatory community spent approximately one hour each in the ICEFTD to get a "hands on" lesson of an iced airplane s reduced performance and handling qualities. Additionally, pilot cues of impending upsets and recovery techniques were demonstrated. The purpose of this training was to help pilots understand how ice contamination affects aircraft handling so they may apply that knowledge to the operations of other aircraft undergoing testing and development. Participant feedback on the ICEFTD was very positive. Pilots stated that the simulation was very valuable, applicable to their occupations, and provided a safe way to explore the flight envelope. Feedback collected at each demonstration was also helpful to define additional improvements to the ICEFTD; many of which were then implemented in subsequent demonstrations

Inhibition Plasticity in Older Adults: Practice and Transfer Effects Using a Multiple Task Approach.

PubMed

Wilkinson, Andrea J; Yang, Lixia

2016-01-01

OBJECTIVE. To examine plasticity of inhibition, as indexed by practice effects of inhibition tasks and the associated transfer effects, using a multiple task approach in healthy older adults. METHOD. Forty-eight healthy older adults were evenly assigned to either a practice group or a no-contact control group. All participants completed pretest (2.5 hours) and posttest (2 hours) sessions, with a 2-week interval in between. During the 2-week interval, only the practice group completed six 30-minute practice sessions (three sessions per week for two consecutive weeks) of three lab-based inhibition tasks. RESULTS. All three inhibition tasks demonstrated significant improvement across practice sessions, suggesting practice-induced plasticity. The benefit, however, only transferred to near-near tasks. The results are inconclusive with regard to the near-far and far-far transfer effects. DISCUSSION. This study further extends literature on practice effects of inhibition in older adults by using a multiple task approach. Together with previous work, the current study suggests that older adults are able to improve inhibition performance through practice and transfer the practice gains to tasks that overlap in both target cognitive ability and task structure (i.e., near-near tasks).

Effects of a simulated emergency airway management education program on the self-efficacy and clinical performance of intensive care unit nurses.

PubMed

Han, Myong-Ja; Lee, Ju-Ry; Shin, Yu-Jung; Son, Jeong-Suk; Choi, Eun-Joo; Oh, Yun-Hee; Lee, Soon-Haeng; Choi, Hye-Ran

2017-12-21

To examine the effects of a simulated emergency airway management education program on the self-efficacy and clinical performance among nurses in intensive care units. A one-group, pre- and post-test design was used. Thirty-five nurses who were working in adult intensive care units participated in this study. The simulation education program included lectures, skill demonstration, skill training, team-based practice, and debriefing. Self-efficacy and clinical performance questionnaires were completed before the program and 1 week after its completion. The data were analyzed by using descriptive statistics and the paired t-test to compare the mean differences between the pre-test and post-test. The scores before and after education were compared. After education, there was a significant improvement in the nurses' self-efficacy and clinical performance in emergency airway management situations. Simulation education effectively improved the self-efficacy and clinical performance of the nurses who were working in intensive care units. Based on the program for clinical nurses within a hospital, it will provide information that might advance clinical nursing education. © 2017 Japan Academy of Nursing Science.

The efficacy of a whole body sprint-interval training intervention in an office setting: A feasibility study.

PubMed

Gurd, Brendon J; Patel, Jugal; Edgett, Brittany A; Scribbans, Trisha D; Quadrilatero, Joe; Fischer, Steven L

2018-05-28

Whole body sprint-interval training (WB-SIT) represents a mode of exercise training that is both time-efficient and does not require access to an exercise facility. The current study examined the feasibility of implementing a WB-SIT intervention in a workplace setting. A total of 747 employees from a large office building were invited to participate with 31 individuals being enrolled in the study. Anthropometrics, aerobic fitness, core and upper body strength, and lower body mobility were assessed before and after a 12-week exercise intervention consisting of 2-4 training sessions per week. Each training session required participants to complete 8, 20-second intervals (separated by 10 seconds of rest) of whole body exercise. Proportion of participation was 4.2% while the response rate was 35% (11/31 participants completed post training testing). In responders, compliance to prescribed training was 83±17%, and significant (p <  0.05) improvements were observed for aerobic fitness, push-up performance and lower body mobility. These results demonstrate the efficacy of WB-FIT for improving fitness and mobility in an office setting, but highlight the difficulties in achieving high rates of participation and response in this setting.

JT90 Ceramic Outer Air Seal System Refinement Program, Phase 2

NASA Technical Reports Server (NTRS)

Shiembob, L. T.

1982-01-01

The sprayed ceramic gas turbine outer air seal system was tested in two JT9D engines to substantiate the abradability and durability of the seals. Of particular significance was that one of the tests, a 150 hour 1000 cycle endurance program at nominal JT9D operating conditions, was completed with minimal effect on the seals and received Federal Aviation Administration cognizance with respect to potential field service use by the airlines. The other engine test completed 1825 endurance cycles at severe operating conditions and no burn through or other serious defects in the structural integrity of a seal segment was observed. These test results combined with other Pratt and Whitney Aircraft engine tests substantiate the potential of the ceramic outer air seal system to attain the durability goal of 50000 hour engine operating capability. Both engine tests subjected the seals to intentional blade rubs and demonstrated good abradability with volume wear ratios greater than 100, far exceeding the design goal of 10. The improved volume wear ratio will allow the turbine tip clearance to be reduced, thereby resulting in an estimated thrust specific fuel consumption improvement of 0.3 percent.

Pulmonary Arteriovenous Malformations After the Superior Cavopulmonary Shunt: Mechanisms and Clinical Implications

PubMed Central

Kavarana, Minoo N.; Jones, Jeffrey A.; Stroud, Robert E.; Bradley, Scott M.; Ikonomidis, John S.; Mukherjee, Rupak

2015-01-01

Children with functional single ventricle heart disease are commonly palliated down a staged clinical pathway toward a Fontan completion procedure (total cavopulmonary connection). The Fontan physiology is fraught with long term complications associated with lower body systemic venous hypertension, eventually resulting in significant morbidity and mortality. The bidirectional Glenn shunt or superior cavopulmonary connection (SCPC) is commonly the transitional stage in single ventricle surgical management and provides excellent palliation. Some studies have demonstrated lower morbidity and mortality with the SCPC when compared with the Fontan. Unfortunately the durability of the SCPC is significantly limited by the development of pulmonary arteriovenous malformations (PAVMs) which have been commonly attributed to the absence of hepatic venous blood flow and the lack of pulsatile flow to the affected lungs. Abnormal angiogenesis has been suggested as a final common pathway to PAVM development. Understanding these fundamental mechanisms through the investigation of angiogenic pathways associated with the pathogenesis of PAVMs would help to develop medical therapies that could prevent or reverse this complication following SCPC. Such therapies could improve the longevity of the SCPC, potentially eliminate or significantly postpone the Fontan completion with its associated complications, and improve long-term survival in children with single ventricle disease. PMID:24758411

Feasibility of Motor Imagery Training for Children with Developmental Coordination Disorder – A Pilot Study

PubMed Central

Adams, Imke L. J.; Smits-Engelsman, Bouwien; Lust, Jessica M.; Wilson, Peter H.; Steenbergen, Bert

2017-01-01

Children with Developmental Coordination Disorder (DCD) experience movement difficulties that may be linked to processes involved in motor imagery (MI). This paper discusses recent advances in theory that underpin the use of MI training for children with DCD. This knowledge is translated in a new MI training protocol which is compared with the cognitive orientation to daily occupational performance (CO-OP). Children meeting DSM-5 criteria for DCD were assigned to MI (n = 4) or CO-OP (n = 4) interventions and completed nine treatment sessions, including homework exercises. Results were positive, with two children in the MI group and three in the CO-OP group improving their m-ABC-2 score by ≥ 2 standard scores, interpreted as a clinically meaningful change. Moreover, all children and parents noticed improvements in motor skills after training. This is the first study to demonstrate the feasibility of a theoretically principled treatment protocol for MI training in children with DCD, and extends earlier work. Trial registration: The complete trial is registered at the Dutch trial register, www.trialregister.nl (NTR5471). http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5471 PMID:28798707

Effects of combined high intensity arm and leg training on performance and cardio-respiratory measures.

PubMed

Zinner, Christoph; Sperlich, Billy; Born, Dennis-Peter; Michels, Guido

2017-01-01

The purpose of this study was to investigate the effects of combined arm and leg high-intensity low-volume interval training (HIITarm+leg) on maximal oxygen uptake, myocardial measures (i.e. stroke volume, cardiac output, ejection fraction), Tissue Oxygenation Index (TOI) of the vastus lateralis and triceps brachii, as well as power output in comparison to leg HIIT (HIITleg) only. The 20 healthy, male and female volunteers completed six sessions of either HIITleg on a cycle ergometer or HIITarm+leg on an arm and leg cycle ergometer. During pre- and post-testing, the volunteers completed a submaximal and incremental test to exhaustion on a cycle ergometer. Magnitude based interference revealed likely to very likely beneficial effects for HIITarm+leg compared to HIITleg in maximal oxygen uptake, cardiac measures as well peak power output. The TOI following HIITarm+leg demonstrated likely to very likely increased oxygenation in the triceps brachii or the vastus lateralis when compared to HIITleg. The results suggest that six sessions of HIITarm+leg may likely to very likely improve maximal oxygen uptake, some inotropy-related cardiac measures with improved tissue oxygenation of the triceps brachii and vastus lateralis muscles resulting in greater leg peak power output.

The Effect of Prior Task Success on Older Adults' Memory Performance: Examining the Influence of Different Types of Task Success.

PubMed

Geraci, Lisa; Hughes, Matthew L; Miller, Tyler M; De Forrest, Ross L

2016-01-01

Negative aging stereotypes can lead older adults to perform poorly on memory tests. Yet, memory performance can be improved if older adults have a single successful experience on a cognitive test prior to participating in a memory experiment (Geraci & Miller, 2013, Psychology and Aging, 28, 340-345). The current study examined the effects of different types of prior task experience on subsequent memory performance. Before participating in a verbal free recall experiment, older adults in Experiment 1 successfully completed either a verbal or a visual cognitive task or no task. In Experiment 2, they successfully completed either a motor task or no task before participating in the free recall experiment. Results from Experiment 1 showed that relative to control (no prior task), participants who had prior success, either on a verbal or a visual task, had better subsequent recall performance. Experiment 2 showed that prior success on a motor task, however, did not lead to a later memory advantage relative to control. These findings demonstrate that older adults' memory can be improved by a successful prior task experience so long as that experience is in a cognitive domain.

Inhibition Plasticity in Older Adults: Practice and Transfer Effects Using a Multiple Task Approach

PubMed Central

Wilkinson, Andrea J.; Yang, Lixia

2016-01-01

Objective. To examine plasticity of inhibition, as indexed by practice effects of inhibition tasks and the associated transfer effects, using a multiple task approach in healthy older adults. Method. Forty-eight healthy older adults were evenly assigned to either a practice group or a no-contact control group. All participants completed pretest (2.5 hours) and posttest (2 hours) sessions, with a 2-week interval in between. During the 2-week interval, only the practice group completed six 30-minute practice sessions (three sessions per week for two consecutive weeks) of three lab-based inhibition tasks. Results. All three inhibition tasks demonstrated significant improvement across practice sessions, suggesting practice-induced plasticity. The benefit, however, only transferred to near-near tasks. The results are inconclusive with regard to the near-far and far-far transfer effects. Discussion. This study further extends literature on practice effects of inhibition in older adults by using a multiple task approach. Together with previous work, the current study suggests that older adults are able to improve inhibition performance through practice and transfer the practice gains to tasks that overlap in both target cognitive ability and task structure (i.e., near-near tasks). PMID:26885407

An Open Trial of a Smartphone-Assisted, Adjunctive Intervention to Improve Treatment Adherence in Bipolar Disorder

PubMed Central

Wenze, Susan J.; Armey, Michael F.; Weinstock, Lauren M.; Gaudiano, Brandon A.; Miller, Ivan W.

2016-01-01

We evaluated the feasibility and acceptability of a novel, 12 week, adjunctive, smartphone-assisted intervention to improve treatment adherence in bipolar disorder (BD). Eight participants completed 4 in-person individual therapy sessions over the course of a month, followed by 60 days of twice-daily ecological momentary intervention (EMI) sessions, with a fifth in-person session after 30 days and a sixth in-person session after 60 days. Perceived credibility of the intervention and expectancy for change were adequate at baseline, and satisfaction on completion of the intervention was very high. Participants demonstrated good adherence to the intervention overall, including excellent adherence to the in-person component and fair adherence to the smartphone-facilitated component. Qualitative feedback revealed very high satisfaction with the in-person sessions and suggested a broad range of ways in which the EMI sessions were helpful. Participants also provided suggestions for improving the intervention, which primarily related to the structure and administration of the EMI (smartphone-administered) sessions. Although this study was not designed to evaluate treatment efficacy, most key outcome variables changed in the expected directions from pre- to post-treatment, and several variables changed significantly over the course of the in-person sessions or during the EMI phase. These findings add to the small but growing body of literature suggesting that EMIs are feasible and acceptable for use in populations with BD. PMID:27824786

Effects of Triple P parenting intervention on child health outcomes for childhood asthma and eczema: Randomised controlled trial.

PubMed

Morawska, Alina; Mitchell, Amy E; Burgess, Scott; Fraser, Jennifer

2016-08-01

Childhood chronic health conditions have considerable impact on children. We aimed to test the efficacy of a brief, group-based parenting intervention for improving illness-related child behaviour problems, parents' self-efficacy, quality of life, parents' competence with treatment, and symptom severity. A 2 (intervention vs. care as usual) by 3 (baseline, post-intervention, 6-month follow-up) design was used, with random group assignment. Participants were 107 parents of 2- to 10-year-old children with asthma and/or eczema. Parents completed self-report questionnaires, symptom diaries, and home observations were completed. The intervention comprised two 2-h group discussions based on Triple P. Parents in the intervention group reported (i) fewer eczema-related, but not asthma-related, child behaviour problems; (ii) improved self-efficacy for managing eczema, but not asthma; (iii) better quality of life for parent and family, but not child; (iv) no change in parental treatment competence; (v) reduced symptom severity, particularly for children prescribed corticosteroid-based treatments. Results demonstrate the potential for brief parenting interventions to improve childhood chronic illness management, child health outcomes, and family wellbeing. Effects were stronger for eczema-specific outcomes compared to asthma-specific outcomes. Effects on symptom severity are very promising, and further research examining effects on objective disease severity and treatment adherence is warranted. ACTRN12611000558921. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparison of breast-feeding knowledge, attitudes, and beliefs before and after educational intervention for rural Appalachian high school students.

PubMed

Seidel, Allison K; Schetzina, Karen E; Freeman, Sherry C; Coulter, Meredith M; Colgrove, Nicole J

2013-03-01

Breast-feeding rates in rural and southeastern regions of the United States are lower than national rates and Healthy People 2020 targets. The objectives of this study were to understand current breast-feeding knowledge, attitudes, and beliefs among rural southern Appalachian adolescents and to explore whether a high school educational intervention designed to address the five tenets (knowledge, attitudes, intentions, perceived behavioral control, and subjective norms) of the theory of planned behavior may be effective in increasing future rates of breast-feeding in this population. An educational session including an interactive game was developed and administered to occupational health science students during a single class period in two county high schools. A presurvey and a postsurvey administered 2 weeks after the intervention were completed by students. Pre- and postsurveys were analyzed using paired t tests and Cohen d and potential differences based on sex and grade were explored. Both pre- and postsurveys were completed by 107 students (78%). Knowledge, attitudes about breast-feeding benefits, subjective norms, and intentions significantly improved following the intervention. Baseline knowledge and attitudes about breast-feeding benefits for mothers were low and demonstrated the greatest improvement. Offering breast-feeding education based on the theory of planned behavior in a single high school class session was effective in improving student knowledge, attitudes, and beliefs about breast-feeding and intention to breast-feed.

[Clinical remission of an HLA B27-positive sacroiliitis on vegan diet].

PubMed

Huber, R; Herdrich, A; Rostock, M; Vogel, T

2001-08-01

Positive effects of fasting and vegan diet in patients with rheumatic diseases are reported in the literature. We present a 33-year-old patient with double-sided HLA B27-positive sacroiliitis, which was diagnosed by magnetic resonance tomography. Since about 10 years he therefore had pain in the iliosacral region. Numerous sessions of physiotherapy, a cure treatment, and treatment with sulfasalazine and doxycycline were not effective. The patient was dependent on the daily intake of the nonsteroidal antirheumatics meloxicam 2 x 7.5 mg and ibuprofen 400-800 mg and the analgetic tramadol 50-150 mg, but evening and night pain and morning stiffness persisted under this treatment. We recommended a temporary vegan diet, i.e. to completely avoid animal fats and proteins. 3-4 days after changing on vegan diet the complaints improved distinctly and persistently. After consumption of meat 6 weeks later, complaints worsened. Consequent vegan diet again resulted in significant improvement of the pain and morning stiffness. At follow-up 3 months after the initial contact, tramadol and ibuprofen intakes had been stopped, meloxicam had been reduced to 1 x 7.5 mg. The patient was almost completely free of complaints. It was demonstrated that in a single case of sacroiliitis which was refractory to other treatment, vegan diet resulted in a convincingly improvement of complaints. Copyright 2001 S. Karger GmbH, Freiburg

Novel Television-Based Cognitive Training Improves Working Memory and Executive Function

PubMed Central

Shatil, Evelyn; Mikulecká, Jaroslava; Bellotti, Francesco; Bureš, Vladimír

2014-01-01

The main study objective was to investigate the effect of interactive television-based cognitive training on cognitive performance of 119 healthy older adults, aged 60–87 years. Participants were randomly allocated to a cognitive training group or to an active control group in a single-blind controlled two-group design. Before and after training interactive television cognitive performance was assessed on well validated tests of fluid, higher-order ability, and system usability was evaluated. The participants in the cognitive training group completed a television-based cognitive training programme, while the participants in the active control group completed a TV-based programme of personally benefiting activities. Significant improvements were observed in well validated working memory and executive function tasks in the cognitive training but not in the control group. None of the groups showed statistically significant improvement in life satisfaction score. Participants' reports of “adequate” to “high” system usability testify to the successful development and implementation of the interactive television-based system and compliant cognitive training contents. The study demonstrates that cognitive training delivered by means of an interactive television system can generate genuine cognitive benefits in users and these are measurable using well-validated cognitive tests. Thus, older adults who cannot use or afford a computer can easily use digital interactive television to benefit from advanced software applications designed to train cognition. PMID:24992187

Face validity, construct validity and training benefits of a virtual reality TURP simulator.

PubMed

Bright, Elizabeth; Vine, Samuel; Wilson, Mark R; Masters, Rich S W; McGrath, John S

2012-01-01

To assess face validity, construct validity and the training benefits of a virtual reality TURP simulator. 11 novices (no TURP experience) and 7 experts (>200 TURP's) completed a virtual reality median lobe prostate resection task on the TURPsim™ (Simbionix USA Corp., Cleveland, OH). Performance indicators (percentage of prostate resected (PR), percentage of capsular resection (CR) and time diathermy loop active without tissue contact (TAWC) were recorded via the TURPsim™ and compared between novices and experts to assess construct validity. Verbal comments provided by experts following task completion were used to assess face validity. Repeated attempts of the task by the novices were analysed to assess the training benefits of the TURPsim™. Experts resected a significantly greater percentage of prostate per minute (p < 0.01) and had significantly less active diathermy time without tissue contact (p < 0.01) than novices. After practice, novices were able to perform the simulation more effectively, with significant improvement in all measured parameters. Improvement in performance was noted in novices following repetitive training, as evidenced by improved TAWC scores that were not significantly different from the expert group (p = 0.18). This study has established face and construct validity for the TURPsim™. The potential benefit in using this tool to train novices has also been demonstrated. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Complete quantum control of a single quantum dot spin using ultrafast optical pulses.

PubMed

Press, David; Ladd, Thaddeus D; Zhang, Bingyang; Yamamoto, Yoshihisa

2008-11-13

A basic requirement for quantum information processing systems is the ability to completely control the state of a single qubit. For qubits based on electron spin, a universal single-qubit gate is realized by a rotation of the spin by any angle about an arbitrary axis. Driven, coherent Rabi oscillations between two spin states can be used to demonstrate control of the rotation angle. Ramsey interference, produced by two coherent spin rotations separated by a variable time delay, demonstrates control over the axis of rotation. Full quantum control of an electron spin in a quantum dot has previously been demonstrated using resonant radio-frequency pulses that require many spin precession periods. However, optical manipulation of the spin allows quantum control on a picosecond or femtosecond timescale, permitting an arbitrary rotation to be completed within one spin precession period. Recent work in optical single-spin control has demonstrated the initialization of a spin state in a quantum dot, as well as the ultrafast manipulation of coherence in a largely unpolarized single-spin state. Here we demonstrate complete coherent control over an initialized electron spin state in a quantum dot using picosecond optical pulses. First we vary the intensity of a single optical pulse to observe over six Rabi oscillations between the two spin states; then we apply two sequential pulses to observe high-contrast Ramsey interference. Such a two-pulse sequence realizes an arbitrary single-qubit gate completed on a picosecond timescale. Along with the spin initialization and final projective measurement of the spin state, these results demonstrate a complete set of all-optical single-qubit operations.

HPV vaccination: Population approaches for improving rates.

PubMed

Oliver, Kristin; Frawley, Alean; Garland, Elizabeth

2016-06-02

To review the literature on interventions to increase HPV vaccinations and assess whether The Community Preventive Services Task Force recommendations are supported by current evidence. We used a PubMed search to identify studies that assessed interventions that looked at provider assessment and feedback, provider reminders, client reminder and recall, and clinic based education programs. Of the 13 studies identified, 8 included client reminder and recall interventions, 4 included provider assessment and feedback and/or provider reminders and 2 included clinic based education. 11 of the 13 studies demonstrated a positive effect on HPV vaccine initiation or completion. Provider assessment and feedback studies were more likely to report a positive effect on HPV vaccine initiation than on series completion, while client reminder recall interventions more frequently produced an effect on series completion than on initiation. There is evidence to support the application of the Community Preventive Services Task Force recommendations specifically to HPV vaccination both for client reminder and recall programs and for provider assessment and feedback interventions. Multiple targeted approaches will be needed to substantially impact HPV vaccine rates.

Optimizing pulse compressibility in completely all-fibered Ytterbium chirped pulse amplifiers for in vivo two photon laser scanning microscopy

PubMed Central

Fernández, A.; Grüner-Nielsen, L.; Andreana, M.; Stadler, M.; Kirchberger, S.; Sturtzel, C.; Distel, M.; Zhu, L.; Kautek, W.; Leitgeb, R.; Baltuska, A.; Jespersen, K.; Verhoef, A.

2017-01-01

A simple and completely all-fiber Yb chirped pulse amplifier that uses a dispersion matched fiber stretcher and a spliced-on hollow core photonic bandgap fiber compressor is applied in nonlinear optical microscopy. This stretching-compression approach improves compressibility and helps to maximize the fluorescence signal in two-photon laser scanning microscopy as compared with approaches that use standard single mode fibers as stretcher. We also show that in femtosecond all-fiber systems, compensation of higher order dispersion terms is relevant even for pulses with relatively narrow bandwidths for applications relying on nonlinear optical effects. The completely all-fiber system was applied to image green fluorescent beads, a stained lily-of-the-valley root and rat-tail tendon. We also demonstrated in vivo imaging in zebrafish larvae, where we simultaneously measure second harmonic and fluorescence from two-photon excited red-fluorescent protein. Since the pulses are compressed in a fiber, this source is especially suited for upgrading existing laser scanning (confocal) microscopes with multiphoton imaging capabilities in space restricted settings or for incorporation in endoscope-based microscopy. PMID:28856032

Optimizing pulse compressibility in completely all-fibered Ytterbium chirped pulse amplifiers for in vivo two photon laser scanning microscopy.

PubMed

Fernández, A; Grüner-Nielsen, L; Andreana, M; Stadler, M; Kirchberger, S; Sturtzel, C; Distel, M; Zhu, L; Kautek, W; Leitgeb, R; Baltuska, A; Jespersen, K; Verhoef, A

2017-08-01

A simple and completely all-fiber Yb chirped pulse amplifier that uses a dispersion matched fiber stretcher and a spliced-on hollow core photonic bandgap fiber compressor is applied in nonlinear optical microscopy. This stretching-compression approach improves compressibility and helps to maximize the fluorescence signal in two-photon laser scanning microscopy as compared with approaches that use standard single mode fibers as stretcher. We also show that in femtosecond all-fiber systems, compensation of higher order dispersion terms is relevant even for pulses with relatively narrow bandwidths for applications relying on nonlinear optical effects. The completely all-fiber system was applied to image green fluorescent beads, a stained lily-of-the-valley root and rat-tail tendon. We also demonstrated in vivo imaging in zebrafish larvae, where we simultaneously measure second harmonic and fluorescence from two-photon excited red-fluorescent protein. Since the pulses are compressed in a fiber, this source is especially suited for upgrading existing laser scanning (confocal) microscopes with multiphoton imaging capabilities in space restricted settings or for incorporation in endoscope-based microscopy.