Speech coding at low to medium bit rates

NASA Astrophysics Data System (ADS)

Leblanc, Wilfred Paul

1992-09-01

Improved search techniques coupled with improved codebook design methodologies are proposed to improve the performance of conventional code-excited linear predictive coders for speech. Improved methods for quantizing the short term filter are developed by employing a tree search algorithm and joint codebook design to multistage vector quantization. Joint codebook design procedures are developed to design locally optimal multistage codebooks. Weighting during centroid computation is introduced to improve the outlier performance of the multistage vector quantizer. Multistage vector quantization is shown to be both robust against input characteristics and in the presence of channel errors. Spectral distortions of about 1 dB are obtained at rates of 22-28 bits/frame. Structured codebook design procedures for excitation in code-excited linear predictive coders are compared to general codebook design procedures. Little is lost using significant structure in the excitation codebooks while greatly reducing the search complexity. Sparse multistage configurations are proposed for reducing computational complexity and memory size. Improved search procedures are applied to code-excited linear prediction which attempt joint optimization of the short term filter, the adaptive codebook, and the excitation. Improvements in signal to noise ratio of 1-2 dB are realized in practice.

Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus.

PubMed

Cohen, Mark E; Ko, Clifford Y; Bilimoria, Karl Y; Zhou, Lynn; Huffman, Kristopher; Wang, Xue; Liu, Yaoming; Kraemer, Kari; Meng, Xiangju; Merkow, Ryan; Chow, Warren; Matel, Brian; Richards, Karen; Hart, Amy J; Dimick, Justin B; Hall, Bruce L

2013-08-01

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) collects detailed clinical data from participating hospitals using standardized data definitions, analyzes these data, and provides participating hospitals with reports that permit risk-adjusted comparisons with a surgical quality standard. Since its inception, the ACS NSQIP has worked to refine surgical outcomes measurements and enhance statistical methods to improve the reliability and validity of this hospital profiling. From an original focus on controlling for between-hospital differences in patient risk factors with logistic regression, ACS NSQIP has added a variable to better adjust for the complexity and risk profile of surgical procedures (procedure mix adjustment) and stabilized estimates derived from small samples by using a hierarchical model with shrinkage adjustment. New models have been developed focusing on specific surgical procedures (eg, "Procedure Targeted" models), which provide opportunities to incorporate indication and other procedure-specific variables and outcomes to improve risk adjustment. In addition, comparative benchmark reports given to participating hospitals have been expanded considerably to allow more detailed evaluations of performance. Finally, procedures have been developed to estimate surgical risk for individual patients. This article describes the development of, and justification for, these new statistical methods and reporting strategies in ACS NSQIP. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Rail-Highway Crossing Resource Allocation Procedure - User's Guide. Third Edition

DOT National Transportation Integrated Search

1987-08-01

To assist states and railroads in determining effective allocations of Federal funds for rail-highway crossing improvements, the U.S. Department of Transportation has developed the DOT Rail-Highway Crossing Resource Allocation Procedure. The procedur...

Improved silicon carbide for advanced heat engines

NASA Technical Reports Server (NTRS)

Whalen, Thomas J.; Mangels, J. A.

1986-01-01

The development of silicon carbide materials of high strength was initiated and components of complex shape and high reliability were formed. The approach was to adapt a beta-SiC powder and binder system to the injection molding process and to develop procedures and process parameters capable of providing a sintered silicon carbide material with improved properties. The initial effort was to characterize the baseline precursor materials, develop mixing and injection molding procedures for fabricating test bars, and characterize the properties of the sintered materials. Parallel studies of various mixing, dewaxing, and sintering procedures were performed in order to distinguish process routes for improving material properties. A total of 276 modulus-of-rupture (MOR) bars of the baseline material was molded, and 122 bars were fully processed to a sinter density of approximately 95 percent. Fluid mixing techniques were developed which significantly reduced flaw size and improved the strength of the material. Initial MOR tests indicated that strength of the fluid-mixed material exceeds the baseline property by more than 33 percent. the baseline property by more than 33 percent.

Advances in the surgical management of prolapse.

PubMed

Slack, Alex; Jackson, Simon

2007-03-01

Prolapse is an extremely common condition, for which 11% of women will have a surgical procedure at some point in their lives. The recurrence rate after most of the traditional surgical procedures is high and upto 29% of women who have had surgery for prolapse will require a further operation. In order to improve the surgical outcome, there is currently much interest in the use of grafts to augment traditional repairs and new procedures have been developed using specifically developed grafts. These have been combined with minimally invasive surgical techniques in an attempt to reduce surgical morbidity. These procedures may improve the outcome of surgery for prolapse. However, there is currently a lack of long-term data from randomized trials to demonstrate their effectiveness and safety.

Safe paediatric intensive care. Part 1: Does more medical care lead to improved outcome?

PubMed

Frey, Bernhard; Argent, Andrew

2004-06-01

Neonatal and paediatric intensive care has improved the prognosis for seriously sick infants and children. This has happened because of a pragmatic approach focused on stabilisation of vital functions and immense technological advances in diagnostic and therapeutic procedures. However, the belief that more medical care must inevitably lead to improved health is increasingly being questioned. This issue is especially relevant in developing countries where the introduction of highly specialised paediatric intensive care may not lead to an overall fall in child mortality. Even in developed countries, the complexity and availability of therapeutics and invasive procedures may put seriously ill children at additional risk. In both developing and industrialised countries the use of safe and simple procedures for appropriate periods, particular attention to drug prescription patterns and selection of appropriate aims and modes of therapy, including non-invasive methods, may minimise the risks of paediatric intensive care.

The Development of a Procedure to Encourage Certain Facilitative Behaviors of Classroom Teachers.

ERIC Educational Resources Information Center

Eggert, Wallace V.; Moore, John N.

The main purpose of this study was to develop a procedure whereby teachers might improve their interpersonal transactions with students. Concomitant purposes were to develop a limited category coding system for easy use by classroom teachers and to develop a classroom observation system for research purposes. Sixteen teachers (three primary, nine…

Phase 2 environmental site investigation procedures and technologies for property transfer and PS and E development

DOT National Transportation Integrated Search

1999-05-01

The purpose of this project is to provide TxDOT with an improved procedure for conducting environmental site investigations at various stages during transportation infrastructure development. The project seeks to identify modern assessment technologi...

Continuation of advanced crew procedures development techniques

NASA Technical Reports Server (NTRS)

Arbet, J. D.; Benbow, R. L.; Evans, M. E.; Mangiaracina, A. A.; Mcgavern, J. L.; Spangler, M. C.; Tatum, I. C.

1976-01-01

An operational computer program, the Procedures and Performance Program (PPP) which operates in conjunction with the Phase I Shuttle Procedures Simulator to provide a procedures recording and crew/vehicle performance monitoring capability was developed. A technical synopsis of each task resulting in the development of the Procedures and Performance Program is provided. Conclusions and recommendations for action leading to the improvements in production of crew procedures development and crew training support are included. The PPP provides real-time CRT displays and post-run hardcopy output of procedures, difference procedures, performance data, parametric analysis data, and training script/training status data. During post-run, the program is designed to support evaluation through the reconstruction of displays to any point in time. A permanent record of the simulation exercise can be obtained via hardcopy output of the display data and via transfer to the Generalized Documentation Processor (GDP). Reference procedures data may be transferred from the GDP to the PPP. Interface is provided with the all digital trajectory program, the Space Vehicle Dynamics Simulator (SVDS) to support initial procedures timeline development.

PARTNERING TO IMPROVE HUMAN EXPOSURE METHODS

EPA Science Inventory

Methods development research is an application-driven scientific area that addresses programmatic needs. The goals are to reduce measurement uncertainties, address data gaps, and improve existing analytical procedures for estimating human exposures. Partnerships have been develop...

Iterating between lessons on concepts and procedures can improve mathematics knowledge.

PubMed

Rittle-Johnson, Bethany; Koedinger, Kenneth

2009-09-01

Knowledge of concepts and procedures seems to develop in an iterative fashion, with increases in one type of knowledge leading to increases in the other type of knowledge. This suggests that iterating between lessons on concepts and procedures may improve learning. The purpose of the current study was to evaluate the instructional benefits of an iterative lesson sequence compared to a concepts-before-procedures sequence for students learning decimal place-value concepts and arithmetic procedures. In two classroom experiments, sixth-grade students from two schools participated (N=77 and 26). Students completed six decimal lessons on an intelligent-tutoring systems. In the iterative condition, lessons cycled between concept and procedure lessons. In the concepts-first condition, all concept lessons were presented before introducing the procedure lessons. In both experiments, students in the iterative condition gained more knowledge of arithmetic procedures, including ability to transfer the procedures to problems with novel features. Knowledge of concepts was fairly comparable across conditions. Finally, pre-test knowledge of one type predicted gains in knowledge of the other type across experiments. An iterative sequencing of lessons seems to facilitate learning and transfer, particularly of mathematical procedures. The findings support an iterative perspective for the development of knowledge of concepts and procedures.

Imperatives for Change; A Management Improvement Analysis of the Seattle Public Library. A Report to the Board of Trustees.

ERIC Educational Resources Information Center

Public Affairs Counseling, San Francisco, CA.

To develop organizational recommendations, propose new management procedures, and assist in budget preparation, a management improvement analysis was undertaken at the Seattle Public Library. Discussions were held with library board and supervising staff on all aspects of organization, operations, and services; a trial budget procedure was…

Improved techniques for thermomechanical testing in support of deformation modeling

NASA Technical Reports Server (NTRS)

Castelli, Michael G.; Ellis, John R.

1992-01-01

The feasibility of generating precise thermomechanical deformation data to support constitutive model development was investigated. Here, the requirement is for experimental data that is free from anomalies caused by less than ideal equipment and procedures. A series of exploratory tests conducted on Hastelloy X showed that generally accepted techniques for strain controlled tests were lacking in at least three areas. Specifically, problems were encountered with specimen stability, thermal strain compensation, and temperature/mechanical strain phasing. The source of these difficulties was identified and improved thermomechanical testing techniques to correct them were developed. These goals were achieved by developing improved procedures for measuring and controlling thermal gradients and by designing a specimen specifically for thermomechanical testing. In addition, innovative control strategies were developed to correctly proportion and phase the thermal and mechanical components of strain. Subsequently, the improved techniques were used to generate deformation data for Hastelloy X over the temperature range, 200 to 1000 C.

Evaluating projects for improving fish and wildlife habitat on National Forests.

Treesearch

Fred H. Everest; Daniel R. Talhelm

1982-01-01

Recent legislation (PL. 93-452; P.L. 94-588) has emphasized improvement of fish and wildlife habitat on lands of the National Forest System. A sequential procedure has been developed for screening potential projects to identify those producing the greatest fishery benefits. The procedure—which includes program planning, project planning, and intensive benefit/cost...

Selecting Students for Training in Health Care. A Practical Guide to Improving Selection Procedures. WHO Offset Publication No. 74.

ERIC Educational Resources Information Center

Bennett, Mick; Wakeford, Richard

This guide is intended to help those responsible for choosing health care trainees to develop and improve their selection procedures. Special reference is given to health workers in maternal and child health. Chapter 1 deals with health care policy implications for selection of trainees, the different functions of selection and conflicts that…

Issues and Procedures in the Development of Criterion Referenced Tests.

ERIC Educational Resources Information Center

Klein, Stephen P.; Kosecoff, Jacqueline

The basic steps and procedures in the development of criterion referenced tests (CRT), as well as the issues and problems associated with these activities are discussed. In the first section of the paper, the discussions focus upon the purpose and defining characteristics of CRTs, item construction and selection, improving item quality, content…

The PrOSTE: identifying key components of effective procedural teaching.

PubMed

McSparron, Jakob I; Ricotta, Daniel N; Moskowitz, Ari; Volpicelli, Frank M; Roberts, David H; Schwartzstein, Richard M; Huang, Grace C

2015-02-01

Novel approaches for faculty development and assessment of procedural teaching skills are needed to improve the procedural education of trainees. The Objective Structured Teaching Exercise (OSTE) entails a simulated encounter in which faculty are observed teaching a standardized student and has been used to evaluate teaching skills. Use of an OSTE to assess the teaching of central venous catheterization has not been reported. The purpose of this study was to develop a procedural OSTE for subclavian central venous catheter (CVC) insertion and to determine specific aspects of procedural teaching associated with improved skills in novices. Critical care faculty/fellows taught a standardized student to insert a CVC in a simulator. We assessed the instructor's teaching skills using rating scales to generate a procedural teaching score. After this encounter, the instructor taught novice medical students to place CVCs in simulators. Novices then independently placed catheters in simulators and were evaluated by trained observers using a checklist. Generalized estimating equations were used to examine the correlation between specific teaching behaviors and the novices' skills in CVC placement. We recruited 10 participants to serve as teachers and 30 preclinical medical students to serve as novice learners. The overall mean procedural teaching score was 85.5 (±15.4). Improved student performance was directly related to the degree to which the teacher "provided positive feedback" (β = 1.53, SE = 0.44, P = 0.001), "offered learner suggestions for improvement" (β = 1.40, SE = 0.35, P < 0.001), and "demonstrated the procedure in a step-by-step manner" (β = 2.50, SE = 0.45, P < 0.001). There was no significant correlation between total scores and student skills (β = 0.06, SE = 0.46, P = 0.18). The OSTE is a standardized method to assess procedural teaching skills. Our findings suggest that specific aspects of procedural teaching should be emphasized to ensure effective transfer of psychomotor skills to trainees.

AgRISTARS: Foreign commodity production forecasting. Corn/soybean decision logic development and testing

NASA Technical Reports Server (NTRS)

Dailey, C. L.; Abotteen, K. M. (Principal Investigator)

1980-01-01

The development and testing of an analysis procedure which was developed to improve the consistency and objectively of crop identification using Landsat data is described. The procedure was developed to identify corn and soybean crops in the U.S. corn belt region. The procedure consists of a series of decision points arranged in a tree-like structure, the branches of which lead an analyst to crop labels. The specific decision logic is designed to maximize the objectively of the identification process and to promote the possibility of future automation. Significant results are summarized.

Diagnosing Expertise: Human Capital, Decision Making, and Performance among Physicians

PubMed Central

Currie, Janet; MacLeod, W. Bentley

2017-01-01

Expert performance is often evaluated assuming that good experts have good outcomes. We examine expertise in medicine and develop a model that allows for two dimensions of physician performance: decision making and procedural skill. Better procedural skill increases the use of intensive procedures for everyone, while better decision making results in a reallocation of procedures from fewer low-risk to high-risk cases. We show that poor diagnosticians can be identified using administrative data and that improving decision making improves birth outcomes by reducing C-section rates at the bottom of the risk distribution and increasing them at the top of the distribution. PMID:29276336

Innovation in internship preparation: an operative anatomy course increases senior medical students' knowledge and confidence.

PubMed

Tocco, Nikki; Brunsvold, Melissa; Kabbani, Loay; Lin, Jules; Stansfield, Brent; Mueller, Dean; Minter, Rebecca M

2013-08-01

An operative anatomy course was developed within the construct of a surgical internship preparatory curriculum. This course provided fourth-year medical students matching into a surgical residency the opportunity to perform intern-level procedures on cadavers under the guidance of surgical faculty members. Senior medical students performed intern-level procedures on cadavers with the assistance of faculty surgeons. Students' confidence, anxiety, and procedural knowledge were evaluated both preoperatively and postoperatively. Preoperative and postoperative data were compared both collectively and based on individual procedures. Student confidence and procedural knowledge significantly increased and anxiety significantly decreased when preoperative and postoperative data were compared (P < .05). Students reported moderate to significant improvement in their ability to perform a variety of surgical tasks. The consistent improvement in confidence, knowledge, and anxiety justifies further development of an operative anatomy course, with future assessment of the impact on performance in surgical residency. Copyright © 2013 Elsevier Inc. All rights reserved.

Mass Spectrometric Rapid Diagnosis of Infectious Diseases.

DTIC Science & Technology

1980-01-01

the analytical procedures to warrant reporting anew the whole analytical procedure. A. Sample Collection and Storage Procedure Urine samples were...positives or false-negatives. Next we have carried out a longitudinal study on urine samples obtained from groups of volunteer subjects vaccinated with...sterilization and storage procedures. 2. Developed new, simpler sample preparation techniques including one to handle tissue culture media. 3. Improved on the

Line pilot perspectives on complexity of terminal instrument flight procedures

DOT National Transportation Integrated Search

2016-09-01

Many new Performance Based Navigation (PBN) Instrument Flight Procedures (IFPs) are being developed as the United States transforms its airspace to improve safety and efficiency. Despite significant efforts to prepare for operational implementation o...

Operational benefits from the terminal configured vehicle

NASA Technical Reports Server (NTRS)

Reeder, J. P.; Schmitz, R. A.; Clark, L. V.

1979-01-01

The NASA Terminal Configured Vehicle is a flying laboratory used to conduct research and development on improved airborne systems (including avionics) and operational flight procedures, with particular emphasis on utilization in the terminal area environment. The objectives of this technology development activity, focused on conventional transport aircraft, are to develop and demonstrate improvements which can lead to increased airport and runway capacity, increased air traffic controller productivity, energy efficient terminal area operations, reduced weather minima with safety, and reduced community noise by use of appropriate procedures. This paper discusses some early results of this activity in addition to defining present efforts and future research plans.

Improving the Unsteady Aerodynamic Performance of Transonic Turbines using Neural Networks

NASA Technical Reports Server (NTRS)

Rai, Man Mohan; Madavan, Nateri K.; Huber, Frank W.

1999-01-01

A recently developed neural net-based aerodynamic design procedure is used in the redesign of a transonic turbine stage to improve its unsteady aerodynamic performance. The redesign procedure used incorporates the advantages of both traditional response surface methodology and neural networks by employing a strategy called parameter-based partitioning of the design space. Starting from the reference design, a sequence of response surfaces based on both neural networks and polynomial fits are constructed to traverse the design space in search of an optimal solution that exhibits improved unsteady performance. The procedure combines the power of neural networks and the economy of low-order polynomials (in terms of number of simulations required and network training requirements). A time-accurate, two-dimensional, Navier-Stokes solver is used to evaluate the various intermediate designs and provide inputs to the optimization procedure. The procedure yielded a modified design that improves the aerodynamic performance through small changes to the reference design geometry. These results demonstrate the capabilities of the neural net-based design procedure, and also show the advantages of including high-fidelity unsteady simulations that capture the relevant flow physics in the design optimization process.

Neural Net-Based Redesign of Transonic Turbines for Improved Unsteady Aerodynamic Performance

NASA Technical Reports Server (NTRS)

Madavan, Nateri K.; Rai, Man Mohan; Huber, Frank W.

1998-01-01

A recently developed neural net-based aerodynamic design procedure is used in the redesign of a transonic turbine stage to improve its unsteady aerodynamic performance. The redesign procedure used incorporates the advantages of both traditional response surface methodology (RSM) and neural networks by employing a strategy called parameter-based partitioning of the design space. Starting from the reference design, a sequence of response surfaces based on both neural networks and polynomial fits are constructed to traverse the design space in search of an optimal solution that exhibits improved unsteady performance. The procedure combines the power of neural networks and the economy of low-order polynomials (in terms of number of simulations required and network training requirements). A time-accurate, two-dimensional, Navier-Stokes solver is used to evaluate the various intermediate designs and provide inputs to the optimization procedure. The optimization procedure yields a modified design that improves the aerodynamic performance through small changes to the reference design geometry. The computed results demonstrate the capabilities of the neural net-based design procedure, and also show the tremendous advantages that can be gained by including high-fidelity unsteady simulations that capture the relevant flow physics in the design optimization process.

Exploration of Terminal Procedures Enabled by NASA Wake VAS Technologies

NASA Technical Reports Server (NTRS)

Lunsford, Clark R.; Smith, Arthur P., III; Cooper, Wayne W., Jr.; Mundra, Anand D.; Gross, Amy E.; Audenaerd, Laurence F.; Killian, Bruce E.

2004-01-01

The National Aeronautics and Space Administration (NASA) tasked The MITRE Corporation's Center for Advanced Aviation System Development (CAASD) to investigate potential air traffic control (ATC) procedures that could benefit from technology used or developed in NASA's Wake Vortex Advisory System (WakeVAS). The task also required developing an estimate of the potential benefits of the candidate procedures. The main thrust of the investigation was to evaluate opportunities for improved capacity and efficiency in airport arrival and departure operations. Other procedures that would provide safety enhancements were also considered. The purpose of this investigation was to provide input to the WakeVAS program office regarding the most promising areas of development for the program. A two-fold perspective was desired: First, identification of benefits from possible procedures enabled by both incremental components and the mature state of WakeVAS technology; second identification of procedures that could be expected to evolve from the current Federal Aviation Administration (FAA) procedures. The evolution of procedures should provide meaningful increments of benefit and a low risk implementation of the WakeVAS technologies.

Improvements in estimating proportions of objects from multispectral data

NASA Technical Reports Server (NTRS)

Horwitz, H. M.; Hyde, P. D.; Richardson, W.

1974-01-01

Methods for estimating proportions of objects and materials imaged within the instantaneous field of view of a multispectral sensor were developed further. Improvements in the basic proportion estimation algorithm were devised as well as improved alien object detection procedures. Also, a simplified signature set analysis scheme was introduced for determining the adequacy of signature set geometry for satisfactory proportion estimation. Averaging procedures used in conjunction with the mixtures algorithm were examined theoretically and applied to artificially generated multispectral data. A computationally simpler estimator was considered and found unsatisfactory. Experiments conducted to find a suitable procedure for setting the alien object threshold yielded little definitive result. Mixtures procedures were used on a limited amount of ERTS data to estimate wheat proportion in selected areas. Results were unsatisfactory, partly because of the ill-conditioned nature of the pure signature set.

Procedure to Generate the MPACT Multigroup Library

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

Kim, Kang Seog

The CASL neutronics simulator MPACT is under development for the neutronics and T-H coupled simulation for the light water reactor. The objective of this document is focused on reviewing the current procedure to generate the MPACT multigroup library. Detailed methodologies and procedures are included in this document for further discussion to improve the MPACT multigroup library.

Development of a High Resolution 3D Infant Stomach Model for Surgical Planning

NASA Astrophysics Data System (ADS)

Chaudry, Qaiser; Raza, S. Hussain; Lee, Jeonggyu; Xu, Yan; Wulkan, Mark; Wang, May D.

Medical surgical procedures have not changed much during the past century due to the lack of accurate low-cost workbench for testing any new improvement. The increasingly cheaper and powerful computer technologies have made computer-based surgery planning and training feasible. In our work, we have developed an accurate 3D stomach model, which aims to improve the surgical procedure that treats the infant pediatric and neonatal gastro-esophageal reflux disease (GERD). We generate the 3-D infant stomach model based on in vivo computer tomography (CT) scans of an infant. CT is a widely used clinical imaging modality that is cheap, but with low spatial resolution. To improve the model accuracy, we use the high resolution Visible Human Project (VHP) in model building. Next, we add soft muscle material properties to make the 3D model deformable. Then we use virtual reality techniques such as haptic devices to make the 3D stomach model deform upon touching force. This accurate 3D stomach model provides a workbench for testing new GERD treatment surgical procedures. It has the potential to reduce or eliminate the extensive cost associated with animal testing when improving any surgical procedure, and ultimately, to reduce the risk associated with infant GERD surgery.

Surgical manual of the Korean Gynecologic Oncology Group: ovarian, tubal, and peritoneal cancers.

PubMed

Jeon, Seob; Lee, Sung Jong; Lim, Myong Cheol; Song, Taejong; Bae, Jaeman; Kim, Kidong; Lee, Jung Yun; Kim, Sang Wun; Chang, Suk Joon; Lee, Jong Min

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncology Group has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we describe surgical procedure for ovarian, fallopian tubal, and peritoneal cancers.

Reliability based fatigue design and maintenance procedures

NASA Technical Reports Server (NTRS)

Hanagud, S.

1977-01-01

A stochastic model has been developed to describe a probability for fatigue process by assuming a varying hazard rate. This stochastic model can be used to obtain the desired probability of a crack of certain length at a given location after a certain number of cycles or time. Quantitative estimation of the developed model was also discussed. Application of the model to develop a procedure for reliability-based cost-effective fail-safe structural design is presented. This design procedure includes the reliability improvement due to inspection and repair. Methods of obtaining optimum inspection and maintenance schemes are treated.

43 CFR 418.32 - Cooperative programs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... THE INTERIOR OPERATING CRITERIA AND PROCEDURES FOR THE NEWLANDS RECLAMATION PROJECT, NEVADA Water... cooperatively to develop a water management and conservation program to promote efficient management of water in..., to improve the District's operations and procedures for greater water delivery conservation. (b) The...

43 CFR 418.32 - Cooperative programs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... INTERIOR OPERATING CRITERIA AND PROCEDURES FOR THE NEWLANDS RECLAMATION PROJECT, NEVADA Water Management... cooperatively to develop a water management and conservation program to promote efficient management of water in..., to improve the District's operations and procedures for greater water delivery conservation. (b) The...

43 CFR 418.32 - Cooperative programs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... THE INTERIOR OPERATING CRITERIA AND PROCEDURES FOR THE NEWLANDS RECLAMATION PROJECT, NEVADA Water... cooperatively to develop a water management and conservation program to promote efficient management of water in..., to improve the District's operations and procedures for greater water delivery conservation. (b) The...

43 CFR 418.32 - Cooperative programs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... THE INTERIOR OPERATING CRITERIA AND PROCEDURES FOR THE NEWLANDS RECLAMATION PROJECT, NEVADA Water... cooperatively to develop a water management and conservation program to promote efficient management of water in..., to improve the District's operations and procedures for greater water delivery conservation. (b) The...

43 CFR 418.32 - Cooperative programs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... THE INTERIOR OPERATING CRITERIA AND PROCEDURES FOR THE NEWLANDS RECLAMATION PROJECT, NEVADA Water... cooperatively to develop a water management and conservation program to promote efficient management of water in..., to improve the District's operations and procedures for greater water delivery conservation. (b) The...

Time Series Trends in Corporate Team Development.

ERIC Educational Resources Information Center

Priest, Simon; Lesperance, Mary Ann

1994-01-01

In two studies, the Team Development Indicator was repeatedly administered to intact work groups participating in intensive 48-hour residential corporate adventure training (CAT) and various follow-up procedures. CAT significantly improved team behaviors in all training groups, but improvements were maintained or increased only in groups that…

Improvement of screening methods for silicon planar semiconductor devices

NASA Technical Reports Server (NTRS)

Berger, W. M.

1972-01-01

The results of the program for the development of a more sensitive method for selecting silicon planar semiconductor devices for long life applications are reported. The manufacturing technologies (MOS and Bipolar) are discussed along with the screening procedures developed as a result of the tests and evaluations, and the effectiveness of the MOS and Bilayer screening procedures are evaluated.

Improving Building Energy Simulation Programs Through Diagnostic Testing (Fact Sheet)

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

Not Available

2012-02-01

New test procedure evaluates quality and accuracy of energy analysis tools for the residential building retrofit market. Reducing the energy use of existing homes in the United States offers significant energy-saving opportunities, which can be identified through building simulation software tools that calculate optimal packages of efficiency measures. To improve the accuracy of energy analysis for residential buildings, the National Renewable Energy Laboratory's (NREL) Buildings Research team developed the Building Energy Simulation Test for Existing Homes (BESTEST-EX), a method for diagnosing and correcting errors in building energy audit software and calibration procedures. BESTEST-EX consists of building physics and utility billmore » calibration test cases, which software developers can use to compare their tools simulation findings to reference results generated with state-of-the-art simulation tools. Overall, the BESTEST-EX methodology: (1) Tests software predictions of retrofit energy savings in existing homes; (2) Ensures building physics calculations and utility bill calibration procedures perform to a minimum standard; and (3) Quantifies impacts of uncertainties in input audit data and occupant behavior. BESTEST-EX is helping software developers identify and correct bugs in their software, as well as develop and test utility bill calibration procedures.« less

Nutritional considerations in project planning.

PubMed

Mason, J; Garcia, M; Mitchell, J; Test, K; Henderson, C; Tabatabai, H

1985-05-01

This paper discusses procedures for "ex ante" assessment of likely nutritional effects of development projects. Reported are results of 1 field trial in the Philippines of the "ex ante" assessment procedure in terms of: its feasibility and timeliness and the recommendations for project design that can be made and their influence. In the procedure described, emphasis is placed on assessing likely direct effects--through income, environmental changes and access to services. Indirect effects through food output and prices are assessed qualitatievly. 2 primary questions are addressed in the "ex ante" assessment: 1) who is to benefit directly from the project, in relation to their need (measured in terms of nutrition) and 2) is there reason to suppose that these benefits will not improve their nutrition? The procedure began with an initial assessment to identify the main issues based on reviewing existing data and a short field visit; since there was insufficient information, a rapid nutrition survey was conducted and analyzed; recommendations for project design were made within the necessary time for inclusion. The assessment of the large-scale development project in the Philippines indicates priority to remote areas, small farmers and subsistence fishermen. It is concluded that production-oriented components (e.g., agricultural and infrastructure development) of the project appear likely to improve nutrition insofar as they reach the priority groups defiend above. There is little reason to believe that increased income will not improve nutrition. Finally, there is evidence that an intervention to improve water supply is likely to be effective. Limitations of the procedure are that the assessment is limitied to direct, microlevel effects; long-term influences on nutrition, through changes in the overall economy of the area, are not assessed. Also, the data used cannot easily quantify expected effects on nutrition of project participants. Future application of such procedures are seen to be important if they can be fully integrated with the overall project planning.

Practice and Educational Gaps in Cosmetic Dermatologic Surgery.

PubMed

Waldman, Abigail; Sobanko, Joseph F; Alam, Murad

2016-07-01

This article identifies gaps in the practice of cosmetic dermatology and cosmetics education, and how to overcome these limitations. There is a rapid development of new devices and procedures, with limited data, patient-reported outcomes, and comparative effectiveness research from which to develop best cosmetic practice. There is a need for increased research and funding dedicated to these goals, improved and convenient training for staff to adopt new devices/procedures, and continuous evolution of databases to pool outcome data and develop outcome sets. Resident education can be improved by dedicated resident cosmetic clinics, didactic teaching from visiting professors, attendance of cosmetic dermatology courses and meetings, and encouraging postresidency training. Copyright © 2016 Elsevier Inc. All rights reserved.

48 CFR 31.002 - Availability of accounting guide.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Availability of accounting... GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES 31.002 Availability of accounting guide. Contractors needing assistance in developing or improving their accounting systems and procedures...

Practicing Surgeons Lead in Quality Care, Safety, and Cost Control

PubMed Central

Shively, Eugene H.; Heine, Michael J.; Schell, Robert H.; Sharpe, J Neal; Garrison, R Neal; Vallance, Steven R.; DeSimone, Kenneth J.S.; Polk, Hiram C.

2004-01-01

Objective: To report the experiences of 66 surgical specialists from 15 different hospitals who performed 43 CPT-based procedures more than 16,000 times. Summary Background Data: Surgeons are under increasing pressure to demonstrate patient safety data as quantitated by objective and subjective outcomes that meet or exceed the standards of benchmark institutions or databases. Methods: Data from 66 surgical specialists on 43 CPT-based procedures were accessioned over a 4-year period. The hospitals vary from a small 30-bed hospital to large teaching hospitals. All reported deaths and complications were verified from hospital and office records and compared with benchmarks. Results: Over a 4-year inclusive period (1999–2002), 16,028 elective operations were accessioned. There was a total 1.4% complication rate and 0.05% death rate. A system has been developed for tracking outcomes. A wide range of improvements have been identified. These include the following: 1) improved classification of indications for systemic prophylactic antibiotic use and reduction in the variety of drugs used, 2) shortened length of stay for standard procedures in different surgical specialties, 3) adherence to strict indicators for selected operative procedures, 4) less use of costly diagnostic procedures, 5) decreased use of expensive home health services, 6) decreased use of very expensive drugs, 7) identification of the unnecessary expense of disposable laparoscopic devices, 8) development of a method to compare a one-surgeon hospital with his peers, and 9) development of unique protocols for interaction of anesthesia and surgery. The system also provides a very good basis for confirmation of patient safety and improvement therein. Conclusions: Since 1998, Quality Surgical Solutions, PLLC, has developed simple physician-authored protocols for delivering high-quality and cost-effective surgery that measure up to benchmark institutions. We have discovered wide areas for improvements in surgery by adherence to simple protocols, minimizing death and complications and clarifying cost issues. PMID:15166954

Towards Verification of Operational Procedures Using Auto-Generated Diagnostic Trees

NASA Technical Reports Server (NTRS)

Kurtoglu, Tolga; Lutz, Robyn; Patterson-Hine, Ann

2009-01-01

The design, development, and operation of complex space, lunar and planetary exploration systems require the development of general procedures that describe a detailed set of instructions capturing how mission tasks are performed. For both crewed and uncrewed NASA systems, mission safety and the accomplishment of the scientific mission objectives are highly dependent on the correctness of procedures. In this paper, we describe how to use the auto-generated diagnostic trees from existing diagnostic models to improve the verification of standard operating procedures. Specifically, we introduce a systematic method, namely the Diagnostic Tree for Verification (DTV), developed with the goal of leveraging the information contained within auto-generated diagnostic trees in order to check the correctness of procedures, to streamline the procedures in terms of reducing the number of steps or use of resources in them, and to propose alternative procedural steps adaptive to changing operational conditions. The application of the DTV method to a spacecraft electrical power system shows the feasibility of the approach and its range of capabilities

Surgical manual of the Korean Gynecologic Oncology Group: classification of hysterectomy and lymphadenectomy

PubMed Central

Choi, Chel Hun; Chun, Yi Kyeong

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncologic Group (KGOG) has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we focused on radical hysterectomy and lymphadenectomy, and we developed a KGOG classification for those conditions. PMID:27670259

Surgical manual of the Korean Gynecologic Oncology Group: classification of hysterectomy and lymphadenectomy.

PubMed

Lee, Maria; Choi, Chel Hun; Chun, Yi Kyeong; Kim, Yun Hwan; Lee, Kwang Beom; Lee, Shin Wha; Shim, Seung Hyuk; Song, Yong Jung; Roh, Ju Won; Chang, Suk Joon; Lee, Jong Min

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncologic Group (KGOG) has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we focused on radical hysterectomy and lymphadenectomy, and we developed a KGOG classification for those conditions.

Acquisition of Motor and Cognitive Skills through Repetition in Typically Developing Children

PubMed Central

Magallón, Sara; Narbona, Juan; Crespo-Eguílaz, Nerea

2016-01-01

Background Procedural memory allows acquisition, consolidation and use of motor skills and cognitive routines. Automation of procedures is achieved through repeated practice. In children, improvement in procedural skills is a consequence of natural neurobiological development and experience. Methods The aim of the present research was to make a preliminary evaluation and description of repetition-based improvement of procedures in typically developing children (TDC). Ninety TDC children aged 6–12 years were asked to perform two procedural learning tasks. In an assembly learning task, which requires predominantly motor skills, we measured the number of assembled pieces in 60 seconds. In a mirror drawing learning task, which requires more cognitive functions, we measured time spent and efficiency. Participants were tested four times for each task: three trials were consecutive and the fourth trial was performed after a 10-minute nonverbal interference task. The influence of repeated practice on performance was evaluated by means of the analysis of variance with repeated measures and the paired-sample test. Correlation coefficients and simple linear regression test were used to examine the relationship between age and performance. Results TDC achieved higher scores in both tasks through repetition. Older children fitted more pieces than younger ones in assembling learning and they were faster and more efficient at the mirror drawing learning task. Conclusions These findings indicate that three consecutive trials at a procedural task increased speed and efficiency, and that age affected basal performance in motor-cognitive procedures. PMID:27384671

Acquisition of Motor and Cognitive Skills through Repetition in Typically Developing Children.

PubMed

Magallón, Sara; Narbona, Juan; Crespo-Eguílaz, Nerea

2016-01-01

Procedural memory allows acquisition, consolidation and use of motor skills and cognitive routines. Automation of procedures is achieved through repeated practice. In children, improvement in procedural skills is a consequence of natural neurobiological development and experience. The aim of the present research was to make a preliminary evaluation and description of repetition-based improvement of procedures in typically developing children (TDC). Ninety TDC children aged 6-12 years were asked to perform two procedural learning tasks. In an assembly learning task, which requires predominantly motor skills, we measured the number of assembled pieces in 60 seconds. In a mirror drawing learning task, which requires more cognitive functions, we measured time spent and efficiency. Participants were tested four times for each task: three trials were consecutive and the fourth trial was performed after a 10-minute nonverbal interference task. The influence of repeated practice on performance was evaluated by means of the analysis of variance with repeated measures and the paired-sample test. Correlation coefficients and simple linear regression test were used to examine the relationship between age and performance. TDC achieved higher scores in both tasks through repetition. Older children fitted more pieces than younger ones in assembling learning and they were faster and more efficient at the mirror drawing learning task. These findings indicate that three consecutive trials at a procedural task increased speed and efficiency, and that age affected basal performance in motor-cognitive procedures.

The development of an automatically produced cholangiography procedure using the reconstruction of portal-phase multidetector-row computed tomography images: preliminary experience.

PubMed

Hirose, Tomoaki; Igami, Tsuyoshi; Koga, Kusuto; Hayashi, Yuichiro; Ebata, Tomoki; Yokoyama, Yukihiro; Sugawara, Gen; Mizuno, Takashi; Yamaguchi, Junpei; Mori, Kensaku; Nagino, Masato

2017-03-01

Fusion angiography using reconstructed multidetector-row computed tomography (MDCT) images, and cholangiography using reconstructed images from MDCT with a cholangiographic agent include an anatomical gap due to the different periods of MDCT scanning. To conquer such gaps, we attempted to develop a cholangiography procedure that automatically reconstructs a cholangiogram from portal-phase MDCT images. The automatically produced cholangiography procedure utilized an original software program that was developed by the Graduate School of Information Science, Nagoya University. This program structured 5 candidate biliary tracts, and automatically selected one as the candidate for cholangiography. The clinical value of the automatically produced cholangiography procedure was estimated based on a comparison with manually produced cholangiography. Automatically produced cholangiograms were reconstructed for 20 patients who underwent MDCT scanning before biliary drainage for distal biliary obstruction. The procedure showed the ability to extract the 5 main biliary branches and the 21 subsegmental biliary branches in 55 and 25 % of the cases, respectively. The extent of aberrant connections and aberrant extractions outside the biliary tract was acceptable. Among all of the cholangiograms, 5 were clinically applied with no correction, 8 were applied with modest improvements, and 3 produced a correct cholangiography before automatic selection. Although our procedure requires further improvement based on the analysis of additional patient data, it may represent an alternative to direct cholangiography in the future.

State-of-the-art and emerging technologies for atrial fibrillation ablation.

PubMed

Dewire, Jane; Calkins, Hugh

2010-03-01

Catheter ablation is an important treatment modality for patients with atrial fibrillation (AF). Although the superiority of catheter ablation over antiarrhythmic drug therapy has been demonstrated in middle-aged patients with paroxysmal AF, the role the procedure in other patient subgroups-particularly those with long-standing persistent AF-has not been well defined. Furthermore, although AF ablation can be performed with reasonable efficacy and safety by experienced operators, long-term success rates for single procedures are suboptimal. Fortunately, extensive ongoing research will improve our understanding of the mechanisms of AF, and considerable funds are being invested in developing new ablation technologies to improve patient outcomes. These technologies include ablation catheters designed to electrically isolate the pulmonary veins with improved safety, efficacy, and speed, catheters designed to deliver radiofrequency energy with improved precision, robotic systems to address the technological demands of the procedure, improved imaging and electrical mapping systems, and MRI-guided ablation strategies. The tools, technologies, and techniques that will ultimately stand the test of time and become the standard approach to AF ablation in the future remain unclear. However, technological advances are sure to result in the necessary improvements in the safety and efficacy of AF ablation procedures.

Improved silicon carbide for advanced heat engines

NASA Technical Reports Server (NTRS)

Whalen, T. J.; Winterbottom, W. L.

1986-01-01

Work performed to develop silicon carbide materials of high strength and to form components of complex shape and high reliability is described. A beta-SiC powder and binder system was adapted to the injection molding process and procedures and process parameters developed capable of providing a sintered silicon carbide material with improved properties. The initial effort has been to characterize the baseline precursor materials (beta silicon carbide powder and boron and carbon sintering aids), develop mixing and injection molding procedures for fabricating test bars, and characterize the properties of the sintered materials. Parallel studies of various mixing, dewaxing, and sintering procedures have been carried out in order to distinguish process routes for improving material properties. A total of 276 MOR bars of the baseline material have been molded, and 122 bars have been fully processed to a sinter density of approximately 95 percent. The material has a mean MOR room temperature strength of 43.31 ksi (299 MPa), a Weibull characteristic strength of 45.8 ksi (315 MPa), and a Weibull modulus of 8.0. Mean values of the MOR strengths at 1000, 1200, and 14000 C are 41.4, 43.2, and 47.2 ksi, respectively. Strength controlling flaws in this material were found to consist of regions of high porosity and were attributed to agglomerates originating in the initial mixing procedures. The mean stress rupture lift at 1400 C of five samples tested at 172 MPa (25 ksi) stress was 62 hours and at 207 MPa (30 ksi) stress was 14 hours. New fluid mixing techniques have been developed which significantly reduce flaw size and improve the strength of the material. Initial MOR tests indicate the strength of the fluid-mixed material exceeds the baseline property by more than 33 percent.

Capacity improvement analytical tools and benchmark development for terminal operations

DOT National Transportation Integrated Search

2009-10-01

With U.S. air traffic predicted to triple over the : next fifteen years, new technologies and procedures are : being considered to cope with this growth. As such, it : may be of use to quickly and easily evaluate any new : technologies or procedures ...

Surgical manual of the Korean Gynecologic Oncology Group: ovarian, tubal, and peritoneal cancers

PubMed Central

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncology Group has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we describe surgical procedure for ovarian, fallopian tubal, and peritoneal cancers. PMID:27670260

Therapeutic apheresis in Asia: An Indonesia single center experience.

PubMed

Triyono, Teguh; Vrielink, Hans

2015-06-01

In developing countries, like Indonesia, apheresis is still a relative new procedure. Nowadays, therapeutic apheresis procedures are performed in the field of hematology and neurology, especially in the teaching hospitals in Indonesia. Therapeutic apheresis procedure, that is, leukocytapheresis, therapeutic plasma exchange (TPE), and thrombocytapheresis are already performed. In the period 2009-2013, 204 apheresis procedures in 137 patients to reduce the leukocytes, 72 TPE procedures in 17 patients, and 14 thrombocyte reductions were performed in the Sardjito hospital, Yogyakarta, Indonesia. In the future, to improve the therapeutic apheresis implementation, it is important to increase the insurance coverage and also should be considered to introduce the apheresis medicine into the curriculum of appropriate physician programs in Indonesia. Especially in Indonesia, a lot of efforts are still being needed to improve implementation of therapeutic apheresis. © 2014 Wiley Periodicals, Inc.

High voltage power transistor development

NASA Technical Reports Server (NTRS)

Hower, P. L.

1981-01-01

Design considerations, fabrication procedures, and methods of evaluation for high-voltage power-transistor development are discussed. Technique improvements such as controlling the electric field at the surface and perserving lifetimes in the collector region which have advanced the state of the art in high-voltage transistors are discussed. These improvements can be applied directly to the development of 1200 volt, 200 ampere transistors.

Virtual reality for health care: a survey.

PubMed

Moline, J

1997-01-01

This report surveys the state of the art in applications of virtual environments and related technologies for health care. Applications of these technologies are being developed for health care in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); medical therapy; preventive medicine and patient education; medical education and training; visualization of massive medical databases; skill enhancement and rehabilitation; and architectural design for health-care facilities. To date, such applications have improved the quality of health care, and in the future they will result in substantial cost savings. Tools that respond to the needs of present virtual environment systems are being refined or developed. However, additional large-scale research is necessary in the following areas: user studies, use of robots for telepresence procedures, enhanced system reality, and improved system functionality.

International Agreement on Planetary Protection

NASA Technical Reports Server (NTRS)

2000-01-01

The maintenance of a NASA policy, is consistent with international agreements. The planetary protection policy management in OSS, with Field Center support. The advice from internal and external advisory groups (NRC, NAC/Planetary Protection Task Force). The technology research and standards development in bioload characterization. The technology research and development in bioload reduction/sterilization. This presentation focuses on: forward contamination - research on the potential for Earth life to exist on other bodies, improved strategies for planetary navigation and collision avoidance, and improved procedures for sterile spacecraft assembly, cleaning and/or sterilization; and backward contamination - development of sample transfer and container sealing technologies for Earth return, improvement in sample return landing target assessment and navigation strategy, planning for sample hazard determination requirements and procedures, safety certification, (liaison to NEO Program Office for compositional data on small bodies), facility planning for sample recovery system, quarantine, and long-term curation of 4 returned samples.

Pediatric Drowning: A Standard Operating Procedure to Aid the Prehospital Management of Pediatric Cardiac Arrest Resulting From Submersion.

PubMed

Best, Rebecca R; Harris, Benjamin H L; Walsh, Jason L; Manfield, Timothy

2017-05-08

Drowning is one of the leading causes of death in children. Resuscitating a child following submersion is a high-pressure situation, and standard operating procedures can reduce error. Currently, the Resuscitation Council UK guidance does not include a standard operating procedure on pediatric drowning. The objective of this project was to design a standard operating procedure to improve outcomes of drowned children. A literature review on the management of pediatric drowning was conducted. Relevant publications were used to develop a standard operating procedure for management of pediatric drowning. A concise standard operating procedure was developed for resuscitation following pediatric submersion. Specific recommendations include the following: the Heimlich maneuver should not be used in this context; however, prolonged resuscitation and therapeutic hypothermia are recommended. This standard operating procedure is a potentially useful adjunct to the Resuscitation Council UK guidance and should be considered for incorporation into its next iteration.

Development and validation of trauma surgical skills metrics: Preliminary assessment of performance after training.

PubMed

Shackelford, Stacy; Garofalo, Evan; Shalin, Valerie; Pugh, Kristy; Chen, Hegang; Pasley, Jason; Sarani, Babak; Henry, Sharon; Bowyer, Mark; Mackenzie, Colin F

2015-07-01

Maintaining trauma-specific surgical skills is an ongoing challenge for surgical training programs. An objective assessment of surgical skills is needed. We hypothesized that a validated surgical performance assessment tool could detect differences following a training intervention. We developed surgical performance assessment metrics based on discussion with expert trauma surgeons, video review of 10 experts and 10 novice surgeons performing three vascular exposure procedures and lower extremity fasciotomy on cadavers, and validated the metrics with interrater reliability testing by five reviewers blinded to level of expertise and a consensus conference. We tested these performance metrics in 12 surgical residents (Year 3-7) before and 2 weeks after vascular exposure skills training in the Advanced Surgical Skills for Exposure in Trauma (ASSET) course. Performance was assessed in three areas as follows: knowledge (anatomic, management), procedure steps, and technical skills. Time to completion of procedures was recorded, and these metrics were combined into a single performance score, the Trauma Readiness Index (TRI). Wilcoxon matched-pairs signed-ranks test compared pretraining/posttraining effects. Mean time to complete procedures decreased by 4.3 minutes (from 13.4 minutes to 9.1 minutes). The performance component most improved by the 1-day skills training was procedure steps, completion of which increased by 21%. Technical skill scores improved by 12%. Overall knowledge improved by 3%, with 18% improvement in anatomic knowledge. TRI increased significantly from 50% to 64% with ASSET training. Interrater reliability of the surgical performance assessment metrics was validated with single intraclass correlation coefficient of 0.7 to 0.98. A trauma-relevant surgical performance assessment detected improvements in specific procedure steps and anatomic knowledge taught during a 1-day course, quantified by the TRI. ASSET training reduced time to complete vascular control by one third. Future applications include assessing specific skills in a larger surgeon cohort, assessing military surgical readiness, and quantifying skill degradation with time since training.

Multiply scaled constrained nonlinear equation solvers. [for nonlinear heat conduction problems

NASA Technical Reports Server (NTRS)

Padovan, Joe; Krishna, Lala

1986-01-01

To improve the numerical stability of nonlinear equation solvers, a partitioned multiply scaled constraint scheme is developed. This scheme enables hierarchical levels of control for nonlinear equation solvers. To complement the procedure, partitioned convergence checks are established along with self-adaptive partitioning schemes. Overall, such procedures greatly enhance the numerical stability of the original solvers. To demonstrate and motivate the development of the scheme, the problem of nonlinear heat conduction is considered. In this context the main emphasis is given to successive substitution-type schemes. To verify the improved numerical characteristics associated with partitioned multiply scaled solvers, results are presented for several benchmark examples.

Development and Face Validation of Strategies for Improving Consultation Skills

ERIC Educational Resources Information Center

Lefroy, Janet; Thomas, Adam; Harrison, Chris; Williams, Stephen; O'Mahony, Fidelma; Gay, Simon; Kinston, Ruth; McKinley, R. K.

2014-01-01

While formative workplace based assessment can improve learners' skills, it often does not because the procedures used do not facilitate feedback which is sufficiently specific to scaffold improvement. Provision of pre-formulated strategies to address predicted learning needs has potential to improve the quality and automate the provision of…

Assistive technology for ultrasound-guided central venous catheter placement.

PubMed

Ikhsan, Mohammad; Tan, Kok Kiong; Putra, Andi Sudjana

2018-01-01

This study evaluated the existing technology used to improve the safety and ease of ultrasound-guided central venous catheterization. Electronic database searches were conducted in Scopus, IEEE, Google Patents, and relevant conference databases (SPIE, MICCAI, and IEEE conferences) for related articles on assistive technology for ultrasound-guided central venous catheterization. A total of 89 articles were examined and pointed to several fields that are currently the focus of improvements to ultrasound-guided procedures. These include improving needle visualization, needle guides and localization technology, image processing algorithms to enhance and segment important features within the ultrasound image, robotic assistance using probe-mounted manipulators, and improving procedure ergonomics through in situ projections of important information. Probe-mounted robotic manipulators provide a promising avenue for assistive technology developed for freehand ultrasound-guided percutaneous procedures. However, there is currently a lack of clinical trials to validate the effectiveness of these devices.

An automation-assisted generic approach for biological sample preparation and LC-MS/MS method validation.

PubMed

Zhang, Jie; Wei, Shimin; Ayres, David W; Smith, Harold T; Tse, Francis L S

2011-09-01

Although it is well known that automation can provide significant improvement in the efficiency of biological sample preparation in quantitative LC-MS/MS analysis, it has not been widely implemented in bioanalytical laboratories throughout the industry. This can be attributed to the lack of a sound strategy and practical procedures in working with robotic liquid-handling systems. Several comprehensive automation assisted procedures for biological sample preparation and method validation were developed and qualified using two types of Hamilton Microlab liquid-handling robots. The procedures developed were generic, user-friendly and covered the majority of steps involved in routine sample preparation and method validation. Generic automation procedures were established as a practical approach to widely implement automation into the routine bioanalysis of samples in support of drug-development programs.

36 CFR 222.53 - Grazing fees in the East-noncompetitive procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... current period's hay price index, less the value of any agency required range improvements. (ii) Grazing Fee Credits for Range Improvements. Any requirements for permittee construction or development of range improvements shall be identified through an agreement and incorporated into the grazing permit...

Small Engine Technology (SET) Task 23 ANOPP Noise Prediction for Small Engines, Wing Reflection Code

NASA Technical Reports Server (NTRS)

Lieber, Lysbeth; Brown, Daniel; Golub, Robert A. (Technical Monitor)

2000-01-01

The work performed under Task 23 consisted of the development and demonstration of improvements for the NASA Aircraft Noise Prediction Program (ANOPP), specifically targeted to the modeling of engine noise enhancement due to wing reflection. This report focuses on development of the model and procedure to predict the effects of wing reflection, and the demonstration of the procedure, using a representative wing/engine configuration.

New Developments in Robotics and Single-site Gynecologic Surgery.

PubMed

Matthews, Catherine A

2017-06-01

Within the last 10 years there have been significant advances in minimal-access surgery. Although no emerging technology has demonstrated improved outcomes or fewer complications than standard laparoscopy, the introduction of the robotic surgical platform has significantly lowered abdominal hysterectomy rates. While operative time and cost were higher in robotic-assisted procedures when the technology was first introduced, newer studies demonstrate equivalent or improved robotic surgical efficiency with increased experience. Single-port hysterectomy has not improved postoperative pain or subjective cosmetic results. Emerging platforms with flexible, articulating instruments may increase the uptake of single-port procedures including natural orifice transluminal endoscopic cases.

Optimization of structures to satisfy a flutter velocity constraint by use of quadratic equation fitting. M.S. Thesis

NASA Technical Reports Server (NTRS)

Motiwalla, S. K.

1973-01-01

Using the first and the second derivative of flutter velocity with respect to the parameters, the velocity hypersurface is made quadratic. This greatly simplifies the numerical procedure developed for determining the values of the design parameters such that a specified flutter velocity constraint is satisfied and the total structural mass is near a relative minimum. A search procedure is presented utilizing two gradient search methods and a gradient projection method. The procedure is applied to the design of a box beam, using finite-element representation. The results indicate that the procedure developed yields substantial design improvement satisfying the specified constraint and does converge to near a local optimum.

Development of a full-scale transmission testing procedure to evaluate advanced lubricants

NASA Technical Reports Server (NTRS)

Lewicki, David G.; Decker, Harry J.; Shimski, John T.

1992-01-01

Experimental tests were performed on the OH-58A helicopter main rotor transmission in the NASA Lewis 500-hp Helicopter Transmission Test Stand. The testing was part of a joint Navy/NASA/Army lubrication program. The objective of the program was to develop a separate lubricant for gearboxes and demonstrate an improved performance in life and load-carrying capacity. The goal of the experiments was to develop a testing procedure to fail certain transmission components using a MIL-L-23699 base reference oil, then run identical tests with improved lubricants and demonstrate performance. The tests were directed at failing components that the Navy has had problems with due to marginal lubrication. These failures included mast shaft bearing micropitting, sun gear and planet bearing fatigue, and spiral bevel gear scoring. A variety of tests were performed and over 900 hours of total run time accumulated for these tests. Some success was achieved in developing a testing procedure to produce sun gear and planet bearing fatigue failures. Only marginal success was achieved in producing mast shaft bearing micropitting and spiral bevel gear scoring.

Virtual simulation as a learning method in interventional radiology.

PubMed

Avramov, Predrag; Avramov, Milena; Juković, Mirela; Kadić, Vuk; Till, Viktor

2013-01-01

Radiology is the fastest growing discipline of medicine thanks to the implementation of new technologies and very rapid development of imaging diagnostic procedures in the last few decades. On the other hand, the development of imaging diagnostic procedures has put aside the traditional gaining of experience by working on real patients, and the need for other alternatives of learning interventional radiology procedures has emerged. A new method of virtual approach was added as an excellent alternative to the currently known methods of training on physical models and animals. Virtual reality represents a computer-generated reconstruction of anatomical environment with tactile interactions and it enables operators not only to learn on their own mistakes without compromising the patient's safety, but also to enhance their knowledge and experience. It is true that studies published so far on the validity of endovascular simulators have shown certain improvement of operator's technical skills and reduction in time needed for the procedure, but on the other hand, it is still a question whether these skills are transferable to the real patients in the angio room. With further improvement of technology, shortcomings of virtual approach to interventional procedures learning will be less significant and this procedure is likely to become the only method of learning in the near future.

Procedures for Trade and Industrial Program Development.

ERIC Educational Resources Information Center

Campbell, Clifton P.

The instructional systems development (ISD) approach for the development and accomplishment of vocational training programs provides a methodology for gathering and analyzing job information, developing instructional materials in a variety of media, conducting instruction, and evaluating and improving the effectiveness of training programs. This…

[Surgical techniques in liver transplantation].

PubMed

Chan, Carlos; Plata-Muñoz, Juan José; Franssen, Bernardo

2005-01-01

Liver transplantation (LT) is probably the biggest surgical aggression that a patient can endure. It was considered only as a last option in the era of experimental LT, yet it evolved into the definitive treatment for some types of acute and chronic end stage liver disease. In terms of technique LT is the most complex of all types of transplantations. The surgical procedure in itself is well established and has changed little through time. Liver transplantation owes its improvement to better and more systematic anesthetic procedures and to perioperative care more than being due to improvement of the surgical technique. The first surgical procedure was described by Thomas Starzl in 1969. His initial work has been strengthened with the development of venous bypass, the refinement in vascular and biliary reconstruction technique and the development of the split liver. Up to date technical aspects of orthotopic liver transplantation are described in the present article.

Integrated aerodynamic-structural design of a forward-swept transport wing

NASA Technical Reports Server (NTRS)

Haftka, Raphael T.; Grossman, Bernard; Kao, Pi-Jen; Polen, David M.; Sobieszczanski-Sobieski, Jaroslaw

1989-01-01

The introduction of composite materials is having a profound effect on aircraft design. Since these materials permit the designer to tailor material properties to improve structural, aerodynamic and acoustic performance, they require an integrated multidisciplinary design process. Futhermore, because of the complexity of the design process, numerical optimization methods are required. The utilization of integrated multidisciplinary design procedures for improving aircraft design is not currently feasible because of software coordination problems and the enormous computational burden. Even with the expected rapid growth of supercomputers and parallel architectures, these tasks will not be practical without the development of efficient methods for cross-disciplinary sensitivities and efficient optimization procedures. The present research is part of an on-going effort which is focused on the processes of simultaneous aerodynamic and structural wing design as a prototype for design integration. A sequence of integrated wing design procedures has been developed in order to investigate various aspects of the design process.

[The history and development of computer assisted orthopaedic surgery].

PubMed

Jenny, J-Y

2006-10-01

Computer assisted orthopaedic surgery (CAOS) was developed to improve the accuracy of surgical procedures. It has improved dramatically over the last years, being transformed from an experimental, laboratory procedure into a routine procedure theoretically available to every orthopaedic surgeon. The first field of application of computer assistance was neurosurgery. After the application of computer guided spinal surgery, the navigation of total hip and knee joints became available. Currently, several applications for computer assisted surgery are available. At the beginning of navigation, a preoperative CT-scan or several fluoroscopic images were necessary. The imageless systems allow the surgeon to digitize patient anatomy at the beginning of surgery without any preoperative imaging. The future of CAOS remains unknown, but there is no doubt that its importance will grow in the next 10 years, and that this technology will probably modify the conventional practice of orthopaedic surgery.

Exploratory development and services for preparing and examining ultrathin polished sections of lunar rocks and particulates, part 1

NASA Technical Reports Server (NTRS)

Beauchamp, R. H.; Williford, J. F.; Gafford, E. L.

1972-01-01

Development of improved procedures is reported for three classes of lunar materials: dense rocks, breccias, and particulates. High quality ultrathin sections of these materials are obtained. Lists of equipment and supplies, procedures, photomicrographic documentation, and training are provided. Advantages of ultrathin polished sections for conventional and unconventional optical microscopy methods are described. Recommendations are provided for use of ultrathin sections in lunar rock studies, for further refinement of ultrathinning procedures, and for additional training efforts to establish a capability at the Manned Space Center. For Part 2, See N72-50754.

SUPPORTING THE INDUSTRY BY DEVELOPING A DESIGN GUIDANCE FOR COMPUTER-BASED PROCEDURES FOR FIELD WORKERS

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

Oxstrand, Johanna; LeBlanc, Katya

The paper-based procedures currently used for nearly all activities in the commercial nuclear power industry have a long history of ensuring safe operation of the plants. However, there is potential to greatly increase efficiency and safety by improving how the human interacts with the procedures, which can be achieved through the use of computer-based procedures (CBPs). A CBP system offers a vast variety of improvements, such as context driven job aids, integrated human performance tools and dynamic step presentation. As a step toward the goal of improving procedure use performance, the U.S. Department of Energy Light Water Reactor Sustainability Programmore » researchers, together with the nuclear industry, have been investigating the possibility and feasibility of replacing current paper-based procedures with CBPs. The main purpose of the CBP research conducted at the Idaho National Laboratory was to provide design guidance to the nuclear industry to be used by both utilities and vendors. After studying existing design guidance for CBP systems, the researchers concluded that the majority of the existing guidance is intended for control room CBP systems, and does not necessarily address the challenges of designing CBP systems for instructions carried out in the field. Further, the guidance is often presented on a high level, which leaves the designer to interpret what is meant by the guidance and how to specifically implement it. The authors developed a design guidance to provide guidance specifically tailored to instructions that are carried out in the field based.« less

Understanding Human Autonomy Teaming Through Applications

NASA Technical Reports Server (NTRS)

Aponso, B.; Stallmann, Summer; Lachter, Joel; Shively, Jay; Benton, J.; Kaneshige, John; Mumaw, Randy; Feary, Michael

2017-01-01

This presentation describes the development and demonstration of human autonomy teaming technologies for improving aviation safety and efficiency during nominal and off-nominal operations by developing and validating increasingly autonomous systems concepts, technologies, and procedures.

Procedural Learning in Children With Developmental Coordination, Reading, and Attention Disorders.

PubMed

Magallón, Sara; Crespo-Eguílaz, Nerea; Narbona, Juan

2015-10-01

The aim is to assess repetition-based learning of procedures in children with developmental coordination disorder (DCD), reading disorder (RD) and attention-deficit hyperactivity disorder (ADHD). Participants included 187 children, studied in 4 groups: (a) DCD comorbid with RD and ADHD (DCD+RD+ADHD) (n = 30); (b) RD comorbid with ADHD (RD+ADHD) (n = 48); (c) ADHD (n = 19); and typically developing children (control group) (n = 90). Two procedural learning tasks were used: Assembly learning and Mirror drawing. Children were tested on 4 occasions for each task: 3 trials were consecutive and the fourth trial was performed after an interference task. Task performance by DCD+RD+ADHD children improved with training (P < .05); however, the improvement was significantly lower than that achieved by the other groups (RD+ADHD, ADHD and controls) (P < .05). In conclusion, children with DCD+RD+ADHD improve in their use of cognitive-motor procedures over a short training period. Aims of intervention in DCD+RD+ADHD should be based on individual learning abilities. © The Author(s) 2015.

Recent Development of Augmented Reality in Surgery: A Review.

PubMed

Vávra, P; Roman, J; Zonča, P; Ihnát, P; Němec, M; Kumar, J; Habib, N; El-Gendi, A

2017-01-01

The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms "augmented reality" and "surgery." Results . The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice.

Fiscal year 1980-81 implementation plan in support of technical development and integration of sampling and aggregation procedures. [crop acreage estimation

NASA Technical Reports Server (NTRS)

1981-01-01

The specific objectives of the FY 1980-81 tasks are: (1) further refinements to the weighted aggregation procedure; (2) improved approaches for estimating within-stratum variance; (3) more intensive investigation of alternative sampling strategies such as full-frame sampling strategy, and (4) further developments in regard to a simulated approach for assessing the performance of the overall designed sampling and aggregation system.

Development, test and evaluation of a computerized procedure for using Landsat data to estimate spring small grains acreage

NASA Technical Reports Server (NTRS)

Mohler, R. R. J.; Palmer, W. F.; Smyrski, M. M.; Baker, T. C.; Nazare, C. V.

1982-01-01

A number of methods which can provide information concerning crop acreages on the basis of a utilization of multispectral scanner (MSS) data require for their implementation a comparatively large amount of labor. The present investigation is concerned with a project designed to improve the efficiency of analysis through increased automation. The Caesar technique was developed to realize this objective. The processability rates of the Caesar procedure versus the historical state-of-the-art proportion estimation procedures were determined in an experiment. Attention is given to the study site, the aggregation technology, the results of the aggregation test, and questions of error characterization. It is found that the Caesar procedure, which has been developed for the spring small grains region of North America, is highly efficient and provides accurate results.

Development of an algorithm to plan and simulate a new interventional procedure.

PubMed

Fujita, Buntaro; Kütting, Maximilian; Scholtz, Smita; Utzenrath, Marc; Hakim-Meibodi, Kavous; Paluszkiewicz, Lech; Schmitz, Christoph; Börgermann, Jochen; Gummert, Jan; Steinseifer, Ulrich; Ensminger, Stephan

2015-07-01

The number of implanted biological valves for treatment of valvular heart disease is growing and a percentage of these patients will eventually undergo a transcatheter valve-in-valve (ViV) procedure. Some of these patients will represent challenging cases. The aim of this study was to develop a feasible algorithm to plan and in vitro simulate a new interventional procedure to improve patient outcome. In addition to standard diagnostic routine, our algorithm includes 3D printing of the annulus, hydrodynamic measurements and high-speed analysis of leaflet kinematics after simulation of the procedure in different prosthesis positions as well as X-ray imaging of the most suitable valve position to create a 'blueprint' for the patient procedure. This algorithm was developed for a patient with a degenerated Perceval aortic sutureless prosthesis requiring a ViV procedure. Different ViV procedures were assessed in the algorithm and based on these results the best option for the patient was chosen. The actual procedure went exactly as planned with help of this algorithm. Here we have developed a new technically feasible algorithm simulating important aspects of a novel interventional procedure prior to the actual procedure. This algorithm can be applied to virtually all patients requiring a novel interventional procedure to help identify risks and find optimal parameters for prosthesis selection and placement in order to maximize safety for the patient. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Hypertext: Improved Capability for Shipboard Naval Messages

DTIC Science & Technology

1989-09-01

message handling system; a complete working model of the system has not been developed . 3 D. ORGANIZATION OF STUDY 1. The "Paperless" Ship Initiative...work in tandem to improve afloat message handling procedures. The objective of the PCMT project is to develop a system that could be installed on...working group has identified a list of requirements to guide the DoD’s progress towards improving its message communication system. These

Probability Quantization for Multiplication-Free Binary Arithmetic Coding

NASA Technical Reports Server (NTRS)

Cheung, K. -M.

1995-01-01

A method has been developed to improve on Witten's binary arithmetic coding procedure of tracking a high value and a low value. The new method approximates the probability of the less probable symbol, which improves the worst-case coding efficiency.

The Development and Evaluation of a Reading Comprehension Strategy with Learning Disabled Students.

ERIC Educational Resources Information Center

Flaro, Lloyd

1987-01-01

Discusses a learning strategy, employing imaginal processes and verbal mediations procedures, designed to improve reading comprehension in 24 learning disabled students. Indicates significant gains and improvement in reading comprehension over a 15 week treatment period. (MM)

Improved Procedure for Transport of Dental Plaque Samples and Other Clinical Specimens Containing Anaerobic Bacteria

PubMed Central

Spiegel, Carol A.; Minah, Glenn E.; Krywolap, George N.

1979-01-01

An improved transport system for samples containing anaerobic bacteria was developed. This system increased the recovery rate of anaerobic bacteria up to 28.8% as compared to a commonly used method. PMID:39087

Innovative Approaches to Increasing the Student Assessment Procedures Effectiveness

ERIC Educational Resources Information Center

Dorozhkin, Evgenij M.; Chelyshkova, Marina B.; Malygin, Alexey A.; Toymentseva, Irina A.; Anopchenko, Tatiana Y.

2016-01-01

The relevance of the investigated problem is determined by the need to improving the evaluation procedures in education and the student assessment in the age of the context of education widening, new modes of study developing (such as blending learning, e-learning, massive open online courses), immediate feedback necessity, reliable and valid…

Enhancing E-Learning Quality through the Application of the AKUE Procedure Model

ERIC Educational Resources Information Center

Bremer, C.

2012-01-01

The paper describes the procedure model AKUE, which aims at the improvement and assurance of quality and cost efficiency in the context of the introduction of e-learning and the development of digital learning material. AKUE divides the whole planning and implementation process into four different phases: analysis, conception, implementation, and…

20 Suggestions for Improving the Departmental Procedures for Hiring Teachers of Sociology.

ERIC Educational Resources Information Center

Ewens, Bill

Twenty suggestions are given to help university sociology departments develop procedures for hiring good teachers in the field. The first five ideas are about publicizing the position and initial screening of applications. Jobs should be announced in professional journals and at graduate departments with good reputations. Standardized forms should…

More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside.

PubMed

Gisondi, Michael A; Regan, Linda; Branzetti, Jeremy; Hopson, Laura R

2018-05-01

There is growing competition for nonoperative, procedural training in teaching hospitals, due to an increased number of individuals seeking to learn procedures from a finite number of appropriate teaching cases. Procedural training is required by students, postgraduate learners, and practicing providers who must maintain their skills. These learner groups are growing in size as the number of medical schools increases and advance practice providers expand their skills to include complex procedures. These various learner needs occur against a background of advancing therapeutic techniques that improve patient care but also act to reduce the overall numbers of procedures available to learners. This article is a brief review of these and other challenges that are arising for program directors, medical school leaders, and hospital administrators who must act to ensure that all of their providers acquire and maintain competency in a wide array of procedural skills. The authors conclude their review with several recommendations to better address procedural training in this new era of learner competition. These include a call for innovative clinical rotations deliberately designed to improve procedural training, access to training opportunities at new clinical sites acquired in health system expansions, targeted faculty development for those who teach procedures, reporting of competition for bedside procedures by trainees, more frequent review of resident procedure and case logs, and the creation of an institutional oversight committee for procedural training.

Laminoplasty for Cervical Myelopathy

PubMed Central

Ito, Manabu; Nagahama, Ken

2012-01-01

This article reviews cervical laminoplasty. The origin of cervical laminoplasty dates back to cervical laminectomy performed in Japan ~50 years ago. To overcome poor surgical outcomes of cervical laminectomy, many Japanese orthopedic spine surgeons devoted their lives to developing better posterior decompression procedures for the cervical spine. Thanks to the development of a high-speed surgical burr, posterior decompression procedures for the cervical spine showed vast improvement from the 1970s to the 1980s, and the original form of cervical laminoplasty was determined. Since around 2000, surgeons performing cervical laminoplasty have been adopting less invasive procedures for the posterior cervical muscle structures so as to minimize postoperative axial neck pain and obtain better functional outcomes of the cervical spine. This article covers the history of cervical laminoplasty, surgical procedures, the benefits and limitation of this procedure, and surgery-related complications. PMID:24353967

NCCDS configuration management process improvement

NASA Technical Reports Server (NTRS)

Shay, Kathy

1993-01-01

By concentrating on defining and improving specific Configuration Management (CM) functions, processes, procedures, personnel selection/development, and tools, internal and external customers received improved CM services. Job performance within the section increased in both satisfaction and output. Participation in achieving major improvements has led to the delivery of consistent quality CM products as well as significant decreases in every measured CM metrics category.

Improved Variable Selection Algorithm Using a LASSO-Type Penalty, with an Application to Assessing Hepatitis B Infection Relevant Factors in Community Residents

PubMed Central

Guo, Pi; Zeng, Fangfang; Hu, Xiaomin; Zhang, Dingmei; Zhu, Shuming; Deng, Yu; Hao, Yuantao

2015-01-01

Objectives In epidemiological studies, it is important to identify independent associations between collective exposures and a health outcome. The current stepwise selection technique ignores stochastic errors and suffers from a lack of stability. The alternative LASSO-penalized regression model can be applied to detect significant predictors from a pool of candidate variables. However, this technique is prone to false positives and tends to create excessive biases. It remains challenging to develop robust variable selection methods and enhance predictability. Material and methods Two improved algorithms denoted the two-stage hybrid and bootstrap ranking procedures, both using a LASSO-type penalty, were developed for epidemiological association analysis. The performance of the proposed procedures and other methods including conventional LASSO, Bolasso, stepwise and stability selection models were evaluated using intensive simulation. In addition, methods were compared by using an empirical analysis based on large-scale survey data of hepatitis B infection-relevant factors among Guangdong residents. Results The proposed procedures produced comparable or less biased selection results when compared to conventional variable selection models. In total, the two newly proposed procedures were stable with respect to various scenarios of simulation, demonstrating a higher power and a lower false positive rate during variable selection than the compared methods. In empirical analysis, the proposed procedures yielding a sparse set of hepatitis B infection-relevant factors gave the best predictive performance and showed that the procedures were able to select a more stringent set of factors. The individual history of hepatitis B vaccination, family and individual history of hepatitis B infection were associated with hepatitis B infection in the studied residents according to the proposed procedures. Conclusions The newly proposed procedures improve the identification of significant variables and enable us to derive a new insight into epidemiological association analysis. PMID:26214802

Full-scale transmission testing to evaluate advanced lubricants

NASA Technical Reports Server (NTRS)

Lewicki, David G.; Decker, Harry J.; Shimski, John T.

1992-01-01

Experimental tests were performed on the OH-58A helicopter main rotor transmission in the NASA Lewis 500 hp helicopter transmission test stand. The testing was part of a lubrication program. The objectives are to develop and show a separate lubricant for gearboxes with improved performance in life and load carrying capacity. The goal was to develop a testing procedure to fail certain transmission components using a MIL-L-23699 based reference oil and then to run identical tests with improved lubricants and show improved performance. The tests were directed at parts that failed due to marginal lubrication from Navy field experience. These failures included mast shaft bearing micropitting, sun gear and planet bearing fatigue, and spiral bevel gear scoring. A variety of tests were performed and over 900 hrs of total run time accumulated for these tests. Some success was achieved in developing a testing procedure to produce sun gear and planet bearing fatigue failures. Only marginal success was achieved in producing mast shaft bearing micropitting and spiral bevel gear scoring.

Improving accuracy of unbound resilient modulus testing

DOT National Transportation Integrated Search

1997-07-01

The P46 Laboratory Startup and Quality Control Procedure was developed to ensure the accuracy and reliability of the resilient modulus data produced while testing soil and aggregate materials using closed-loop servo-hydraulic systems. It was develope...

Recent developments in the Dorfman-Berbaum-Metz procedure for multireader ROC study analysis.

PubMed

Hillis, Stephen L; Berbaum, Kevin S; Metz, Charles E

2008-05-01

The Dorfman-Berbaum-Metz (DBM) method has been one of the most popular methods for analyzing multireader receiver-operating characteristic (ROC) studies since it was proposed in 1992. Despite its popularity, the original procedure has several drawbacks: it is limited to jackknife accuracy estimates, it is substantially conservative, and it is not based on a satisfactory conceptual or theoretical model. Recently, solutions to these problems have been presented in three papers. Our purpose is to summarize and provide an overview of these recent developments. We present and discuss the recently proposed solutions for the various drawbacks of the original DBM method. We compare the solutions in a simulation study and find that they result in improved performance for the DBM procedure. We also compare the solutions using two real data studies and find that the modified DBM procedure that incorporates these solutions yields more significant results and clearer interpretations of the variance component parameters than the original DBM procedure. We recommend using the modified DBM procedure that incorporates the recent developments.

Identifying Psychological Contract Breaches to Guide Improvements in Faculty Recruitment, Retention, and Development

PubMed Central

Desselle, Shane P.; Draugalis, JoLaine R.; Spies, Alan R.; Davis, Tamra S.; Bolino, Mark

2012-01-01

Objective. To identify pharmacy faculty members’ perceptions of psychological contract breaches that can be used to guide improvements in faculty recruitment, retention, and development. Methods. A list of psychological contract breaches was developed using a Delphi procedure involving a panel of experts assembled through purposive sampling. The Delphi consisted of 4 rounds, the first of which elicited examples of psychological contract breaches in an open-ended format. The ensuing 3 rounds consisting of a survey and anonymous feedback on aggregated group responses. Results. Usable responses were obtained from 11 of 12 faculty members who completed the Delphi procedure. The final list of psychological contract breaches included 27 items, after modifications based on participant feedback in subsequent rounds. Conclusion. The psychological contract breach items generated in this study provide guidance for colleges and schools of pharmacy regarding important aspects of faculty recruitment, retention, and development. PMID:22919084

Identifying psychological contract breaches to guide improvements in faculty recruitment, retention, and development.

PubMed

Peirce, Gretchen L; Desselle, Shane P; Draugalis, JoLaine R; Spies, Alan R; Davis, Tamra S; Bolino, Mark

2012-08-10

To identify pharmacy faculty members' perceptions of psychological contract breaches that can be used to guide improvements in faculty recruitment, retention, and development. A list of psychological contract breaches was developed using a Delphi procedure involving a panel of experts assembled through purposive sampling. The Delphi consisted of 4 rounds, the first of which elicited examples of psychological contract breaches in an open-ended format. The ensuing 3 rounds consisting of a survey and anonymous feedback on aggregated group responses. Usable responses were obtained from 11 of 12 faculty members who completed the Delphi procedure. The final list of psychological contract breaches included 27 items, after modifications based on participant feedback in subsequent rounds. The psychological contract breach items generated in this study provide guidance for colleges and schools of pharmacy regarding important aspects of faculty recruitment, retention, and development.

Conversion from Tree to Graph Representation of Requirements

NASA Technical Reports Server (NTRS)

Mayank, Vimal; Everett, David Frank; Shmunis, Natalya; Austin, Mark

2009-01-01

A procedure and software to implement the procedure have been devised to enable conversion from a tree representation to a graph representation of the requirements governing the development and design of an engineering system. The need for this procedure and software and for other requirements-management tools arises as follows: In systems-engineering circles, it is well known that requirements- management capability improves the likelihood of success in the team-based development of complex systems involving multiple technological disciplines. It is especially desirable to be able to visualize (in order to identify and manage) requirements early in the system- design process, when errors can be corrected most easily and inexpensively.

Use of Key Performance Indicators to Improve Milestone Assessment in Semi-Annual Clinical Competency Committee Meetings.

PubMed

Chen, Fei; Arora, Harendra; Martinelli, Susan M

2017-01-01

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires residency programs to semiannually submit composite milestone data on each resident's performance. This report describes and evaluates a new assessment review procedure piloted in our departmental Clinical Competency Committee (CCC) semi-annual meeting in June 2016. A modified Delphi technique was utilized to develop key performance indicators (KPI) linking milestone descriptors to clinical practice. In addition, the CCC identified six specific milestone sub-competencies that would be prescored with objective data prior to the meeting. Each resident was independently placed on the milestones by 3 different CCC faculty members. Milestone placement data of the same cohort of 42 residents (Clinical Anesthesia Years 1-3) were collected to calculate inter-rater reliability of the assessment procedures before and after the implemented changes. A survey was administrated to collect CCC feedback on the new procedure. The procedure assisted in reducing meeting time from 8 to 3.5 hours. Survey of the CCC members revealed positive perception of the procedure. Higher inter-rater reliability of the milestone placement was obtained using the implemented KPIs (Intraclass correlation coefficient [ICC] single measure range: before=.53-.94, after=.74-.98). We found the new assessment procedure beneficial to the efficiency and transparency of the assessment process. Further improvement of the procedure involves refinement of KPIs and additional faculty development on KPIs to allow non-CCC faculty to provide more accurate resident evaluations.

Use of Key Performance Indicators to Improve Milestone Assessment in Semi-Annual Clinical Competency Committee Meetings

PubMed Central

Arora, Harendra; Martinelli, Susan M.

2017-01-01

Background: The Accreditation Council for Graduate Medical Education's Next Accreditation System requires residency programs to semiannually submit composite milestone data on each resident's performance. This report describes and evaluates a new assessment review procedure piloted in our departmental Clinical Competency Committee (CCC) semi-annual meeting in June 2016. Methods: A modified Delphi technique was utilized to develop key performance indicators (KPI) linking milestone descriptors to clinical practice. In addition, the CCC identified six specific milestone sub-competencies that would be prescored with objective data prior to the meeting. Each resident was independently placed on the milestones by 3 different CCC faculty members. Milestone placement data of the same cohort of 42 residents (Clinical Anesthesia Years 1–3) were collected to calculate inter-rater reliability of the assessment procedures before and after the implemented changes. A survey was administrated to collect CCC feedback on the new procedure. Results: The procedure assisted in reducing meeting time from 8 to 3.5 hours. Survey of the CCC members revealed positive perception of the procedure. Higher inter-rater reliability of the milestone placement was obtained using the implemented KPIs (Intraclass correlation coefficient [ICC] single measure range: before=.53–.94, after=.74–.98). Conclusion: We found the new assessment procedure beneficial to the efficiency and transparency of the assessment process. Further improvement of the procedure involves refinement of KPIs and additional faculty development on KPIs to allow non-CCC faculty to provide more accurate resident evaluations. PMID:29766033

The learning effect of intraoperative video-enhanced surgical procedure training.

PubMed

van Det, M J; Meijerink, W J H J; Hoff, C; Middel, L J; Koopal, S A; Pierie, J P E N

2011-07-01

The transition from basic skills training in a skills lab to procedure training in the operating theater using the traditional master-apprentice model (MAM) lacks uniformity and efficiency. When the supervising surgeon performs parts of a procedure, training opportunities are lost. To minimize this intervention by the supervisor and maximize the actual operating time for the trainee, we created a new training method called INtraoperative Video-Enhanced Surgical Training (INVEST). Ten surgical residents were trained in laparoscopic cholecystectomy either by the MAM or with INVEST. Each trainee performed six cholecystectomies that were objectively evaluated on an Objective Structured Assessment of Technical Skills (OSATS) global rating scale. Absolute and relative improvements during the training curriculum were compared between the groups. A questionnaire evaluated the trainee's opinion on this new training method. Skill improvement on the OSATS global rating scale was significantly greater for the trainees in the INVEST curriculum compared to the MAM, with mean absolute improvement 32.6 versus 14.0 points and mean relative improvement 59.1 versus 34.6% (P=0.02). INVEST significantly enhances technical and procedural skill development during the early learning curve for laparoscopic cholecystectomy. Trainees were positive about the content and the idea of the curriculum.

Standards for reporting fish toxicity tests

USGS Publications Warehouse

Cope, O.B.

1961-01-01

The growing impetus of studies on fish and pesticides focuses attention on the need for standardized reporting procedures. Good methods have been developed for laboratory and field procedures in testing programs and in statistical features of assay experiments; and improvements are being made on methods of collecting and preserving fish, invertebrates, and other materials exposed to economic poisons. On the other had, the reporting of toxicity data in a complete manner has lagged behind, and today's literature is little improved over yesterday's with regard to completeness and susceptibility to interpretation.

Development of mix design procedures for gap-graded asphalt-rubber asphalt concrete

DOT National Transportation Integrated Search

2007-11-01

A research project was conducted to identify and document current modifications to ARIZONA 815c (75-blow Marshall method) used to develop gap-graded asphalt rubber asphalt concrete (GG AR AC) mix designs, and to develop and test improvements to provi...

Models and Procedures for Improving the Planning, Management, and Evaluation of Cooperative Education Programs. Final Report. Volume I.

ERIC Educational Resources Information Center

Blaschke, Charles L.; Steiger, JoAnn

This report of a project to design a set of training guidelines for planning, managing, and evaluating cooperative education programs describes briefly the procedures used in developing the guidelines and model; discusses the various components of the planning, management, and evaluation process; and presents guidelines and criteria for designing…

Consumer involvement in the health technology assessment program.

PubMed

Royle, Jane; Oliver, Sandy

2004-01-01

This study aims to describe a cycle of development leading to sustainable methods for involving consumers in the management of a program commissioning health technology assessment. Staff time was dedicated to developing procedures for recruiting and briefing consumers to participate in prioritizing, commissioning, and reporting research. Resources and support were developed in light of early feedback from consumers and those working with them. These were piloted and amended before being used routinely. Over 4 years, procedures and resources have been developed to support six consumers attending seven to eight prioritization meetings a year; thirty to forty-five consumers each year commenting on research need for particular topics; thirty consumers a year commenting on research proposals, and twenty a year commenting on research reports. The procedures include clear job descriptions, induction and development days, clear briefing materials, payment for substantial tasks, and regularly seeking feedback to improve procedures. Explicit, inclusive, and reproducible methods for supporting consumer involvement that satisfy National Health Service policy recommendations for involving consumers in research require dedicated staff time to support a cycle of organizational development.

Competency-Based Education in Low Resource Settings: Development of a Novel Surgical Training Program.

PubMed

McCullough, Meghan; Campbell, Alex; Siu, Armando; Durnwald, Libby; Kumar, Shubha; Magee, William P; Swanson, Jordan

2018-03-01

The unmet burden of surgical disease represents a major global health concern, and a lack of trained providers is a critical component of the inadequacy of surgical care worldwide. Competency-based training has been advanced in high-income countries, improving technical skills and decreasing training time, but it is poorly understood how this model might be applied to low- and middle-income countries. We describe the development of a competency-based program to accelerate specialty training of in-country providers in cleft surgery techniques. The program was designed and piloted among eight trainees at five international cleft lip and palate surgical mission sites in Latin America and Africa. A competency-based evaluation form, designed for the program, was utilized to grade general technical and procedure-specific competencies, and pre- and post-training scores were analyzed using a paired t test. Trainees demonstrated improvement in average procedure-specific competency scores for both lip repairs (60.4-71.0%, p < 0.01) and palate (50.6-66.0%, p < 0.01). General technical competency scores also improved (63.6-72.0%, p < 0.01). Among the procedural competencies assessed, surgical markings showed the greatest improvement (19.0 and 22.8% for lip and palate, respectively), followed by nasal floor/mucosal approximation (15.0%) and hard palate dissection (17.1%). Surgical delivery models in LMICs are varied, and trade-offs often exist between goals of case throughput, quality and training. Pilot program results show that procedure-specific and general technical competencies can be improved over a relatively short time and demonstrate the feasibility of incorporating such a training program into surgical outreach missions.

Workflow in interventional radiology: nerve blocks and facet blocks

NASA Astrophysics Data System (ADS)

Siddoway, Donald; Ingeholm, Mary Lou; Burgert, Oliver; Neumuth, Thomas; Watson, Vance; Cleary, Kevin

2006-03-01

Workflow analysis has the potential to dramatically improve the efficiency and clinical outcomes of medical procedures. In this study, we recorded the workflow for nerve block and facet block procedures in the interventional radiology suite at Georgetown University Hospital in Washington, DC, USA. We employed a custom client/server software architecture developed by the Innovation Center for Computer Assisted Surgery (ICCAS) at the University of Leipzig, Germany. This software runs in an internet browser, and allows the user to record the actions taken by the physician during a procedure. The data recorded during the procedure is stored as an XML document, which can then be further processed. We have successfully gathered data on a number if cases using a tablet PC, and these preliminary results show the feasibility of using this software in an interventional radiology setting. We are currently accruing additional cases and when more data has been collected we will analyze the workflow of these procedures to look for inefficiencies and potential improvements.

The Rural Experience of Nation-Building: Implications for Educational Research and School Improvement in the Latest Era of "Globalization."

ERIC Educational Resources Information Center

Howley, Craig

This paper explores changes needed in the focus and commitment of educational research to better reflect issues relevant to rural schools and their communities. Historically, educational researchers have focused on national or cosmopolitan concerns in efforts to develop widely applicable procedures for school improvement. However, improving rural…

Improving Follow-up Response Rate at Brevard Community College. Final Report from September 24, 1984 to August 31, 1985.

ERIC Educational Resources Information Center

Lawton, Robert E.

A plan was developed to improve followup study response rates by refining techniques for data collection and improving student motivation to respond to daily requests. Factors affecting response rate to followup surveys were investigated, and alternative approaches were recommended. Findings indicated that current procedures--two mailouts of…

34 CFR 609.21 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2010 CFR

2010-07-01

... achieving the objectives. (4) A description of methods, processes and procedures that will be used by the... improvements developed under the proposed funded activities. (Approved by the Office of Management and Budget...

34 CFR 608.21 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2010 CFR

2010-07-01

... achieving the objectives. (4) A description of methods, processes, and procedures that will be used by the... improvements developed under the proposed funded activities. (Approved by the Office of Management and Budget...

Development of simulation-based learning programme for improving adherence to time-out protocol on high-risk invasive procedures outside of operating room.

PubMed

Jeong, Eun Ju; Chung, Hyun Soo; Choi, Jeong Yun; Kim, In Sook; Hong, Seong Hee; Yoo, Kyung Sook; Kim, Mi Kyoung; Won, Mi Yeol; Eum, So Yeon; Cho, Young Soon

2017-06-01

The aim of this study was to develop a simulation-based time-out learning programme targeted to nurses participating in high-risk invasive procedures and to figure out the effects of application of the new programme on acceptance of nurses. This study was performed using a simulation-based learning predesign and postdesign to figure out the effects of implementation of this programme. It was targeted to 48 registered nurses working in the general ward and the emergency department in a tertiary teaching hospital. Difference between acceptance and performance rates has been figured out by using mean, standard deviation, and Wilcoxon-signed rank test. The perception survey and score sheet have been validated through content validation index, and the reliability of evaluator has been verified by using intraclass correlation coefficient. Results showed high level of acceptance of high-risk invasive procedure (P<.01). Further, improvement was consistent regardless of clinical experience, workplace, or experience in simulation-based learning. The face validity of the programme showed over 4.0 out of 5.0. This simulation-based learning programme was effective in improving the recognition of time-out protocol and has given the participants the opportunity to become proactive in cases of high-risk invasive procedures performed outside of operating room. © 2017 John Wiley & Sons Australia, Ltd.

T-Cell Gene Therapy to Eradicate Disseminated Breast Cancers

DTIC Science & Technology

2011-05-01

reactivation of cytomegalovirus infection following successful rituximab therapy for Epstein - Barr virus - associated posttransplantation lymphoproliferative...improve virus transduction b. New vector supernatants with higher viral titer 2. Development of procedures for improved expansions (>10^6 fold) a...nude mice by passaging cell line. Development of novel dendritic cell vaccine that harnesses the G250-Fc’s capability to elicit both CTL and Th

Implementation of "New Directions" in Development Assistance: Report to the Committee on International Relations on Implementation of Legislative Reforms in the Foreign Assistance Act of 1973.

ERIC Educational Resources Information Center

Agency for International Development (Dept. of State), Washington, DC.

This report discusses the many policy and procedural issues of the Agency for International Development (AID) in implementing the reforms included in the congressional Foreign Assistance Act of 1973. The act concentrated aid efforts on food and nutrition improvement, population control, health improvement, education, and human resource…

Laparoscopic and endoscopic cooperative surgery for gastrointestinal tumor

PubMed Central

Ishibashi, Rei; Mitsui, Takashi; Aikou, Susumu; Kodashima, Shinya; Yamashita, Hiroharu; Yamamichi, Nobutake; Hirata, Yoshihiro; Fujishiro, Mitsuhiro; Seto, Yasuyuki; Koike, Kazuhiko

2017-01-01

With technological progress of endoscopic submucosal dissection (ESD) in the last decade, several laparoscopic and endoscopic cooperative surgeries (LECS) for gastrointestinal tumor have recently been developed. LECS is definitely favorable to the minimization of surgical margin, which leads to functional and anatomical preservation of gastrointestinal tract. LECS for gastrointestinal tumor is mainly sorted by two categories: exposure procedures and non-exposure procedures between endoluminal and extraluminal spaces. Exposure procedures have the potential risk of gastric contents or tumor cells spilling out over the abdominal cavity, because the stomach wall has to be perforated intentionally during the procedure. In order to avoid the potential these risks, non-exposure procedures have been developed. Currently, the LECS concept has rapidly permeated for treatment of gastrointestinal tumor due to its certainty and safety, although there is still room for improvement to lessen its technical difficulty. This review describes the current LECS for gastrointestinal tumor based on the several articles. PMID:28616402

Quality of life before and after cosmetic surgery.

PubMed

Bensoussan, Jean-Charles; Bolton, Michael A; Pi, Sarah; Powell-Hicks, Allycin L; Postolova, Anna; Razani, Bahram; Reyes, Kevin; IsHak, Waguih William

2014-08-01

This article reviews the literature regarding the impact of cosmetic surgery on health-related quality of life (QOL). Studies were identified through PubMed/Medline and PsycINFO searches from January 1960 to December 2011. Twenty-eight studies were included in this review, according to specific selection criteria. The procedures and tools employed in cosmetic surgery research studies were remarkably diverse, thus yielding difficulties with data analysis. However, data indicate that individuals undergoing cosmetic surgery began with lower values on aspects of QOL than control subjects, and experienced significant QOL improvement post-procedurally, an effect that appeared to plateau with time. Despite the complexity of measuring QOL in cosmetic surgery patients, most studies showed an improvement in QOL after cosmetic surgery procedures. However, this finding was clouded by measurement precision as well as heterogeneity of procedures and study populations. Future research needs to focus on refining measurement techniques, including developing cosmetic surgery-specific QOL measures.

Recent Development of Augmented Reality in Surgery: A Review

PubMed Central

Vávra, P.; Zonča, P.; Ihnát, P.; El-Gendi, A.

2017-01-01

Introduction The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. Methods We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms “augmented reality” and “surgery.” Results. The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. Conclusions The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice. PMID:29065604

The Effectiveness of a Cognitive Task Analysis Informed Curriculum to Increase Self-Efficacy and Improve Performance for an Open Cricothyrotomy

DTIC Science & Technology

2011-01-01

either the CTA group (n 12) or the control group (n 14). The CTA group learned the open cricothyrotomy procedure using the CTA curriculum. The...completed a 6-item pretest that posed open - ended questions regarding actions and decisions required to conduct the procedure given a specific... posttest assessing their knowl- edge of the procedure. Parallel forms of the pretest and post- test instruments were developed using different case scenar

Evaluation of Approval Request 47; Call for Release Procedures for Charlotte Douglas International Airport

NASA Technical Reports Server (NTRS)

Stevens, Lindsay; Martin, Lynne; Jobe, Kimberly; Parke, Bonny; Chevalley, Eric; Lee, Hanbong; Verma, Savita; Dulchinos, Victoria

2017-01-01

NASA is collaborating with the Federal Aviation Administration (FAA) and aviation industry partners to develop and demonstrate new concepts and technologies for Integrated Arrival, Departure, and Surface (IADS) traffic management capabilities under the Airspace Technology Demonstration 2 (ATD-2) project. One of the goals of the IADS capabilities in the ATD-2 project is to increase predictability and throughput of airspace operations by improving Traffic Management Initiative (TMI) compliance. This paper focuses on the Approval Request (APREQ) procedures developed for the ATD-2 project between the Air Traffic Control (ATC) Tower at Charlotte Douglas International Airport and Washington Center. In March 2017, NASA conducted a Human-in-the-Loop (HITL) simulation to evaluate the operational procedures and information requirements for the APREQ procedures in the ATD-2 IADS system between ATC Tower and Center. The findings from the HITL are used to compare ATD-2 APREQ procedures with information about current day APREQ procedures.

Evaluation of Approval Request/Call for Release Coordination Procedures for Charlotte Douglas International Airport

NASA Technical Reports Server (NTRS)

Stevens, Lindsay; Martin, Lynne; Jobe, Kimberly; Parke, Bonny; Chevalley, Eric; Lee, Hanbong; Verma, Savita; Dulchinos, Victoria

2017-01-01

NASA is collaborating with the Federal Aviation Administration (FAA) and aviation industry partners to develop and demonstrate new concepts and technologies for Integrated Arrival, Departure, and Surface (IADS) traffic management capabilities under the Airspace Technology Demonstration 2 (ATD-2) project. One of the goals of the IADS capabilities in the ATD-2 project is to increase predictability and throughput of airspace operations by improving Traffic Management Initiative (TMI) compliance. This paper focuses on the Approval Request (APREQ) procedures developed for the ATD-2 project between the Air Traffic Control (ATC) Tower at Charlotte Douglas International Airport and Washington Center. In March 2017, NASA conducted a Human-in-the-Loop (HITL) simulation to evaluate the operational procedures and information requirements for the APREQ procedures in the ATD-2 IADS system between ATC Tower and Center. The findings from the HITL are used to compare ATD-2 APREQ procedures with information about current day APREQ procedures.

Visual Compositions and Language Development.

ERIC Educational Resources Information Center

Sinatra, Richard

1981-01-01

Presents an approach for improving verbal development by using organized slide shows to produce visual/verbal interaction in classroom. Suggests strength of visual involvement is that it provides a procedure for language discovery while achieving cooperation between right and left brain processing. (Author/BK)

An electromagnetic induction method for underground target detection and characterization

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

Bartel, L.C.; Cress, D.H.

1997-01-01

An improved capability for subsurface structure detection is needed to support military and nonproliferation requirements for inspection and for surveillance of activities of threatening nations. As part of the DOE/NN-20 program to apply geophysical methods to detect and characterize underground facilities, Sandia National Laboratories (SNL) initiated an electromagnetic induction (EMI) project to evaluate low frequency electromagnetic (EM) techniques for subsurface structure detection. Low frequency, in this case, extended from kilohertz to hundreds of kilohertz. An EMI survey procedure had already been developed for borehole imaging of coal seams and had successfully been applied in a surface mode to detect amore » drug smuggling tunnel. The SNL project has focused on building upon the success of that procedure and applying it to surface and low altitude airborne platforms. Part of SNL`s work has focused on improving that technology through improved hardware and data processing. The improved hardware development has been performed utilizing Laboratory Directed Research and Development (LDRD) funding. In addition, SNL`s effort focused on: (1) improvements in modeling of the basic geophysics of the illuminating electromagnetic field and its coupling to the underground target (partially funded using LDRD funds) and (2) development of techniques for phase-based and multi-frequency processing and spatial processing to support subsurface target detection and characterization. The products of this project are: (1) an evaluation of an improved EM gradiometer, (2) an improved gradiometer concept for possible future development, (3) an improved modeling capability, (4) demonstration of an EM wave migration method for target recognition, and a demonstration that the technology is capable of detecting targets to depths exceeding 25 meters.« less

A Simple and Reliable Method for Hybridization of Homothallic Wine Strains of Saccharomyces cerevisiae

PubMed Central

Ramírez, Manuel; Peréz, Francisco; Regodón, José A.

1998-01-01

A procedure was developed for the hybridization and improvement of homothallic industrial wine yeasts. Killer cycloheximide-sensitive strains were crossed with killer-sensitive cycloheximide-resistant strains to get killer cycloheximide-resistant hybrids, thereby enabling hybrid selection and identification. This procedure also allows backcrossing of spore colonies from the hybrids with parental strains. PMID:9835605

Tribal Library Procedures Manual. TRAILS (Training and Assistance for Indian Library Services), September 10, 1985-January 10, 1987.

ERIC Educational Resources Information Center

Patterson, Lotsee

This manual resulted from a 2-year project to improve, develop, and expand public library and information services to American Indians and Alaska Natives. Designed to serve as a guide for tribal and community librarians who may lack professional training, the manual offers descriptions of library services, procedures, and management issues. An…

Small Schools Mathematics Curriculum, Grades 7-8: Reading, Language Arts, Mathematics, Science, Social Studies. Scope, Objectives, Activities, Resources, Monitoring Procedures.

ERIC Educational Resources Information Center

Hartl, David, Ed.; And Others

Developed during the 1976-77 school year to assist Washington grade 7-8 teachers in small school districts with the improvement of curriculum and instruction, this learning-objective-based curriculum suggests activities, monitoring procedures and resources for mathematics. Introductory materials describe the organization of Small School materials,…

Job Knowledge Test Design: A Cognitively-Oriented Approach. Institute Report No. 241.

ERIC Educational Resources Information Center

DuBois, David; And Others

Selected cognitive science methods were used to modify existing test development procedures so that the modified procedures could in turn be used to improve the usefulness of job knowledge tests as a proxy for hands-on performance. A plan-goal graph representation was used to capture the knowledge content and goal structure of the task of using a…

Augmented Reality Image Guidance in Minimally Invasive Prostatectomy

NASA Astrophysics Data System (ADS)

Cohen, Daniel; Mayer, Erik; Chen, Dongbin; Anstee, Ann; Vale, Justin; Yang, Guang-Zhong; Darzi, Ara; Edwards, Philip'eddie'

This paper presents our work aimed at providing augmented reality (AR) guidance of robot-assisted laparoscopic surgery (RALP) using the da Vinci system. There is a good clinical case for guidance due to the significant rate of complications and steep learning curve for this procedure. Patients who were due to undergo robotic prostatectomy for organ-confined prostate cancer underwent preoperative 3T MRI scans of the pelvis. These were segmented and reconstructed to form 3D images of pelvic anatomy. The reconstructed image was successfully overlaid onto screenshots of the recorded surgery post-procedure. Surgeons who perform minimally-invasive prostatectomy took part in a user-needs analysis to determine the potential benefits of an image guidance system after viewing the overlaid images. All surgeons stated that the development would be useful at key stages of the surgery and could help to improve the learning curve of the procedure and improve functional and oncological outcomes. Establishing the clinical need in this way is a vital early step in development of an AR guidance system. We have also identified relevant anatomy from preoperative MRI. Further work will be aimed at automated registration to account for tissue deformation during the procedure, using a combination of transrectal ultrasound and stereoendoscopic video.

System Development of Estimated Figures of Volume Production Plan

ERIC Educational Resources Information Center

Brazhnikov, Maksim A.; Khorina, Irina V.; Minina, Yulia I.; Kolyasnikova, Lyudmila V.; Streltsov, Aleksey V.

2016-01-01

The relevance of this problem is primarily determined by a necessity of improving production efficiency in conditions of innovative development of the economy and implementation of Import Substitution Program. The purpose of the article is development of set of criteria and procedures for the comparative assessment of alternative volume production…

Progress in Organization Development Research.

ERIC Educational Resources Information Center

Roberts, Nancy C.; Porras, Jerry I.

1982-01-01

Describes major areas of progress in organization development (OD): progress in operationalizing the concept of change; progress in improving measurement; and progress in designing statistical procedures used to analyze OD intervention data. Suggests recent research developments point to a more solid base on which to build OD practice and theory.…

[The development of hospital medical supplies information management system].

PubMed

Cao, Shaoping; Gu, Hongqing; Zhang, Peng; Wang, Qiang

2010-05-01

The information management of medical materials by using high-tech computer, in order to improve the efficiency of the consumption of medical supplies, hospital supplies and develop a new technology way to manage the hospital and material support. Using C # NET, JAVA techniques to develop procedures for the establishment of hospital material management information system, set the various management modules, production of various statistical reports, standard operating procedures. The system is convenient, functional and strong, fluent statistical functions. It can always fully grasp and understand the whole hospital supplies run dynamic information, as a modern and effective tool for hospital materials management.

Improved synthetic route to methyl 1-fluoroindan-1-carboxylate (FICA Me ester) and 4-methyl derivatives.

PubMed

Koyanagi, Jyunichi; Kamei, Tomoyo; Ishizaki, Miyuki; Nakamura, Hiroshi; Takahashi, Tamiko

2014-01-01

An improved synthetic route has been developed for the preparation of methyl 1-fluoroindan-1-carboxylate (FICA Me ester) from 1-indanone. Methyl 4-methyl-1-fluoroindan-1-carboxylate (4-Me-FICA Me ester) was also prepared following the same procedure.

Assessment of the NASA Flight Assurance Review Program

NASA Technical Reports Server (NTRS)

Holmes, J.; Pruitt, G.

1983-01-01

The NASA flight assurance review program to develop minimum standard guidelines for flight assurance reviews was assessed. Documents from NASA centers and NASA headquarters to determine current design review practices and procedures were evaluated. Six reviews were identified for the recommended minimum. The practices and procedures used at the different centers to incorporate the most effective ones into the minimum standard review guidelines were analyzed and guidelines for procedures, personnel and responsibilies, review items/data checklist, and feedback and closeout were defined. The six recommended reviews and the minimum standards guidelines developed for flight assurance reviews are presented. Observations and conclusions for further improving the NASA review and quality assurance process are outlined.

The Improvement of Student Teaching Through a Consortium of Greater Cleveland Schools and Colleges. Vol. 1-3. Final Report.

ERIC Educational Resources Information Center

Morford, John A.; Swegan, Donald B.

This three-volume report describes a research project which had the following objectives: 1) to improve the orientation programs for cooperating teachers who work with student teachers; 2) to improve procedures for selection and utilization of cooperating teachers in schools which accept student teachers; and 3) to develop experimental, innovative…

Progress in the blood supply of Afghanistan.

PubMed

Riley, William J; McCullough, Terri Konstenius; Rhamani, Ahmad Masoud; McCullough, Jeffrey

2017-07-01

The blood supply system in Afghanistan was badly damaged by years of conflict. In 2009, the Afghanistan National Blood Safety and Transfusion Service (ANBSTS) was established. For 6 years, we collaborated to assist with policy and infrastructure development; blood bank operations; blood collection, testing, and component production; transfusion practices; and training of technicians, nurses, midwives, and physicians. Policies were established, infrastructure was strengthened, and capable staff was acquired and trained. Standard operating procedures were developed, testing was improved, and quality systems were established. Thirty trainings were held for blood center staff. Four additional formal trainings were held for 39 physicians, 36 nurses and/or midwives, and 38 laboratory technicians. During 5 years of this project, blood collection increased by 40%. The ANBSTS has made impressive progress developing infrastructure, personnel, procedures, quality systems, and training programs and increasing blood collection. Knowledge of transfusion medicine was improved through structured training. © 2017 AABB.

NRL Fact Book

DTIC Science & Technology

1976-07-01

Systems Division ......... ........................ 60 Oceanology Area ........... ............................ 62 Shipboard Computing Group...directed toward new and improved materials, equipment, techniques, systems , and related operational procedures for the Navy. In fulfillment of this...Within areas of technological expertise, develops prototype systems applicable to specific projects. (d) Performs scientific research development for

Interdependence of science requirements and safety limitations on the space station

NASA Technical Reports Server (NTRS)

Barber, Patrick G.

1990-01-01

One of the benefits of experimentation on the Space Station is the ability to carry out the experiment, to immediately analyze the results, to calculate improved experimental parameters, and to quickly repeat the experiment. In this improved mode of operation there are new safety considerations that must be addressed in the design stages of both the station and the experiments. Some of the chemical and procedural requirements are shared, and some of the earth-bound storage, dispensing, and disposal techniques that may assist in the development of analogous procedures for the Space Station are discussed.

Changes in operational procedures to improve spaceflight experiments in plant biology in the European Modular Cultivation System

NASA Astrophysics Data System (ADS)

Kiss, John Z.; Aanes, Gjert; Schiefloe, Mona; Coelho, Liz H. F.; Millar, Katherine D. L.; Edelmann, Richard E.

2014-03-01

The microgravity environment aboard orbiting spacecraft has provided a unique laboratory to explore topics in basic plant biology as well as applied research on the use of plants in bioregenerative life support systems. Our group has utilized the European Modular Cultivation System (EMCS) aboard the International Space Station (ISS) to study plant growth, development, tropisms, and gene expression in a series of spaceflight experiments. The most current project performed on the ISS was termed Seedling Growth-1 (SG-1) which builds on the previous TROPI (for tropisms) experiments performed in 2006 and 2010. Major technical and operational changes in SG-1 (launched in March 2013) compared to the TROPI experiments include: (1) improvements in lighting conditions within the EMCS to optimize the environment for phototropism studies, (2) the use of infrared illumination to provide high-quality images of the seedlings, (3) modifications in procedures used in flight to improve the focus and overall quality of the images, and (4) changes in the atmospheric conditions in the EMCS incubator. In SG-1, a novel red-light-based phototropism in roots and hypocotyls of seedlings that was noted in TROPI was confirmed and now can be more precisely characterized based on the improvements in procedures. The lessons learned from sequential experiments in the TROPI hardware provide insights to other researchers developing space experiments in plant biology.

Developing a framework for gathering and using service user experiences to improve integrated health and social care: the SUFFICE framework.

PubMed

Ward, Vicky; Pinkney, Lisa; Fry, Gary

2016-09-08

More people than ever receive care and support from health and social care services. Initiatives to integrate the work of health and social care staff have increased rapidly across the UK but relatively little has been done to chart and improve their impact on service users. Our aim was to develop a framework for gathering and using service user feedback to improve integrated health and social care in one locality in the North of England. We used published literature and interviews with health and social care managers to determine the expected service user experiences of local community-based integrated teams and the ways in which team members were expected to work together. We used the results to devise qualitative data collection and analysis tools for gathering and analyzing service user feedback. We used developmental evaluation and service improvement methodologies to devise a procedure for developing service improvement plans. We identified six expected service user experiences of integrated care and 15 activities that health and social care teams were expected to undertake. We used these to develop logic models and tools for collecting and analysing service user experiences. These include a narrative interview schedule, a plan for analyzing data, and a method for synthesizing the results into a composite 'story'. We devised a structured service improvement procedure which involves teams of health and social care staff listening to a composite service user story, identifying how their actions as a team may have contributed to the story and developing a service improvement plan. This framework aims to put service user experiences at the heart of efforts to improve integration. It has been developed in collaboration with National Health Service (NHS) and Social Care managers. We expect it to be useful for evaluating and improving integrated care initiatives elsewhere.

Active control of aerothermoelastic effects for a conceptual hypersonic aircraft

NASA Technical Reports Server (NTRS)

Heeg, Jennifer; Gilbert, Michael G.; Pototzky, Anthony S.

1990-01-01

This paper describes the procedures for an results of aeroservothermoelastic studies. The objectives of these studies were to develop the necessary procedures for performing an aeroelastic analysis of an aerodynamically heated vehicle and to analyze a configuration in the classical 'cold' state and in a 'hot' state. Major tasks include the development of the structural and aerodynamic models, open loop analyses, design of active control laws for improving dynamic responses and analyses of the closed loop vehicles. The analyses performed focused on flutter speed calculations, short period eigenvalue trends and statistical analyses of the vehicle response to controls and turbulence. Improving the ride quality of the vehicle and raising the flutter boundary of the aerodynamically-heated vehicle up to that of the cold vehicle were the objectives of the control law design investigations.

Developing tools to measure quality in congenital catheterization and interventions: the congenital cardiac catheterization project on outcomes (C3PO).

PubMed

Chaudhry-Waterman, Nadia; Coombs, Sandra; Porras, Diego; Holzer, Ralf; Bergersen, Lisa

2014-01-01

The broad range of relatively rare procedures performed in pediatric cardiac catheterization laboratories has made the standardization of care and risk assessment in the field statistically quite problematic. However, with the growing number of patients who undergo cardiac catheterization, it has become imperative that the cardiology community overcomes these challenges to study patient outcomes. The Congenital Cardiac Catheterization Project on Outcomes was able to develop benchmarks, tools for measurement, and risk adjustment methods while exploring procedural efficacy. Based on the success of these efforts, the collaborative is pursuing a follow-up project, the Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement, aimed at improving the outcomes for all patients undergoing catheterization for congenital heart disease by reducing radiation exposure.

Participatory redesign of work organisation in hospital nursing: A study of the implementation process.

PubMed

Stab, Nicole; Hacker, Winfried

2018-05-01

The main goal of the study was to apply and analyse a moderated participatory small-group procedure with registered nurses, which aims at the development and implementation of measures to improve work organisation in hospital wards and nursing units. Participation in job redesign is an essential prerequisite of the successful implementation of improvement measures in nursing. The study was carried out in a public hospital of maximum care in Germany. We selected 25 wards with the most critical reported exhaustion and general health and applied a series of moderated small-group sessions in which the registered nurses jointly identified deficits in their work organisation, developed improvement measures, and then implemented and assessed them. Registered nurses of 22 wards actively took part in the small-group procedure. All nursing units jointly identified organisational deficits, developed possible improvement measures, and implemented them. The nursing teams then evaluated the implemented measures which were already assessable at the end of our research period; nearly all (99.0%) showed improvements, while 69.4% actually attained the desired goals. Participatory small-group activities may be successfully applied in hospital nursing in order to improve work organisation. Participatory assessment and redesign of nurses' work organisation should be integrated into regular team meetings. The nursing management should actively support the implementation process. © 2018 John Wiley & Sons Ltd.

Barcode identification for transfusion safety.

PubMed

Murphy, M F; Kay, J D S

2004-09-01

Errors related to blood transfusion in hospitals may produce catastrophic consequences. This review addresses potential solutions to prevent patient misidentification including the use of new technology, such as barcoding. A small number of studies using new technology for the transfusion process in hospitals have shown promising results in preventing errors. The studies demonstrated improved transfusion safety and staff preference for new technology such as bedside handheld scanners to carry out pretransfusion bedside checking. They also highlighted the need for considerable efforts in the training of staff in the new procedures before their successful implementation. Improvements in hospital transfusion safety are a top priority for transfusion medicine, and will depend on a combined approach including a better understanding of the causes of errors, a reduction in the complexity of routine procedures taking advantage of new technology, improved staff training, and regular monitoring of practice. The use of new technology to improve the safety of transfusion is very promising. Further development of the systems is needed to enable staff to carry out bedside transfusion procedures quickly and accurately, and to increase their functionality to justify the cost of their wider implementation.

Testing and Further Development of Improved Etches and Etching Methods for the Analysis of Bridgman Grown Semiconductor Crystals with an Emphasis on Lead-Tin-Telluride

NASA Technical Reports Server (NTRS)

Barber, Patrick G.

1998-01-01

The goals outlined for the research project for this year have been completed, and the following supporting documentation is attached: 1. A copy of the proposal outlining the principal goals: (a) Improve the characterization of semiconductor crystals through new etches and etching procedures. (b) Developed a novel voltammetric method to characterize semiconductor crystals as a result of searching for improved etches for lead-tin-telluride. (c) Presented paper at ACCG- 10. (d) Prepared manuscripts for publication. Completed additional testing suggested by reviewers and re-submitted manuscripts. (e) Worked with an undergraduate student on this project to provide her an opportunity to have a significant research experience prior to graduation. 2. In addition to the anticipated goals the following were also accomplished: (a) Submitted the newly developed procedures for consideration as a patent or a NASA Tech Brief. (b) Submitted a paper for presentation at the forthcoming ICCG- 12 conference. 3. A copy of the final draft of the publication as submitted to the editors of the Journal of Crystal Growth.

Review of a Parent's Influence on Pediatric Procedural Distress and Recovery.

PubMed

Brown, Erin A; De Young, Alexandra; Kimble, Roy; Kenardy, Justin

2018-06-01

Understanding how parents influence their child's medical procedures can inform future work to reduce pediatric procedural distress and improve recovery outcomes. Following a pediatric injury or illness diagnosis, the associated medical procedures can be potentially traumatic events that are often painful and distressing and can lead to the child experiencing long-term physical and psychological problems. Children under 6 years old are particularly at risk of illness or injury, yet their pain-related distress during medical procedures is often difficult to manage because of their young developmental level. Parents can also experience ongoing psychological distress following a child's injury or illness diagnosis. The parent and parenting behavior is one of many risk factors for increased pediatric procedural distress. The impact of parents on pediatric procedural distress is an important yet not well-understood phenomenon. There is some evidence to indicate parents influence their child through their own psychological distress and through parenting behavior. This paper has three purposes: (1) review current empirical research on parent-related risk factors for distressing pediatric medical procedures, and longer-term recovery outcomes; (2) consider and develop existing theories to present a new model for understanding the parent-child distress relationship during medical procedures; and (3) review and make recommendations regarding current assessment tools and developing parenting behavior interventions for reducing pediatric procedural distress.

IMPROVED RISK CHARACTERIZATION METHODS FOR DEVELOPING AQUATIC LIFE CRITERIA FOR NON-BIOACCUMULATIVE TOXICANTS

EPA Science Inventory

This project will use existing and developing information to evaluate and demonstrate procedures for more fully characterizing risks of non-bioaccumulative toxicants to aquatic organisms, and for incorporating these risks into aquatic life criteria. These efforts will address a v...

Procedures for Developing Evidence-Informed Performance Checklists for Improving Early Childhood Intervention Practices

ERIC Educational Resources Information Center

Dunst, Carl J.

2017-01-01

A conceptualization-operationalization-measurement framework is described for developing evidence-informed early childhood intervention performance checklists. Performance checklists include lists of practice indicators where the indicators, taken together, operationally define particular types of intervention practices that, when used as…

Team Communication Influence on Procedure Performance: Findings From Interprofessional Simulations with Nursing and Medical Students.

PubMed

Reising, Deanna L; Carr, Douglas E; Gindling, Sally; Barnes, Roxie; Garletts, Derrick; Ozdogan, Zulfukar

Interprofessional team performance is believed to be dependent on the development of effective team communication skills. Yet, little evidence exists in undergraduate nursing programs on whether team communication skills affect team performance. A secondary analysis of a larger study on interprofessional student teams in simulations was conducted to determine if there is a relationship between team communication and team procedure performance. The results showed a positive, significant correlation between interprofessional team communication ratings and procedure accuracy in the simulation. Interprofessional team training in communication skills for nursing and medical students improves the procedure accuracy in a simulated setting.

Proficiency-based cervical cancer brachytherapy training.

PubMed

Zhao, Sherry; Francis, Louise; Todor, Dorin; Fields, Emma C

2018-04-25

Although brachytherapy increases the local control rate for cervical cancer, there has been a progressive decline in its use. Furthermore, the training among residency programs for gynecologic brachytherapy varies considerably, with some residents receiving little to no training. This trend is especially concerning given the association between poor applicator placement and decline in local control. Considering the success of proficiency-based training in other procedural specialties, we developed and implemented a proficiency-based cervical brachytherapy training curriculum for our residents. Each resident placed tandem and ovoid applicators with attending guidance and again alone 2 weeks later using a pelvic model that was modified to allow for cervical brachytherapy. Plain films were taken of the pelvic model, and applicator placement quality was evaluated. Other evaluated metrics included retention of key procedural details, the time taken for each procedure and presession and postsession surveys to assess confidence. During the initial session, residents on average met 4.5 of 5 placement criteria, which improved to 5 the second session. On average, residents were able to remember 7.6 of the 8 key procedural steps. Execution time decreased by an average of 10.5%. Resident confidence with the procedure improved dramatically, from 2.6 to 4.6 of 5. Residents who had previously never performed a tandem and ovoid procedure showed greater improvements in these criteria than those who had. All residents strongly agreed that the training was helpful and wanted to participate again the following year. Residents participating in this simulation training had measurable improvements in the time to perform the procedure, applicator placement quality, and confidence. This curriculum is easy to implement and is of great value for training residents, and would be particularly beneficial in programs with low volume of cervical brachytherapy cases. Simulation programs could also be created for other technically challenging radiation oncology procedures. Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Prospective Cohort Study Investigating Changes in Body Image, Quality of Life, and Self-Esteem Following Minimally Invasive Cosmetic Procedures.

PubMed

Sobanko, Joseph F; Dai, Julia; Gelfand, Joel M; Sarwer, David B; Percec, Ivona

2018-04-13

Minimally invasive cosmetic injectable procedures are increasingly common. However, a few studies have investigated changes in psychosocial functioning following these treatments. To assess changes in body image, quality of life, and self-esteem following cosmetic injectable treatment with soft tissue fillers and neuromodulators. Open, prospective study of 75 patients undergoing cosmetic injectable procedures for facial aging to evaluate changes in psychosocial functioning within 6 weeks of treatment. Outcome measures included the Derriford appearance scale (DAS-24), body image quality of life inventory (BIQLI), and the Rosenberg self-esteem scale. Body image dissatisfaction, as assessed by the DAS-24, improved significantly 6 weeks after the treatment. Body image quality of life, as assessed by the BIQLI, improved, but the change did not reach statistical significance. Self-esteem was unchanged after the treatment. Minimally invasive cosmetic injectable procedures were associated with reductions in body image dissatisfaction. Future research, using recently developed cosmetic surgery-specific instruments, may provide further insight into the psychosocial benefits of minimally invasive procedures.

SSET Project: Cost-effectiveness Analysis of Surgical Specialty Emergency Trays in the Emergency Department.

PubMed

Humphries, Laura S; Shenaq, Deana S; Teven, Chad M; Park, Julie E; Song, David H

2018-01-01

We hypothesize that reusable, on-site specialty instrument trays available to plastic surgery residents in the emergency department (ED) for bedside procedures are more cost-effective than disposable on-site and remote re-usable operating room (OR) instruments at our institution. We completed a cost-effectiveness analysis comparing the use of disposable on-site kits and remote OR trays to a hypothetical, custom, reusable tray for ED procedures completed by PRS residents. Material costs of existing OR trays were used to estimate the purchasing and use-cost of a custom on-site tray for the same procedures. Cost of per procedure 'consult time' was estimated using procedure and resident salary. Sixteen bedside procedures were completed over a 4.5 month period. A mean of 2.14 disposable kits were used per-procedure. Mean consultation time was 1.66 hours. Procedures that used OR trays took 3 times as long as procedures that used on-site kits (4 vs. 1.1 hours). Necessary, additional instruments were unavailable for 75% of procedures. Mean cost of using disposable kits and OR trays was $115.03/procedure versus an estimated $26.67/procedure cost of using a custom tray, yielding $88.36/procedure cost-savings. Purchase of a single custom tray ($1,421.55) would be redeemed after 2.3 weeks at 1 procedure/day. Purchasing 4 trays has projected annual cost-savings of $26,565.20. The purchase of specialized procedure trays will yield valuable time and cost-savings while providing quality patient care. Improving time efficiency will help achieve the Accreditation Council of Graduate Medical Education (ACGME) goals of maintaining resident well-being and developing quality improvement competency.

The Use of the Software MATLAB To Improve Chemical Engineering Education.

ERIC Educational Resources Information Center

Damatto, T.; Maegava, L. M.; Filho, R. Maciel

In all the Brazilian Universities involved with the project "Prodenge-Reenge", the main objective is to improve teaching and learning procedures for the engineering disciplines. The Chemical Engineering College of Campinas State University focused its effort on the use of engineering softwares. The work developed by this project has…

Improved production of isobutanol in pervaporation-coupled bioreactor using sugarcane bagasse hydrolysate in engineered Enterobacter aerogenes.

PubMed

Jung, Hwi-Min; Lee, Ju Yeon; Lee, Jung-Hyun; Oh, Min-Kyu

2018-07-01

A process of isobutanol production from sugarcane bagasse hydrolysates in Enterobacter aerogenes was developed here with a pervaporation-integrated procedure. Isobutanol pathway was overexpressed in a mutant strain with eliminated byproduct-forming enzymes (LdhA, BudA, and PflB). A glucose-and-xylose-coconsuming ptsG mutant was constructed for effective utilization of lignocellulosic biomass. Toxic effects of isobutanol were alleviated by in situ recovery via a pervaporation procedure. Compared to single-batch fermentation, cell growth and isobutanol titer were improved by 60% and 100%, respectively, in the pervaporation-integrated fermentation process. A lab-made cross-linked polydimethylsiloxane membrane was cast on polyvinylidene fluoride and used in the pervaporation process. The membrane-penetrating condensate contained 55-226 g m -2  h -1 isobutanol with 6-25 g L -1 ethanol after separation. This study offers improved fermentative production of isobutanol from lignocellulosic biomass with a pervaporation procedure. Copyright © 2018 Elsevier Ltd. All rights reserved.

Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair : Laparoscopic approach for inguinodynia.

PubMed

Ramshaw, Bruce; Vetrano, Vincent; Jagadish, Mayuri; Forman, Brandie; Heidel, Eric; Mancini, Matthew

2017-12-01

Traditional methods of clinical research may not be adequate to improve the value of care for patients with complex medical problems such as chronic pain after inguinal hernia repair. This problem is very complex with many potential factors contributing to the development of this complication. We have implemented a clinical quality improvement (CQI) effort in an attempt to better measure and improve outcomes for patients suffering with chronic groin pain (inguinodynia) after inguinal hernia repair. Between April 2011 and June 2016, there were 93 patients who underwent 94 operations in an attempt to relieve pain (1 patient had two separate unilateral procedures). Patients who had prior laparoscopic inguinal hernia repair (26) had their procedure completed laparoscopically. Patients who had open inguinal hernia repair (68) had a combination of a laparoscopic and open procedure in an attempt to relieve pain. Initiatives to attempt to improve measurement and outcomes during this period included the administration of pre-operative bilateral transversus abdominis plane and intra-operative inguinal nerve blocks using long-acting local anesthetic as a part of a multimodal regimen, the introduction of a low pressure pneumoperitoneum system, and the expansion of a pre-operative questionnaire to assess emotional health pre-operatively. The results included the assessment of how much improvement was achieved after recovery from the operation. Forty-five patients (48%) reported significant improvement, 39 patients (41%) reported moderate improvement, and 10 patients (11%) reported little or no improvement. There were 3 (3%) complications, 13 (11%) hernia recurrences, and 15 patients (13%) developed a new pain in the inguinal region after the initial pain had resolved. The principles of CQI can be applied to a group of patients suffering from chronic pain after inguinal hernia repair. Based on these results additional process improvement ideas will be implemented in an attempt to improve outcomes.

Information sharing for traffic incident management.

DOT National Transportation Integrated Search

2009-01-01

Traffic incident management focuses on developing procedures, implementing policies, and deploying technologies to more quickly identify incidents, improve response times, and more effectively and efficiently manage the incident scene. Because so man...

Robot-assisted procedures in pediatric neurosurgery.

PubMed

De Benedictis, Alessandro; Trezza, Andrea; Carai, Andrea; Genovese, Elisabetta; Procaccini, Emidio; Messina, Raffaella; Randi, Franco; Cossu, Silvia; Esposito, Giacomo; Palma, Paolo; Amante, Paolina; Rizzi, Michele; Marras, Carlo Efisio

2017-05-01

OBJECTIVE During the last 3 decades, robotic technology has rapidly spread across several surgical fields due to the continuous evolution of its versatility, stability, dexterity, and haptic properties. Neurosurgery pioneered the development of robotics, with the aim of improving the quality of several procedures requiring a high degree of accuracy and safety. Moreover, robot-guided approaches are of special interest in pediatric patients, who often have altered anatomy and challenging relationships between the diseased and eloquent structures. Nevertheless, the use of robots has been rarely reported in children. In this work, the authors describe their experience using the ROSA device (Robotized Stereotactic Assistant) in the neurosurgical management of a pediatric population. METHODS Between 2011 and 2016, 116 children underwent ROSA-assisted procedures for a variety of diseases (epilepsy, brain tumors, intra- or extraventricular and tumor cysts, obstructive hydrocephalus, and movement and behavioral disorders). Each patient received accurate preoperative planning of optimal trajectories, intraoperative frameless registration, surgical treatment using specific instruments held by the robotic arm, and postoperative CT or MR imaging. RESULTS The authors performed 128 consecutive surgeries, including implantation of 386 electrodes for stereo-electroencephalography (36 procedures), neuroendoscopy (42 procedures), stereotactic biopsy (26 procedures), pallidotomy (12 procedures), shunt placement (6 procedures), deep brain stimulation procedures (3 procedures), and stereotactic cyst aspiration (3 procedures). For each procedure, the authors analyzed and discussed accuracy, timing, and complications. CONCLUSIONS To the best their knowledge, the authors present the largest reported series of pediatric neurosurgical cases assisted by robotic support. The ROSA system provided improved safety and feasibility of minimally invasive approaches, thus optimizing the surgical result, while minimizing postoperative morbidity.

Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine.

PubMed

Sawyer, Taylor; White, Marjorie; Zaveri, Pavan; Chang, Todd; Ades, Anne; French, Heather; Anderson, JoDee; Auerbach, Marc; Johnston, Lindsay; Kessler, David

2015-08-01

Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to prove competency prior to performing the procedure on a patient (Prove). Once competency is demonstrated on a simulator, the trainee is allowed to perform the procedure on patients with direct supervision, until he or she can be entrusted to perform the procedure independently (Do). Maintenance of the skill is ensured through continued clinical practice, supplemented by simulation-based training as needed (Maintain). Evidence in support of each component of the framework is presented. Implementation of the proposed framework presents a paradigm shift in procedural skill training. However, the authors believe that adoption of the framework will improve procedural skill training and patient safety.

Laboratory animal science: a resource to improve the quality of science.

PubMed

Forni, M

2007-08-01

The contribution of animal experimentation to biomedical research is of undoubted value, nevertheless the real usefulness of animal models is still being hotly debated. Laboratory Animal Science is a multidisciplinary approach to humane animal experimentation that allows the choice of the correct animal model and the collection of unbiased data. Refinement, Reduction and Replacement, the "3Rs rule", are now widely accepted and have a major influence on animal experimentation procedures. Refinement, namely any decrease in the incidence or severity of inhumane procedures applied to animals, has been today extended to the entire lives of the experimental animals. Reduction of the number of animals used to obtain statistically significant data may be achieved by improving experimental design and statistical analysis of data. Replacement refers to the development of validated alternative methods. A Laboratory Animal Science training program in biomedical degrees can promote the 3Rs and improve the welfare of laboratory animals as well as the quality of science with ethical, scientific and economic advantages complying with the European requirement that "persons who carry out, take part in, or supervise procedures on animals, or take care of animals used in procedures, shall have had appropriate education and training".

[Standard operating procedures in ethic committees].

PubMed

Czarkowski, Marek

2006-02-01

Polish ethic committees should have to work together in order to maintain and develop high quality standards in the protection of human subjects. Exchanging knowledge, know-how and information polish ethic committees should have to implement standard operating procedures. Procedures should improve quality and proficiency of all types of ethic committee's activities. Standard operating procedures should cover as important problems as conflict of interest, trial's insurance or elections of ethic committees. The opinions of experts who have been reviewing medical research projects for several years may prove to be especially valuable in this setting. Governmental initiatives and creation of forum for polish ethic committees are essential in the effective standardisation, coordination and implementation of procedures in regional ethic committees. These projects need support via public funding from our authorities.

Recovering activity and illusion: the nephrology day care unit.

PubMed

Remón Rodríguez, C; Quirós Ganga, P L; González-Outón, J; del Castillo Gámez, R; García Herrera, A L; Sánchez Márquez, M G

2011-01-01

Day Care Units are an alternative to hospital care that improves more efficiency. The Nephrology, by its technical characteristics, would be benefit greatly from further development of this care modality. The objectives of this study are to present the process we have developed the Nephrology Day Care Unit in the Puerto Real University Hospital (Cádiz, Spain). For this project we followed the Deming Management Method of Quality improvement, selecting opportunities, analyzing causes, select interventions, implement and monitor results. The intervention plan includes the following points: 1) Define the place of the Day Care Unit in the organization of our Clinical Department of Nephrology, 2) Define the Manual of organization, 3) Define the structural and equipment resources, 4) Define the Catalogue of services and procedures, 5) Standards of Care Processes. Protocols and Clinical Pathways; and 6) Information and Registration System. In the first 8 months we have been performed nearly 2000 procedures, which corresponds to an average of about 10 procedures per day, and essentially related to Hemodialysis in critical or acute patients, the Interventional Nephrology, the Clinical Nephrology and Peritoneal Dialysis. The development of the Nephrology Day Care Units can help to increase our autonomy, our presence in Hospitals, recover the progressive loss of clinical activity (diagnostic and therapeutic skills) in the past to the benefit of other Specialties. It also contributes to: Promote and develop the Diagnostic and Interventional Nephrology; improve the clinical management of patients with Primary Health Level, promote the Health Education and Investigation, collaborate in the Resources Management, and finally, to make more attractive and exciting our Specialty, both for nephrologists to training specialists.

Back to Anatomy: Improving Landmarking Accuracy of Clinical Procedures Using a Novel Approach to Procedural Teaching.

PubMed

Zeller, Michelle; Cristancho, Sayra; Mangel, Joy; Goldszmidt, Mark

2015-06-01

Many believe that knowledge of anatomy is essential for performing clinical procedures; however, unlike their surgical counterparts, internal medicine (IM) programs rarely incorporate anatomy review into procedural teaching. This study tested the hypothesis that an educational intervention focused on teaching relevant surface and underlying anatomy would result in improved bone marrow procedure landmarking accuracy. This was a preintervention-postintervention prospective study on landmarking accuracy of consenting IM residents attending their mandatory academic half-day. The intervention included an interactive video and visualization exercise; the video was developed specifically to teach the relevant underlying anatomy and includes views of live volunteers, cadavers, and skeletons. Thirty-one IM residents participated. At pretest, 48% (15/31) of residents landmarked accurately. Inaccuracy of pretest landmarking varied widely (n = 16, mean 20.06 mm; standard deviation 30.03 mm). At posttest, 74% (23/31) of residents accurately performed the procedure. McNemar test revealed a nonsignificant trend toward increased performance at posttest (P = 0.076; unadjusted odds for discordant pairs 3; 95% confidence interval 0.97-9.3). The Wilcoxon signed rank test demonstrated a significant difference between pre- and posttest accuracy in the 16 residents who were inaccurate at pretest (P = 0.004). No association was detected between participant baseline characteristics and pretest accuracy. This study demonstrates that residents who were initially inaccurate were able to significantly improve their landmarking skills by interacting with an educational tool emphasizing the relation between the surface and underlying anatomy. Our results support the use of basic anatomy in teaching bone marrow procedures. Results also support the proper use of video as an effective means for incorporating anatomy teaching around procedural skills.

EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision.

PubMed

Verberne, Hein J; Acampa, Wanda; Anagnostopoulos, Constantinos; Ballinger, Jim; Bengel, Frank; De Bondt, Pieter; Buechel, Ronny R; Cuocolo, Alberto; van Eck-Smit, Berthe L F; Flotats, Albert; Hacker, Marcus; Hindorf, Cecilia; Kaufmann, Philip A; Lindner, Oliver; Ljungberg, Michael; Lonsdale, Markus; Manrique, Alain; Minarik, David; Scholte, Arthur J H A; Slart, Riemer H J A; Trägårdh, Elin; de Wit, Tim C; Hesse, Birger

2015-11-01

Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/publications/guidelines/2015_07_EANM_FINAL_myocardial_perfusion_guideline.pdf .

Mutilating Procedures, Management Practices, and Housing Conditions That May Affect the Welfare of Farm Animals: Implications for Welfare Research.

PubMed

Nordquist, Rebecca E; van der Staay, Franz Josef; van Eerdenburg, Frank J C M; Velkers, Francisca C; Fijn, Lisa; Arndt, Saskia S

2017-02-21

A number of mutilating procedures, such as dehorning in cattle and goats and beak trimming in laying hens, are common in farm animal husbandry systems in an attempt to prevent or solve problems, such as injuries from horns or feather pecking. These procedures and other practices, such as early maternal separation, overcrowding, and barren housing conditions, raise concerns about animal welfare. Efforts to ensure or improve animal welfare involve adapting the animal to its environment, i.e., by selective breeding (e.g., by selecting "robust" animals) adapting the environment to the animal (e.g., by developing social housing systems in which aggressive encounters are reduced to a minimum), or both. We propose adapting the environment to the animals by improving management practices and housing conditions, and by abandoning mutilating procedures. This approach requires the active involvement of all stakeholders: veterinarians and animal scientists, the industrial farming sector, the food processing and supply chain, and consumers of animal-derived products. Although scientific evidence about the welfare effects of current practices in farming such as mutilating procedures, management practices, and housing conditions is steadily growing, the gain in knowledge needs a boost through more scientific research. Considering the huge number of animals whose welfare is affected, all possible effort must be made to improve their welfare as quickly as possible in order to ban welfare-compromising procedures and practices as soon as possible.

EVA Training and Development Facilities

NASA Technical Reports Server (NTRS)

Cupples, Scott

2016-01-01

Overview: Vast majority of US EVA (ExtraVehicular Activity) training and EVA hardware development occurs at JSC; EVA training facilities used to develop and refine procedures and improve skills; EVA hardware development facilities test hardware to evaluate performance and certify requirement compliance; Environmental chambers enable testing of hardware from as large as suits to as small as individual components in thermal vacuum conditions.

Computer-enhanced visual learning method: a paradigm to teach and document surgical skills.

PubMed

Maizels, Max; Mickelson, Jennie; Yerkes, Elizabeth; Maizels, Evelyn; Stork, Rachel; Young, Christine; Corcoran, Julia; Holl, Jane; Kaplan, William E

2009-09-01

Changes in health care are stimulating residency training programs to develop new methods for teaching surgical skills. We developed Computer-Enhanced Visual Learning (CEVL) as an innovative Internet-based learning and assessment tool. The CEVL method uses the educational procedures of deliberate practice and performance to teach and learn surgery in a stylized manner. CEVL is a learning and assessment tool that can provide students and educators with quantitative feedback on learning a specific surgical procedure. Methods involved examine quantitative data of improvement in surgical skills. Herein, we qualitatively describe the method and show how program directors (PDs) may implement this technique in their residencies. CEVL allows an operation to be broken down into teachable components. The process relies on feedback and remediation to improve performance, with a focus on learning that is applicable to the next case being performed. CEVL has been shown to be effective for teaching pediatric orchiopexy and is being adapted to additional adult and pediatric procedures and to office examination skills. The CEVL method is available to other residency training programs.

Computer-Enhanced Visual Learning Method: A Paradigm to Teach and Document Surgical Skills

PubMed Central

Maizels, Max; Mickelson, Jennie; Yerkes, Elizabeth; Maizels, Evelyn; Stork, Rachel; Young, Christine; Corcoran, Julia; Holl, Jane; Kaplan, William E.

2009-01-01

Innovation Changes in health care are stimulating residency training programs to develop new methods for teaching surgical skills. We developed Computer-Enhanced Visual Learning (CEVL) as an innovative Internet-based learning and assessment tool. The CEVL method uses the educational procedures of deliberate practice and performance to teach and learn surgery in a stylized manner. Aim of Innovation CEVL is a learning and assessment tool that can provide students and educators with quantitative feedback on learning a specific surgical procedure. Methods involved examine quantitative data of improvement in surgical skills. Herein, we qualitatively describe the method and show how program directors (PDs) may implement this technique in their residencies. Results CEVL allows an operation to be broken down into teachable components. The process relies on feedback and remediation to improve performance, with a focus on learning that is applicable to the next case being performed. CEVL has been shown to be effective for teaching pediatric orchiopexy and is being adapted to additional adult and pediatric procedures and to office examination skills. The CEVL method is available to other residency training programs. PMID:21975716

Germ tube and chlamydospore formation by Candida albicans on a new medium.

PubMed

Beheshti, F; Smith, A G; Krause, G W

1975-10-01

A new medium composed of "cream of rice" infusion, oxgall, Tween 80, and agar is described for the sequential development of germ tubes and chlamydospores by Candida albicans. The procedure used (Dalmau's technique) is an improvement over the fluid substrate procedures previously advocated for germ tube formation. That the same preparation is then used for chlamydospore production is of practical importance for the clinical mycology laboratory.

Intra-opeartive OCT imaging and sensing devices for clinical translation (Conference Presentation)

NASA Astrophysics Data System (ADS)

Chen, Yu

2017-02-01

Stereotactic procedures that require insertion of needle-based instruments into the brain serve important roles in a variety of neurosurgical interventions, such as biopsy, catheterization, and electrode placement. A fundamental limitation of these stereotactic procedures is that they are blind procedures in that the operator does not have real-time feedback as to what lies immediately ahead of the advancing needle. Therefore, there is a great clinical need to navigate the instrument safely and accurately to the targets. Towards that end, we developed a forwarding-imaging needle-type optical coherence tomography (OCT) probe for avoiding the hemorrhage and guiding neurosurgical interventions. The needle probe has a thin diameter of 0.7 mm. The feasibility of vessel detection and neurosurgical guidance were demonstrated on sheep brain in vivo and human brain ex vivo. In addition, we further reduced the probe size to 0.3 mm using an optical Doppler sensing (ODS) fiber probe that can integrate with microelectrode recording (MER) to detect the blood vessels lying ahead to improve the safety of this procedure. Furthermore, to overcome the field-of-view limitation of OCT probe, we developed an MRI-compatible OCT imaging probe for neurosurgery. MRI/OCT multi-scale imaging integrates micro-resolution optical imaging with wide-field MRI imaging, and has potential to further improve the targeting accuracy.

Mutilating Procedures, Management Practices, and Housing Conditions That May Affect the Welfare of Farm Animals: Implications for Welfare Research

PubMed Central

Nordquist, Rebecca E.; van der Staay, Franz Josef; van Eerdenburg, Frank J. C. M.; Velkers, Francisca C.; Fijn, Lisa; Arndt, Saskia S.

2017-01-01

Simple summary Intensive farming systems are confronted with a number of animal welfare issues such as injuries from horns in cattle and feather pecking in poultry. To solve these problems, mutilating procedures, such as dehorning in cattle and goats and beak trimming in laying hens, are applied routinely. These and other procedures such as early maternal separation, overcrowding, and barren housing conditions impair animal welfare. Scientific underpinning of the efficacy of these interventions and management practices is poor. We advocate that all stakeholders, in particular animal scientists and veterinarians, take the lead in evaluating common, putative mutilating and welfare reducing procedures and management practices to develop better, scientifically supported alternatives, focused on adaptation of the environment to the animals, to ensure uncompromised animal welfare. Abstract A number of mutilating procedures, such as dehorning in cattle and goats and beak trimming in laying hens, are common in farm animal husbandry systems in an attempt to prevent or solve problems, such as injuries from horns or feather pecking. These procedures and other practices, such as early maternal separation, overcrowding, and barren housing conditions, raise concerns about animal welfare. Efforts to ensure or improve animal welfare involve adapting the animal to its environment, i.e., by selective breeding (e.g., by selecting “robust” animals) adapting the environment to the animal (e.g., by developing social housing systems in which aggressive encounters are reduced to a minimum), or both. We propose adapting the environment to the animals by improving management practices and housing conditions, and by abandoning mutilating procedures. This approach requires the active involvement of all stakeholders: veterinarians and animal scientists, the industrial farming sector, the food processing and supply chain, and consumers of animal-derived products. Although scientific evidence about the welfare effects of current practices in farming such as mutilating procedures, management practices, and housing conditions is steadily growing, the gain in knowledge needs a boost through more scientific research. Considering the huge number of animals whose welfare is affected, all possible effort must be made to improve their welfare as quickly as possible in order to ban welfare-compromising procedures and practices as soon as possible. PMID:28230800

A new software for prediction of femoral neck fractures.

PubMed

Testi, Debora; Cappello, Angelo; Sgallari, Fiorella; Rumpf, Martin; Viceconti, Marco

2004-08-01

Femoral neck fractures are an important clinical, social and economic problem. Even if many different attempts have been carried out to improve the accuracy predicting the fracture risk, it was demonstrated in retrospective studies that the standard clinical protocol achieves an accuracy of about 65%. A new procedure was developed including for the prediction not only bone mineral density but also geometric and femoral strength information and achieving an accuracy of about 80% in a previous retrospective study. Aim of the present work was to re-engineer research-based procedures and develop a real-time software for the prediction of the risk for femoral fracture. The result was efficient, repeatable and easy to use software for the evaluation of the femoral neck fracture risk to be inserted in the daily clinical practice providing a useful tool for the improvement of fracture prediction.

Dividing the common pond: regionalizing EU ocean governance.

PubMed

Maier, Nina; Markus, Till

2013-02-15

EU ocean policies increasingly incorporate regional measures. Under the long standing Common Fisheries Policy, such measures aim at improving and reforming existing policy, either by taking into account region specific social or ecologic requirements or by establishing procedures and institutions to achieve a regional fit. By contrast, the EU's emerging integrated Marine Environmental Policy was designed to draw heavily on regional procedural and institutional mechanisms from the outset. The developing regional measures raise the question whether they contribute to improving institutional structures governing the use and conservation of EU waters. This article analyzes the existing and future regional measures of the two policies and their varying purposes and scopes. It develops a typology for categorizing the regional aspects and examines the effects of regional measures on EU institutions and the theoretical EU integration debate. Copyright © 2012 Elsevier Ltd. All rights reserved.

A Complete Procedure for Predicting and Improving the Performance of HAWT's

NASA Astrophysics Data System (ADS)

Al-Abadi, Ali; Ertunç, Özgür; Sittig, Florian; Delgado, Antonio

2014-06-01

A complete procedure for predicting and improving the performance of the horizontal axis wind turbine (HAWT) has been developed. The first process is predicting the power extracted by the turbine and the derived rotor torque, which should be identical to that of the drive unit. The BEM method and a developed post-stall treatment for resolving stall-regulated HAWT is incorporated in the prediction. For that, a modified stall-regulated prediction model, which can predict the HAWT performance over the operating range of oncoming wind velocity, is derived from existing models. The model involves radius and chord, which has made it more general in applications for predicting the performance of different scales and rotor shapes of HAWTs. The second process is modifying the rotor shape by an optimization process, which can be applied to any existing HAWT, to improve its performance. A gradient- based optimization is used for adjusting the chord and twist angle distribution of the rotor blade to increase the extraction of the power while keeping the drive torque constant, thus the same drive unit can be kept. The final process is testing the modified turbine to predict its enhanced performance. The procedure is applied to NREL phase-VI 10kW as a baseline turbine. The study has proven the applicability of the developed model in predicting the performance of the baseline as well as the optimized turbine. In addition, the optimization method has shown that the power coefficient can be increased while keeping same design rotational speed.

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.

Development of quality indicators to evaluate antibiotic treatment of patients with community-acquired pneumonia in Indonesia.

PubMed

Farida, Helmia; Rondags, Angelique; Gasem, M Hussein; Leong, Katharina; Adityana, A; van den Broek, Peterhans J; Keuter, Monique; Natsch, Stephanie

2015-04-01

To develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country. A previous study and Indonesian guidelines were reviewed to derive potential quality of care indicators (QIs). An expert panel performed a two-round Delphi consensus procedure on the QI's relevance to patient recovery, reduction of antimicrobial resistance and cost containment. Applicability in practice, including reliability, feasibility and opportunity for improvement, was determined in a data set of 128 patients hospitalised with CAP in Semarang, Indonesia. Fifteen QIs were selected by the consensus procedure. Five QIs did not pass feasibility criteria, because of inappropriate documentation, inefficient laboratory services or patient factors. Three QIs provided minor opportunity for improvement. Two QIs contradicted each other; one of these was considered not valid and excluded. A final set of six QIs was defined for use in the Indonesian setting. Using the Delphi method, we defined a list of QIs for assessing the quality of care, in particular antibiotic treatment, for CAP in Indonesia. For further improvement, a modified Delphi method that includes discussion, a sound medical documentation system, improvement of microbiology laboratory services, and multi-center applicability tests are needed to develop a valid and applicable QI list for the Indonesian setting. © 2014 John Wiley & Sons Ltd.

Task analysis method for procedural training curriculum development.

PubMed

Riggle, Jakeb D; Wadman, Michael C; McCrory, Bernadette; Lowndes, Bethany R; Heald, Elizabeth A; Carstens, Patricia K; Hallbeck, M Susan

2014-06-01

A central venous catheter (CVC) is an important medical tool used in critical care and emergent situations. Integral to proper care in many circumstances, insertion of a CVC introduces the risk of central line-associated blood stream infections and mechanical adverse events; proper training is important for safe CVC insertion. Cognitive task analysis (CTA) methods have been successfully implemented in the medical field to improve the training of postgraduate medical trainees, but can be very time-consuming to complete and require a significant time commitment from many subject matter experts (SMEs). Many medical procedures such as CVC insertion are linear processes with well-documented procedural steps. These linear procedures may not require a traditional CTA to gather the information necessary to create a training curriculum. Accordingly, a novel, streamlined CTA method designed primarily to collect cognitive cues for linear procedures was developed to be used by medical professionals with minimal CTA training. This new CTA methodology required fewer trained personnel, fewer interview sessions, and less time commitment from SMEs than a traditional CTA. Based on this study, a streamlined CTA methodology can be used to efficiently gather cognitive information on linear medical procedures for the creation of resident training curricula and procedural skills assessments.

Perspectives for Teachers of Latin American Culture.

ERIC Educational Resources Information Center

Seelye, H. Ned, Ed.

Articles treating various aspects of the teaching of Hispanic culture at the secondary and junior high school levels are intended to improve methodology and facilitate the development of teacher-made instructional materials. An overview of the field relating problems and procedures in several areas is developed. Selections cover: (1) bilinguality,…

Plan to Improve Student Attendance in California Public Schools.

ERIC Educational Resources Information Center

California State Dept. of Education, Sacramento.

The plan described in this report was developed in response to language in the 1979 Budget Act that required the California Department of Education to development a comprehensive plan for addressing problems in administering the state's attendance laws and attendance accounting requirements. The current attendance accounting procedures and…

Merging Quality Processes & Tools with DACUM.

ERIC Educational Resources Information Center

McLennan, Krystyna S.

This paper explains how merging DACUM (Developing a Curriculum) analysis with quality initiatives can reduce waste, increase job efficiency, assist in development of standard operating procedures, and involve employees in positive job improvement methods. In the first half of the paper, the following principles of total quality management (TQM)…

Developing and Improving Modified Achievement Level Descriptors: Rationale, Procedures, and Tools

ERIC Educational Resources Information Center

Quenemoen, Rachel; Albus, Debra; Rogers, Chris; Lazarus, Sheryl

2010-01-01

Some states are developing alternate assessments based on modified achievement standards (AA-MAS) to measure the academic achievement of some students with disabilities (Albus, Lazarus, Thurlow, & Cormier, 2009; Lazarus, Thurlow, Christensen, & Cormier, 2007). These assessments measure the same content as the general assessment for a given…

Piagetian Research as Applied to Teaching Science to Secondary and College Students.

ERIC Educational Resources Information Center

Gabel, Dorothy L.

1979-01-01

Piaget's formal operational stage is related to the teaching of science by focusing on the development of paper and pencil tests for determining students' cognitive level of development and on procedures for helping concrete operational students improve achievement and become more formal in their thinking. (JMF)

Prioritizing quality improvement in general surgery.

PubMed

Schilling, Peter L; Dimick, Justin B; Birkmeyer, John D

2008-11-01

Despite growing interest in quality improvement, uncertainty remains about which procedures offer the most room for improvement in general surgery. In this context, we sought to describe the relative contribution of different procedures to overall morbidity, mortality, and excess length of stay in general surgery. Using data from the American College of Surgeons' National Surgery Quality Improvement Program (ACS-NSQIP), we identified all patients undergoing a general surgery procedure in 2005 and 2006 (n=129,233). Patients were placed in 36 distinct procedure groups based on Current Procedural Terminology codes. We first examined procedure groups according to their relative contribution to overall morbidity and mortality. We then assessed procedure groups according to their contribution to overall excess length of stay. Ten procedure groups alone accounted for 62% of complications and 54% of excess hospital days. Colectomy accounted for the greatest share of adverse events, followed by small intestine resection, inpatient cholecystectomy, and ventral hernia repair. In contrast, several common procedures contributed little to overall morbidity and mortality. For example, outpatient cholecystectomy, breast procedures, thyroidectomy, parathyroidectomy, and outpatient inguinal hernia repair together accounted for 34% of procedures, but only 6% of complications (and only 4% of major complications). These same procedures accounted for < 1% of excess hospital days. A relatively small number of procedures account for a disproportionate share of the morbidity, mortality, and excess hospital days in general surgery. Focusing quality improvement efforts on these procedures may be an effective strategy for improving patient care and reducing cost.

[Project to enhance bone bank tissue storage and distribution procedures].

PubMed

Huang, Jui-Chen; Wu, Chiung-Lan; Chen, Chun-Chuan; Chen, Shu-Hua

2011-10-01

Organ and tissue transplantation are now commonly preformed procedures. Improper organ bank handling procedures may increase infection risks. Execution accuracy in terms of tissue storage and distribution at our bone bank was 80%. We thus proposed an execution improvement project to enhance procedures in order to fulfill the intent of donors and ensure recipient safety. This project was designed to raise nurse professionalism, and ensure patient safety through enhanced tissue storage and distribution procedures. Education programs developed for this project focus on teaching standard operating procedures for bone and ligament storage and distribution, bone bank facility maintenance, trouble shooting and solutions, and periodic inspection systems. Cognition of proper storage and distribution procedures rose from 81% to 100%; Execution accuracy also rose from 80% to 100%. The project successfully conveyed concepts essential to the correct execution of organ storage and distribution procedures and proper organ bank facility management. Achieving and maintaining procedural and management standards is crucial to continued organ donations and the recipient safety.

Adult and pediatric anesthesia/sedation for gastrointestinal procedures outside of the operating room.

PubMed

Michel Foehn, Esther R

2015-08-01

This review presents current trends of safe and efficient anesthesia and sedation for adults and children for gastrointestinal procedures outside of the operating room with a special focus on total intravenous anesthesia (TIVA), target-controlled infusion (TCI), intravenous or topical lidocaine, and the use of the video laryngoscope. The concepts of a well tolerated and adequate anesthesia or sedation for gastrointestinal procedures outside of the operating room have to meet the needs of the adult and pediatric patients and the special requests of the gastroenterologists. Anesthesia and sedation of adults for gastrointestinal procedures with TIVA or TCI and spontaneous breathing is well established. Many institutions perform anesthesia for pediatric patients undergoing gastrointestinal procedures with an inhalational agent, especially in young children and for short procedures. Unlike adults, in young children the airways frequently must be secured with a tracheal tube or laryngeal mask. Respiration may be spontaneous, assisted, or controlled. TIVA and TCI are increasingly chosen for older children and longer procedures. A local anesthetic administered intravenously or topically to the upper airways and the use of the video laryngoscope can facilitate the insertion of the endoscope. Both anesthesiologists and nonanesthesiologists have to achieve a consensus and develop quality-improvement strategies to provide safe and efficient anesthesia and sedation for gastrointestinal procedures outside of the operating room for pediatric and adult patients. Techniques using TIVA, TCI, intravenous or topical application of lidocaine, and the video laryngoscope may improve and facilitate gastrointestinal procedures for the patients, the anesthesiologists, and the gastroenterologists.

Bon-EV: an improved multiple testing procedure for controlling false discovery rates.

PubMed

Li, Dongmei; Xie, Zidian; Zand, Martin; Fogg, Thomas; Dye, Timothy

2017-01-03

Stability of multiple testing procedures, defined as the standard deviation of total number of discoveries, can be used as an indicator of variability of multiple testing procedures. Improving stability of multiple testing procedures can help to increase the consistency of findings from replicated experiments. Benjamini-Hochberg's and Storey's q-value procedures are two commonly used multiple testing procedures for controlling false discoveries in genomic studies. Storey's q-value procedure has higher power and lower stability than Benjamini-Hochberg's procedure. To improve upon the stability of Storey's q-value procedure and maintain its high power in genomic data analysis, we propose a new multiple testing procedure, named Bon-EV, to control false discovery rate (FDR) based on Bonferroni's approach. Simulation studies show that our proposed Bon-EV procedure can maintain the high power of the Storey's q-value procedure and also result in better FDR control and higher stability than Storey's q-value procedure for samples of large size(30 in each group) and medium size (15 in each group) for either independent, somewhat correlated, or highly correlated test statistics. When sample size is small (5 in each group), our proposed Bon-EV procedure has performance between the Benjamini-Hochberg procedure and the Storey's q-value procedure. Examples using RNA-Seq data show that the Bon-EV procedure has higher stability than the Storey's q-value procedure while maintaining equivalent power, and higher power than the Benjamini-Hochberg's procedure. For medium or large sample sizes, the Bon-EV procedure has improved FDR control and stability compared with the Storey's q-value procedure and improved power compared with the Benjamini-Hochberg procedure. The Bon-EV multiple testing procedure is available as the BonEV package in R for download at https://CRAN.R-project.org/package=BonEV .

DEVELOPMENT OF AGENTS AND PROCEDURES FOR DECONTAMINATION OF THE YANKEE REACTOR PRIMARY COOLANT SYSTEM

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

Watkins, R.M.

1959-03-01

Developments relative to decontamination achieved under the Yankee Reasearch and Development program are reported. The decontamination of a large test loop which had been used to conduct corrosion rate studies for the Yankee reactor program is described. The basic permanganate-citrate decontamination procedure suggested for application in Yankee reactor primary system cleanup was used. A study of the chemistry of this decontamination operation is presented, together with conclusions pertaining to the effectiveness of the solutions under the conditions studied. In an attempt to further improve the efficiency of the procedure, an additional series of static and dynamic tests was performcd usingmore » contaminated sections of stainless steel tubing from the original SlW steam generator. Survival variables in the process (reagent composition, contact time, temperature, and flow velocity) were studied. The changes in decontamination efficiency produced by these variations are discussed and compared with results obtained throughthe use of similar procedures. Based on the observations made, conclusions are drawn concerning the optimum conditions for this cleanup process, a new set of suggested basic permanganate-citrate decontamination instructions is presented, and recommendations are made concerning future studies involving this procedure. (auth)« less

Characterization of structural connections using free and forced response test data

NASA Technical Reports Server (NTRS)

Lawrence, Charles; Huckelbridge, Arthur A.

1989-01-01

The accurate prediction of system dynamic response often has been limited by deficiencies in existing capabilities to characterize connections adequately. Connections between structural components often are complex mechanically, and difficult to accurately model analytically. Improved analytical models for connections are needed to improve system dynamic preditions. A procedure for identifying physical connection properties from free and forced response test data is developed, then verified utilizing a system having both a linear and nonlinear connection. Connection properties are computed in terms of physical parameters so that the physical characteristics of the connections can better be understood, in addition to providing improved input for the system model. The identification procedure is applicable to multi-degree of freedom systems, and does not require that the test data be measured directly at the connection locations.

A brief history of early neuroanesthesia.

PubMed

Chivukula, Srinivas; Grandhi, Ramesh; Friedlander, Robert M

2014-04-01

Two key discoveries in the 19th century--infection control and the development of general anesthesia--provided an impetus for the rapid advancement of surgery, especially within the field of neurosurgery. Improvements in anesthesia and perioperative care, in particular, fostered the development of meticulous surgical technique conducive to the refinement of neuroanatomical understanding and optimization of neurosurgical procedures and outcomes. Yet, even dating back to the earliest times, some form of anesthesia or perioperative pain management was used during neurosurgical procedures. Despite a few reports on anesthesia published around the time of William Morton's now-famous public demonstration of ether anesthesia in 1846, relatively little is known or written of early anesthetics in neurosurgery. In the present article the authors discuss the history of anesthesia pertaining to neurosurgical procedures and draw parallels between the refinements and developments in anesthesia care over time with some of the concomitant advances in neurosurgery.

Report from a quality assurance program on patients undergoing the MILD procedure.

PubMed

Durkin, Brian; Romeiser, Jamie; Shroyer, A Laurie W; Schiller, Robin; Bae, Jin; Davis, Raphael P; Peyster, Robert; Benveniste, Helene

2013-05-01

To characterize trends in pain and functional outcomes and identify risk factors in patients with lumbar spinal stenosis (LSS) and neurogenic claudication undergoing the "Minimally Invasive Lumbar Decompression" (MILD) procedure. Retrospective observational cohort study. Academic multidisciplinary pain center at Stony Brook Medicine. Patients undergoing the MILD procedure from October 2010 to November 2012. De-identified perioperative, pain and function related data for 50 patients undergoing MILD were extracted from the Center for Pain Management's quality assessment database. Data included numerical rating scale (NRS), symptom severity and physical function (Zurich Claudication Questionnaire), functional status (Oswestry Disability Index [ODI]), pain interference scores (National Institutes of Health Patient-Reported Outcomes Measurement Information System [PROMIS]), and patients' self-reported low back and lower extremity pain distribution. No MILD patient incurred procedure-related complications. Average NRS scores decreased postoperatively and 64.3% of patients reported less pain at 3 months. Clinically meaningful functional ODI improvements of at least 20% from baseline were present in 25% of the patients at 6 months. Preliminary analysis of changes in PROMIS scores at 3 months revealed that pre-MILD "severe" lumbar canal stenosis may be associated with high risk of "no improvement." No such impact was observed for NRS or ODI outcomes. Overall, pain is reduced and functional status improved in LSS patients following the MILD procedure at 3 and 6 months. Given the small sample size, it is not yet possible to identify patient subgroups at risk for "no improvement." Continued follow-up of longer-term outcomes appears warranted to develop evidence-based patient selection criteria. Wiley Periodicals, Inc.

High plastic concrete temperature specifications for paving mixtures.

DOT National Transportation Integrated Search

2011-08-01

This report documents a study performed for the Illinois Department of Transportation (IDOT) regarding : concrete roadway construction in hot weather. The main objective in this project is to develop improved : specifications and procedures with resp...

Analytical procedures for determining the impacts of reliability mitigation strategies. [supporting datasets

DOT National Transportation Integrated Search

2012-11-30

The objective of this project was to develop technical relationships between reliability improvement strategies and reliability performance metrics. This project defined reliability, explained the importance of travel time distributions for measuring...

7 CFR 2610.2 - Headquarters organization.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Management (AIG/PD&RM) formulates OIG policies and procedures; develops, administers and directs comprehensive programs for the management, budget, financial, personnel, systems improvement, and information... information management systems. The staff maintains OIG's directives system; Departmental Regulations and...

Evaluation of liquefaction hazards in Washington state.

DOT National Transportation Integrated Search

2008-12-01

This report describes the results of a detailed investigation of improved procedures for evaluation of : liquefaction hazards in Washington State, and describes the development and use of a computer : program, WSliq, that allows rapid and convenient ...

Guidelines for software inspections

NASA Technical Reports Server (NTRS)

1983-01-01

Quality control inspections are software problem finding procedures which provide defect removal as well as improvements in software functionality, maintenance, quality, and development and testing methodology is discussed. The many side benefits include education, documentation, training, and scheduling.

Three-dimensional illumination procedure for photodynamic therapy of dermatology

NASA Astrophysics Data System (ADS)

Hu, Xiao-ming; Zhang, Feng-juan; Dong, Fei; Zhou, Ya

2014-09-01

Light dosimetry is an important parameter that affects the efficacy of photodynamic therapy (PDT). However, the irregular morphologies of lesions complicate lesion segmentation and light irradiance adjustment. Therefore, this study developed an illumination demo system comprising a camera, a digital projector, and a computing unit to solve these problems. A three-dimensional model of a lesion was reconstructed using the developed system. Hierarchical segmentation was achieved with the superpixel algorithm. The expected light dosimetry on the targeted lesion was achieved with the proposed illumination procedure. Accurate control and optimization of light delivery can improve the efficacy of PDT.

Development of a standardized sequential extraction protocol for simultaneous extraction of multiple actinide elements

DOE PAGES

Faye, Sherry A.; Richards, Jason M.; Gallardo, Athena M.; ...

2017-02-07

Sequential extraction is a useful technique for assessing the potential to leach actinides from soils; however, current literature lacks uniformity in experimental details, making direct comparison of results impossible. This work continued development toward a standardized five-step sequential extraction protocol by analyzing extraction behaviors of 232Th, 238U, 239,240Pu and 241Am from lake and ocean sediment reference materials. Results produced a standardized procedure after creating more defined reaction conditions to improve method repeatability. A NaOH fusion procedure is recommended following sequential leaching for the complete dissolution of insoluble species.

Procedures for determining MATMOD-4V material constants

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

Lowe, T.C.

1993-11-01

The MATMOD-4V constitutive relations were developed from the original MATMOD model to extend the range of nonelastic deformation behaviors represented to include transient phenomena such as strain softening. Improvements in MATMOD-4V increased the number of independent material constants and the difficulty in determining their values. Though the constitutive relations are conceptually simple, their form and procedures for obtaining their constants can be complex. This paper reviews in detail the experiments, numerical procedures, and assumptions that have been used to determine a complete set of MATMOD-4V constants for high purity aluminum.

Fusion Imaging for Procedural Guidance.

PubMed

Wiley, Brandon M; Eleid, Mackram F; Thaden, Jeremy J

2018-05-01

The field of percutaneous structural heart interventions has grown tremendously in recent years. This growth has fueled the development of new imaging protocols and technologies in parallel to help facilitate these minimally-invasive procedures. Fusion imaging is an exciting new technology that combines the strength of 2 imaging modalities and has the potential to improve procedural planning and the safety of many commonly performed transcatheter procedures. In this review we discuss the basic concepts of fusion imaging along with the relative strengths and weaknesses of static vs dynamic fusion imaging modalities. This review will focus primarily on echocardiographic-fluoroscopic fusion imaging and its application in commonly performed transcatheter structural heart procedures. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Germ tube and chlamydospore formation by Candida albicans on a new medium.

PubMed Central

Beheshti, F; Smith, A G; Krause, G W

1975-01-01

A new medium composed of "cream of rice" infusion, oxgall, Tween 80, and agar is described for the sequential development of germ tubes and chlamydospores by Candida albicans. The procedure used (Dalmau's technique) is an improvement over the fluid substrate procedures previously advocated for germ tube formation. That the same preparation is then used for chlamydospore production is of practical importance for the clinical mycology laboratory. Images PMID:1102561

Surface grid generation for complex three-dimensional geometries

NASA Technical Reports Server (NTRS)

Luh, Raymond Ching-Chung

1988-01-01

An outline is presented for the creation of surface grids from primitive geometry data such as obtained from CAD/CAM systems. The general procedure is applicable to any geometry including full aircraft with wing, nacelle, and empennage. When developed in an interactive graphics environment, a code based on this procedure is expected to substantially improve the turn around time for generating surface grids on complex geometries. Results are shown for a general hypersonic airplane geometry.

Surface grid generation for complex three-dimensional geometries

NASA Technical Reports Server (NTRS)

Luh, Raymond Ching-Chung

1988-01-01

An outline is presented for the creation of surface grids from primitive geometry data such as obtained from CAD/CAM systems. The general procedure is applicable to any geometry including full aircraft with wing, nacelle, and empennage. When developed in an interactive graphics environment, a code base on this procedure is expected to substantially improve the turn around time for generating surface grids on complex geometries. Results are shown for a general hypersonic airplane geometry.

Very High Performance High Nitrogen Energetic Ingredients and Energetic Polymers for Structural Components

DTIC Science & Technology

2011-12-31

have developed a vastly improved procedure for synthesis of the n- propyl ester that gives essentially quantitative yield and uses concentrated... Synthesis of n- propyl 4-aminofurazan-3-carboxylate. We next turned our attention to the synthesis of the amide. Again, the literature procedure is... synthesis and chemistry of 3-hydroxymethyl-4-amino[1,2,5]oxadiazole and 5) work on energetic polymers for structural components. 15. SUBJECT TERMS

Computer based interpretation of infrared spectra-structure of the knowledge-base, automatic rule generation and interpretation

NASA Astrophysics Data System (ADS)

Ehrentreich, F.; Dietze, U.; Meyer, U.; Abbas, S.; Schulz, H.

1995-04-01

It is a main task within the SpecInfo-Project to develop interpretation tools that can handle a great deal more of the complicated, more specific spectrum-structure-correlations. In the first step the empirical knowledge about the assignment of structural groups and their characteristic IR-bands has been collected from literature and represented in a computer readable well-structured form. Vague, verbal rules are managed by introduction of linguistic variables. The next step was the development of automatic rule generating procedures. We had combined and enlarged the IDIOTS algorithm with the algorithm by Blaffert relying on set theory. The procedures were successfully applied to the SpecInfo database. The realization of the preceding items is a prerequisite for the improvement of the computerized structure elucidation procedure.

USDA/federal user of LANDSAT remote sensing

NASA Technical Reports Server (NTRS)

Allen, R.

1981-01-01

Developed and potential uses of remote sensing in crop condition and acreage assessment, renewable resources inventories, conservation practices, and water and forest management applications are described. Operational approaches, the adaptation of procedures to needs, and the agency's concern about data continuity and cost are discussed as well as support for future technology development for enhanced sensing capability. The use of improved camera systems for soil mapping and conservation monitoring from space shuttle, and of aerospace radar to improve soil moisture monitoring are mentioned.

Assessing the detection, reporting and investigation of adverse events in clinical trial protocols implemented in Cameroon: a documentary review of clinical trial protocols.

PubMed

Ebile, Akoh Walter; Ateudjieu, Jerome; Yakum, Martin Ndinakie; Djuidje, Marceline Ngounoue; Watcho, Pierre

2015-09-29

International guidelines recommend ethical and scientific quality standards for managing and reporting adverse events occurring during clinical trials to competent research ethics committees and regulatory authorities. The purpose of this study was to determine whether clinical trial protocols in Cameroon are developed in line with national requirements and international guidelines as far as detecting, reporting and investigating of adverse events is concerned. It was a documentary review of all approved clinical trial protocols that were submitted at the Cameroon National Ethics Committee for evaluation from 1997 through 2012. Data were extracted using a preconceived and validated grid. Protocol review process targeted the title, abstract, objectives, methodology, resources, and the chapter on safety. In total, 106 (4.9 %) clinical trial protocols were identified from 2173 protocols seen in the archive and 104 (4.8 %) included for review. Seventy six (73.1 %) trials did not include the surveillance of adverse events as part of their objective. A total of 91 (87.5 %) protocols did not budget for adverse event surveillance, 76 (73.1 %) did not have a data safety management board (DSMB), 11(10.6 %) included insurance for participants, 47 (45.2 %) did not include a case definition for serious adverse events, 33 (31.7 %) described procedures to detect adverse events, 33 (31.7 %) described procedure for reporting and 22 (21.2 %) described procedure for investigating adverse events. Most clinical trial protocols in Cameroon are developed to focus on benefits and pay little attention to harms. The development of national guidelines can improve the surveillance of adverse events in clinical trial research conducted in Cameroon. Adverse events surveillance tools and a budget are critical for an adequate planning for adverse event surveillance when developing trial protocols. Clinical trial protocols submitted in the Cameroon National Ethics Committee do not adequately plan to assess adverse events in clinical trial protocols. In order to improve on the safety of participants and marketed drug, there is a need to develop national guidelines for clinical trials by the government, and to improve evaluation procedures and monitoring of ongoing trials by the ethics committee.

Achieving Consistent Doppler Measurements from SDO/HMI Vector Field Inversions

NASA Technical Reports Server (NTRS)

Schuck, Peter W.; Antiochos, S. K.; Leka, K. D.; Barnes, Graham

2016-01-01

NASA's Solar Dynamics Observatory is delivering vector magnetic field observations of the full solar disk with unprecedented temporal and spatial resolution; however, the satellite is in a highly inclined geosynchronous orbit. The relative spacecraft-Sun velocity varies by +/-3 kms-1 over a day, which introduces major orbital artifacts in the Helioseismic Magnetic Imager (HMI) data. We demonstrate that the orbital artifacts contaminate all spatial and temporal scales in the data. We describe a newly developed three-stage procedure for mitigating these artifacts in the Doppler data obtained from the Milne-Eddington inversions in the HMI pipeline. The procedure ultimately uses 32 velocity-dependent coefficients to adjust 10 million pixels-a remarkably sparse correction model given the complexity of the orbital artifacts. This procedure was applied to full-disk images of AR 11084 to produce consistent Dopplergrams. The data adjustments reduce the power in the orbital artifacts by 31 dB. Furthermore, we analyze in detail the corrected images and show that our procedure greatly improves the temporal and spectral properties of the data without adding any new artifacts. We conclude that this new procedure makes a dramatic improvement in the consistency of the HMI data and in its usefulness for precision scientific studies.

Promoting North-South partnership in space data use and applications: Case study - East African countries space programs/projects new- concepts in document management

NASA Astrophysics Data System (ADS)

Mlimandago, S.

This research paper have gone out with very simple and easy (several) new concepts in document management for space projects and programs which can be applied anywhere both in the developing and developed countries. These several new concepts are and have been applied in Tanzania, Kenya and Uganda and found out to bear very good results using simple procedures. The intergral project based its documentation management approach from the outset on electronic document sharing and archiving. The main objective of having new concepts was to provide a faster and wider availability of the most current space information to all parties rather than creating a paperless office. Implementation of the new concepts approach required the capturing of documents in an appropriate and simple electronic format at source establishing new procedures for project wide information sharing and the deployment of a new generation of simple procedure - WEB - based tools. Key success factors were the early adoption of Internet technologies and simple procedures for improved information flow new concepts which can be applied anywhere both in the developed and the developing countries.

45 CFR 2524.10 - For what purposes will technical assistance and training funds be made available?

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Promote leadership development in such programs; (3) Improve the instructional and programmatic quality of such programs to build an ethic of civic responsibility; (4) Develop the management and budgetary... programs; (6) Encourage AmeriCorps programs to adhere to risk management procedures, including the training...

The Potential of Environmental Sensors for Improving the Mobility Performance of Mainstream Blind Students. Final Report.

ERIC Educational Resources Information Center

Weisgerber, Robert A.; deHaas, Carla

The report describes an effort to develop and test instructional materials, techniques and procedures - ESSETS (environmental sensing, selection, evaluation and training system) - for teaching functionally blind young adults to use electronic travel aids (ETAs). Considered are development of training guidelines, field site selection and instructor…

An investigation of the compressive strength of PRD-49-3/Epoxy composites

NASA Technical Reports Server (NTRS)

Kulkarni, S. V.; Rice, J. S.; Rosen, B. W.

1973-01-01

The development of unidirectional fiber composite materials is discussed. The mechanical and physical properties of the materials are described. Emphasis is placed in analyzing the compressive behavior of composite materials and developing methods for increasing compressive strength. The test program for evaluating the various procedures for improving compressive strength are reported.

Recent Developments in Australian Gold Extraction.

ERIC Educational Resources Information Center

Thiele, Rodney B.

1995-01-01

Describes new technologies that have greatly improved the extraction efficiency of gold ore, including: altering plant layout to promote efficiency, engaging Filiblast forced oxidation and bioxidation systems, and updating the electrowinning procedure at the gold recovery stage. (JRH)

Development of safety performance monitoring procedures.

DOT National Transportation Integrated Search

2010-02-01

Highway safety is an ongoing concern to the Texas Department of Transportation (TxDOT). As part of its : proactive commitment to improving highway safety, TxDOT is moving toward including quantitative safety : analyses earlier in the project developm...

Development of alternative data analysis techniques for improving the accuracy and specificity of natural resource inventories made with digital remote sensing data

NASA Technical Reports Server (NTRS)

Lillesand, T. M.; Meisner, D. E. (Principal Investigator)

1980-01-01

An investigation was conducted into ways to improve the involvement of state and local user personnel in the digital image analysis process by isolating those elements of the analysis process which require extensive involvement by field personnel and providing means for performing those activities apart from a computer facility. In this way, the analysis procedure can be converted from a centralized activity focused on a computer facility to a distributed activity in which users can interact with the data at the field office level or in the field itself. A general image processing software was developed on the University of Minnesota computer system (Control Data Cyber models 172 and 74). The use of color hardcopy image data as a primary medium in supervised training procedures was investigated and digital display equipment and a coordinate digitizer were procured.

Federal Aviation Administration aging aircraft nondestructive inspection research plan

NASA Technical Reports Server (NTRS)

Seher, Chris C.

1992-01-01

This paper highlights the accomplishments and plans of the Federal Aviation Administration (FAA) for the development of improved nondestructive evaluation (NDE) equipment, procedures, and training. The role of NDE in aircraft safety and the need for improvement are discussed. The FAA program participants, and coordination of activities within the program and with relevant organizations outside the program are also described.

Use of the Job Model Concept to Guide Job Description Procedures for Army Officers.

ERIC Educational Resources Information Center

Whitmore, Paul G.

The objective of Work Unit SKYGUARD has been to facilitate the development of an improved Air Defense Officers Advanced Course (C-22) by the U.S. Army Air Defense School. Focus is on techniques for improving the completeness and relevance of the instructional objectives with respect to future job requirements. The job description procedures…

Curriculum Development Based On INQF and Business/Industries Sector for Improvement Competency of Basic Pattern Making Students at Vocational High School

NASA Astrophysics Data System (ADS)

Nilasari, Yoni; Dasining

2018-04-01

In this era of globalization, every human resource is faced with a competitive climate that will have a major impact on the development of the business and industrial sector. Therefore it is deemed necessary to research the development of curriculum based on INQF and the business/industries sector in order to improve the competence of Sewing Technique for Vocational High School Students of fashion clothing program. The development of curricula based on INQF and the business/industries is an activity to produce a curriculum that suits the needs of the business and industries sector. The formulation of the problem in this research are: (1) what is the curriculum based on INQF and the business/industries sector?; (2) how is the process and procedure of curriculum development of fashion program profession based on INQF and the business/industries sector?; And (3) how the result of the curriculum of fashion expertise based on INQF and the business/industries sector. The aims of research are: (1) explain what is meant by curriculum based on INQF and business/industries sector; (2) to know the process and procedure of curriculum development of fashion program profession based on INQF and the business/industries sectors ; And (3) to know result the curriculum of clothing expertise based on INQF and the business/industries sector. The research method chosen in developing curriculum based on INQFand business/industry sector is using by 4-D model from Thiagarajan, which includes: (1) define; (2) design; (3) development; And (4) disseminate. Step 4, not done but in this study. The result of the research shows that: (1) the curriculum based on INQF and the business/industries sector is the curriculum created by applying the principles and procedures of the Indonesian National Qualification Framework (INQF) that will improve the quality of graduates of Vocational High School level 2, and establish cooperation with Business/industries as a guest teacher (counselor) in the learning process; (2) process and procedure of curriculum development of fashion program profession based on INQF and business/industries sector is process and procedure of curriculum development of fashion program profession based on INQF and business/industries sector there are several stages: feasibility study and requirement, preparation of initial concept of curriculum planning based on INQF and the business/industries sector in the field of fashion, as well as the development of a plan to implement the curriculum based on INQF and the business/industries sector in the field of fashion, this development will produce a curriculum of fashion proficiency program in the form of learning competency of sewing technology where the implementer of learning (counselor) Is a guest teacher from business/industries sector. (3) the learning device validity aspect earns an average score of 3.5 with very valid criteria and the practicality aspect of the device obtains an average score of 3.3 with practical criteria.

Improving oversight of the graduate medical education enterprise: one institution's strategies and tools.

PubMed

Afrin, Lawrence B; Arana, George W; Medio, Franklin J; Ybarra, Angela F N; Clarke, Harry S

2006-05-01

Accreditation organizations, financial stakeholders, legal systems, and regulatory agencies have increased the need for accountability in educational processes and curricular outcomes of graduate medical education. This demand for greater programmatic monitoring has placed pressure on institutions with graduate medical education (GME) programs to develop greater oversight of these programs. Meeting these challenges requires development of new GME management strategies and tools for institutional GME administrators to scrutinize programs, while still allowing these programs the autonomy to develop and implement educational methods to meet their unique training needs. At the Medical University of South Carolina (MUSC), senior administrators in the college of medicine felt electronic information management was a critical strategy for success and thus proceeded to carefully select an electronic residency management system (ERMS) to provide functionality for both individual programs and the GME enterprise as a whole. Initial plans in 2002 for a phased deployment had to be changed to a much more rapid deployment due to regulatory issues. Extensive communication and cooperation among MUSC's GME leaders resulted in a successful deployment in 2003. Evaluation completion rates have substantially improved, duty hours are carefully monitored, patient safety has improved through more careful oversight of residents' procedural privileges, regulators have been pleased, and central GME administrative visibility of program performance has dramatically improved. The system is now being expanded to MUSC's medical school and other health professions colleges. The authors discuss lessons learned and opportunities and challenges ahead, which include improving tracking of development of procedural competency, establishing and monitoring program performance standards, and integrating the ERMS with GME reimbursement systems.

Improving Performance During Image-Guided Procedures

PubMed Central

Duncan, James R.; Tabriz, David

2015-01-01

Objective Image-guided procedures have become a mainstay of modern health care. This article reviews how human operators process imaging data and use it to plan procedures and make intraprocedural decisions. Methods A series of models from human factors research, communication theory, and organizational learning were applied to the human-machine interface that occupies the center stage during image-guided procedures. Results Together, these models suggest several opportunities for improving performance as follows: 1. Performance will depend not only on the operator’s skill but also on the knowledge embedded in the imaging technology, available tools, and existing protocols. 2. Voluntary movements consist of planning and execution phases. Performance subscores should be developed that assess quality and efficiency during each phase. For procedures involving ionizing radiation (fluoroscopy and computed tomography), radiation metrics can be used to assess performance. 3. At a basic level, these procedures consist of advancing a tool to a specific location within a patient and using the tool. Paradigms from mapping and navigation should be applied to image-guided procedures. 4. Recording the content of the imaging system allows one to reconstruct the stimulus/response cycles that occur during image-guided procedures. Conclusions When compared with traditional “open” procedures, the technology used during image-guided procedures places an imaging system and long thin tools between the operator and the patient. Taking a step back and reexamining how information flows through an imaging system and how actions are conveyed through human-machine interfaces suggest that much can be learned from studying system failures. In the same way that flight data recorders revolutionized accident investigations in aviation, much could be learned from recording video data during image-guided procedures. PMID:24921628

Procedural virtual reality simulation in minimally invasive surgery.

PubMed

Våpenstad, Cecilie; Buzink, Sonja N

2013-02-01

Simulation of procedural tasks has the potential to bridge the gap between basic skills training outside the operating room (OR) and performance of complex surgical tasks in the OR. This paper provides an overview of procedural virtual reality (VR) simulation currently available on the market and presented in scientific literature for laparoscopy (LS), flexible gastrointestinal endoscopy (FGE), and endovascular surgery (EVS). An online survey was sent to companies and research groups selling or developing procedural VR simulators, and a systematic search was done for scientific publications presenting or applying VR simulators to train or assess procedural skills in the PUBMED and SCOPUS databases. The results of five simulator companies were included in the survey. In the literature review, 116 articles were analyzed (45 on LS, 43 on FGE, 28 on EVS), presenting a total of 23 simulator systems. The companies stated to altogether offer 78 procedural tasks (33 for LS, 12 for FGE, 33 for EVS), of which 17 also were found in the literature review. Although study type and used outcomes vary between the three different fields, approximately 90 % of the studies presented in the retrieved publications for LS found convincing evidence to confirm the validity or added value of procedural VR simulation. This was the case in approximately 75 % for FGE and EVS. Procedural training using VR simulators has been found to improve clinical performance. There is nevertheless a large amount of simulated procedural tasks that have not been validated. Future research should focus on the optimal use of procedural simulators in the most effective training setups and further investigate the benefits of procedural VR simulation to improve clinical outcome.

Donor and procurement related issues in vascularized composite allograft transplantation.

PubMed

McDiarmid, Sue V

2013-12-01

To understand the unique requirements of vascularized composite allograft (VCA) donation and procurement practices and the integral role of the established nationwide organ procurement organizations in organ procurement. The recent issuance of a Final Rule (July 2013) by the United States Secretary of Health that redefines VCAs as organs rather than tissues, opens up the potential to formalize policies and procedures, under the auspices of the Organ Procurement and Transplantation Network, that can improve VCA donation, procurement practices, develop allocation algorithms and provide transparent oversight. Improved VCA donation rates, procurement procedures and broader sharing nationwide of VCA donors will have important implications in advancing the emerging field of VCA transplantation.

Integration of a Low-Cost Introductory Ultrasound Curriculum Into Existing Procedural Skills Education for Preclinical Medical Students.

PubMed

Maloney, Lauren; Zach, Kristen; Page, Christopher; Tewari, Neera; Tito, Matthew; Seidman, Peggy

2017-02-01

We evaluated integration of an introductory ultrasound curriculum into our existing mandatory procedural skills program for preclinical medical students. Phantoms consisting of olives, pimento olives, and grapes embedded in opaque gelatin were developed. Four classes encouraged progressive refinement of phantom-scanning and object identification skills. Students improved their ability to identify hidden objects, although each object type achieved a statistically significant improvement in correct identification at different time points. The total phantom cost per student was $0.76. Our results suggest that short repeated experiences scanning simple, low-cost ultrasound phantoms confer basic ultrasound skills. © 2016 by the American Institute of Ultrasound in Medicine.

Quality improvement in neonatal care - a new paradigm for developing countries.

PubMed

Chawla, Deepak; Suresh, Gautham K

2014-12-01

Infrastructure for facility-based neonatal care has rapidly grown in India over last few years. Experience from developed countries indicates that different health facilities have varying clinical outcomes despite accounting for differences in illness severity of admitted neonates and random variation. Variation in quality of care provided at different neonatal units may account for variable clinical outcomes. Monitoring quality of care, comparing outcomes across different centers and conducting collaborative quality improvement projects can improve outcome of neonates in health facilities. Top priority should be given to establishing quality monitoring and improvement procedures at special care neonatal units and neonatal intensive care units of the country. This article presents an overview of methods of quality improvement. Literature reports of successful collaborative quality improvement projects in neonatal health are also reviewed.

Neurodevelopmental Outcome and Health-related Quality of Life in Children With Single-ventricle Heart Disease Before Fontan Procedure.

PubMed

Reich, Bettina; Heye, Kristina; Tuura, Ruth; Beck, Ingrid; Wetterling, Kristina; Hahn, Andreas; Hofmann, Karoline; Schranz, Dietmar; Akintürk, Hakan; Latal, Beatrice; Knirsch, Walter

2017-12-05

Neurodevelopmental impairment and impaired quality of life constitute a major source of morbidity among children with complex congenital heart disease, in particular for single-ventricle (SV) morphologies. Risk factors and quality of life determining clinical and neurodevelopmental outcome at 2 years of age are examined. In a 2-center cohort study, 48 patients with SV morphology (26 hypoplastic left heart syndrome and 22 other types of univentricular heart defect) have been examined before Fontan procedure between 2010 and 2015. Patients were assessed with the Bayley Scales of Infant and Toddler Development, Third Version (Bayley-III), and the Preschool Children Quality of Life (TAPQOL) questionnaire. A total of 44 patients underwent hybrid procedure (n = 25), Norwood procedure (n = 7), or shunt or banding procedure (n = 12) as first surgery before subsequent bidirectional cavopulmonary anastomosis (n = 48). Median cognitive, language, and motor composite scores on the Bayley-III were 100 (range 65-120), 97 (68-124), and 97 (55-124), respectively. The language composite score was significantly below the norm (P = 0.025). Risk factors for poorer neurodevelopmental outcome were prolonged mechanical ventilation, longer days of hospital stay, and more reinterventions (all P < 0.05). Parents reported a good quality of life for their children. Children undergoing Fontan procedure show a favorable development and good quality of life. More complicated postoperative course and reinterventions constitute risk factors for impaired neurodevelopment. Improving postoperative management and implementing routine follow-up assessments aremeasures to further improve the neurodevelopmental outcome of this high-risk patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

A vertical-energy-thresholding procedure for data reduction with multiple complex curves.

PubMed

Jung, Uk; Jeong, Myong K; Lu, Jye-Chyi

2006-10-01

Due to the development of sensing and computer technology, measurements of many process variables are available in current manufacturing processes. It is very challenging, however, to process a large amount of information in a limited time in order to make decisions about the health of the processes and products. This paper develops a "preprocessing" procedure for multiple sets of complicated functional data in order to reduce the data size for supporting timely decision analyses. The data type studied has been used for fault detection, root-cause analysis, and quality improvement in such engineering applications as automobile and semiconductor manufacturing and nanomachining processes. The proposed vertical-energy-thresholding (VET) procedure balances the reconstruction error against data-reduction efficiency so that it is effective in capturing key patterns in the multiple data signals. The selected wavelet coefficients are treated as the "reduced-size" data in subsequent analyses for decision making. This enhances the ability of the existing statistical and machine-learning procedures to handle high-dimensional functional data. A few real-life examples demonstrate the effectiveness of our proposed procedure compared to several ad hoc techniques extended from single-curve-based data modeling and denoising procedures.

Biobanking of different body fluids within the frame of IVF-a standard operating procedure to improve reproductive biology research.

PubMed

Schenk, Michael; Huppertz, Berthold; Obermayer-Pietsch, Barbara; Kastelic, Darja; Hörmann-Kröpfl, Martina; Weiss, Gregor

2017-02-01

The aim of the present study was to develop a standard operating procedure (SOP) for the collection, transport, and storage of human cumulus cells, follicular fluid, blood serum, seminal plasma, embryo culture supernatant, and embryo culture supernatant control obtained within the IVF process under approved protocols and written informed consent from participating patients. The SOP was developed at the Kinderwunsch Institut Schenk, Dobl, Austria, together with Biobank Graz of the Medical University of Graz, Austria. The SOP provides comprehensive details of laboratory procedures and sampling of the different fluids within the IVF process. Furthermore, information on sample coding, references of involved laboratory techniques (e.g., oocyte retrieval with a Steiner-TAN needle), ethical approvals, and biobanking procedures are presented. The result of the present study is a standard operating procedure. The SOP ensures a professional way for collection and scientific use of IVF samples by the Kinderwunsch Institut Schenk, Dobl, Austria, and Biobank Graz of the Medical University of Graz, Austria. It can be used as a template for other institutions to unify specimen collection procedures in the field of reproductive health research.

Modelling of wildlife migrations and its economic impacts

NASA Astrophysics Data System (ADS)

Myšková, Kateřina; Žák, Jaroslav

2013-10-01

Natural wildlife migrations are often disrupted by the construction of line structures, especially freeways. Various overpasses and underpasses (migration objects) are being designed to enable species to pass through line structures. The newly developed original procedure for the quantification of the utility of migration objects (migration potentials) and sections of line structures retrieves the deficiencies of the previous ones. The procedure has been developed under bulk information obtained by monitoring migrations using camera system and spy games. The log-normal distribution functions are used. The procedure for the evaluation of the probability of the permeability of the line structures sectors is also presented. The above mentioned procedures and algorithms can be used while planning, preparing, constructing or verifying the measures to assure the permeability of line structures for selected feral species. Using the procedures can significantly reduce financial costs and improve the permeability. When the migration potentials are correctly determined and the whole sector is taken into account for the migrations, some originally designed objects may be found to be redundant and not building them will bring financial savings.

Linking Six Sigma to simulation: a new roadmap to improve the quality of patient care.

PubMed

Celano, Giovanni; Costa, Antonio; Fichera, Sergio; Tringali, Giuseppe

2012-01-01

Improving the quality of patient care is a challenge that calls for a multidisciplinary approach, embedding a broad spectrum of knowledge and involving healthcare professionals from diverse backgrounds. The purpose of this paper is to present an innovative approach that implements discrete-event simulation (DES) as a decision-supporting tool in the management of Six Sigma quality improvement projects. A roadmap is designed to assist quality practitioners and health care professionals in the design and successful implementation of simulation models within the define-measure-analyse-design-verify (DMADV) or define-measure-analyse-improve-control (DMAIC) Six Sigma procedures. A case regarding the reorganisation of the flow of emergency patients affected by vertigo symptoms was developed in a large town hospital as a preliminary test of the roadmap. The positive feedback from professionals carrying out the project looks promising and encourages further roadmap testing in other clinical settings. The roadmap is a structured procedure that people involved in quality improvement can implement to manage projects based on the analysis and comparison of alternative scenarios. The role of Six Sigma philosophy in improvement of the quality of healthcare services is recognised both by researchers and by quality practitioners; discrete-event simulation models are commonly used to improve the key performance measures of patient care delivery. The two approaches are seldom referenced and implemented together; however, they could be successfully integrated to carry out quality improvement programs. This paper proposes an innovative approach to bridge the gap and enrich the Six Sigma toolbox of quality improvement procedures with DES.

[Why is brachytherapy still essential in 2017?

PubMed

Haie-Méder, C; Maroun, P; Fumagalli, I; Lazarescu, I; Dumas, I; Martinetti, F; Chargari, C

2018-05-16

These recent years, brachytherapy has benefited from imaging modalities advances. A more systematic use of tomodensitometric, ultrasonographic and MRI images during brachytherapy procedures has allowed an improvement in target and organs at risk assessment as well as their relationship with the applicators. New concepts integrating tumor regression during treatment have been defined and have been clinically validated. New applicators have been developed and are commercially available. Optimization processes have been developed, integrating hypofractionation modalities leading to tumor control improvement. All these opportunities led to further development of brachytherapy, with indisputable ballistic advantages, especially compared to external irradiation. Copyright © 2018. Published by Elsevier SAS.

[A simplified occupational health and safety management system designed for small enterprises. Initial validation results].

PubMed

Bacchi, Romana; Veneri, L; Ghini, P; Caso, Maria Alessandra; Baldassarri, Giovanna; Renzetti, F; Santarelli, R

2009-01-01

Occupational Health and Safety Management Systems (OHSMS) are known to be effective in improving safety at work. Unfortunately they are often too resource-heavy for small businesses. The aim of this project was to develop and test a simplified model of OHSMS suitable for small enterprises. The model consists of 7 procedures and various operating forms and check lists, that guide the enterprise in managing safety at work. The model was tested in 15 volunteer enterprises. In most of the enterprises two audits showed increased awareness and participation of workers; better definition and formalisation of respon sibilities in 8 firms; election of Union Safety Representatives in over one quarter of the enterprises; improvement of safety equipment. The study also helped identify areas where the model could be improved by simplification of unnecessarily complex and redundant procedures.

On the generalized VIP time integral methodology for transient thermal problems

NASA Technical Reports Server (NTRS)

Mei, Youping; Chen, Xiaoqin; Tamma, Kumar K.; Sha, Desong

1993-01-01

The paper describes the development and applicability of a generalized VIrtual-Pulse (VIP) time integral method of computation for thermal problems. Unlike past approaches for general heat transfer computations, and with the advent of high speed computing technology and the importance of parallel computations for efficient use of computing environments, a major motivation via the developments described in this paper is the need for developing explicit computational procedures with improved accuracy and stability characteristics. As a consequence, a new and effective VIP methodology is described which inherits these improved characteristics. Numerical illustrative examples are provided to demonstrate the developments and validate the results obtained for thermal problems.

Strategies and Procedures in Developing and Implementing Curriculum. Report of a Sub-Regional Training Workshop on Curriculum Development (Seoul, August 1-30, 1977).

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Bangkok (Thailand).

Nine representatives of Thailand, Nepal, Iran, and the Republic of Korea met in Seoul during the month of August, 1977, for a curriculum development training workshop co-sponsored by the Korean National Commission for UNESCO and the Asian Centre of Educational Innovation for Development (ACEID). One aim of the workshop was to improve the…

Pain Palliation by Percutaneous Acetabular Osteoplasty for Metastatic Hepatocellular Carcinoma

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

Hokotate, Hirofumi; Baba, Yasutaka; Churei, Hisahiko

2001-09-15

A 68-year-old man with hepatocellular carcinoma and known skeletal metastasis developed right hip pain and gait disturbance due to an osteolytic metastasis in the right acetabulum. This was treated initially with chemoembolization and radiation therapy. When these procedures proved unsuccessful percutaneous injection of acrylic bone cement into the acetabulum was undertaken. Immediately after this procedure, he obtained sufficient pain relief and improved walking ability, which continued for 3 months until he died of hepatic insufficiency.

POWER-ENHANCED MULTIPLE DECISION FUNCTIONS CONTROLLING FAMILY-WISE ERROR AND FALSE DISCOVERY RATES.

PubMed

Peña, Edsel A; Habiger, Joshua D; Wu, Wensong

2011-02-01

Improved procedures, in terms of smaller missed discovery rates (MDR), for performing multiple hypotheses testing with weak and strong control of the family-wise error rate (FWER) or the false discovery rate (FDR) are developed and studied. The improvement over existing procedures such as the Šidák procedure for FWER control and the Benjamini-Hochberg (BH) procedure for FDR control is achieved by exploiting possible differences in the powers of the individual tests. Results signal the need to take into account the powers of the individual tests and to have multiple hypotheses decision functions which are not limited to simply using the individual p -values, as is the case, for example, with the Šidák, Bonferroni, or BH procedures. They also enhance understanding of the role of the powers of individual tests, or more precisely the receiver operating characteristic (ROC) functions of decision processes, in the search for better multiple hypotheses testing procedures. A decision-theoretic framework is utilized, and through auxiliary randomizers the procedures could be used with discrete or mixed-type data or with rank-based nonparametric tests. This is in contrast to existing p -value based procedures whose theoretical validity is contingent on each of these p -value statistics being stochastically equal to or greater than a standard uniform variable under the null hypothesis. Proposed procedures are relevant in the analysis of high-dimensional "large M , small n " data sets arising in the natural, physical, medical, economic and social sciences, whose generation and creation is accelerated by advances in high-throughput technology, notably, but not limited to, microarray technology.

Flexible robotic catheters in the visceral segment of the aorta: advantages and limitations.

PubMed

Li, Mimi M; Hamady, Mohamad S; Bicknell, Colin D; Riga, Celia V

2018-06-01

Flexible robotic catheters are an emerging technology which provide an elegant solution to the challenges of conventional endovascular intervention. Originally developed for interventional cardiology and electrophysiology procedures, remotely steerable robotic catheters such as the Magellan system enable greater precision and enhanced stability during target vessel navigation. These technical advantages facilitate improved treatment of disease in the arterial tree, as well as allowing execution of otherwise unfeasible procedures. Occupational radiation exposure is an emerging concern with the use of increasingly complex endovascular interventions. The robotic systems offer an added benefit of radiation reduction, as the operator is seated away from the radiation source during manipulation of the catheter. Pre-clinical studies have demonstrated reduction in force and frequency of vessel wall contact, resulting in reduced tissue trauma, as well as improved procedural times. Both safety and feasibility have been demonstrated in early clinical reports, with the first robot-assisted fenestrated endovascular aortic repair in 2013. Following from this, the Magellan system has been used to successfully undertake a variety of complex aortic procedures, including fenestrated/branched endovascular aortic repair, embolization, and angioplasty.

Alternative methods for the median lethal dose (LD(50)) test: the up-and-down procedure for acute oral toxicity.

PubMed

Rispin, Amy; Farrar, David; Margosches, Elizabeth; Gupta, Kailash; Stitzel, Katherine; Carr, Gregory; Greene, Michael; Meyer, William; McCall, Deborah

2002-01-01

The authors have developed an improved version of the up-and-down procedure (UDP) as one of the replacements for the traditional acute oral toxicity test formerly used by the Organisation for Economic Co-operation and Development member nations to characterize industrial chemicals, pesticides, and their mixtures. This method improves the performance of acute testing for applications that use the median lethal dose (classic LD50) test while achieving significant reductions in animal use. It uses sequential dosing, together with sophisticated computer-assisted computational methods during the execution and calculation phases of the test. Staircase design, a form of sequential test design, can be applied to acute toxicity testing with its binary experimental endpoints (yes/no outcomes). The improved UDP provides a point estimate of the LD50 and approximate confidence intervals in addition to observed toxic signs for the substance tested. It does not provide information about the dose-response curve. Computer simulation was used to test performance of the UDP without the need for additional laboratory validation.

Broadcast control of air traffic

NASA Technical Reports Server (NTRS)

Litchford, G. B.

1972-01-01

Applications of wide range broadcast procedures to improve air traffic control and make more airspace available are discussed. A combination of the Omega navigation system and the very high frequency omnirange (VOR) is recommended as a means for accomplishing improved air traffic control. The benefits to be derived by commercial and general aviation are described. The air/ground communications aspects of the improved air traffic control system are explained. Research and development programs for implementing the broadcast concept are recommended.

Is percutaneous nephrolithotomy in solitary kidneys safe?

PubMed

Wong, Kathie Alexina; Sahai, Arun; Patel, Amit; Thomas, Kay; Bultitude, Matthew; Glass, Jonathan

2013-11-01

To review our experience from a high volume stone center with a focus on efficacy, safety, and renal function. Stones requiring percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys can pose significant anxiety to the urologist. Limited data are available in published reports in this setting. A comprehensive retrospective review of medical records was performed on patients who underwent PCNL and had a solitary kidney or a single functioning renal unit. Data were collected on patient demographics, stone burden, outcomes, complications, and renal function. Of 378 PCNLs performed between January 2003 and September 2011, 22 were performed in 17 patients with a single functioning kidney. Three procedures were performed in a transplanted kidney. In those with solitary calculus, the longest mean length and stone surface area were 37 mm and 825 mm(2), respectively. Stone-free rate was 59%. Auxiliary procedures were required in 6 cases, resulting in a stone-free rate of 77%. Median inpatient stay was 4 days. Serum creatinine values improved from 144 to 126 umol/L before and after the procedure and mean estimated glomerular filtration rate improved similarly from 51 to 59 mls/minute, respectively. Blood transfusion was required in 1 patient, sepsis developed in 3, and 2 patients required a stent for obstruction. PCNL in solitary kidneys is safe with an acceptable complication rate if performed in a high volume center. Outcomes are good, although auxiliary procedures may be necessary. Renal function remains stable or improves after procedure. Copyright © 2013 Elsevier Inc. All rights reserved.

[Endovascular treatment in acute ischaemic stroke. A stroke care plan for the region of Madrid].

PubMed

Alonso de Leciñana, M; Díaz-Guzmán, J; Egido, J A; García Pastor, A; Martínez-Sánchez, P; Vivancos, J; Díez-Tejedor, E

2013-09-01

Endovascular therapies (intra-arterial thrombolysis and mechanical thrombectomy) after acute ischaemic stroke are being implemented in the clinical setting even as they are still being researched. Since we lack sufficient data to establish accurate evidence-based recommendations for use of these treatments, we must develop clinical protocols based on current knowledge and carefully monitor all procedures. After review of the literature and holding work sessions to reach a consensus among experts, we developed a clinical protocol including indications and contraindications for endovascular therapies use in acute ischaemic stroke. The protocol includes methodology recommendations for diagnosing and selecting patients, performing revascularisation procedures, and for subsequent patient management. Its objective is to increase the likelihood of efficacy and treatment benefit and minimise risk of complications and ineffective recanalisation. Based on an analysis of healthcare needs and available resources, a cooperative inter-hospital care system has been developed. This helps to ensure availability of endovascular therapies to all patients, a fast response time, and a good cost-to-efficacy ratio. It includes also a prospective register which serves to monitor procedures in order to identify any opportunities for improvement. Implementation of endovascular techniques for treating acute ischaemic stroke requires the elaboration of evidence-based clinical protocols and the establishment of appropriate cooperative healthcare networks guaranteeing both the availability and the quality of these actions. Such procedures must be monitored in order to improve methodology. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

Development and Pilot Testing of a Video-Assisted Informed Consent Process

PubMed Central

Sonne, Susan C.; Andrews, Jeannette O.; Gentilin, Stephanie M.; Oppenheimer, Stephanie; Obeid, Jihad; Brady, Kathleen; Wolf, Sharon; Davis, Randal; Magruder, Kathryn

2013-01-01

The informed consent process for research has come under scrutiny, as consent documents are increasingly long and difficult to understand. Innovations are needed to improve comprehension in order to make the consent process truly informed. We report on the development and pilot testing of video clips that could be used during the consent process to better explain research procedures to potential participants. Based on input from researchers and community partners, 15 videos of common research procedures/concepts were produced. The utility of the videos was then tested by embedding them in mock informed consent documents that were presented via an online electronic consent system designed for delivery via iPad. Three mock consents were developed, each containing five videos. All participants (n=61) read both a paper version and the video-assisted iPad version of the same mock consent and were randomized to which format they reviewed first. Participants were given a competency quiz that posed specific questions about the information in the consent after reviewing the first consent document to which they were exposed. Most participants (78.7%) preferred the video-assisted format compared to paper (12.9%). Nearly all (96.7%) reported that the videos improved their understanding of the procedures described in the consent document; however, comprehension of material did not significantly differ by consent format. Results suggest videos may be helpful in providing participants with information about study procedures in a way that is easy to understand. Additional testing of video consents for complex protocols and with subjects of lower literacy is warranted. PMID:23747986

Development and pilot testing of a video-assisted informed consent process.

PubMed

Sonne, Susan C; Andrews, Jeannette O; Gentilin, Stephanie M; Oppenheimer, Stephanie; Obeid, Jihad; Brady, Kathleen; Wolf, Sharon; Davis, Randal; Magruder, Kathryn

2013-09-01

The informed consent process for research has come under scrutiny, as consent documents are increasingly long and difficult to understand. Innovations are needed to improve comprehension in order to make the consent process truly informed. We report on the development and pilot testing of video clips that could be used during the consent process to better explain research procedures to potential participants. Based on input from researchers and community partners, 15 videos of common research procedures/concepts were produced. The utility of the videos was then tested by embedding them in mock-informed consent documents that were presented via an online electronic consent system designed for delivery via iPad. Three mock consents were developed, each containing five videos. All participants (n = 61) read both a paper version and the video-assisted iPad version of the same mock consent and were randomized to which format they reviewed first. Participants were given a competency quiz that posed specific questions about the information in the consent after reviewing the first consent document to which they were exposed. Most participants (78.7%) preferred the video-assisted format compared to paper (12.9%). Nearly all (96.7%) reported that the videos improved their understanding of the procedures described in the consent document; however, the comprehension of material did not significantly differ by consent format. Results suggest videos may be helpful in providing participants with information about study procedures in a way that is easy to understand. Additional testing of video consents for complex protocols and with subjects of lower literacy is warranted. Copyright © 2013 Elsevier Inc. All rights reserved.

Evaluation of the ROSA™ Spine robot for minimally invasive surgical procedures.

PubMed

Lefranc, M; Peltier, J

2016-10-01

The ROSA® robot (Medtech, Montpellier, France) is a new medical device designed to assist the surgeon during minimally invasive spine procedures. The device comprises a patient-side cart (bearing the robotic arm and a workstation) and an optical navigation camera. The ROSA® Spine robot enables accurate pedicle screw placement. Thanks to its robotic arm and navigation abilities, the robot monitors movements of the spine throughout the entire surgical procedure and thus enables accurate, safe arthrodesis for the treatment of degenerative lumbar disc diseases, exactly as planned by the surgeon. Development perspectives include (i) assistance at all levels of the spine, (ii) improved planning abilities (virtualization of the entire surgical procedure) and (iii) use for almost any percutaneous spinal procedures not limited in screw positioning such as percutaneous endoscopic lumbar discectomy, intracorporeal implant positioning, over te top laminectomy or radiofrequency ablation.

Curtailing Perovskite Processing Limitations via Lamination at the Perovskite/Perovskite Interface

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

Van Hest, Marinus F; Moore, David; Klein, Talysa

Standard layer-by-layer solution processing methods constrain lead-halide perovskite device architectures. The layer below the perovskite must be robust to the strong organic solvents used to form the perovskite while the layer above has a limited thermal budget and must be processed in nonpolar solvents to prevent perovskite degradation. To circumvent these limitations, we developed a procedure where two transparent conductive oxide/transport material/perovskite half stacks are independently fabricated and then laminated together at the perovskite/perovskite interface. Using ultraviolet-visible absorption spectroscopy, external quantum efficiency, X-ray diffraction, and time-resolved photoluminesence spectroscopy, we show that this procedure improves photovoltaic properties of the perovskite layer.more » Applying this procedure, semitransparent devices employing two high-temperature oxide transport layers were fabricated, which realized an average efficiency of 9.6% (maximum: 10.6%) despite series resistance limitations from the substrate design. Overall, the developed lamination procedure curtails processing constraints, enables new device designs, and affords new opportunities for optimization.« less

Object oriented development of engineering software using CLIPS

NASA Technical Reports Server (NTRS)

Yoon, C. John

1991-01-01

Engineering applications involve numeric complexity and manipulations of a large amount of data. Traditionally, numeric computation has been the concern in developing an engineering software. As engineering application software became larger and more complex, management of resources such as data, rather than the numeric complexity, has become the major software design problem. Object oriented design and implementation methodologies can improve the reliability, flexibility, and maintainability of the resulting software; however, some tasks are better solved with the traditional procedural paradigm. The C Language Integrated Production System (CLIPS), with deffunction and defgeneric constructs, supports the procedural paradigm. The natural blending of object oriented and procedural paradigms has been cited as the reason for the popularity of the C++ language. The CLIPS Object Oriented Language's (COOL) object oriented features are more versatile than C++'s. A software design methodology based on object oriented and procedural approaches appropriate for engineering software, and to be implemented in CLIPS was outlined. A method for sensor placement for Space Station Freedom is being implemented in COOL as a sample problem.

Orthoptic Changes following Photorefractive Keratectomy

PubMed Central

Rajavi, Zhale; Nassiri, Nader; Azizzadeh, Monir; Ramezani, Alireza; yaseri, Mehdi

2011-01-01

Purpose To report orthoptic changes after photorefractive keratectomy (PRK). Methods This interventional case series included 297 eyes of 150 patients scheduled for PRK. Complete ophthalmologic evaluations focusing on orthoptic examinations were performed before and 3 months after PRK. Results Before PRK, 2 (1.3%) patients had esotropia which remained unchanged; 3 (2%) patients had far exotropia which improved after the procedure. Of 12 cases (8%) with initial exotropia at near, 3 (2%) cases became orthophoric, however 6 patients (4%) developed new near exotropia. A significant reduction in convergence and divergence amplitudes (P < 0.001) and a significant increase in near point of convergence (NPC) (P < 0.006) were noticed after PRK. A reduction ≥ 10 PD in convergence amplitude and ≥ 5 PD in divergence amplitude occurred in 10 and 5 patients, respectively. Four patients had initial NPC > 10 cm which remained unchanged after surgery. Out of 9 (6%) patients with baseline stereopsis > 60 seconds of arc, 2 (1.33%) showed an improvement in stereopsis following PRK. No patient developed diplopia postoperatively. Conclusion Preexisting strabismus may improve or remain unchanged after PRK, and new deviations can develop following the procedure. A decrease in fusional amplitudes, an increase in NPC, and an improvement in stereopsis may also occur after PRK. Preoperative evaluation of orthoptic status for detection of baseline abnormalities and identification of susceptible patients seem advisable. PMID:22454717

Model of Procedure Usage – Results from a Qualitative Study to Inform Design of Computer-Based Procedures

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

Johanna H Oxstrand; Katya L Le Blanc

The nuclear industry is constantly trying to find ways to decrease the human error rate, especially the human errors associated with procedure use. As a step toward the goal of improving procedure use performance, researchers, together with the nuclear industry, have been looking at replacing the current paper-based procedures with computer-based procedure systems. The concept of computer-based procedures is not new by any means; however most research has focused on procedures used in the main control room. Procedures reviewed in these efforts are mainly emergency operating procedures and normal operating procedures. Based on lessons learned for these previous efforts wemore » are now exploring a more unknown application for computer based procedures - field procedures, i.e. procedures used by nuclear equipment operators and maintenance technicians. The Idaho National Laboratory, the Institute for Energy Technology, and participants from the U.S. commercial nuclear industry are collaborating in an applied research effort with the objective of developing requirements and specifications for a computer-based procedure system to be used by field operators. The goal is to identify the types of human errors that can be mitigated by using computer-based procedures and how to best design the computer-based procedures to do this. The underlying philosophy in the research effort is “Stop – Start – Continue”, i.e. what features from the use of paper-based procedures should we not incorporate (Stop), what should we keep (Continue), and what new features or work processes should be added (Start). One step in identifying the Stop – Start – Continue was to conduct a baseline study where affordances related to the current usage of paper-based procedures were identified. The purpose of the study was to develop a model of paper based procedure use which will help to identify desirable features for computer based procedure prototypes. Affordances such as note taking, markups, sharing procedures between fellow coworkers, the use of multiple procedures at once, etc. were considered. The model describes which affordances associated with paper based procedures should be transferred to computer-based procedures as well as what features should not be incorporated. The model also provides a means to identify what new features not present in paper based procedures need to be added to the computer-based procedures to further enhance performance. The next step is to use the requirements and specifications to develop concepts and prototypes of computer-based procedures. User tests and other data collection efforts will be conducted to ensure that the real issues with field procedures and their usage are being addressed and solved in the best manner possible. This paper describes the baseline study, the construction of the model of procedure use, and the requirements and specifications for computer-based procedures that were developed based on the model. It also addresses how the model and the insights gained from it were used to develop concepts and prototypes for computer based procedures.« less

Improvements to the fastex flutter analysis computer code

NASA Technical Reports Server (NTRS)

Taylor, Ronald F.

1987-01-01

Modifications to the FASTEX flutter analysis computer code (UDFASTEX) are described. The objectives were to increase the problem size capacity of FASTEX, reduce run times by modification of the modal interpolation procedure, and to add new user features. All modifications to the program are operable on the VAX 11/700 series computers under the VAX operating system. Interfaces were provided to aid in the inclusion of alternate aerodynamic and flutter eigenvalue calculations. Plots can be made of the flutter velocity, display and frequency data. A preliminary capability was also developed to plot contours of unsteady pressure amplitude and phase. The relevant equations of motion, modal interpolation procedures, and control system considerations are described and software developments are summarized. Additional information documenting input instructions, procedures, and details of the plate spline algorithm is found in the appendices.

Enhanced Multiobjective Optimization Technique for Comprehensive Aerospace Design. Part A

NASA Technical Reports Server (NTRS)

Chattopadhyay, Aditi; Rajadas, John N.

1997-01-01

A multidisciplinary design optimization procedure which couples formal multiobjectives based techniques and complex analysis procedures (such as computational fluid dynamics (CFD) codes) developed. The procedure has been demonstrated on a specific high speed flow application involving aerodynamics and acoustics (sonic boom minimization). In order to account for multiple design objectives arising from complex performance requirements, multiobjective formulation techniques are used to formulate the optimization problem. Techniques to enhance the existing Kreisselmeier-Steinhauser (K-S) function multiobjective formulation approach have been developed. The K-S function procedure used in the proposed work transforms a constrained multiple objective functions problem into an unconstrained problem which then is solved using the Broyden-Fletcher-Goldfarb-Shanno (BFGS) algorithm. Weight factors are introduced during the transformation process to each objective function. This enhanced procedure will provide the designer the capability to emphasize specific design objectives during the optimization process. The demonstration of the procedure utilizes a computational Fluid dynamics (CFD) code which solves the three-dimensional parabolized Navier-Stokes (PNS) equations for the flow field along with an appropriate sonic boom evaluation procedure thus introducing both aerodynamic performance as well as sonic boom as the design objectives to be optimized simultaneously. Sensitivity analysis is performed using a discrete differentiation approach. An approximation technique has been used within the optimizer to improve the overall computational efficiency of the procedure in order to make it suitable for design applications in an industrial setting.

Development and application of a local linearization algorithm for the integration of quaternion rate equations in real-time flight simulation problems

NASA Technical Reports Server (NTRS)

Barker, L. E., Jr.; Bowles, R. L.; Williams, L. H.

1973-01-01

High angular rates encountered in real-time flight simulation problems may require a more stable and accurate integration method than the classical methods normally used. A study was made to develop a general local linearization procedure of integrating dynamic system equations when using a digital computer in real-time. The procedure is specifically applied to the integration of the quaternion rate equations. For this application, results are compared to a classical second-order method. The local linearization approach is shown to have desirable stability characteristics and gives significant improvement in accuracy over the classical second-order integration methods.

The use of high-fidelity human patient simulation as an evaluative tool in the development of clinical research protocols and procedures.

PubMed

Wright, Melanie C; Taekman, Jeffrey M; Barber, Linda; Hobbs, Gene; Newman, Mark F; Stafford-Smith, Mark

2005-12-01

Errors in clinical research can be costly, in terms of patient safety, data integrity, and data collection. Data inaccuracy in early subjects of a clinical study may be associated with problems in the design of the protocol, procedures, and data collection tools. High-fidelity patient simulation centers provide an ideal environment to apply human-centered design to clinical trial development. A draft of a complex clinical protocol was designed, evaluated and modified using a high-fidelity human patient simulator in the Duke University Human Simulation and Patient Safety Center. The process included walk-throughs, detailed modifications of the protocol and development of procedural aids. Training of monitors and coordinators provided an opportunity for observation of performance that was used to identify further improvements to the protocol. Evaluative steps were used to design the research protocol and procedures. Iterative modifications were made to the protocol and data collection tools. The success in use of human simulation in the preparation of a complex clinical drug trial suggests the benefits of human patient simulation extend beyond training and medical equipment evaluation. Human patient simulation can provide a context for informal expert evaluation of clinical protocol design and for formal "rehearsal" to evaluate the efficacy of procedures and support tools.

Development of Facial Rejuvenation Procedures: Thirty Years of Clinical Experience with Face Lifts

PubMed Central

Kim, Byung Jun; Choi, Jun Ho

2015-01-01

Facial rejuvenation procedures can be roughly divided into face lift surgery and nonoperative, less invasive procedures, such as fat grafts, fillers, botulinum toxin injections, thread lifts, or laserbrasion. Face lift surgery or rhytidectomy is the procedure most directly associated with rejuvenation, due to its fundamental ability to restore the anatomical changes caused by aging. Various methods of face lift surgery have been developed over the last hundred years, thanks to advances in the understanding of facial anatomy and the mechanisms of aging, as well as the dedication of innovative surgeons. However, no generally applicable standard method exists, because the condition of each patient is different, and each operative method has advantages and disadvantages. Specific characteristics of the skin of Asians and their skeletal anatomy should be considered when determining the operative method to be used on Asian patients. Plastic surgeons should improve their ability to analyze the original aesthetic properties and problem areas of each patient, drawing on scientific knowledge about the aging process, and they should develop the skills necessary to perform various rejuvenative techniques. In the present article, we reviewed various face lift procedures and the current methods of modified double plane face lift, based on our clinical experience of over 30 years. PMID:26430622

Age-related differences in perceptuomotor procedural learning in children.

PubMed

Lejeune, Caroline; Catale, Corinne; Schmitz, Xavier; Quertemont, Etienne; Meulemans, Thierry

2013-10-01

Procedural learning is generally considered to proceed in a series of phases, with cognitive resources playing an important role during the initial step. From a developmental perspective, little is known about the development of procedural learning or the role played by explicit cognitive processes during learning. The main objectives of this study were (a) to determine whether procedural learning performance improves with age by comparing groups of 7-year-old children, 10-year-old children, and adults and (b) to investigate the role played by executive functions during the acquisition in these three age groups. The 76 participants were assessed on a computerized adaptation of the mirror tracing paradigm. Results revealed that the youngest children had more difficulty in adapting to the task (they were slower and committed more errors at the beginning of the learning process) than 10-year-olds, but despite this age effect observed at the outset, all children improved performance across trials and transferred their skill to a different figure as well as adults. Correlational analyses showed that inhibition abilities play a key role in the performance of 10-year-olds and adults at the beginning of the learning but not in that of 7-year-olds. Overall, our results suggest that the age-related differences observed in our procedural learning task are at least partly due to the differential involvement of inhibition abilities, which may facilitate learning (so long as they are sufficiently developed) during the initial steps of the learning process; however, they would not be a necessary condition for skill learning to occur. Copyright © 2013 Elsevier Inc. All rights reserved.

Developing a Benchmarking Process in Perfusion: A Report of the Perfusion Downunder Collaboration

PubMed Central

Baker, Robert A.; Newland, Richard F.; Fenton, Carmel; McDonald, Michael; Willcox, Timothy W.; Merry, Alan F.

2012-01-01

Abstract: Improving and understanding clinical practice is an appropriate goal for the perfusion community. The Perfusion Downunder Collaboration has established a multi-center perfusion focused database aimed at achieving these goals through the development of quantitative quality indicators for clinical improvement through benchmarking. Data were collected using the Perfusion Downunder Collaboration database from procedures performed in eight Australian and New Zealand cardiac centers between March 2007 and February 2011. At the Perfusion Downunder Meeting in 2010, it was agreed by consensus, to report quality indicators (QI) for glucose level, arterial outlet temperature, and pCO2 management during cardiopulmonary bypass. The values chosen for each QI were: blood glucose ≥4 mmol/L and ≤10 mmol/L; arterial outlet temperature ≤37°C; and arterial blood gas pCO2 ≥ 35 and ≤45 mmHg. The QI data were used to derive benchmarks using the Achievable Benchmark of Care (ABC™) methodology to identify the incidence of QIs at the best performing centers. Five thousand four hundred and sixty-five procedures were evaluated to derive QI and benchmark data. The incidence of the blood glucose QI ranged from 37–96% of procedures, with a benchmark value of 90%. The arterial outlet temperature QI occurred in 16–98% of procedures with the benchmark of 94%; while the arterial pCO2 QI occurred in 21–91%, with the benchmark value of 80%. We have derived QIs and benchmark calculations for the management of several key aspects of cardiopulmonary bypass to provide a platform for improving the quality of perfusion practice. PMID:22730861

Accreditation in the USA: Origins, Developments and Future Prospects. Improving the Managerial Effectiveness of Higher Education.

ERIC Educational Resources Information Center

El-Khawas, Elaine

This study analyzes the accreditation experience in the United States with special emphasis on the issues and decisions that surrounded the development of evaluation procedures and standards. Attention is given to the relationship between accrediting agencies and governmental agencies, the effect of accrediting requirements on the way that…

The Development of Visual Expectations in the First Year.

ERIC Educational Resources Information Center

Reznick, J. Steven; Chawarska, Katarzyna; Betts, Stephanie

2000-01-01

Two experiments used Visual Expectations Procedure to investigate development of expectations in infants up to 12 months old. Reaction time improved and the percentage of anticipations increased between 6 and 9 months using an alternation pattern or a complex pivot pattern, and between 4 and 8 months when using a left-right alternation or a…

The Development of an Accelerometer System for Measuring Pelvic Motion During Walking.

DTIC Science & Technology

1979-01-01

9. PERFORMING ORGANIZATION NAME AND ADDRESS 10. PROGRAM ELEMENT, PROJECT, T ASK AFIT STUDENT AT: University of Oxford CONTROLLING OFFICE NAME AND...bones, joints or muscles and physiotherapy to improve the functioning of impaired lower limbs. When irreparable damage occurs, the normal locomotor system...restoring near normal functioning of the locomotor system. Any improvement in surgical procedures, physiotherapy techniques, orthoses or prostheses

On computational methods for crashworthiness

NASA Technical Reports Server (NTRS)

Belytschko, T.

1992-01-01

The evolution of computational methods for crashworthiness and related fields is described and linked with the decreasing cost of computational resources and with improvements in computation methodologies. The latter includes more effective time integration procedures and more efficient elements. Some recent developments in methodologies and future trends are also summarized. These include multi-time step integration (or subcycling), further improvements in elements, adaptive meshes, and the exploitation of parallel computers.

Update on Standard Operating Procedures in Preclinical Research for DMD and SMA Report of TREAT-NMD Alliance Workshop, Schiphol Airport, 26 April 2015, The Netherlands.

PubMed

van Putten, Maaike; Aartsma-Rus, Annemieke; Grounds, Miranda D; Kornegay, Joe N; Mayhew, Anna; Gillingwater, Thomas H; Takeda, Shin'ichi; Rüegg, Markus A; De Luca, Annamaria; Nagaraju, Kanneboyina; Willmann, Raffaella

A workshop took place in 2015 to follow up TREAT-NMD activities dedicated to improving quality in the preclinical phase of drug development for neuromuscular diseases. In particular, this workshop adressed necessary future steps regarding common standard experimental protocols and the issue of improving the translatability of preclinical efficacy studies.

Improving Early Reading Skills in Young Children through an iPad App: Small-Group Instruction and Observational Learning

ERIC Educational Resources Information Center

Chai, Zhen

2017-01-01

This study evaluated the effectiveness of using a researcher-developed iPad app with a 0- to 5-s constant time delay procedure to improve phonological awareness skills of young children with mild developmental delays in a small-group arrangement in a rural public elementary school in Southwest United States. The study was conducted using a…

Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics.

PubMed

Kuo, Benjamin J; Vissoci, Joao Ricardo N; Egger, Joseph R; Smith, Emily R; Grant, Gerald A; Haglund, Michael M; Rice, Henry E

2017-03-01

OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012-2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas admission from outside hospital transfer was a significant predictor of any AE for all procedure groups except craniotomy/craniectomy. CONCLUSIONS This analysis of NSQIP-Peds, a large risk-adjusted national data set, confirms low perioperative mortality but high morbidity for pediatric neurosurgical procedures. These data provide a baseline understanding of current expected clinical outcomes for pediatric neurosurgical procedures, identify the need for collecting neurosurgery-specific risk factors and complications, and should support targeted QI programs and clinical management interventions to improve care of children.

Short- and long-term effects of clinical audits on compliance with procedures in CT scanning.

PubMed

Oliveri, Antonio; Howarth, Nigel; Gevenois, Pierre Alain; Tack, Denis

2016-08-01

To test the hypothesis that quality clinical audits improve compliance with the procedures in computed tomography (CT) scanning. This retrospective study was conducted in two hospitals, based on 6950 examinations and four procedures, focusing on the acquisition length in lumbar spine CT, the default tube current applied in abdominal un-enhanced CT, the tube potential selection for portal phase abdominal CT and the use of a specific "paediatric brain CT" procedure. The first clinical audit reported compliance with these procedures. After presenting the results to the stakeholders, a second audit was conducted to measure the impact of this information on compliance and was repeated the next year. Comparisons of proportions were performed using the Chi-square Pearson test. Depending on the procedure, the compliance rate ranged from 27 to 88 % during the first audit. After presentation of the audit results to the stakeholders, the compliance rate ranged from 68 to 93 % and was significantly improved for all procedures (P ranging from <0.001 to 0.031) in both hospitals and remained unchanged during the third audit (P ranging from 0.114 to 0.999). Quality improvement through repeated compliance audits with CT procedures durably improves this compliance. • Compliance with CT procedures is operator-dependent and not perfect. • Compliance differs between procedures and hospitals, even within a unified department. • Compliance is improved through audits followed by communication to the stakeholders. • This improvement is sustainable over a one-year period.

Improvement of Railroad Roller Bearing Test Procedures & Development of Roller Bearing Diagnostic Techniques. Volume 2.

DOT National Transportation Integrated Search

1982-04-01

A comprehensive review of existing basic diagnostic techniques applicable to the railcar roller bearing defect and failure problem was made. Of the potentially feasible diagnostic techniques identified, high frequency vibration was selected for exper...

Overview of Vertical Axis Wind Turbine (VAWT)

NASA Technical Reports Server (NTRS)

Sullivan, W. N.

1979-01-01

A survey is presented of the practices which were applied for designing VAWT blades. An attempt is made to discuss strengths and weaknesses of the existing procedures. Discussion is provided on planned or suggested future work in developing improved design tools.

Expert systems as applied to bridges : knowledge acquisition phase : final report.

DOT National Transportation Integrated Search

1987-01-01

Presented in this report is a detailed description of the procedure to be followed to develop a knowledge-based computerized expert system for determining whether to rehabilitate, improve, replace, abandon, or just to routinely maintain an old highwa...

Considerations in the development of procedures for prioritizing transportation improvement projects in Virginia.

DOT National Transportation Integrated Search

2002-01-01

The transportation programming process is undergoing a fundamental change akin to that which transpired with the advent of the Intermodal Surface Transportation Efficiency Act in 1991. Some stakeholders have expressed a desire that the programming pr...

Determination of frontal offset test conditions based on crash data

DOT National Transportation Integrated Search

1998-01-01

This paper reports on the test procedure development : phase of the agencys Improved Frontal Protection : research program. It is anticipated that even after all cars : and light trucks have air bags for drivers and front seat : passengers there w...

Lettuce and spinach breeding

USDA-ARS?s Scientific Manuscript database

Lettuce and spinach production is beset by numerous biotic an abiotic challenges, thus the leafy-vegetable industry of California requires continued development of improved, adapted cultivars to meet new disease and insect problems, changes in the market, and changes in growing procedures. The lettu...

An integrated optimum design approach for high speed prop rotors

NASA Technical Reports Server (NTRS)

Chattopadhyay, Aditi; Mccarthy, Thomas R.

1995-01-01

The objective is to develop an optimization procedure for high-speed and civil tilt-rotors by coupling all of the necessary disciplines within a closed-loop optimization procedure. Both simplified and comprehensive analysis codes are used for the aerodynamic analyses. The structural properties are calculated using in-house developed algorithms for both isotropic and composite box beam sections. There are four major objectives of this study. (1) Aerodynamic optimization: The effects of blade aerodynamic characteristics on cruise and hover performance of prop-rotor aircraft are investigated using the classical blade element momentum approach with corrections for the high lift capability of rotors/propellers. (2) Coupled aerodynamic/structures optimization: A multilevel hybrid optimization technique is developed for the design of prop-rotor aircraft. The design problem is decomposed into a level for improved aerodynamics with continuous design variables and a level with discrete variables to investigate composite tailoring. The aerodynamic analysis is based on that developed in objective 1 and the structural analysis is performed using an in-house code which models a composite box beam. The results are compared to both a reference rotor and the optimum rotor found in the purely aerodynamic formulation. (3) Multipoint optimization: The multilevel optimization procedure of objective 2 is extended to a multipoint design problem. Hover, cruise, and take-off are the three flight conditions simultaneously maximized. (4) Coupled rotor/wing optimization: Using the comprehensive rotary wing code CAMRAD, an optimization procedure is developed for the coupled rotor/wing performance in high speed tilt-rotor aircraft. The developed procedure contains design variables which define the rotor and wing planforms.

Engine dynamic analysis with general nonlinear finite element codes. Part 2: Bearing element implementation overall numerical characteristics and benchmaking

NASA Technical Reports Server (NTRS)

Padovan, J.; Adams, M.; Fertis, J.; Zeid, I.; Lam, P.

1982-01-01

Finite element codes are used in modelling rotor-bearing-stator structure common to the turbine industry. Engine dynamic simulation is used by developing strategies which enable the use of available finite element codes. benchmarking the elements developed are benchmarked by incorporation into a general purpose code (ADINA); the numerical characteristics of finite element type rotor-bearing-stator simulations are evaluated through the use of various types of explicit/implicit numerical integration operators. Improving the overall numerical efficiency of the procedure is improved.

The use of geologic and seismologic information to reduce earthquake Hazards in California

USGS Publications Warehouse

Kockelman, W.J.; Campbell, C.C.

1984-01-01

Five examples illustrate how geologic and seismologic information can be used to reduce the effects of earthquakes Included are procedures for anticipating damage to critical facilities, preparing, adopting, or implementing seismic safety studies, plans, and programs, retrofitting highway bridges, regulating development in areas subject to fault-rupture, and strengthening or removing unreinforced masonry buildings. The collective effect of these procedures is to improve the public safety, health, and welfare of individuals and their communities. ?? 1984 Springer-Verlag New York Inc.

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

Faye, Sherry A.; Richards, Jason M.; Gallardo, Athena M.

Sequential extraction is a useful technique for assessing the potential to leach actinides from soils; however, current literature lacks uniformity in experimental details, making direct comparison of results impossible. This work continued development toward a standardized five-step sequential extraction protocol by analyzing extraction behaviors of 232Th, 238U, 239,240Pu and 241Am from lake and ocean sediment reference materials. Results produced a standardized procedure after creating more defined reaction conditions to improve method repeatability. A NaOH fusion procedure is recommended following sequential leaching for the complete dissolution of insoluble species.

RNase alleviates neurological dysfunction in mice undergoing cardiac arrest and cardiopulmonary resuscitation

PubMed Central

Ma, Ye; Chen, Chan; Zhang, Shu; Wang, Qiao; Chen, Hai; Dong, Yuanlin; Zhang, Zheng; Li, Yan; Niu, Zhendong; Zhu, Tao; Yu, Hai; Liu, Bin

2017-01-01

Cardiac arrest (CA) is one of the leading lethal factors. Despite cardiopulmonary resuscitation (CPR) procedure has been consecutively improved and lots of new strategies have been developed, neurological outcome of the patients experienced CPR is still disappointing. Ribonuclease (RNase) has been demonstrated to have neuroprotective effects in acute stroke and postoperative cognitive impairment, possibly through acting against endogenous RNA that released from damaged tissue. However, the role of RNase in post-cardiac arrest cerebral injury is unknown. In the present study, we investigated the role of RNase in neurological outcome of mice undergoing 5 minutes of CA and followed by CPR. RNase or the same dosage of normal saline was administrated. We found that RNase administration could: 1) improve neurologic score on day 1 and day 3 after CA/CPR performance; 2) improve memory and learning ability on day 3 after training in contextual fear-conditioning test; 3) reduce extracellular RNA (exRNA) level in plasma and hippocampus tissue, and hippocampal cytokines mRNA production on day 3 after CA/CPR procedure; 4) attenuate autophagy levels in hippocampus tissue on day 3 after CA/CPR procedure. In conclusion, RNase could improve neurological function by reducing inflammation response and autophagy in mice undergoing CA/CPR. PMID:28881795

Potential impacts of advanced technologies on the ATC capacity of high-density terminal areas

NASA Technical Reports Server (NTRS)

Simpson, R. W.; Odoni, A. R.; Salas-Roche, F.

1986-01-01

Advanced technologies for airborne systems (automatic flight control, flight displays, navigation) and for ground ATC systems (digital communications, improved surveillance and tracking, automated decision-making) create the possibility of advanced ATC operations and procedures which can bring increased capacity for runway systems. A systematic analysis is carried out to identify certain such advanced ATC operations, and then to evaluate the potential benefits occurring over time at typical US high-density airports (Denver and Boston). The study is divided into three parts: (1) A Critical Examination of Factors Which Determine Operational Capacity of Runway Systems at Major Airports, is an intensive review of current US separation criteria and terminal area ATC operations. It identifies 11 new methods to increase the capacity of landings and takeoffs for runway systems; (2) Development of Risk Based Separation Criteria is the development of a rational structure for establishing reduced ATC separation criteria which meet a consistent Target Level of Safety using advanced technology and operational procedures; and (3) Estimation of Capacity Benefits from Advanced Terminal Area Operations - Denver and Boston, provides an estimate of the overall annual improvement in runway capacity which might be expected at Denver and Boston from using some of the advanced ATC procedures developed in Part 1. Whereas Boston achieved a substantial 37% increase, Denver only achieved a 4.7% increase in its overall annual capacity.

The role of standards in the development and implementation of clinical laboratory tests: a domestic and global perspective.

PubMed

Michaud, Ginette Y

2005-01-01

In the field of clinical laboratory medicine, standardization is aimed at increasing the trueness and reliability of measured values. Standardization relies on the use of written standards, reference measurement procedures and reference materials. These are important tools for the design and validation of new tests, and for establishing the metrological traceability of diagnostic assays. Their use supports the translation of research technologies into new diagnostic assays and leads to more rapid advances in science and medicine, as well as improvements in the quality of patient care. The various standardization tools are described, as are the procedures by which written standards, reference procedures and reference materials are developed. Recent efforts to develop standards for use in the field of molecular diagnostics are discussed. The recognition of standardization tools by the FDA and other regulatory authorities is noted as evidence of their important role in ensuring the safety and performance of in vitro diagnostic devices.

In vivo bioluminescence imaging of cell differentiation in biomaterials: a platform for scaffold development.

PubMed

Bagó, Juli R; Aguilar, Elisabeth; Alieva, Maria; Soler-Botija, Carolina; Vila, Olaia F; Claros, Silvia; Andrades, José A; Becerra, José; Rubio, Nuria; Blanco, Jerónimo

2013-03-01

In vivo testing is a mandatory last step in scaffold development. Agile longitudinal noninvasive real-time monitoring of stem cell behavior in biomaterials implanted in live animals should facilitate the development of scaffolds for tissue engineering. We report on a noninvasive bioluminescence imaging (BLI) procedure for simultaneous monitoring of changes in the expression of multiple genes to evaluate scaffold performance in vivo. Adipose tissue-derived stromal mensenchymal cells were dually labeled with Renilla red fluorescent protein and firefly green fluorescent protein chimeric reporters regulated by cytomegalovirus and tissue-specific promoters, respectively. Labeled cells were induced to differentiate in vitro and in vivo, by seeding in demineralized bone matrices (DBMs) and monitored by BLI. Imaging results were validated by RT-polymerase chain reaction and histological procedures. The proposed approach improves molecular imaging and measurement of changes in gene expression of cells implanted in live animals. This procedure, applicable to the simultaneous analysis of multiple genes from cells seeded in DBMs, should facilitate engineering of scaffolds for tissue repair.

In Vivo Bioluminescence Imaging of Cell Differentiation in Biomaterials: A Platform for Scaffold Development

PubMed Central

Bagó, Juli R.; Aguilar, Elisabeth; Alieva, Maria; Soler-Botija, Carolina; Vila, Olaia F.; Claros, Silvia; Andrades, José A.; Becerra, José; Rubio, Nuria

2013-01-01

In vivo testing is a mandatory last step in scaffold development. Agile longitudinal noninvasive real-time monitoring of stem cell behavior in biomaterials implanted in live animals should facilitate the development of scaffolds for tissue engineering. We report on a noninvasive bioluminescence imaging (BLI) procedure for simultaneous monitoring of changes in the expression of multiple genes to evaluate scaffold performance in vivo. Adipose tissue-derived stromal mensenchymal cells were dually labeled with Renilla red fluorescent protein and firefly green fluorescent protein chimeric reporters regulated by cytomegalovirus and tissue-specific promoters, respectively. Labeled cells were induced to differentiate in vitro and in vivo, by seeding in demineralized bone matrices (DBMs) and monitored by BLI. Imaging results were validated by RT-polymerase chain reaction and histological procedures. The proposed approach improves molecular imaging and measurement of changes in gene expression of cells implanted in live animals. This procedure, applicable to the simultaneous analysis of multiple genes from cells seeded in DBMs, should facilitate engineering of scaffolds for tissue repair. PMID:23013334

Toward Worldwide Hepcidin Assay Harmonization: Identification of a Commutable Secondary Reference Material.

PubMed

van der Vorm, Lisa N; Hendriks, Jan C M; Laarakkers, Coby M; Klaver, Siem; Armitage, Andrew E; Bamberg, Alison; Geurts-Moespot, Anneke J; Girelli, Domenico; Herkert, Matthias; Itkonen, Outi; Konrad, Robert J; Tomosugi, Naohisa; Westerman, Mark; Bansal, Sukhvinder S; Campostrini, Natascia; Drakesmith, Hal; Fillet, Marianne; Olbina, Gordana; Pasricha, Sant-Rayn; Pitts, Kelly R; Sloan, John H; Tagliaro, Franco; Weykamp, Cas W; Swinkels, Dorine W

2016-07-01

Absolute plasma hepcidin concentrations measured by various procedures differ substantially, complicating interpretation of results and rendering reference intervals method dependent. We investigated the degree of equivalence achievable by harmonization and the identification of a commutable secondary reference material to accomplish this goal. We applied technical procedures to achieve harmonization developed by the Consortium for Harmonization of Clinical Laboratory Results. Eleven plasma hepcidin measurement procedures (5 mass spectrometry based and 6 immunochemical based) quantified native individual plasma samples (n = 32) and native plasma pools (n = 8) to assess analytical performance and current and achievable equivalence. In addition, 8 types of candidate reference materials (3 concentrations each, n = 24) were assessed for their suitability, most notably in terms of commutability, to serve as secondary reference material. Absolute hepcidin values and reproducibility (intrameasurement procedure CVs 2.9%-8.7%) differed substantially between measurement procedures, but all were linear and correlated well. The current equivalence (intermeasurement procedure CV 28.6%) between the methods was mainly attributable to differences in calibration and could thus be improved by harmonization with a common calibrator. Linear regression analysis and standardized residuals showed that a candidate reference material consisting of native lyophilized plasma with cryolyoprotectant was commutable for all measurement procedures. Mathematically simulated harmonization with this calibrator resulted in a maximum achievable equivalence of 7.7%. The secondary reference material identified in this study has the potential to substantially improve equivalence between hepcidin measurement procedures and contributes to the establishment of a traceability chain that will ultimately allow standardization of hepcidin measurement results. © 2016 American Association for Clinical Chemistry.

A decade of improvements in Mimiviridae and Marseilleviridae isolation from amoeba.

PubMed

Pagnier, Isabelle; Reteno, Dorine-Gaelle Ikanga; Saadi, Hanene; Boughalmi, Mondher; Gaia, Morgan; Slimani, Meriem; Ngounga, Tatsiana; Bekliz, Meriem; Colson, Philippe; Raoult, Didier; La Scola, Bernard

2013-01-01

Since the isolation of the first giant virus, the Mimivirus, by T.J. Rowbotham in a cooling tower in Bradford, UK, and after its characterisation by our group in 2003, we have continued to develop novel strategies to isolate additional strains. By first focusing on cooling towers using our original time-consuming procedure, we were able to isolate a new lineage of giant virus called Marseillevirus and a new Mimivirus strain called Mamavirus. In the following years, we have accumulated the world's largest unique collection of giant viruses by improving the use of antibiotic combinations to avoid bacterial contamination of amoeba, developing strategies of preliminary screening of samples by molecular methods, and using a high-throughput isolation method developed by our group. Based on the inoculation of nearly 7,000 samples, our collection currently contains 43 strains of Mimiviridae (14 in lineage A, 6 in lineage B, and 23 in lineage C) and 17 strains of Marseilleviridae isolated from various environments, including 3 of human origin. This study details the procedures used to build this collection and paves the way for the high-throughput isolation of new isolates to improve the record of giant virus distribution in the environment and the determination of their pangenome.

Development of a human cadaver model for training in laparoscopic donor nephrectomy.

PubMed

Sutton, Erica R H; Billeter, Adrian; Druen, Devin; Roberts, Henry; Rice, Jonathan

2017-06-01

The organ procurement network recommends a surgeon record 15 cases as surgeon or assistant for laparoscopic donor nephrectomies (LDN) prior to independent practice. The literature suggests that the learning curve for improved perioperative and patient outcomes is closer to 35 cases. In this article, we describe our development of a model utilizing fresh tissue and objective, quantifiable endpoints to document surgical progress, and efficiency in each of the major steps involved in LDN. Phase I of model development focused on the modifications necessary to maintain visualization for laparoscopic surgery in a human cadaver. Phase II tested proposed learner-based metrics of procedural competency for multiport LDN by timing procedural steps of LDN in a novice learner. Phases I and II required 12 and nine cadavers, with a total of 35 kidneys utilized. The following metrics improved with trial number for multiport LDN: time taken for dissection of the gonadal vein, ureter, renal hilum, adrenal and lumbrical veins, simulated warm ischemic time (WIT), and operative time. Human cadavers can be used for training in LDN as evidenced by improvements in timed learner-based metrics. This simulation-based model fills a gap in available training options for surgeons. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Proposal for an Evaluation Method for the Performance of Work Procedures.

PubMed

Mohammed, Mouda; Mébarek, Djebabra; Wafa, Boulagouas; Makhlouf, Chati

2016-12-01

Noncompliance of operators with work procedures is a recurrent problem. This human behavior has been said to be situational and studied by many different approaches (ergonomic and others), which consider the noncompliance with work procedures to be obvious and seek to analyze its causes as well as consequences. The object of the proposed method is to solve this problem by focusing on the performance of work procedures and ensuring improved performance on a continuous basis. This study has multiple results: (1) assessment of the work procedures' performance by a multicriteria approach; (2) the use of a continuous improvement approach as a framework for the sustainability of the assessment method of work procedures' performance; and (3) adaptation of the Stop-Card as a facilitator support for continuous improvement of work procedures. The proposed method emphasizes to put in value the inputs of continuous improvement of the work procedures in relation with the conventional approaches which adopt the obvious evidence of the noncompliance to the working procedures and seek to analyze the cause-effect relationships related to this unacceptable phenomenon, especially in strategic industry.

Ignition improvement by injector arrangement in a multi-fuel combustor for micro gas turbine

NASA Astrophysics Data System (ADS)

Antoshkiv, O.; Poojitganont, T.; Jeansirisomboon, S.; Berg, H. P.

2018-01-01

The novel combustor design also has an impact on the ignitor arrangement. The conventional ignitor system cannot guarantee optimal ignition performance in the usual radial position. The difficult ignitability of gaseous fuels was the main challenge for the ignitor system improvement. One way to improve the ignition performance significantly is a torch ignitor system in which the gaseous fuel is directly mixed with a large amount of the combustor air. To reach this goal, the ignition process was investigated in detail. The micro gas turbine (MGT) ignition was optimised considering three main procedures: torch ignitor operation, burner ignition and flame propagation between the neighbour injectors. A successful final result of the chain of ignition procedures depends on multiple aspects of the combustor design. Performed development work shows an important step towards designing modern high-efficiency low-emission combustors.

Estimating Surgical Procedure Times Using Anesthesia Billing Data and Operating Room Records.

PubMed

Burgette, Lane F; Mulcahy, Andrew W; Mehrotra, Ateev; Ruder, Teague; Wynn, Barbara O

2017-02-01

The median time required to perform a surgical procedure is important in determining payment under Medicare's physician fee schedule. Prior studies have demonstrated that the current methodology of using physician surveys to determine surgical times results in overstated times. To measure surgical times more accurately, we developed and validated a methodology using available data from anesthesia billing data and operating room (OR) records. We estimated surgical times using Medicare 2011 anesthesia claims and New York Statewide Planning and Research Cooperative System 2011 OR times. Estimated times were validated using data from the National Surgical Quality Improvement Program. We compared our time estimates to those used by Medicare in the fee schedule. We estimate surgical times via piecewise linear median regression models. Using 3.0 million observations of anesthesia and OR times, we estimated surgical time for 921 procedures. Correlation between these time estimates and directly measured surgical time from the validation database was 0.98. Our estimates of surgical time were shorter than the Medicare fee schedule estimates for 78 percent of procedures. Anesthesia and OR times can be used to measure surgical time and thereby improve the payment for surgical procedures in the Medicare fee schedule. © Health Research and Educational Trust.

ACHIEVING CONSISTENT DOPPLER MEASUREMENTS FROM SDO /HMI VECTOR FIELD INVERSIONS

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

Schuck, Peter W.; Antiochos, S. K.; Leka, K. D.

NASA’s Solar Dynamics Observatory is delivering vector magnetic field observations of the full solar disk with unprecedented temporal and spatial resolution; however, the satellite is in a highly inclined geosynchronous orbit. The relative spacecraft–Sun velocity varies by ±3 km s{sup −1} over a day, which introduces major orbital artifacts in the Helioseismic Magnetic Imager (HMI) data. We demonstrate that the orbital artifacts contaminate all spatial and temporal scales in the data. We describe a newly developed three-stage procedure for mitigating these artifacts in the Doppler data obtained from the Milne–Eddington inversions in the HMI pipeline. The procedure ultimately uses 32more » velocity-dependent coefficients to adjust 10 million pixels—a remarkably sparse correction model given the complexity of the orbital artifacts. This procedure was applied to full-disk images of AR 11084 to produce consistent Dopplergrams. The data adjustments reduce the power in the orbital artifacts by 31 dB. Furthermore, we analyze in detail the corrected images and show that our procedure greatly improves the temporal and spectral properties of the data without adding any new artifacts. We conclude that this new procedure makes a dramatic improvement in the consistency of the HMI data and in its usefulness for precision scientific studies.« less

Laparoscopic proximal Roux-en-Y gastrojejunal diversion in children: preliminary experience from a single center.

PubMed

Mattioli, Girolamo; Buffa, Piero; Gandullia, Paolo; Schiaffino, Maria Cristina; Avanzini, Stefano; Rapuzzi, Giovanni; Pini Prato, Alessio; Guida, Edoardo; Costanzo, Sara; Rossi, Valentina; Basile, Angelina; Montobbio, Giovanni; DellaRocca, Mirta; Mameli, Leila; Disma, Nicola; Pessagno, Alice; Tomà, Paolo; Jasonni, Vincenzo

2009-12-01

Neurologically impaired children (NIC) have a high risk of recurrence of gastroesophageal reflux (GER) following fundoplication. A postpyloric feeding tube may be useful when gastric emptying disorders occur; however, dislocation and difficulty in feeding management often require more aggressive procedures. Total esophagogastric dissociation (Bianchi's TEGD) is an alternative to the classic fundoplication procedure, whereas laparoscopic gastric bypass is a frequently performed procedure in morbid obesity, improving gastric outlet. The aim of this paper is to present a preliminary experience on the laparoscopic Roux-en-Y gastrojejunal bypass, associated with Nissen fundoplication and gastrostomy, to treat and prevent GER in NIC with gastric emptying disorders. Eight neurologically impaired children underwent surgical treatment because of feeding problems and pulmonary complications. The procedure included: 1) hiatoplasty, 2) Nissen fundoplication, 3) 20-cm Roux-en-Y gastrojejunal anastomosis and jejuno-jejunal anastomosis, and 4) gastrostomy. All cases were fed on postoperative day 3 without any intraoperative complications. One case developed an obstruction of the distal anastomosis due to adhesion and needed reoperation. Outcome was clinically evaluated with serial upper gastrointestinal contrast studies and endoscopies. Laparoscopic proximal Roux-en-Y gastrojejunal diversion, without gastric resection, is a safe, feasible procedure that improves gastric emptying and reduces the risk of GER recurrence. Yet, long-term results still have to be evaluated.

Development of a Haptic Interface for Natural Orifice Translumenal Endoscopic Surgery Simulation

PubMed Central

Dargar, Saurabh; Sankaranarayanan, Ganesh

2016-01-01

Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive procedure, which utilizes the body’s natural orifices to gain access to the peritoneal cavity. The NOTES procedure is designed to minimize external scarring and patient trauma, however flexible endoscopy based pure NOTES procedures require critical scope handling skills. The delicate nature of the NOTES procedure requires extensive training, thus to improve access to training while reducing risk to patients we have designed and developed the VTEST©, a virtual reality NOTES simulator. As part of the simulator, a novel decoupled 2-DOF haptic device was developed to provide realistic force feedback to the user in training. A series of experiments were performed to determine the behavioral characteristics of the device. The device was found capable of rendering up to 5.62N and 0.190Nm of continuous force and torque in the translational and rotational DOF, respectively. The device possesses 18.1Hz and 5.7Hz of force bandwidth in the translational and rotational DOF, respectively. A feedforward friction compensator was also successfully implemented to minimize the negative impact of friction during the interaction with the device. In this work we have presented the detailed development and evaluation of the haptic device for the VTEST©. PMID:27008674

Improving Aircraft Refueling Procedures at Naval Air Station Oceana

DTIC Science & Technology

2012-06-01

Station (NAS) Oceana, VA, using aircraft waiting time for fuel as a measure of performance. We develop a computer-assisted discrete-event simulation to...Station (NAS) Oceana, VA, using aircraft waiting time for fuel as a measure of performance. We develop a computer-assisted discrete-event simulation...server queue, with general interarrival and service time distributions gpm Gallons per minute JDK Java development kit M/M/1 Single-server queue

Using time-delay to improve social play skills with peers for children with autism.

PubMed

Liber, Daniella B; Frea, William D; Symon, Jennifer B G

2008-02-01

Interventions that teach social communication and play skills are crucial for the development of children with autism. The time delay procedure is effective in teaching language acquisition, social use of language, discrete behaviors, and chained activities to individuals with autism and developmental delays. In this study, three boys with autism, attending a non-public school, were taught play activities that combined a play sequence with requesting peer assistance, using a graduated time delay procedure. A multiple-baseline across subjects design demonstrated the success of this procedure to teach multiple-step social play sequences. Results indicated an additional gain of an increase in pretend play by one of the participants. Two also demonstrated a generalization of the skills learned through the time delay procedure.

Endoscopic surgery and telemedicine in microgravity: developing contingency procedures for exploratory class spaceflight.

PubMed

Jones, J A; Johnston, S; Campbell, M; Miles, B; Billica, R

1999-05-01

The risk of a urinary calculus during an extended duration mission into the reduced gravity environment of space is significant. For medical operations to develop a comprehensive strategy for the spaceflight stone risk, both preventive countermeasures and contingency management (CM) plans must be included. A feasibility study was conducted to demonstrate the potential CM technique of endoscopic ureteral stenting with ultrasound guidance for the possible in-flight urinary calculus contingency. The procedure employed the International Space Station/Human Research Facility ultrasound unit for guide wire and stent localization, a flexible cystoscope for visual guidance, and banded, biocompatible soft ureteral stents to successfully stent porcine ureters bilaterally in zero gravity (0g). The study demonstrated that downlinked endoscopic surgical and ultrasound images obtained in 0g are comparable in quality to 1g images, and therefore are useful for diagnostic clinical utility via telemedicine transmission. In order to be successful, surgical procedures in 0g require excellent positional stability of the operating surgeon, assistant, and patient, relative to one another. The technological development of medical procedures for long-duration spaceflight contingencies may lead to improved terrestrial patient care methodology and subsequently reduced morbidity.

Endoscopic surgery and telemedicine in microgravity: developing contingency procedures for exploratory class spaceflight

NASA Technical Reports Server (NTRS)

Jones, J. A.; Johnston, S.; Campbell, M.; Miles, B.; Billica, R.

1999-01-01

OBJECTIVES: The risk of a urinary calculus during an extended duration mission into the reduced gravity environment of space is significant. For medical operations to develop a comprehensive strategy for the spaceflight stone risk, both preventive countermeasures and contingency management (CM) plans must be included. METHODS: A feasibility study was conducted to demonstrate the potential CM technique of endoscopic ureteral stenting with ultrasound guidance for the possible in-flight urinary calculus contingency. The procedure employed the International Space Station/Human Research Facility ultrasound unit for guide wire and stent localization, a flexible cystoscope for visual guidance, and banded, biocompatible soft ureteral stents to successfully stent porcine ureters bilaterally in zero gravity (0g). RESULTS: The study demonstrated that downlinked endoscopic surgical and ultrasound images obtained in 0g are comparable in quality to 1g images, and therefore are useful for diagnostic clinical utility via telemedicine transmission. CONCLUSIONS: In order to be successful, surgical procedures in 0g require excellent positional stability of the operating surgeon, assistant, and patient, relative to one another. The technological development of medical procedures for long-duration spaceflight contingencies may lead to improved terrestrial patient care methodology and subsequently reduced morbidity.

Management of Patients with Orthopaedic Implants Undergoing Dental Procedures.

PubMed

Quinn, Robert H; Murray, Jayson N; Pezold, Ryan; Sevarino, Kaitlyn S

2017-07-01

The American Academy of Orthopaedic Surgeons, in collaboration with the American Dental Association, has developed Appropriate Use Criteria (AUC) for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Management of Patients with Orthopaedic Implants Undergoing Dental Procedures AUC clinical patient scenarios were derived from indications of patients with orthopaedic implants presenting for dental procedures, as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of the use of prophylactic antibiotics. The 64 patient scenarios and 1 treatment were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

Procedural volume and structure of interventional pulmonary fellowships: a survey of fellows and fellowship program directors.

PubMed

Yarmus, Lonny; Feller-Kopman, David; Imad, Melhem; Kim, Stephanie; Lee, Hans J

2013-09-01

Current interventional pulmonary (IP) procedural guidelines for competency are based on expert opinion. There are few objective data to support competency metrics for IP procedures. This survey reports procedural volume during IP fellowships to help define new standards in training and curriculum development. A web-based survey was developed to evaluate IP training procedural volume. The survey was administered to all US and Canadian IP fellowship directors and graduates in training from 2006 to 2011. The survey inquired about all diagnostic and therapeutic procedures performed during the specialized year of IP training. Questions regarding the training program structure were collected and analyzed. There was a 92.5% fellow response rate (37 of 40) and 77% fellowship director response rate (10 of 13) from programs in existence at the time of the survey. Procedural volume was consistent between fellowship directors and graduates (P = .64). Although there was a wide range of procedural volume and types of procedures between different programs, the procedural mean volumes were all significantly higher than the American College of Chest Physicians (ACCP) and American Thoracic Society/European Respiratory Society (ATS/ERS) guideline recommendations (P < .005). US and Canadian IP fellowships produce fellows with variable procedural volumes; however, these are significantly higher than ACCP and ATS/ERS guidelines for most programs and procedures. With a uniform training curriculum being adopted by the majority of IP fellowship programs in the United States and Canada, as well as data showing improved core knowledge in IP fellows undergoing a dedicated year of additional training, further metrics examining the impact of advanced IP training on patient outcomes are needed.

Tracking and Reporting Outcomes Of Procedural Sedation (TROOPS): Standardized Quality Improvement and Research Tools from the International Committee for the Advancement of Procedural Sedation.

PubMed

Roback, M G; Green, S M; Andolfatto, G; Leroy, P L; Mason, K P

2018-01-01

Many hospitals, and medical and dental clinics and offices, routinely monitor their procedural-sedation practices-tracking adverse events, outcomes, and efficacy in order to optimize the sedation delivery and practice. Currently, there exist substantial differences between settings in the content, collection, definition, and interpretation of such sedation outcomes, with resulting widespread reporting variation. With the objective of reducing such disparities, the International Committee for the Advancement of Procedural Sedation has herein developed a multidisciplinary, consensus-based, standardized tool intended to be applicable for all types of sedation providers in all locations worldwide. This tool is amenable for inclusion in either a paper or an electronic medical record. An additional, parallel research tool is presented to promote consistency and standardized data collection for procedural-sedation investigations. Copyright © 2017. Published by Elsevier Ltd.

Improvement for determining the axial capacity of drilled shafts in shale in Illinois.

DOT National Transportation Integrated Search

2013-05-01

In this project, Illinois-specific design procedures were developed for drilled shafts founded in weak shale. In addition, : recommendations for field and laboratory testing to characterize the in situ condition of weak shales in Illinois were : deve...

EPA Geospatial Quality Council Promoting Quality Assurance in the Geospatial Coummunity

EPA Science Inventory

After establishing a foundation for the EPA National Geospatial Program, the EPA Geospatial Quality Council (GQC) is, in part, focusing on improving administrative efficiency in the geospatial community. To realize this goal, the GQC is developing Standard Operating Procedures (S...

A Resource Manual for Speech and Hearing Programs in Oklahoma.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Education, Oklahoma City.

Administrative aspects of the Oklahoma speech and hearing program are described, including state requirements, school administrator role, and organizational and operational procedures. Information on speech and language development and remediation covers language, articulation, stuttering, voice disorders, cleft palate, speech improvement,…

Accounting Systems for School Districts.

ERIC Educational Resources Information Center

Atwood, E. Barrett, Jr.

1983-01-01

Advises careful analysis and improvement of existing school district accounting systems prior to investment in new ones. Emphasizes the importance of attracting and maintaining quality financial staffs, developing an accounting policies and procedures manual, and designing a good core accounting system before purchasing computer hardware and…

Improving Teaching Effectiveness: Florida Essential Competency Studies.

ERIC Educational Resources Information Center

Wilson, Garfield

The Florida Council on Teacher Education (COTE) planned and conducted statewide involvement studies to determine competencies that are essential and acceptable to the profession. This included systematic involvement procedures for gaining professional agreement on identification, assessment, implementation, and other development and research on…

Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease.

PubMed

Krasznai, A G; Sigterman, T A; Welten, R J; Heijboer, R; Sikkink, C J J M; van de Akker, L H J M; Bouwman, L H

2013-11-01

Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries. From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure. Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively. PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Cerebral Aneurysm Clipping Surgery Simulation Using Patient-Specific 3D Printing and Silicone Casting.

PubMed

Ryan, Justin R; Almefty, Kaith K; Nakaji, Peter; Frakes, David H

2016-04-01

Neurosurgery simulator development is growing as practitioners recognize the need for improved instructional and rehearsal platforms to improve procedural skills and patient care. In addition, changes in practice patterns have decreased the volume of specific cases, such as aneurysm clippings, which reduces the opportunity for operating room experience. The authors developed a hands-on, dimensionally accurate model for aneurysm clipping using patient-derived anatomic data and three-dimensional (3D) printing. Design of the model focused on reproducibility as well as adaptability to new patient geometry. A modular, reproducible, and patient-derived medical simulacrum was developed for medical learners to practice aneurysmal clipping procedures. Various forms of 3D printing were used to develop a geometrically accurate cranium and vascular tree featuring 9 patient-derived aneurysms. 3D printing in conjunction with elastomeric casting was leveraged to achieve a patient-derived brain model with tactile properties not yet available from commercial 3D printing technology. An educational pilot study was performed to gauge simulation efficacy. Through the novel manufacturing process, a patient-derived simulacrum was developed for neurovascular surgical simulation. A follow-up qualitative study suggests potential to enhance current educational programs; assessments support the efficacy of the simulacrum. The proposed aneurysm clipping simulator has the potential to improve learning experiences in surgical environment. 3D printing and elastomeric casting can produce patient-derived models for a dynamic learning environment that add value to surgical training and preparation. Copyright © 2016 Elsevier Inc. All rights reserved.

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department.

PubMed

Thomas, Anita A; Uspal, Neil G; Oron, Assaf P; Klein, Eileen J

2016-12-01

Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills ( P  < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use ( P  = .30, paired difference -0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use ( P  < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use ( P  < .05, paired difference -0.4 points). Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training.

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department

PubMed Central

Thomas, Anita A.; Uspal, Neil G.; Oron, Assaf P.; Klein, Eileen J.

2016-01-01

Background  Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. Objective  We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Methods  Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Results  Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills (P < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use (P = .30, paired difference −0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use (P < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use (P < .05, paired difference −0.4 points). Conclusions  Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training. PMID:28018542

Railroad safety program, volume 1

NASA Technical Reports Server (NTRS)

1985-01-01

Since 1981, the Federal Railroad Administration (FRA) has annually prepared a National Inspection Plan (NIP) whose purpose is to summarize regional efforts to improve railroad transportation safety. The research concluded on the following tasks including the problems, conclusions and recommendations associated with these tasks is summarized: (1) the preparation of the 1983 NIP, with recommended procedures for improving future NIPs; (2) the development of an outline for the 1984 NIP, including a methodology for the allocation of inspection resources and other specialized regional activities; (3) the management and development of the 1984 NIP; and (4) the development of an instruction manual to be used in the preparation of future NIPs.

Improved modeling of GaN HEMTs for predicting thermal and trapping-induced-kink effects

NASA Astrophysics Data System (ADS)

Jarndal, Anwar; Ghannouchi, Fadhel M.

2016-09-01

In this paper, an improved modeling approach has been developed and validated for GaN high electron mobility transistors (HEMTs). The proposed analytical model accurately simulates the drain current and its inherent trapping and thermal effects. Genetic-algorithm-based procedure is developed to automatically find the fitting parameters of the model. The developed modeling technique is implemented on a packaged GaN-on-Si HEMT and validated by DC and small-/large-signal RF measurements. The model is also employed for designing and realizing a switch-mode inverse class-F power amplifier. The amplifier simulations showed a very good agreement with RF large-signal measurements.

Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

PubMed

Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

2008-01-01

The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.

US Army Institute of Dental Research Annual Progress Report FY80.

DTIC Science & Technology

1980-10-01

indicates that use of the laser technique does result in increased connectiv tissue regeneration and improved resolution of the periodontal defects...connectiv tissue regeneration and improved resolution of the periodontal defects. Final analysis of histologic data on the use of the neodymium laser for in...and 21 Bone Regeneration in Trnumatic Wounds (Pathology) DA OH 6038 Development of Endodontic Procedures for 22 Military Dentistry ( Oral Biology) DA OK

Introducing a laparoscopic simulation training and credentialing program in gynaecology: an observational study.

PubMed

Janssens, Sarah; Beckmann, Michael; Bonney, Donna

2015-08-01

Simulation training in laparoscopic surgery has been shown to improve surgical performance. To describe the implementation of a laparoscopic simulation training and credentialing program for gynaecology registrars. A pilot program consisting of protected, supervised laparoscopic simulation time, a tailored curriculum and a credentialing process, was developed and implemented. Quantitative measures assessing simulated surgical performance were measured over the simulation training period. Laparoscopic procedures requiring credentialing were assessed for both the frequency of a registrar being the primary operator and the duration of surgery and compared to a presimulation cohort. Qualitative measures regarding quality of surgical training were assessed pre- and postsimulation. Improvements were seen in simulated surgical performance in efficiency domains. Operative time for procedures requiring credentialing was reduced by 12%. Primary operator status in the operating theatre for registrars was unchanged. Registrar assessment of training quality improved. The introduction of a laparoscopic simulation training and credentialing program resulted in improvements in simulated performance, reduced operative time and improved registrar assessment of the quality of training. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Using Six Sigma to reduce medication errors in a home-delivery pharmacy service.

PubMed

Castle, Lon; Franzblau-Isaac, Ellen; Paulsen, Jim

2005-06-01

Medco Health Solutions, Inc. conducted a project to reduce medication errors in its home-delivery service, which is composed of eight prescription-processing pharmacies, three dispensing pharmacies, and six call-center pharmacies. Medco uses the Six Sigma methodology to reduce process variation, establish procedures to monitor the effectiveness of medication safety programs, and determine when these efforts do not achieve performance goals. A team reviewed the processes in home-delivery pharmacy and suggested strategies to improve the data-collection and medication-dispensing practices. A variety of improvement activities were implemented, including a procedure for developing, reviewing, and enhancing sound-alike/look-alike (SALA) alerts and system enhancements to improve processing consistency across the pharmacies. "External nonconformances" were reduced for several categories of medication errors, including wrong-drug selection (33%), wrong directions (49%), and SALA errors (69%). Control charts demonstrated evidence of sustained process improvement and actual reduction in specific medication error elements. Establishing a continuous quality improvement process to ensure that medication errors are minimized is critical to any health care organization providing medication services.

Development, Implementation, and Evaluation of a Strategic Plan for Improving Physical Plant Management at Southwest Texas Junior College.

ERIC Educational Resources Information Center

Box, Wilford Winston

A study was conducted at Southwest Texas Junior College (STJC) to assess current management practices used by the physical plant maintenance department (PPMD) and to develop a strategic plan for physical plant management. Procedures included an analysis of current management practices and systems that affect physical resources, and periodic and…

The Role of OERI and Its Institutional Projects in Establishing an Effective Research, Development, and Dissemination Program. A Symposium (Rosslyn, Virginia, May 9, 1989).

ERIC Educational Resources Information Center

Office of Educational Research and Improvement (ED), Washington, DC.

This symposium was intended to promote discussion of policies, procedures, and activities to enhance collaboration among programs of the Office of Educational Research and Improvement (OERI) in ways that would contribute to more efficient and effective management of the nation's overall educational research, development, and dissemination…

Paediatric musculoskeletal interventional radiology.

PubMed

Natali, Gian L; Paolantonio, Guglielmo; Fruhwirth, Rodolfo; Alvaro, Giuseppe; Parapatt, George K; Toma', Paolo; Rollo, Massimo

2016-01-01

Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population.

Development of Advanced Verification and Validation Procedures and Tools for the Certification of Learning Systems in Aerospace Applications

NASA Technical Reports Server (NTRS)

Jacklin, Stephen; Schumann, Johann; Gupta, Pramod; Richard, Michael; Guenther, Kurt; Soares, Fola

2005-01-01

Adaptive control technologies that incorporate learning algorithms have been proposed to enable automatic flight control and vehicle recovery, autonomous flight, and to maintain vehicle performance in the face of unknown, changing, or poorly defined operating environments. In order for adaptive control systems to be used in safety-critical aerospace applications, they must be proven to be highly safe and reliable. Rigorous methods for adaptive software verification and validation must be developed to ensure that control system software failures will not occur. Of central importance in this regard is the need to establish reliable methods that guarantee convergent learning, rapid convergence (learning) rate, and algorithm stability. This paper presents the major problems of adaptive control systems that use learning to improve performance. The paper then presents the major procedures and tools presently developed or currently being developed to enable the verification, validation, and ultimate certification of these adaptive control systems. These technologies include the application of automated program analysis methods, techniques to improve the learning process, analytical methods to verify stability, methods to automatically synthesize code, simulation and test methods, and tools to provide on-line software assurance.

Micro-scale experimental study of Microbial-Induced Carbonate Precipitation (MICP) by using microfluidic devices

NASA Astrophysics Data System (ADS)

Wang, Y.; Soga, K.; DeJong, J. T.; Kabla, A.

2017-12-01

Microbial-induced carbonate precipitation (MICP), one of the bio-mineralization processes, is an innovative subsurface improvement technique for enhancing the strength and stiffness of soils, and controlling their hydraulic conductivity. These macro-scale engineering properties of MICP treated soils controlled by micro-scale factors of the precipitated carbonate, such as its content, amount and distribution in the soil matrix. The precipitation process itself is affected by bacteria amount, reaction kinetics, porous medium geometry and flow distribution in the soils. Accordingly, to better understand the MICP process at the pore scale a new experimental technique that can observe the entire process of MICP at the pore-scale was developed. In this study, a 2-D transparent microfluidic chip made of Polydimethylsiloxane (PDMS) representing the soil matrix was designed and fabricated. A staged-injection MICP treatment procedure was simulated inside the microfluidic chip while continuously monitored using microscopic techniques. The staged-injection MICP treatment procedure started with the injection of bacteria suspension, followed with the bacteria setting for attachment, and then ended with the multiple injections of cementation liquid. The main MICP processes visualized during this procedure included the bacteria transport and attachment during the bacteria injection, the bacteria attachment and growth during the bacteria settling, the bacteria detachment during the cementation liquid injection, the cementation development during the cementation liquid injection, and the cementation development after the completion of cementation liquid injection. It is suggested that the visualization of the main MICP processes using the microfluidic technique can improve understating of the fundamental mechanisms of MICP and consequently help improve the treatment technique for in situ implementation of MICP.

Articulated Arm Coordinate Measuring Machine Calibration by Laser Tracker Multilateration

PubMed Central

Majarena, Ana C.; Brau, Agustín; Velázquez, Jesús

2014-01-01

A new procedure for the calibration of an articulated arm coordinate measuring machine (AACMM) is presented in this paper. First, a self-calibration algorithm of four laser trackers (LTs) is developed. The spatial localization of a retroreflector target, placed in different positions within the workspace, is determined by means of a geometric multilateration system constructed from the four LTs. Next, a nonlinear optimization algorithm for the identification procedure of the AACMM is explained. An objective function based on Euclidean distances and standard deviations is developed. This function is obtained from the captured nominal data (given by the LTs used as a gauge instrument) and the data obtained by the AACMM and compares the measured and calculated coordinates of the target to obtain the identified model parameters that minimize this difference. Finally, results show that the procedure presented, using the measurements of the LTs as a gauge instrument, is very effective by improving the AACMM precision. PMID:24688418

PDF approach for compressible turbulent reacting flows

NASA Technical Reports Server (NTRS)

Hsu, A. T.; Tsai, Y.-L. P.; Raju, M. S.

1993-01-01

The objective of the present work is to develop a probability density function (pdf) turbulence model for compressible reacting flows for use with a CFD flow solver. The probability density function of the species mass fraction and enthalpy are obtained by solving a pdf evolution equation using a Monte Carlo scheme. The pdf solution procedure is coupled with a compressible CFD flow solver which provides the velocity and pressure fields. A modeled pdf equation for compressible flows, capable of capturing shock waves and suitable to the present coupling scheme, is proposed and tested. Convergence of the combined finite-volume Monte Carlo solution procedure is discussed, and an averaging procedure is developed to provide smooth Monte-Carlo solutions to ensure convergence. Two supersonic diffusion flames are studied using the proposed pdf model and the results are compared with experimental data; marked improvements over CFD solutions without pdf are observed. Preliminary applications of pdf to 3D flows are also reported.

Effectiveness of facilitated introduction of a standard operating procedure into routine processes in the operating theatre: a controlled interrupted time series.

PubMed

Morgan, Lauren; New, Steve; Robertson, Eleanor; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; Pickering, Sharon P; Hadi, Mohammed; Griffin, Damian; McCulloch, Peter

2015-02-01

Standard operating procedures (SOPs) should improve safety in the operating theatre, but controlled studies evaluating the effect of staff-led implementation are needed. In a controlled interrupted time series, we evaluated three team process measures (compliance with WHO surgical safety checklist, non-technical skills and technical performance) and three clinical outcome measures (length of hospital stay, complications and readmissions) before and after a 3-month staff-led development of SOPs. Process measures were evaluated by direct observation, using Oxford Non-Technical Skills II for non-technical skills and the 'glitch count' for technical performance. All staff in two orthopaedic operating theatres were trained in the principles of SOPs and then assisted to develop standardised procedures. Staff in a control operating theatre underwent the same observations but received no training. The change in difference between active and control groups was compared before and after the intervention using repeated measures analysis of variance. We observed 50 operations before and 55 after the intervention and analysed clinical data on 1022 and 861 operations, respectively. The staff chose to structure their efforts around revising the 'whiteboard' which documented and prompted tasks, rather than directly addressing specific task problems. Although staff preferred and sustained the new system, we found no significant differences in process or outcome measures before/after intervention in the active versus the control group. There was a secular trend towards worse outcomes in the postintervention period, seen in both active and control theatres. SOPs when developed and introduced by frontline staff do not necessarily improve operative processes or outcomes. The inherent tension in improvement work between giving staff ownership of improvement and maintaining control of direction needs to be managed, to ensure staff are engaged but invest energy in appropriate change. 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.

Reconstruction and systemization of the methodologies for strategic environmental assessment in Taiwan

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

Liou, M.-L.; Yeh, S.-C.; Yu, Y.-H.

2006-03-15

This paper discusses the current SEA procedures and assessment methodologies, aiming to propose strategies that can lead to effective improvement in a newly industrialized Asian country, Taiwan. Institutional and practical problems with regard to the regulations and tools of SEA in Taiwan are compared to those in other countries. According to the research results, it is suggested that extra evaluation processes should be incorporated into the current assessment procedures to improve their scientific validity and integrity. Moreover, it is also suggested that the sustainability appraisal approaches be included in the SEA framework. In this phase, revised evaluation indicators associated withmore » corresponding targets can be the first attempt for modifying the SEA system. It is believed that these can promote the operability in practice and also lead the whole assessment procedures to a direction closer to sustainable development. The trails that Taiwan has followed can help other countries that are going to adopt SEA to find a more effective and efficient way to follow.« less

Proposed use of two-part interactive modeling as a means to increase functional skills in children with a variety of disabilities.

PubMed

Pepperberg, I M; Sherman, D

2000-01-01

Many behavior modification and intervention programs are based on operant procedures developed for animal subjects, but few use modeling procedures in which one student observes interactions between two proficient trainers. We show how such procedures, which successfully trained Grey parrots (Psittacus erithacus) to produce and comprehend elements of human language, can be adapted for use with children with three types of disabilities: (a) autism with limited social and language skills, (b) developmental delay with physical handicaps and lack of language skills, and (c) hyperactivity with impaired cognitive and social skills. Children were evaluated before entering the program and outcomes were recorded to determine improvement levels. No child reached totally normative (physical age-appropriate) levels, but all significantly improved their social and communication skills and use of contextually appropriate behavior. A two-trainer modeling system can be a valuable intervention tool for children whose disabilities involve social and communicative skills.

Improving the human readability of Arden Syntax medical logic modules using a concept-oriented terminology and object-oriented programming expressions.

PubMed

Choi, Jeeyae; Bakken, Suzanne; Lussier, Yves A; Mendonça, Eneida A

2006-01-01

Medical logic modules are a procedural representation for sharing task-specific knowledge for decision support systems. Based on the premise that clinicians may perceive object-oriented expressions as easier to read than procedural rules in Arden Syntax-based medical logic modules, we developed a method for improving the readability of medical logic modules. Two approaches were applied: exploiting the concept-oriented features of the Medical Entities Dictionary and building an executable Java program to replace Arden Syntax procedural expressions. The usability evaluation showed that 66% of participants successfully mapped all Arden Syntax rules to Java methods. These findings suggest that these approaches can play an essential role in the creation of human readable medical logic modules and can potentially increase the number of clinical experts who are able to participate in the creation of medical logic modules. Although our approaches are broadly applicable, we specifically discuss the relevance to concept-oriented nursing terminologies and automated processing of task-specific nursing knowledge.

Current Status of Laparoendoscopic Single-Site Surgery in Urologic Surgery

PubMed Central

2012-01-01

Since the introduction of laparoscopic surgery, the promise of lower postoperative morbidity and improved cosmesis has been achieved. Laparoendoscopic single-site surgery (LESS) potentially takes this further. Following the first human urological LESS report in 2007, numerous case series have emerged, as well as comparative studies comparing LESS with standard laparoscopy. However, comparative series between conventional laparoscopy and LESS for different procedures suggest a non-inferiority of LESS over standard laparoscopy, but the only objective benefit remains an improved cosmetic outcome. Challenging ergonomics, instrument clashing, lack of true triangulation, and in-line vision are the main concerns with LESS surgery. Various new instruments have been designed, but only experienced laparoscopists and well-selected patients are pivotal for a successful LESS procedure. Robotic-assisted LESS procedures have been performed. The available robotic platform remains bulky, but development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery. PMID:22866213

An experimental protocol for the definition of upper limb anatomical frames on children using magneto-inertial sensors.

PubMed

Ricci, L; Formica, D; Tamilia, E; Taffoni, F; Sparaci, L; Capirci, O; Guglielmelli, E

2013-01-01

Motion capture based on magneto-inertial sensors is a technology enabling data collection in unstructured environments, allowing "out of the lab" motion analysis. This technology is a good candidate for motion analysis of children thanks to the reduced weight and size as well as the use of wireless communication that has improved its wearability and reduced its obtrusivity. A key issue in the application of such technology for motion analysis is its calibration, i.e. a process that allows mapping orientation information from each sensor to a physiological reference frame. To date, even if there are several calibration procedures available for adults, no specific calibration procedures have been developed for children. This work addresses this specific issue presenting a calibration procedure for motion capture of thorax and upper limbs on healthy children. Reported results suggest comparable performance with similar studies on adults and emphasize some critical issues, opening the way to further improvements.

The Application of Six Sigma Techniques in the Evaluation of Enzyme Measurement Procedures in China.

PubMed

Zhang, Chuanbao; Zhao, Haijian; Wang, Jing; Zeng, Jie; Wang, Zhiguo

2015-01-01

Recently, Six Sigma techniques have been adopted by clinical laboratories to evaluate laboratory performance. Measurement procedures in laboratories can be categorized as "excellent", "good", and "improvement needed" based on sigma (σ) metrics of σ ≥ 6, 3 ≤ σ < 6, and σ < 3, respectively. The quality goal index (QGI) was further investigated for measurement procedures with σ ≤ 3. Improvements of the procedures were recommended based on QGI: QGI < 0.8 indicates that the precision of the procedure needs to be improved; QGI > 1.2 indicates that the trueness of the procedure needs to be improved; 0.8 ≤ QGI ≤ 1.2 indicates that both the precision and trueness of the procedure need to be improved. Fresh frozen sera containing seven enzymes (ALT, ALP, AMY, AST, CK, GGT, and LDH) were sent to 78 clinical laboratories in China. The biases for measurement procedures in each laboratory (Bias) were calculated based on the target values assigned by 18 laboratories performing IFCC (International Federation of Clinical Chemistry and Laboratory medicine) recommended reference methods. The imprecision of each measurement procedure was represented by coefficient variations (CV) calculated based on internal quality control (IQC) data. The σ and QGI values were calculated as follows: σ = (TEa-Bias)/CV; QGI = Bias/(1.5 x CV). TEa is allowable total error for each enzyme derived from biological variation. Our study indicated that 7.9% (6/76, ALP) to 31.0% (18/58, AMY) of the participating laboratories were scored as "excellent" (σ ≥ 6), 21.1% (16/76, ALP) to 41.3% (31/75, CK) of the laboratories were scored as "good" (3 ≤ σ < 6), and 31.0% (18/58, AMY) to 71.1% (54/76, ALP) of the laboratories need to improve their enzyme measurement procedures (σ < 3). For those with σ < 3, QGIs were further calculated. Based on QGI values, 8.6% (5/58, AMY) to 35.9% (28/78, LDH) of the laboratories (QGI < 0.8) need to improve the precision of the procedures, 8.0% (6/75, CK) to 52.6% (40/76, ALP) of the laboratories (QGI ≤ 1.2) need to improve the trueness of the procedures; and 2.7% (2/75, AST) to 16.3% (8/49, GGT) of the laboratories (0.8 ≤ QGI ≤ 1.2) need to improve both the precision and trueness of the procedures. Even though rapid progress has been made to standardize serum enzyme measurements in China in recent years, our study using Six Sigma techniques still suggested that approximately 31.1% to 71.0% of the laboratories need to improve their enzyme measurement procedures, either in terms of precision, trueness, or both.

N-gram support vector machines for scalable procedure and diagnosis classification, with applications to clinical free text data from the intensive care unit.

PubMed

Marafino, Ben J; Davies, Jason M; Bardach, Naomi S; Dean, Mitzi L; Dudley, R Adams

2014-01-01

Existing risk adjustment models for intensive care unit (ICU) outcomes rely on manual abstraction of patient-level predictors from medical charts. Developing an automated method for abstracting these data from free text might reduce cost and data collection times. To develop a support vector machine (SVM) classifier capable of identifying a range of procedures and diagnoses in ICU clinical notes for use in risk adjustment. We selected notes from 2001-2008 for 4191 neonatal ICU (NICU) and 2198 adult ICU patients from the MIMIC-II database from the Beth Israel Deaconess Medical Center. Using these notes, we developed an implementation of the SVM classifier to identify procedures (mechanical ventilation and phototherapy in NICU notes) and diagnoses (jaundice in NICU and intracranial hemorrhage (ICH) in adult ICU). On the jaundice classification task, we also compared classifier performance using n-gram features to unigrams with application of a negation algorithm (NegEx). Our classifier accurately identified mechanical ventilation (accuracy=0.982, F1=0.954) and phototherapy use (accuracy=0.940, F1=0.912), as well as jaundice (accuracy=0.898, F1=0.884) and ICH diagnoses (accuracy=0.938, F1=0.943). Including bigram features improved performance on the jaundice (accuracy=0.898 vs 0.865) and ICH (0.938 vs 0.927) tasks, and outperformed NegEx-derived unigram features (accuracy=0.898 vs 0.863) on the jaundice task. Overall, a classifier using n-gram support vectors displayed excellent performance characteristics. The classifier generalizes to diverse patient populations, diagnoses, and procedures. SVM-based classifiers can accurately identify procedure status and diagnoses among ICU patients, and including n-gram features improves performance, compared to existing methods. 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.

Surgical task analysis of simulated laparoscopic cholecystectomy with a navigation system.

PubMed

Sugino, T; Kawahira, H; Nakamura, R

2014-09-01

   Advanced surgical procedures, which have become complex and difficult, increase the burden of surgeons. Quantitative analysis of surgical procedures can improve training, reduce variability, and enable optimization of surgical procedures. To this end, a surgical task analysis system was developed that uses only surgical navigation information.    Division of the surgical procedure, task progress analysis, and task efficiency analysis were done. First, the procedure was divided into five stages. Second, the operating time and progress rate were recorded to document task progress during specific stages, including the dissecting task. Third, the speed of the surgical instrument motion (mean velocity and acceleration), as well as the size and overlap ratio of the approximate ellipse of the location log data distribution, was computed to estimate the task efficiency during each stage. These analysis methods were evaluated based on experimental validation with two groups of surgeons, i.e., skilled and "other" surgeons. The performance metrics and analytical parameters included incidents during the operation, the surgical environment, and the surgeon's skills or habits.    Comparison of groups revealed that skilled surgeons tended to perform the procedure in less time and involved smaller regions; they also manipulated the surgical instruments more gently.    Surgical task analysis developed for quantitative assessment of surgical procedures and surgical performance may provide practical methods and metrics for objective evaluation of surgical expertise.

Improved Cryopreservation of Human Umbilical Vein Endothelial Cells: A Systematic Approach

NASA Astrophysics Data System (ADS)

Sultani, A. Billal; Marquez-Curtis, Leah A.; Elliott, Janet A. W.; McGann, Locksley E.

2016-10-01

Cryopreservation of human umbilical vein endothelial cells (HUVECs) facilitated their commercial availability for use in vascular biology, tissue engineering and drug delivery research; however, the key variables in HUVEC cryopreservation have not been comprehensively studied. HUVECs are typically cryopreserved by cooling at 1 °C/min in the presence of 10% dimethyl sulfoxide (DMSO). We applied interrupted slow cooling (graded freezing) and interrupted rapid cooling with a hold time (two-step freezing) to identify where in the cooling process cryoinjury to HUVECs occurs. We found that linear cooling at 1 °C/min resulted in higher membrane integrities than linear cooling at 0.2 °C/min or nonlinear two-step freezing. DMSO addition procedures and compositions were also investigated. By combining hydroxyethyl starch with DMSO, HUVEC viability after cryopreservation was improved compared to measured viabilities of commercially available cryopreserved HUVECs and viabilities for HUVEC cryopreservation studies reported in the literature. Furthermore, HUVECs cryopreserved using our improved procedure showed high tube forming capability in a post-thaw angiogenesis assay, a standard indicator of endothelial cell function. As well as presenting superior cryopreservation procedures for HUVECs, the methods developed here can serve as a model to optimize the cryopreservation of other cells.

Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest

PubMed Central

2012-01-01

Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development. PMID:22762776

Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.

PubMed

Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven

2012-07-04

Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

[Laparoscopic technique--which developments are possible?].

PubMed

Voges, U

1996-05-01

The progress of laparoscopy is influenced by both the medical and technical aspects. The development of endoscopes and various rigid instruments has increased the indication options. Nevertheless, several drawbacks remain, e.g. the limited spatial view, the missing sense of touch, and reduced mobility in the operation area. New 3D visual systems now introduce spatial view. Flexible instruments are being developed that allow thorough examination of organs. While these enhancements are now becoming available, research and development are making progress and preparing the next steps. One vision is the development of a telepresence and telemanipulation system. With it, at the patient's side we will have an endoscope guidance system and several instrument guidance systems, which will be telemanipulated from a control station. At the control station, a 3D picture from the operation scene, together with virtual reality simulation pictures will be available. Force reflection as well as palpatory sensing information will be readily available to the telesurgeon. These new developments will improve the quality of the surgery for the benefit of both the patient and surgeon. Furthermore, the training of new surgeons will be eased by the use of sophisticated simulators using virtual reality techniques. These and further technical developments will not only lead to an improvement in current laparoscopy procedures, but it can be expected that additional procedures will be developed that are not yet possible and accessible to laparoscopy.

Need for Initiatives to Promote Procedural Understanding in Physics among School Teachers

NASA Astrophysics Data System (ADS)

Khaparde, Rajesh B.

2010-07-01

It is believed that there are three essential abilities which a student develops through a set of introductory physics laboratory courses. These abilities include 1) conceptual understanding, 2) experimental skills, and 3) procedural understanding. While the first two are well accepted, the third one is often implicit and goes behind the planning and execution of experimental physics. Procedural understanding has been described by a number of researchers including R. Gott and S. Duggan [1], and R. Roberts [2]. The author in his work [3] has adopted the approach of these researchers and extended it to physics laboratory training at the university level. Procedural understanding is the understanding of a set of ideas or concepts related to the `knowing how' of science and needed to put science into practice. It is the understanding of `concepts of evidence' like variable identification, sample size, variable types, relative scale, range, interval, choice of instruments, repeatability, graph type, etc. It is the thinking behind the doing and is a kind of cognitive understanding in its own right. It has been observed that while school (Grade 1-12) teachers are reasonably prepared to help students with respect to the development of conceptual understanding and experimental skills, a few are aware of the contents, methods and strategies related to the development of procedural understanding. It is felt that school teachers can play a very important role in helping students to develop procedural understanding at an early stage of their education and before students enter university courses. A need was felt to initiate and promote well-planned teacher improvement programmes at various levels of school education, with an objective to develop procedural understanding and understand the strategies of teaching suitable for various regions and learning environments. The author has initiated one such programme in India and will present details of a workshop organized at Mumbai, India.

Design and Evaluation of Ergonomic Interventions for the Prevention of Musculoskeletal Disorders in India

PubMed Central

2014-01-01

Background Improper workstation, work procedures and tools are found to be the risk factors for the development of musculoskeletal disorders among the informal sector workers of the developing countries. Low cost ergonomic interventions can effectively improve such adverse conditions. Case presentation In the present article some studies related to design interventions in different informal and agricultural sectors were discussed and their efficacies were analyzed. It was observed that with the help of appropriate interventions musculoskeletal disorders were reduced, adverse physiological conditions were improved when awkward postures were corrected and ultimately the organisational productivity was increased. Conclusion Proper implementation of ergonomic interventions can ultimately improve the economy of the nation. PMID:25009740

Decision making technical support study for the US Army's Chemical Stockpile Disposal Program

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

Feldman, D.L.; Dobson, J.E.

1990-08-01

This report examines the adequacy of current command and control systems designed to make timely decisions that would enable sufficient warning and protective response to an accident at the Edgewood area of Aberdeen Proving Ground (APG), Maryland, and at Pine Bluff Arsenal (PBA), Arkansas. Institutional procedures designed to facilitate rapid accident assessment, characterization, warning, notification, and response after the onset of an emergency and computer-assisted decision-making aids designed to provide salient information to on- and-off-post emergency responders are examined. The character of emergency decision making at APG and PBA, as well as potential needs for improvements to decision-making practices, procedures,more » and automated decision-support systems (ADSSs), are described and recommendations are offered to guide equipment acquisition and improve on- and off-post command and control relationships. We recommend that (1) a continued effort be made to integrate on- and off-post command control, and decision-making procedures to permit rapid decision making; (2) the pathways for alert and notification among on- and off-post officials be improved and that responsibilities and chain of command among off-post agencies be clarified; (3) greater attention be given to organizational and social context factors that affect the adequacy of response and the likelihood that decision-making systems will work as intended; and (4) faster improvements be made to on-post ADSSs being developed at APG and PBA, which hold considerable promise for depicting vast amounts of information. Phased development and procurement of computer-assisted decision-making tools should be undertaken to balance immediate needs against available resources and to ensure flexibility, equity among sites, and compatibility among on- and off-post systems. 112 refs., 6 tabs.« less

Procedural Portfolio Planning in Plastic Surgery, Part 2: Collaboration Between Surgeons and Hospital Administrators to Develop a Funds Flow Model for Procedures Performed at an Academic Medical Center.

PubMed

Hultman, Charles Scott

2016-06-01

Although plastic surgeons make important contributions to the clinical, educational, and research missions of academic medical centers (AMCs), determining the financial value of a plastic surgery service can be difficult, due to complex cost accounting systems. We analyzed the financial impact of plastic surgery on an AMC, by examining the contribution margins and operating income of surgical procedures. We collaborated with hospital administrators to implement 3 types of strategic changes: (1) growth of areas with high contribution margin, (2) curtailment of high-risk procedures with negative contribution margin, (3) improved efficiency of mission-critical services with high resource consumption. Outcome measures included: facility charges, hospital collections, contribution margin, operating margin, and operating room times. We also studied the top 50 Current Procedural Terminology codes (total case number × charge/case), ranking procedures for profitability, as determined by operating margin. During the 2-year study period, we had no turnover in faculty; did not pursue any formal marketing; did not change our surgical fees, billing system, or payer mix; and maintained our commitment to indigent care. After rebalancing our case mix, through procedural portfolio planning, average hospital operating income/procedure increased from $-79 to $+816. Volume and diversity of cases increased, with no change in payer mix. Although charges/case decreased, both contribution margin and operating margin increased, due to improved throughput and decreased operating room times. The 5 most profitable procedures for the hospital were hernia repair, mandibular osteotomy, hand skin graft, free fibula flap, and head and neck flap, whereas the 5 least profitable were latissimus breast reconstruction, craniosynostosis repair, free-flap breast reconstruction, trunk skin graft, and cutaneous free flap. Total operating income for the hospital, from plastic surgery procedures, increased from $-115,103 to $+1,277,040, of which $350,000 (25%) was returned to the practice plan as enterprise funds to support program development. Through focused strategic initiatives, plastic surgeons and hospital administrators can work together to unlock the latent value of a plastic surgery service to an AMC. Specific financial benefits to the hospital include increased contribution margin and operating income, the latter of which can be reinvested in the plastic surgery service through a gain-sharing model.

Review of advanced catheter technologies in radiation oncology brachytherapy procedures

PubMed Central

Zhou, Jun; Zamdborg, Leonid; Sebastian, Evelyn

2015-01-01

The development of new catheter and applicator technologies in recent years has significantly improved treatment accuracy, efficiency, and outcomes in brachytherapy. In this paper, we review these advances, focusing on the performance of catheter imaging and reconstruction techniques in brachytherapy procedures using magnetic resonance images and electromagnetic tracking. The accuracy of catheter reconstruction, imaging artifacts, and other notable properties of plastic and titanium applicators in gynecologic treatments are reviewed. The accuracy, noise performance, and limitations of electromagnetic tracking for catheter reconstruction are discussed. Several newly developed applicators for accelerated partial breast irradiation and gynecologic treatments are also reviewed. New hypofractionated high dose rate treatment schemes in prostate cancer and accelerated partial breast irradiation are presented. PMID:26203277

Miniature high temperature plug-type heat flux gauges

NASA Technical Reports Server (NTRS)

Liebert, Curt H.

1992-01-01

The objective is to describe continuing efforts to develop methods for measuring surface heat flux, gauge active surface temperature, and heat transfer coefficient quantities. The methodology involves inventing a procedure for fabricating improved plug-type heat flux gauges and also for formulating inverse heat conduction models and calculation procedures. These models and procedures are required for making indirect measurements of these quantities from direct temperature measurements at gauge interior locations. Measurements of these quantities were made in a turbine blade thermal cycling tester (TBT) located at MSFC. The TBT partially simulates the turbopump turbine environment in the Space Shuttle Main Engine. After the TBT test, experiments were performed in an arc lamp to analyze gauge quality.

7 CFR 1781.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-01-01

... (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS) LOANS AND ADVANCES § 1781.1 Purpose. This part prescribes the policies and procedures for making: (a) Watershed (WS) loans and Watershed (WS) advances for works of improvement in a watershed project; and (b) Resource Conservation and...

7 CFR 1781.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-01-01

... (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS) LOANS AND ADVANCES § 1781.1 Purpose. This part prescribes the policies and procedures for making: (a) Watershed (WS) loans and Watershed (WS) advances for works of improvement in a watershed project; and (b) Resource Conservation and...

7 CFR 1781.1 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-01-01

... (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS) LOANS AND ADVANCES § 1781.1 Purpose. This part prescribes the policies and procedures for making: (a) Watershed (WS) loans and Watershed (WS) advances for works of improvement in a watershed project; and (b) Resource Conservation and...

7 CFR 1781.1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-01-01

... (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS) LOANS AND ADVANCES § 1781.1 Purpose. This part prescribes the policies and procedures for making: (a) Watershed (WS) loans and Watershed (WS) advances for works of improvement in a watershed project; and (b) Resource Conservation and...

7 CFR 1781.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS) LOANS AND ADVANCES § 1781.1 Purpose. This part prescribes the policies and procedures for making: (a) Watershed (WS) loans and Watershed (WS) advances for works of improvement in a watershed project; and (b) Resource Conservation and...

Evaluating and improving incident management using historical incident data : case studies at Texas transportation management centers.

DOT National Transportation Integrated Search

2009-08-01

The companion guidebook (0-5485-P2) developed as part of this study provides the procedures and : methodologies for effective use of historical incident data at Texas Transportation Management Centers : (TMCs). This research report documents the resu...

The Orthopaedic Training Study. Final Report.

ERIC Educational Resources Information Center

Miller, George E.; And Others

A four year study was initiated to systematically improve the certification procedures of the American Board of Orthopaedic Surgery. Consequently, the immediate research aim was the development of more valid and reliable techniques in assessing professional competence in orthopedics. A definition of professional competence was reached through…

77 FR 43837 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-26

...), and their staff, and provides leadership and direction for CDC acquisition, assistance, and materiel management activities to improve the public's health; (2) plans and develops CDC-wide policies, procedures, and practices in acquisition, assistance, and materiel management areas to support public health...

How to Activate Teachers through Teacher Evaluation?

ERIC Educational Resources Information Center

Tuytens, Melissa; Devos, Geert

2014-01-01

There is a general doubt on whether teacher evaluation can contribute to teachers' professional development. Recently, standards-based teacher evaluation has been introduced in many countries to improve teaching practice. This study wants to investigate which teacher evaluation procedural, leadership, and teacher characteristics can stimulate…

Development of a TL-3 deep beam tubular backup bridge rail : executive summary report.

DOT National Transportation Integrated Search

2010-12-01

Ohio Department of Transportation (ODOT)s Office of Structural Engineering has a need to evaluate and, if necessary, improve an existing bridge rail design with a simple retrofitting procedure to meet current or proposed crash testing standards. T...

National Aeronautics Research and Development Plan

DTIC Science & Technology

2010-02-01

aeronautics research to improve aviation safety, air transportation, and reduce the environmental impacts of aviation; • Promotes the advancement of fuel...Reduce the Adverse Impacts of Weather on Air Traffic Management Decisions...Operational Procedures to Decrease the Significant Environmental Impacts of the Aviation System. . . 42 Future Implementation

40 CFR 1.41 - Office of Air and Radiation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Office of Air and Radiation. 1.41 Section 1.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL STATEMENT OF ORGANIZATION... of technological developments into improved control program procedures. (c) Office of Radiation...

40 CFR 1.41 - Office of Air and Radiation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Office of Air and Radiation. 1.41 Section 1.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL STATEMENT OF ORGANIZATION... of technological developments into improved control program procedures. (c) Office of Radiation...

40 CFR 1.41 - Office of Air and Radiation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Office of Air and Radiation. 1.41 Section 1.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL STATEMENT OF ORGANIZATION... of technological developments into improved control program procedures. (c) Office of Radiation...

40 CFR 1.41 - Office of Air and Radiation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Office of Air and Radiation. 1.41 Section 1.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL STATEMENT OF ORGANIZATION... of technological developments into improved control program procedures. (c) Office of Radiation...

40 CFR 1.41 - Office of Air and Radiation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Office of Air and Radiation. 1.41 Section 1.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL STATEMENT OF ORGANIZATION... of technological developments into improved control program procedures. (c) Office of Radiation...

Maternal and fetal outcomes in pregnant women undergoing balloon mitral valvotomy for rheumatic mitral stenosis.

PubMed

Vinayakumar, Desabandhu; Vinod, G V; Madhavan, Suresh; Krishnan, Mangalath Narayanan

Rheumatic mitral stenosis constitutes a major cause of acquired heart disease complicating pregnancy in India. In the present study, we have studied the fetal and maternal outcomes of women undergoing balloon mitral valvotomy during pregnancy. 49 pregnant ladies were included in this study in whom balloon mitral valvotomy was performed. The mean age of these patients was 25.7±3.1 years. The mean gestational age was 23.5±5.2 weeks (12-36 weeks). The procedure was successful in 48 patients (95.9%). Mean two-dimensional MVA increased from baseline value of 0.93±0.17cm 2 to 1.75±0.27cm 2 (p value <0.0001). Pre-procedure peak pulmonary artery pressure was 43.05±15.88mmHg, which decreased to 22.31±6.36mmHg (p value <0.0001). Hemodynamic data showed pre-BMV left atrial mean pressure of 29.6±6.6mmHg, which decreased to 13.7±4.8mmHg after the procedure (p value <0.0001). Mean fluoroscopy time was 6.4±1.2min. There was no maternal mortality in our study. One procedure had to be abandoned, because of failed septal puncture. One of the patients developed cardiac tamponade and another patient developed severe mitral regurgitation, which were managed medically. The patient who developed severe mitral regurgitation later underwent mitral valve replacement. Post-procedure follow-up showed an improvement in NYHA status by at least one class in 81.3% of patients. Thirty-nine (81.3%) patients had a term normal vaginal delivery and 8 (16.7%) underwent cesarean section for obstetric indications. One of the patients had abortion on the second day of the procedure. Percutaneous mitral valvotomy during pregnancy is safe and provides excellent symptomatic relief and hemodynamic improvement. This should be considered as the treatment of choice when managing pregnant women with severe mitral stenosis. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Automated Developmental Disabilities Out-Patient Treatment Review System (ADDOPTRS)—Development and Automation of a Microcomputer Based Case Management System

PubMed Central

Fisch, Clifford B.; Fisch, Martin L.

1979-01-01

The Stanley S. Lamm Institute for Developmental Disabilities of The Long Island College Hospital, in conjunction with Micro-Med Systems has developed a low cost micro-computer based information system (ADDOP TRS) which monitors quality of care in outpatient settings rendering services to the developmentally disabled population. The process of conversion from paper record keeping systems to direct key-to-disk data capture at the point of service delivery is described. Data elements of the information system including identifying patient information, coded and English-grammar entry procedures for tracking elements of service as well as their delivery status are described. Project evaluation criteria are defined including improved quality of care, improved productivity for clerical and professional staff and enhanced decision making capability. These criteria are achieved in a cost effective manner as a function of more efficient information flow. Administrative applications including staff/budgeting procedures, submissions for third party reimbursement and case reporting to utilization review committees are considered.

Implementing bright light treatment for MSFC payload operations shiftworkers

NASA Technical Reports Server (NTRS)

Hayes, Benita C.; Stewart, Karen T.; Eastman, Charmane I.

1994-01-01

Intense light can phase-shift circadian rhythms and improve performance, sleep, and wellbeing during shiftwork simulations, but to date there have been very few attempts to administer light treatment to real shiftworkers. We have developed procedures for implementing light treatment and have conducted controlled trials of light treatment for MSFC Payload Operations staff during the USML-1 mission. We found that treatment had beneficial effects on fatigue, alertness, self-rated job performance, sleep, mood, and work attendance. Although there are portable bright light boxes commercially available, there is no testing protocol and little performance information available. We measure the illuminance of two candidate boxes for use in this study and found that levels were consistently lower than those advertised by manufacturers. A device was developed to enhance the illuminance output of such units. This device increased the illuminance by at least 60 % and provided additional improvements in visual comfort and overall exposure. Both the design of this device and some suggested procedures for evaluating light devices are presented.

[Improvement of 2-mercaptoimidazoline analysis in rubber products containing chlorine].

PubMed

Kaneko, Reiko; Haneishi, Nahoko; Kawamura, Yoko

2012-01-01

An improved analysis method for 2-mercaptoimidazoline in rubber products containing chlorine was developed. 2-Mercaptoimidazoline (20 µg/mL) is detected by means of TLC with two developing solvents in the official method. But, this method is not quantitative. Instead, we employed HPLC using water-methanol (9 : 1) as the mobile phase. This procedure decreased interfering peaks, and the quantitation limit was 2 µg/mL of standard solution. 2-Mercaptoimidazoline was confirmed by GC-MS (5 µg/mL) and LC/MS (1 µg/mL) in the scan mode. For preparation of test solution, a soaking extraction method, in which 20 mL of methanol was added to the sample and allowed to stand overnight at about 40°C, was used. This gave similar values to the Soxhlet extraction method (official method) and was more convenient. The results indicate that our procedure is suitable for analysis of 2-mercaptoimidazoline. When 2-mercaptoimidazoline is detected, it is confirmed by either GC/MS or LC/MS.

Laparoscopic-assisted tension-free vaginal mesh: an innovative approach to placing synthetic mesh: transvaginally for surgical correction of pelvic organ prolapse.

PubMed

Watanabe, Toyohiko; Inoue, Miyabi; Ishii, Ayano; Yamato, Toyoko; Yamamoto, Masumi; Sasaki, Katsumi; Kobayashi, Yasuyuki; Araki, Motoo; Uehara, Shinya; Saika, Takashi; Kumon, Hiromi

2012-01-01

Polypropylene mesh implants for the correction of pelvic organ prolapse (POP) are now available in Japan. We developed an innovative approach for correcting POP by placing polypropylene mesh transvaginally with laparoscopic assistance. From June 2007 through March 2010, sixteen consecutive patients with symptomatic stage 2 or 3 pelvic organ prolapse underwent the laparoscopic-assisted tension-free vaginal mesh procedure at Okayama University Hospital. All patients were evaluated before and at 1, 3, 6, and 12 months after surgery. Female sexual function was also evaluated with the Female Sexual Function Index (FSFI). The procedure was performed successfully without significant complications. Fifteen of 16 patients were considered anatomically cured (93.8%) at 12 months postoperatively. One patient with a recurrent stage 3 vaginal vault prolapse required sacral colpopexy six months postoperatively. Total FSFI scores improved significantly from 10.3 ± 1.3 at baseline to 18.0 ± 1.2 at 12 months after surgery. The laparoscopic-assisted trans-vaginal mesh is a safe, effective, and simple procedure for POP repairs. The procedure not only restores anatomic relationships but also improves sexual function.

Facial recognition using multisensor images based on localized kernel eigen spaces.

PubMed

Gundimada, Satyanadh; Asari, Vijayan K

2009-06-01

A feature selection technique along with an information fusion procedure for improving the recognition accuracy of a visual and thermal image-based facial recognition system is presented in this paper. A novel modular kernel eigenspaces approach is developed and implemented on the phase congruency feature maps extracted from the visual and thermal images individually. Smaller sub-regions from a predefined neighborhood within the phase congruency images of the training samples are merged to obtain a large set of features. These features are then projected into higher dimensional spaces using kernel methods. The proposed localized nonlinear feature selection procedure helps to overcome the bottlenecks of illumination variations, partial occlusions, expression variations and variations due to temperature changes that affect the visual and thermal face recognition techniques. AR and Equinox databases are used for experimentation and evaluation of the proposed technique. The proposed feature selection procedure has greatly improved the recognition accuracy for both the visual and thermal images when compared to conventional techniques. Also, a decision level fusion methodology is presented which along with the feature selection procedure has outperformed various other face recognition techniques in terms of recognition accuracy.

Identification of potential neuromotor mechanisms of manual therapy in patients with musculoskeletal disablement: rationale and description of a clinical trial.

PubMed

Fisher, Beth E; Davenport, Todd E; Kulig, Kornelia; Wu, Allan D

2009-05-21

Many health care practitioners use a variety of hands-on treatments to improve symptoms and disablement in patients with musculoskeletal pathology.Research to date indirectly suggests a potentially broad effect of manual therapy on the neuromotor processing of functional behavior within the supraspinal central nervous system (CNS) in a manner that may be independent of modification at the level of local spinal circuits. However, the effect of treatment speed, as well as the specific mechanism and locus of CNS changes, remain unclear. We developed a placebo-controlled, randomized study to test the hypothesis that manual therapy procedures directed to the talocrural joint in individuals with post-acute ankle sprain induce a change in corticospinal excitability that is relevant to improve the performance of lower extremity functional behavior. This study is designed to identify potential neuromotor changes associated with manual therapy procedures directed to the appendicular skeleton, compare the relative effect of treatment speed on potential neuromotor effects of manual therapy procedures, and determine the behavioral relevance of potential neuromotor effects of manual therapy procedures. http://www.clinicaltrials.gov identifier NCT00847769.

Identification of potential neuromotor mechanisms of manual therapy in patients with musculoskeletal disablement: rationale and description of a clinical trial

PubMed Central

Fisher, Beth E; Davenport, Todd E; Kulig, Kornelia; Wu, Allan D

2009-01-01

Background Many health care practitioners use a variety of hands-on treatments to improve symptoms and disablement in patients with musculoskeletal pathology. Research to date indirectly suggests a potentially broad effect of manual therapy on the neuromotor processing of functional behavior within the supraspinal central nervous system (CNS) in a manner that may be independent of modification at the level of local spinal circuits. However, the effect of treatment speed, as well as the specific mechanism and locus of CNS changes, remain unclear. Methods/Design We developed a placebo-controlled, randomized study to test the hypothesis that manual therapy procedures directed to the talocrural joint in individuals with post-acute ankle sprain induce a change in corticospinal excitability that is relevant to improve the performance of lower extremity functional behavior. Discussion This study is designed to identify potential neuromotor changes associated with manual therapy procedures directed to the appendicular skeleton, compare the relative effect of treatment speed on potential neuromotor effects of manual therapy procedures, and determine the behavioral relevance of potential neuromotor effects of manual therapy procedures. Trial Registration identifier NCT00847769. PMID:19460169

Is outpatient brain tumor surgery feasible in India?

PubMed

Turel, Mazda K; Bernstein, Mark

2016-01-01

The current trend in all fields of surgery is towards less invasive procedures with shorter hospital stays. The reasons for this change include convenience to patients, optimal resource utilization, and cost saving. Technological advances in neurosurgery, aided by improvements in anesthesia, have resulted in surgery that is faster, simpler, and safer with excellent perioperative recovery. As a result of improved outcomes, some centers are performing brain tumor surgery on an outpatient basis, wherein patients arrive at the hospital the morning of their procedure and leave the hospital the same evening, thus avoiding an overnight stay in the hospital. In addition to the medical benefits of the outpatient procedure, its impact on patient satisfaction is substantial. The economic benefits are extremely favorable for the patient, physician, as well as the hospital. In high volume centers, a day surgery program can exist alongside those for elective and emergency surgeries, providing another pathway for patient care. However, due to skepticism surrounding the medicolegal aspects, and how radical the concept at first sounds, these procedures have not gained widespread popularity. We provide an overview of outpatient brain tumor surgery in the western world, discussing the socioeconomic, medicolegal, and ethical issues related to its adaptability in a developing nation.

Computer-aided placement of deep brain stimulators: from planning to intraoperative guidance

NASA Astrophysics Data System (ADS)

D'Haese, Pierre-Francois; Pallavaram, Srivatsan; Kao, Chris; Konrad, Peter E.; Dawant, Benoit M.

2005-04-01

The long term objective of our research is to develop a system that will automate as much as possible DBS implantation procedures. It is estimated that about 180,000 patients/year would benefit from DBS implantation. Yet, only 3000 procedures are performed annually. This is so because the combined expertise required to perform the procedure successfully is only available at a limited number of sites. Our goal is to transform this procedure into a procedure that can be performed by a general neurosurgeon at a community hospital. In this work we report on our current progress toward developing a system for the computer-assisted pre-operative selection of target points and for the intra-operative adjustment of these points. The system consists of a deformable atlas of optimal target points that can be used to select automatically the pre-operative target, of an electrophysiological atlas, and of an intra-operative interface. The atlas is deformed using a rigid then a non-rigid registration algorithm developed at our institution. Results we have obtained show that automatic prediction of target points is an achievable goal. Our results also indicate that electrophysiological information can be used to resolve structures not visible in anatomic images, thus improving both pre-operative and intra-operative guidance. Our intra-operative system has reached the stage of a working prototype that is clinically used at our institution.

Improved compliance by BPM-driven workflow automation.

PubMed

Holzmüller-Laue, Silke; Göde, Bernd; Fleischer, Heidi; Thurow, Kerstin

2014-12-01

Using methods and technologies of business process management (BPM) for the laboratory automation has important benefits (i.e., the agility of high-level automation processes, rapid interdisciplinary prototyping and implementation of laboratory tasks and procedures, and efficient real-time process documentation). A principal goal of the model-driven development is the improved transparency of processes and the alignment of process diagrams and technical code. First experiences of using the business process model and notation (BPMN) show that easy-to-read graphical process models can achieve and provide standardization of laboratory workflows. The model-based development allows one to change processes quickly and an easy adaption to changing requirements. The process models are able to host work procedures and their scheduling in compliance with predefined guidelines and policies. Finally, the process-controlled documentation of complex workflow results addresses modern laboratory needs of quality assurance. BPMN 2.0 as an automation language to control every kind of activity or subprocess is directed to complete workflows in end-to-end relationships. BPMN is applicable as a system-independent and cross-disciplinary graphical language to document all methods in laboratories (i.e., screening procedures or analytical processes). That means, with the BPM standard, a communication method of sharing process knowledge of laboratories is also available. © 2014 Society for Laboratory Automation and Screening.

Development and fabrication of improved Schottky power diodes, phases I and II

NASA Technical Reports Server (NTRS)

Cordes, L. F.; Garfinkle, M.; Taft, E. A.

1974-01-01

Reproducible methods for the fabrication of silicon Schottky diodes were developed for the metals tungsten, aluminum, conventional platinum silicide and low temperature platinum silicide. Barrier heights and barrier lowering were measured permitting the accurate prediction of ideal forward and reverse diode performance. Processing procedures were developed which permit the fabrication of large area (approximately 1 sqcm) mesa-geometry power Schottky diodes with forward and reverse characteristics that approach theoretical values.

An improved diffusion welding technique for TD-NiCr

NASA Technical Reports Server (NTRS)

Holko, K. H.

1973-01-01

An improved diffusion welding technique has been developed for TD-NiCr sheet. In the most preferred form, the improved technique consists of diffusion welding 320-grit sanded plus chemically polished surfaces of unrecrystallized TD-NiCr at 760 C under 140 MN/m2 pressure for 1hr followed by postheating at 1180 C for 2hr. Compared to previous work, this improved technique has the advantages of shorter welding time, lower welding temperature, lower welding pressure, and a simpler and more reproducible surface preparation procedure. Weldments were made that had parent-metal creep-rupture shear strength at 1100 C.

Improved Skin Friction Interferometer

NASA Technical Reports Server (NTRS)

Westphal, R. V.; Bachalo, W. D.; Houser, M. H.

1986-01-01

An improved system for measuring aerodynamic skin friction which uses a dual-laser-beam oil-film interferometer was developed. Improvements in the optical hardware provided equal signal characteristics for each beam and reduced the cost and complexity of the system by replacing polarization rotation by a mirrored prism for separation of the two signals. An automated, objective, data-reduction procedure was implemented to eliminate tedious manual manipulation of the interferometry data records. The present system was intended for use in two-dimensional, incompressible flows over a smooth, level surface without pressure gradient, but the improvements discussed are not limited to this application.

Improving the breed - Shuttle development

NASA Technical Reports Server (NTRS)

Brand, V.

1985-01-01

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

Design and implementation of software for automated quality control and data analysis for a complex LC/MS/MS assay for urine opiates and metabolites.

PubMed

Dickerson, Jane A; Schmeling, Michael; Hoofnagle, Andrew N; Hoffman, Noah G

2013-01-16

Mass spectrometry provides a powerful platform for performing quantitative, multiplexed assays in the clinical laboratory, but at the cost of increased complexity of analysis and quality assurance calculations compared to other methodologies. Here we describe the design and implementation of a software application that performs quality control calculations for a complex, multiplexed, mass spectrometric analysis of opioids and opioid metabolites. The development and implementation of this application improved our data analysis and quality assurance processes in several ways. First, use of the software significantly improved the procedural consistency for performing quality control calculations. Second, it reduced the amount of time technologists spent preparing and reviewing the data, saving on average over four hours per run, and in some cases improving turnaround time by a day. Third, it provides a mechanism for coupling procedural and software changes with the results of each analysis. We describe several key details of the implementation including the use of version control software and automated unit tests. These generally useful software engineering principles should be considered for any software development project in the clinical lab. Copyright © 2012 Elsevier B.V. All rights reserved.

How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program.

PubMed

Cho, Yu Kyung

2016-07-01

In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.

Class Model Development Using Business Rules

NASA Astrophysics Data System (ADS)

Skersys, Tomas; Gudas, Saulius

New developments in the area of computer-aided system engineering (CASE) greatly improve processes of the information systems development life cycle (ISDLC). Much effort is put into the quality improvement issues, but IS development projects still suffer from the poor quality of models during the system analysis and design cycles. At some degree, quality of models that are developed using CASE tools can be assured using various. automated. model comparison, syntax. checking procedures. It. is also reasonable to check these models against the business domain knowledge, but the domain knowledge stored in the repository of CASE tool (enterprise model) is insufficient (Gudas et al. 2004). Involvement of business domain experts into these processes is complicated because non- IT people often find it difficult to understand models that were developed by IT professionals using some specific modeling language.

CBP for Field Workers – Results and Insights from Three Usability and Interface Design Evaluations

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

Oxstrand, Johanna Helene; Le Blanc, Katya Lee; Bly, Aaron Douglas

2015-09-01

Nearly all activities that involve human interaction with the systems in a nuclear power plant are guided by procedures. Even though the paper-based procedures (PBPs) currently used by industry have a demonstrated history of ensuring safety, improving procedure use could yield significant savings in increased efficiency as well as improved nuclear safety through human performance gains. The nuclear industry is constantly trying to find ways to decrease the human error rate, especially the human errors associated with procedure use. As a step toward the goal of improving procedure use and adherence, researchers in the Light-Water Reactor Sustainability (LWRS) Program, togethermore » with the nuclear industry, have been investigating the possibility and feasibility of replacing the current paper-based procedure process with a computer-based procedure (CBP) system. This report describes a field evaluation of new design concepts of a prototype computer-based procedure system.« less

Co-streaming classes: a follow-up study in improving the user experience to better reach users.

PubMed

Hayes, Barrie E; Handler, Lara J; Main, Lindsey R

2011-01-01

Co-streaming classes have enabled library staff to extend open classes to distance education students and other users. Student evaluations showed that the model could be improved. Two areas required attention: audio problems experienced by online participants and staff teaching methods. Staff tested equipment and adjusted software configuration to improve user experience. Staff training increased familiarity with specialized teaching techniques and troubleshooting procedures. Technology testing and staff training were completed, and best practices were developed and applied. Class evaluations indicate improvements in classroom experience. Future plans include expanding co-streaming to more classes and on-going data collection, evaluation, and improvement of classes.

Simulation center training as a means to improve resident performance in percutaneous noncontinuous CT-guided fluoroscopic procedures with dose reduction.

PubMed

Mendiratta-Lala, Mishal; Williams, Todd R; Mendiratta, Vivek; Ahmed, Hafeez; Bonnett, John W

2015-04-01

The purpose of this study was to evaluate the effectiveness of a multifaceted simulation-based resident training for CT-guided fluoroscopic procedures by measuring procedural and technical skills, radiation dose, and procedure times before and after simulation training. A prospective analysis included 40 radiology residents and eight staff radiologists. Residents took an online pretest to assess baseline procedural knowledge. Second-through fourth-year residents' baseline technical skills with a procedural phantom were evaluated. First-through third-year residents then underwent formal didactic and simulation-based procedural and technical training with one of two interventional radiologists and followed the training with 1 month of supervised phantom-based practice. Thereafter, residents underwent final written and practical examinations. The practical examination included essential items from a 20-point checklist, including site and side marking, consent, time-out, and sterile technique along with a technical skills portion assessing pedal steps, radiation dose, needle redirects, and procedure time. The results indicated statistically significant improvement in procedural and technical skills after simulation training. For residents, the median number of pedal steps decreased by three (p=0.001), median dose decreased by 15.4 mGy (p<0.001), median procedure time decreased by 4.0 minutes (p<0.001), median number of needle redirects decreased by 1.0 (p=0.005), and median number of 20-point checklist items successfully completed increased by three (p<0.001). The results suggest that procedural skills can be acquired and improved by simulation-based training of residents, regardless of experience. CT simulation training decreases procedural time, decreases radiation dose, and improves resident efficiency and confidence, which may transfer to clinical practice with improved patient care and safety.

Restoring tactile and erogenous penile sensation in low-spinal-lesion patients: procedural and technical aspects following 43 TOMAX nerve transfer procedures.

PubMed

Overgoor, Max L E; de Jong, Tom P V M; Kon, Moshe

2014-08-01

The "TOMAX" (TO MAX-imize sensation, sexuality, and quality of life) procedure restores genital sensation in men with low spinal lesions, improving sexual health, as shown previously. It connects the dorsal nerve of the penis to the intact ipsilateral ilioinguinal nerve, unilaterally or bilaterally. This study reports on the technical aspects based on 43 TOMAX nerve transfers. In 40 patients with no penile but intact groin sensation, 43 nerve transfers were performed. Data on patient selection, surgical history, anatomy of the ilioinguinal nerve and dorsal nerve of the penis, unilateral or bilateral surgery, surgical technique, complications, and patient information were collected prospectively. Regardless of origin, all patients with no penile but good groin sensation are eligible for the procedure, provided the ilioinguinal nerve is not damaged because of former inguinal surgery or absent because of anatomical variations. Selection of a unilateral or bilateral procedure depends on the presence or absence of reflex erections and bulbocavernosus reflex. Preliminary experience with the first three bilateral cases shows that it is technically feasible, with encouraging results. The surgical technique has evolved (described in detail, including video) to enhance outcome and reduce complications. Patients are better informed, resulting in realistic expectations. This article synthesizes the procedural and technical experience of 43 TOMAX nerve transfers. Anyone skilled in peripheral nerve surgery and microsurgery can adopt this concept and further develop it. The TOMAX procedure can then be used to restore erogenous penile sensation and improve the quality of sexual health in patients with absent penile but good groin sensation.

[Research progress of three-dimensional digital model for repair and reconstruction of knee joint].

PubMed

Tong, Lu; Li, Yanlin; Hu, Meng

2013-01-01

To review recent advance in the application and research of three-dimensional digital knee model. The recent original articles about three-dimensional digital knee model were extensively reviewed and analyzed. The digital three-dimensional knee model can simulate the knee complex anatomical structure very well. Based on this, there are some developments of new software and techniques, and good clinical results are achieved. With the development of computer techniques and software, the knee repair and reconstruction procedure has been improved, the operation will be more simple and its accuracy will be further improved.

ERIC First Analysis: 1976-77 National High School Debate Resolutions (How Can the Criminal Justice System in the United States Best Be Improved?)

ERIC Educational Resources Information Center

Huber, Robert B.

The goal of this booklet is to assist debaters in developing problem-solving skills as represented in the 1976-77 debate topic: How can the criminal justice system in the United States best be improved? The sections of this document focus on the need for criminal justice reform; procedural steps in the criminal justice system; discussing or…

Dielectric Coating Thermal Stabilization During GaAs-Based Laser Fabrication for Improved Device Yield

DTIC Science & Technology

2015-11-25

1 Dielectric coating thermal stabilization during GaAs-based laser fabrication for improved device yield 1 Michael K. Connors a, c), Jamal...side contact metal, underlying SiO2 dielectric coating, and semiconductor surface. A thermal-anneal procedure developed for the fabrication of GaAs...slab coupled optical waveguide (SCOW) ridge waveguide devices stabilizes the SiO2 dielectric coating, by means of outgassing and stress reduction

Some ideas and opportunities concerning three-dimensional wind-tunnel wall corrections

NASA Technical Reports Server (NTRS)

Rubbert, P. E.

1982-01-01

Opportunities for improving the accuracy and reliability of wall corrections in conventional ventilated test sections are presented. The approach encompasses state-of-the-art technology in transonic computational methods combined with the measurement of tunnel-wall pressures. The objective is to arrive at correction procedures of known, verifiable accuracy that are practical within a production testing environment. It is concluded that: accurate and reliable correction procedures can be developed for cruise-type aerodynamic testing for any wall configuration; passive walls can be optimized for minimal interference for cruise-type aerodynamic testing (tailored slots, variable open area ratio, etc.); monitoring and assessment of noncorrectable interference (buoyancy and curvature in a transonic stream) can be an integral part of a correction procedure; and reasonably good correction procedures can probably be developd for complex flows involving extensive separation and other unpredictable phenomena.

Improved method for roadside barrier length of need modeling using real-world trajectories.

PubMed

Johnson, Nicholas S; Thomson, Robert; Gabler, Hampton C

2015-07-01

The 2011 AASHTO Roadside Design Guide (RDG) contains perhaps the most widely used procedure for choosing an appropriate length of need (LON) for roadside barriers. However, this procedure has several limitations. The procedure uses a highly simplified model of vehicle departure, and the procedure does not allow designers to specify an explicit level of protection. A new procedure for choosing LON that addresses these limitations is presented in this paper. This new procedure is based on recent, real-world road departure trajectories and uses this departure data in a more realistic way. The new procedure also allows LON to be specified for a precisely known level of protection - a level which can be based on number of crashes, injury outcomes or even estimated crash cost - while still remaining straightforward and quick to use like the 2011 RDG procedure. In this analysis, the improved procedure was used to explore the effects of the RDG procedure's assumptions. LON recommendations given by the 2011 RDG procedure were compared with recommendations given by this improved procedure. For 55 mph roads, the 2011 RDG procedure appears to lead to a LON sufficient to intercept between 80% and 90% of right-side departures that would otherwise strike a hazard located 10 m from the roadway. For hazards closer than 10 m, the 2011 RDG procedure intercepts progressively higher percentages of real-world departures. This suggests the protection level provided by the 2011 RDG procedure varies with the hazard offset, becoming more conservative as the hazard moves closer to the roadway. The improved procedure, by comparison, gives a consistent protection level regardless of hazard location. Copyright © 2015. Published by Elsevier Ltd.

Evaluating innovation. Part 2: Development in neurosurgery.

PubMed

Schnurman, Zane; Kondziolka, Douglas

2016-01-01

OBJECT Patients, practitioners, payers, and regulators are advocating for reform in how medical advances are evaluated. Because surgery does not adhere to a standardized developmental pathway, how the medical community accepts a procedure remains unclear. The authors developed a new model, using publication data and patterns, that quantifies this process. Using this technique, the authors identified common archetypes and influences on neurosurgical progress from idea inception to acceptance. METHODS Seven neurosurgical procedures developed in the past 15-25 years were used as developmental case studies (endovascular coil, deep brain stimulation, vagus nerve stimulation, 1,3-bis(2-chloroethyl)-l-nitrosourea wafer, and 3 radiosurgery procedures), and the literature on each topic was evaluated. A new metric the authors termed "progressive scholarly acceptance" (PSA) was used as an end point for community acceptance. PSA was reached when the number of investigations that refine or improve a procedure eclipsed the total number of reports assessing initial efficacy. Report characteristics, including the number of patients studied, study design, and number of authoring groups from the first report to the point of PSA, were assessed. RESULTS Publication data implicated factors that had an outsized influence on acceptance. First, procedural accessibility to investigators was found to influence the number of reports, number of patients studied, and number of authoring groups contributing. Barriers to accessibility included target disease rarity, regulatory restrictions, and cost. Second, the ease or difficulty in applying a randomized controlled trial had an impact on study design. Based on these 2 factors, 3 developmental archetypes were characterized to generally describe the development of surgery. CONCLUSIONS Common surgical development archetypes can be described based on factors that impact investigative methods, data accumulation, and ultimate acceptance by society. The approach and proposed terminologies in this report could inform future procedural development as well as any attempts to regulate surgical innovation.

[Current overview of cartilage regeneration procedures].

PubMed

Schenker, H; Wild, M; Rath, B; Tingart, M; Driessen, A; Quack, V; Betsch, M

2017-11-01

Cartilage is an avascular, alymphatic and non-innervated tissue with limited intrinsic repair potential. The high prevalence of cartilage defects and their tremendous clinical importance are a challenge for all treating physicians. This article provides the reader with an overview about current cartilage treatment options and their clinical outcome. Microfracture is still considered the gold standard in the treatment of small cartilage lesions. Small osteochondral defects can be effectively treated with the autologous osteochondral transplantation system. Larger cartilage defects are successfully treated by autologous membrane-induced chondrogenesis (AMIC) or by membrane-assisted autologous chondrocyte implantation (MACI). Despite limitations of current cartilage repair strategies, such procedures can result in short- and mid-term clinical improvement of the patients. Further developments and clinical studies are necessary to improve the long-term outcome following cartilage repair.

The complexity of patient safety reporting systems in UK dentistry.

PubMed

Renton, T; Master, S

2016-10-21

Since the 'Francis Report', UK regulation focusing on patient safety has significantly changed. Healthcare workers are increasingly involved in NHS England patient safety initiatives aimed at improving reporting and learning from patient safety incidents (PSIs). Unfortunately, dentistry remains 'isolated' from these main events and continues to have a poor record for reporting and learning from PSIs and other events, thus limiting improvement of patient safety in dentistry. The reasons for this situation are complex.This paper provides a review of the complexities of the existing systems and procedures in relation to patient safety in dentistry. It highlights the conflicting advice which is available and which further complicates an overly burdensome process. Recommendations are made to address these problems with systems and procedures supporting patient safety development in dentistry.

To Tell the Truth: A Classroom Gaming Procedure.

ERIC Educational Resources Information Center

Hisgen, Jon W.

1981-01-01

Gaming activities increase a student's motivation to learn cognitive material, develop a student's sensitivity to the way media works, and improve the student's decision making skills. The game presented is based on the television program "To Tell the Truth," and centers on questions concerning arthritis. (JN)

Software tools for data modelling and processing of human body temperature circadian dynamics.

PubMed

Petrova, Elena S; Afanasova, Anastasia I

2015-01-01

This paper is presenting a software development for simulating and processing thermometry data. The motivation of this research is the miniaturization of actuators attached to human body which allow frequent temperature measurements and improve the medical diagnosis procedures related to circadian dynamics.

Improvement of Railroad Roller Bearing Test Procedures & Development of Roller Bearing Diagnostic Techniques. Volume 1.

DOT National Transportation Integrated Search

1982-03-01

Bearing defect data from 8,000 railroad roller bearings are analyzed to determine their defect modes and defect rate distributions. Cone bore growth, brinelling, and fatigue are identified as the predominant defect modes during the first 12 years of ...

Reading Improvement in the Secondary School.

ERIC Educational Resources Information Center

Dechant, Emerald

This book, a comprehensive statement about the reading problems of adolescent students, relates the principles of learning and learning theory to the teaching of reading. Using a linguistic orientation, the author guides the teacher through the procedure for developing word recognition skills, comprehension skills, content-area reading skills, and…

Optimizing winter/snow removal operations in MoDOT St. Louis district : includes outcome based evaluation of operations.

DOT National Transportation Integrated Search

2011-10-01

The objective of this project was to develop fleet location, route decision, material selection, and treatment procedures for winter snow removal operations to improve MoDOTs services and lower costs. This work uses a systematic, heuristic-based o...

Students Can Control Their Emotions

ERIC Educational Resources Information Center

Harati, Saba; Parsa, Nasrin Arian

2014-01-01

As emotional intelligence contributes extensively in people's lives, it can also find some significance in language teaching. From this perspective, it is inevitable for teachers to know how to improve students' emotional intelligence. This paper made an effort to provide procedures to develop emotional intelligence. Although success has various…

Consumerism: Life Centered Curriculum Program (Elementary Career Education).

ERIC Educational Resources Information Center

Syracuse City School District, NY.

The mid-intermediate elementary level curriculum guide on consumerism is designed to help students better define their own value system, develop an improved decision-making procedure, evaluate alternatives in the marketplace, and understand their consumer rights and responsibilities. The guide contains five sections related to five major…

Development of a Quality of Meals and Meal Service Set of Indicators for Residential Facilities for Elderly.

PubMed

Van Damme, N; Buijck, B; Van Hecke, A; Verhaeghe, S; Goossens, E; Beeckman, D

2016-01-01

To develop a content validated set of indicators to evaluate the quality of meals and meal service in residential facilities for elderly. Inadequate food intake is an important risk factor for malnutrition in residential facilities for elderly. Through better meeting the needs and preferences of residents and optimization of meals and meal service, residents' food intake can improve. No indicators were available which could help to guide strategies to improve the quality of meals and meal service. The indicator set was developed according to the Indicator Development Manual of the Dutch Institute for Health Care Improvement (CBO). The working group consisted of three nurse researchers and one expert in gastrology and had expertise in elderly care, malnutrition, indicator development, and food quality. A preliminary list of potential indicators was compiled using the literature and the working group's expertise. Criteria necessary to measure the indicator in practice were developed for each potential indicator. In a double Delphi procedure, the list of potential indicators and respective criteria were analyzed for content validity, using a multidisciplinary expert panel of 11 experts in elderly meal care. A preliminary list of 20 quality indicators, including 45 criteria, was submitted to the expert panel in a double Delphi procedure. After the second Delphi round, 13 indicators and 25 criteria were accepted as having content validity. The content validity index (CVI) ranged from 0.83 to 1. The indicator set consisted of six structural, four result, and three outcome indicators covering the quality domains food, service and choice, as well as nutritional screening. The criteria measure diverse aspects of meal care which are part of the responsibility of kitchen staff and health care professionals. The 'quality of meals and meal service' set of indicators is a resource to map meal quality in residential facilities for elderly. As soon as feasibility tests in practice are completed, the indicator set can be used to guide meal and meal service quality improvement projects in collaboration with kitchen staff and health care professionals. These improvement projects will help to improve food intake and reduce the risk of malnutrition among elders living in residential facilities.

Dynamic Assessment of Writing: The Impact of Implicit/Explicit Mediations on L2 Learners' Internalization of Writing Skills and Strategies

ERIC Educational Resources Information Center

Alavi, Sayyed Mohammad; Taghizadeh, Mahboubeh

2014-01-01

Dynamic assessment is a procedure in which development is simultaneously assessed and improved with regard to the individual's or group's Zone of Proximal Development (ZPD; Lantolf & Poehner, 2004). This study aimed to follow dynamic assessment and investigate the impact of three types of implicit and explicit feedback on the essay writing of…

IMPROVING PROCEDURES FOR PRODUCING OVERHEAD TRANSPARENCIES WITH THE ULTIMATE AIM OF INCORPORATING THESE TECHNIQUES INTO THE DEVELOPMENT OF A REGIONAL CURRICULAR MATERIALS CENTER FOR VOCATIONAL EDUCATION. FINAL REPORT.

ERIC Educational Resources Information Center

JENSEN, ARTHUR K.

THE INVESTIGATION RESULTED IN THE PRODUCTION OF 88 LOW-COST OVERHEAD PROJECTION TRANSPARENCIES ON THE BASIC PRINCIPLES OF POWER TRANSMISSION IN AGRICULTURAL MACHINERY. DEVELOPING TECHNIQUES FOR OFFSET PRINTING ON PLASTIC REQUIRED OVERCOMING PROBLEMS OF STATIC ELECTRICITY, INK ADHESION, OFFSETTING, AND DRYING. MACHINERY, ENVIRONMENT, AND INK WERE…

SimCenter Hawaii: Virtual Reality Applications for Health Care Education and Training

DTIC Science & Technology

2008-12-01

systems can provide realistic, procedural skills training,(12) the scenarios developed for triage would primarily develop and assess cognitive skill...Education and Training Conclusions Simulator-based training has been shown to improve outcomes for both cognitive as well as motor-skills...training.(7) Cognitive modules can be distributed through advanced learning networks.(4) This has significant implications, because enterprise wide

Improving the transition from medical school to internship - evaluation of a preparation for internship course.

PubMed

Scicluna, Helen A; Grimm, Michael C; Jones, Philip D; Pilotto, Louis S; McNeil, H Patrick

2014-02-03

This study evaluates the impact of a new 'Preparation for Internship' (PRINT) course, which was developed to facilitate the transition of University of New South Wales (UNSW) medical graduates from Medical School to Internship. During a period of major curricular reform, the 2007 (old program) and 2009 (new program) cohorts of UNSW final year students completed the Clinical Capability Questionnaire (CCQ) prior to and after undertaking the PRINT course. Clinical supervisors' ratings and self-ratings of UNSW 2009 medical graduates were obtained from the Hospital-based Prevocational Progress Review Form. Prior to PRINT, students from both cohorts perceived they had good clinical skills, with lower ratings for capability in procedural skills, operational management, and administrative tasks. After completing PRINT, students from both cohorts perceived significant improvement in their capability in procedural skills, operational management, and administrative tasks. Although PRINT also improved student-perceived capability in confidence, interpersonal skills and collaboration in both cohorts, curriculum reform to a new outcomes-based program was far more influential in improving self-perceptions in these facets of preparedness for hospital practice than PRINT. The PRINT course was most effective in improving students' perceptions of their capability in procedural skills, operational management and administrative tasks, indicating that student-to-intern transition courses should be clinically orientated, address relevant skills, use experiential learning, and focus on practical tasks. Other aspects that are important in preparation of medical students for hospital practice cannot be addressed in a PRINT course, but major improvements are achievable by program-wide curriculum reform.

Improving the transition from medical school to internship – evaluation of a preparation for internship course

PubMed Central

2014-01-01

Background This study evaluates the impact of a new 'Preparation for Internship’ (PRINT) course, which was developed to facilitate the transition of University of New South Wales (UNSW) medical graduates from Medical School to Internship. Methods During a period of major curricular reform, the 2007 (old program) and 2009 (new program) cohorts of UNSW final year students completed the Clinical Capability Questionnaire (CCQ) prior to and after undertaking the PRINT course. Clinical supervisors’ ratings and self-ratings of UNSW 2009 medical graduates were obtained from the Hospital-based Prevocational Progress Review Form. Results Prior to PRINT, students from both cohorts perceived they had good clinical skills, with lower ratings for capability in procedural skills, operational management, and administrative tasks. After completing PRINT, students from both cohorts perceived significant improvement in their capability in procedural skills, operational management, and administrative tasks. Although PRINT also improved student-perceived capability in confidence, interpersonal skills and collaboration in both cohorts, curriculum reform to a new outcomes-based program was far more influential in improving self-perceptions in these facets of preparedness for hospital practice than PRINT. Conclusions The PRINT course was most effective in improving students’ perceptions of their capability in procedural skills, operational management and administrative tasks, indicating that student-to-intern transition courses should be clinically orientated, address relevant skills, use experiential learning, and focus on practical tasks. Other aspects that are important in preparation of medical students for hospital practice cannot be addressed in a PRINT course, but major improvements are achievable by program-wide curriculum reform. PMID:24485072

Periodontal considerations for esthetics: edentulous ridge augmentation.

PubMed

Rosenberg, E S; Cutler, S A

1993-01-01

Edentulous ridge augmentation is a plastic surgical technique that is performed to improve patient esthetics when unsightly, deformed ridges exist. This article describes the etiology of ridge deformities and the many procedures that can be executed to achieve an esthetic, functional result. Historically, soft-tissue mucogingival techniques were described to augment collapsed ridges. Pedicle grafts, free soft-tissue grafts, and subepithelial connective tissue grafts are predictable forms of therapy. More recently, ridge augmentation techniques were developed that regenerate the lost periodontium. These include allografts, bioglasses, guided tissue regenerative procedures, and tissue expansion.

New test techniques and analytical procedures for understanding the behavior of advanced propellers

NASA Technical Reports Server (NTRS)

Stefko, G. L.; Bober, L. J.; Neumann, H. E.

1983-01-01

Analytical procedures and experimental techniques were developed to improve the capability to design advanced high speed propellers. Some results from the propeller lifting line and lifting surface aerodynamic analysis codes are compared with propeller force data, probe data and laser velocimeter data. In general, the code comparisons with data indicate good qualitative agreement. A rotating propeller force balance demonstrated good accuracy and reduced test time by 50 percent. Results from three propeller flow visualization techniques are shown which illustrate some of the physical phenomena occurring on these propellers.

Application of industry-standard guidelines for the validation of avionics software

NASA Technical Reports Server (NTRS)

Hayhurst, Kelly J.; Shagnea, Anita M.

1990-01-01

The application of industry standards to the development of avionics software is discussed, focusing on verification and validation activities. It is pointed out that the procedures that guide the avionics software development and testing process are under increased scrutiny. The DO-178A guidelines, Software Considerations in Airborne Systems and Equipment Certification, are used by the FAA for certifying avionics software. To investigate the effectiveness of the DO-178A guidelines for improving the quality of avionics software, guidance and control software (GCS) is being developed according to the DO-178A development method. It is noted that, due to the extent of the data collection and configuration management procedures, any phase in the life cycle of a GCS implementation can be reconstructed. Hence, a fundamental development and testing platform has been established that is suitable for investigating the adequacy of various software development processes. In particular, the overall effectiveness and efficiency of the development method recommended by the DO-178A guidelines are being closely examined.

A study for hypergolic vapor sensor development

NASA Technical Reports Server (NTRS)

Stetter, J. R.; Tellefsen, K.

1977-01-01

In summary, the following tasks were completed within the scope of this work: (1) a portable Monomethylhydrazine analyzer was developed, designed, fabricated and tested. (2) A portable NO2 analyzer was developed, designed, fabricated and tested. (3) Sampling probes and accessories were designed and fabricated for this instrumentation. (4) Improvements and modifications were made to the model 7630 Ecolyzer in preparation for field testing. (5) Instrument calibration procedures and hydrazine handling techniques necessary to the successful application of this hardware were developed.

Recent Advances in Image Assisted Neurosurgical Procedures: Improved Navigational Accuracy and Patient Safety

ScienceCinema

Olivi, Alessandro, M.D.

2017-12-09

Neurosurgical procedures require precise planning and intraoperative support. Recent advances in image guided technology have provided neurosurgeons with improved navigational support for more effective and safer procedures. A number of exemplary cases will be presented.

Permutation tests for goodness-of-fit testing of mathematical models to experimental data.

PubMed

Fişek, M Hamit; Barlas, Zeynep

2013-03-01

This paper presents statistical procedures for improving the goodness-of-fit testing of theoretical models to data obtained from laboratory experiments. We use an experimental study in the expectation states research tradition which has been carried out in the "standardized experimental situation" associated with the program to illustrate the application of our procedures. We briefly review the expectation states research program and the fundamentals of resampling statistics as we develop our procedures in the resampling context. The first procedure we develop is a modification of the chi-square test which has been the primary statistical tool for assessing goodness of fit in the EST research program, but has problems associated with its use. We discuss these problems and suggest a procedure to overcome them. The second procedure we present, the "Average Absolute Deviation" test, is a new test and is proposed as an alternative to the chi square test, as being simpler and more informative. The third and fourth procedures are permutation versions of Jonckheere's test for ordered alternatives, and Kendall's tau(b), a rank order correlation coefficient. The fifth procedure is a new rank order goodness-of-fit test, which we call the "Deviation from Ideal Ranking" index, which we believe may be more useful than other rank order tests for assessing goodness-of-fit of models to experimental data. The application of these procedures to the sample data is illustrated in detail. We then present another laboratory study from an experimental paradigm different from the expectation states paradigm - the "network exchange" paradigm, and describe how our procedures may be applied to this data set. Copyright © 2012 Elsevier Inc. All rights reserved.

Frey's procedure for chronic pancreatitis improves the nutritional status of these patients.

PubMed

Sato, Hideaki; Ishida, Masaharu; Motoi, Fuyuhiko; Sakata, Naoaki; Aoki, Takeshi; Kudoh, Katsuyoshi; Ohtsuka, Hideo; Mizuma, Masamichi; Morikawa, Takanori; Hayashi, Hiroki; Nakagawa, Kei; Naitoh, Takeshi; Egawa, Shinich; Unno, Michiaki

2018-01-01

The aim of surgical intervention for chronic pancreatitis (CP) is to relieve symptoms and improve quality of life. However, the precise effect of surgery on the nutritional status of CP patients, which is often impaired by exocrine and endocrine pancreatic dysfunction, has not been elucidated. We conducted this study to evaluate whether Frey's procedure improves the nutritional status of CP patients. The nutritional status of 35 patients who underwent Frey's procedure for CP at our institute between April 2005 and December 2014, was assessed by the controlling nutritional status (CONUT) scoring before and 1 year after the surgery, and compared with that of seven CP patients who underwent pancreatoduodenectomy. The occurrence of postoperative hepatic steatosis was also monitored. The nutritional status improved after Frey's procedure, but not after pancreatoduodenectomy. The median postoperative CONUT score after Frey's procedure was significantly lower than the preoperative score (1.0 ± 0.5 vs. 4.0 ± 2.5; p < 0.001). Frey's procedure is superior to pancreatoduodenectomy for improving the nutritional status of CP patients.

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

PubMed

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

2016-06-01

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

New endoscopic platform for endoluminal en bloc tissue resection in the gastrointestinal tract (with videos).

PubMed

Kantsevoy, Sergey V; Bitner, Marianne; Piskun, Gregory

2016-07-01

Endoscopic removal of gastrointestinal tract lesions is increasingly popular around the world. We evaluated feasibility, safety, effectiveness, and user learning curve of new endoscopic platform for complex intraluminal interventions. A novel system, consisting of expandable working chamber with two independent instrument guides (LIG), was inserted into colon. Simulated colonic lesions were removed with endoscopic submucosal (ESD) and submuscular (ESmD) dissection. In all nine in vivo models, an intraluminal chamber and its dynamic tissue retractors (via LIG) provided a stable working space with excellent visualization and adequate access to target tissue. Endoscopic platform facilitated successful completion of 11 en bloc ESDs (mean size 43.0 ± 11.3 mm, mean time 46.3 ± 41.2 min) and eight ESmD (mean size 50.0 ± 14.1 mm, mean time 48.0 ± 21.2 min). The learning curve for ESD using this platform demonstrated three phases: rapid improvement in procedural skills took place during the first three procedures (mean ESD time 98.7 ± 40.0 min). A plateau phase then occurred (procedures 4-7) with mean procedure time 42.0 ± 13.4 min (p = 0.04), followed by another sharp improvement in procedural skills (procedures 8-11) requiring only 16.3 ± 11.4 min (p = 0.03) to complete ESD. Especially dramatic (p = 0.002) was the time difference between the first three procedures (mean time 98.7 ± 40.0 min) and subsequent eight procedures (mean time 29.1 ± 17.9 min). A newly developed endoscopic platform provides stable intraluminal working space, dynamic tissue retraction, and instrument triangulation, improving visualization and access to the target tissue for safer and more effective en bloc endoscopic submucosal and submuscular dissection. The learning curve for ESD was markedly facilitated by this new endoscopic platform.

Research and partnerships with schools.

PubMed

Svirydzenka, Nadzeya; Aitken, Jill; Dogra, Nisha

2016-08-01

Despite the quantity of research on child and adolescent mental health being done in schools, little output has focused on the practical aspects of recruiting schools and students into a study. Furthermore, there is limited knowledge on how to develop and sustain productive and mutually beneficial partnerships with schools after the project finishes. A large study examining prevalence of mental health problems in young people involving nine schools is used as an example for the procedure of recruitment and carrying out a research project, while developing and sustaining partnerships with schools. While recruiting the schools, a three-stage model was developed that corresponded closely to the school's needs and existing demands. The suggested procedure for the study, thus, closely reflected the varying existing cultures of participating schools. Partnerships, developed as a result of the project, were used in developing further projects and interventions for promoting good mental health in schools. Rather than a blanket research recruitment and procedural approach with an end to school involvement at the end of the project, the paper advocates for a deeper understanding of the schools' internal culture for improved recruitment and study outcomes. Developed partnerships, when sustained past the completion of research, prove to be a useful tool in applying the findings in promoting good mental health in schools and continuing research further.

Modeling Major Adverse Outcomes of Pediatric and Adult Patients With Congenital Heart Disease Undergoing Cardiac Catheterization: Observations From the NCDR IMPACT Registry (National Cardiovascular Data Registry Improving Pediatric and Adult Congenital Treatment).

PubMed

Jayaram, Natalie; Spertus, John A; Kennedy, Kevin F; Vincent, Robert; Martin, Gerard R; Curtis, Jeptha P; Nykanen, David; Moore, Phillip M; Bergersen, Lisa

2017-11-21

Risk standardization for adverse events after congenital cardiac catheterization is needed to equitably compare patient outcomes among different hospitals as a foundation for quality improvement. The goal of this project was to develop a risk-standardization methodology to adjust for patient characteristics when comparing major adverse outcomes in the NCDR's (National Cardiovascular Data Registry) IMPACT Registry (Improving Pediatric and Adult Congenital Treatment). Between January 2011 and March 2014, 39 725 consecutive patients within IMPACT undergoing cardiac catheterization were identified. Given the heterogeneity of interventional procedures for congenital heart disease, new procedure-type risk categories were derived with empirical data and expert opinion, as were markers of hemodynamic vulnerability. A multivariable hierarchical logistic regression model to identify patient and procedural characteristics predictive of a major adverse event or death after cardiac catheterization was derived in 70% of the cohort and validated in the remaining 30%. The rate of major adverse event or death was 7.1% and 7.2% in the derivation and validation cohorts, respectively. Six procedure-type risk categories and 6 independent indicators of hemodynamic vulnerability were identified. The final risk adjustment model included procedure-type risk category, number of hemodynamic vulnerability indicators, renal insufficiency, single-ventricle physiology, and coagulation disorder. The model had good discrimination, with a C-statistic of 0.76 and 0.75 in the derivation and validation cohorts, respectively. Model calibration in the validation cohort was excellent, with a slope of 0.97 (standard error, 0.04; P value [for difference from 1] =0.53) and an intercept of 0.007 (standard error, 0.12; P value [for difference from 0] =0.95). The creation of a validated risk-standardization model for adverse outcomes after congenital cardiac catheterization can support reporting of risk-adjusted outcomes in the IMPACT Registry as a foundation for quality improvement. © 2017 American Heart Association, Inc.

77 FR 31615 - Improving Mail Management Policies, Procedures, and Activities

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-29

... Mail Management Policies, Procedures, and Activities AGENCY: Office of Governmentwide Policy, General... Administration (GSA) has issued Federal Management Regulation (FMR) Bulletin G-03 which provides guidance to Executive Branch agencies for improving mail management policies, procedures, and activities. FMR Bulletin G...

Transcatheter heart valves for the treatment of aortic stenosis: state-of-the-art.

PubMed

Del Valle-Fernández, R; Ruiz, C E

2008-10-01

Degenerative aortic stenosis is the most frequent heart valve disease. As an alternative to surgical aortic valve replacement, several companies are working on the development of new prosthesis designed to be deployed by transcatheter approaches. Both transfemoral and transapical techniques are feasible, and initial trials in high-risk patients show good procedural outcomes and mid-term (up to 2 years) functionality. Two first-generation prosthesis (Edwards-SAPIEN and CoreValve Revalving System) are commercially available in Europe, and a number of other second-generation valves (with the capabilities of repositioning and retrievability) are under evaluation. Among them, the Sadra-Lotus Valve, The Direct Flow Medical valve and the Paniagua Heart Valve have published first-in-man results; the JenaValve and AorTx devices have also been temporarily implanted in humans. The development of repositionable and retrievable prosthesis with improved profile is mandatory, and it is the main focus of current projects. Not only technical improvements but also operators specialization and an optimal patient selection are essential to improve these initial Some procedural challenges need to be overcome prior to the expansion of these techniques to lower risk groups, and time is needed for detailed long-term outcomes and risk estimations. Only with a close collaboration among different specialists, basic researchers and the industry will the future development of transcatheter aortic implantation techniques be ensured.

The Application of Physiologically Based Pharmacokinetic Modeling to Determine Route-Specific Contributions to Tissue Dosimetry of Trihalomethanes in Drinking Water

EPA Science Inventory

This project summary describes an improved approach for estimating route-specific exposures and tissue doses for trihalomethane (THM) compounds found in drinking water.