IDC System Specification Document Version 1.1.

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

Harris, James M.; Lober, Randall R.

2015-02-01

This document contains the system specifications derived to satisfy the system requirements found in the IDC System Requirements Document for the IDC Reengineering Phase 2 project. Revisions Version Date Author/Team Revision Description Authorized by V1.0 12/2014 IDC Reengineering Project Team Initial delivery M. Harris V1.1 2/2015 IDC Reengineering Project Team Iteration I2 Review Comments M. Harris

77 FR 33782 - License Amendment To Construct and Operate New In Situ Leach Uranium Recovery Facility; Uranium...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-07

...-Filing system also distributes an email notice that provides access to the document to the NRC's Office... mail, or expedited delivery service to the Office of the Secretary, Sixteenth Floor, One White Flint... courier, express mail, or expedited delivery service upon depositing the document with the provider of the...

Fluorescent Microscope System to Monitor Real-Time Interactions between Focused Ultrasound, Echogenic Drug Delivery Vehicles, and Live Cell Membranes

PubMed Central

Ibsen, Stuart; Benchimol, Michael; Esener, Sadik

2012-01-01

Rapid development in the field of ultrasound triggered drug delivery has made it essential to study the real-time interaction between the membranes of live cells and the membranes of echogenic delivery vehicles under exposure to focused ultrasound. The objective of this work was to design an analysis system that combined fluorescent imagining, high speed videography, and definable pulse sequences of focused ultrasound to allow for real time observations of both cell and vehicle membranes. Documenting the behavior of the membranes themselves has not previously been possible due to limitations with existing optical systems used to understand the basic physics of microbubble/ultrasound interaction and the basic interaction between microbubbles and cells. The performance of this new system to monitor membrane behavior was demonstrated by documenting the modes of vehicle fragmentation at different ultrasound intensity levels. At 1.5 MPa the membranes were shown to completely fragment while at intensities below 1 MPa there is a popping and slow unfolding. The interaction between these vehicles and cell membranes was also documented by the removal of fluorescent particles from the surfaces of live cells out to 20 μm from the microbubble location. The fluid flow created by microstreaming around ensonated microbubbles was documented at video recording speeds from 60 to 18,000 frames per second. This information about membrane behavior allows the chemical and physical properties of the drug delivery vehicle to be designed along with the ultrasound pulse sequence to cause the most efficient drug delivery. PMID:22749476

Fluorescent microscope system to monitor real-time interactions between focused ultrasound, echogenic drug delivery vehicles, and live cell membranes.

PubMed

Ibsen, Stuart; Benchimol, Michael; Esener, Sadik

2013-01-01

Rapid development in the field of ultrasound triggered drug delivery has made it essential to study the real-time interaction between the membranes of live cells and the membranes of echogenic delivery vehicles under exposure to focused ultrasound. The objective of this work was to design an analysis system that combined fluorescent imagining, high speed videography, and definable pulse sequences of focused ultrasound to allow for real time observations of both cell and vehicle membranes. Documenting the behavior of the membranes themselves has not previously been possible due to limitations with existing optical systems used to understand the basic physics of microbubble/ultrasound interaction and the basic interaction between microbubbles and cells. The performance of this new system to monitor membrane behavior was demonstrated by documenting the modes of vehicle fragmentation at different ultrasound intensity levels. At 1.5MPa the membranes were shown to completely fragment while at intensities below 1MPa the membranes pop open and slowly unfold. The interaction between these vehicles and cell membranes was also documented by the removal of fluorescent particles from the surfaces of live cells out to 20μm from the microbubble location. The fluid flow created by microstreaming around ensonated microbubbles was documented at video recording speeds from 60 to 18,000 frames per second. This information about membrane behavior allows the chemical and physical properties of the drug delivery vehicle to be designed along with the ultrasound pulse sequence to cause the most efficient drug delivery. Copyright © 2012 Elsevier B.V. All rights reserved.

[Support of the nursing process through electronic nursing documentation systems (UEPD) – Initial validation of an instrument].

PubMed

Hediger, Hannele; Müller-Staub, Maria; Petry, Heidi

2016-01-01

Electronic nursing documentation systems, with standardized nursing terminology, are IT-based systems for recording the nursing processes. These systems have the potential to improve the documentation of the nursing process and to support nurses in care delivery. This article describes the development and initial validation of an instrument (known by its German acronym UEPD) to measure the subjectively-perceived benefits of an electronic nursing documentation system in care delivery. The validity of the UEPD was examined by means of an evaluation study carried out in an acute care hospital (n = 94 nurses) in German-speaking Switzerland. Construct validity was analyzed by principal components analysis. Initial references of validity of the UEPD could be verified. The analysis showed a stable four factor model (FS = 0.89) scoring in 25 items. All factors loaded ≥ 0.50 and the scales demonstrated high internal consistency (Cronbach's α = 0.73 – 0.90). Principal component analysis revealed four dimensions of support: establishing nursing diagnosis and goals; recording a case history/an assessment and documenting the nursing process; implementation and evaluation as well as information exchange. Further testing with larger control samples and with different electronic documentation systems are needed. Another potential direction would be to employ the UEPD in a comparison of various electronic documentation systems.

From a Content Delivery Portal to a Knowledge Management System for Standardized Cancer Documentation.

PubMed

Schlue, Danijela; Mate, Sebastian; Haier, Jörg; Kadioglu, Dennis; Prokosch, Hans-Ulrich; Breil, Bernhard

2017-01-01

Heterogeneous tumor documentation and its challenges of interpretation of medical terms lead to problems in analyses of data from clinical and epidemiological cancer registries. The objective of this project was to design, implement and improve a national content delivery portal for oncological terms. Data elements of existing handbooks and documentation sources were analyzed, combined and summarized by medical experts of different comprehensive cancer centers. Informatics experts created a generic data model based on an existing metadata repository. In order to establish a national knowledge management system for standardized cancer documentation, a prototypical tumor wiki was designed and implemented. Requirements engineering techniques were applied to optimize this platform. It is targeted to user groups such as documentation officers, physicians and patients. The linkage to other information sources like PubMed and MeSH was realized.

A Document-Based EHR System That Controls the Disclosure of Clinical Documents Using an Access Control List File Based on the HL7 CDA Header.

PubMed

Takeda, Toshihiro; Ueda, Kanayo; Nakagawa, Akito; Manabe, Shirou; Okada, Katsuki; Mihara, Naoki; Matsumura, Yasushi

2017-01-01

Electronic health record (EHR) systems are necessary for the sharing of medical information between care delivery organizations (CDOs). We developed a document-based EHR system in which all of the PDF documents that are stored in our electronic medical record system can be disclosed to selected target CDOs. An access control list (ACL) file was designed based on the HL7 CDA header to manage the information that is disclosed.

Does teaching of documentation of shoulder dystocia delivery through simulation result in improved documentation in real life?

PubMed

Comeau, Robyn; Craig, Catherine

2014-03-01

Documentation of deliveries complicated by shoulder dystocia is a valuable communication skill necessary for residents to attain during residency training. Our objective was to determine whether the teaching of documentation of shoulder dystocia in a simulation environment would translate to improved documentation of the event in an actual clinical situation. We conducted a cohort study involving obstetrics and gynaecology residents in years 2 to 5 between November 2010 and December 2012. Each resident participated in a shoulder dystocia simulation teaching session and was asked to write a delivery note immediately afterwards. They were given feedback regarding their performance of the delivery and their documentation of the events. Following this, dictated records of shoulder dystocia deliveries immediately before and after the simulation session were identified through the Meditech system. An itemized checklist was used to assess the quality of residents' dictated documentation before and after the simulation session. All eligible residents (18) enrolled in the study, and 17 met the inclusion criteria. For 10 residents (59%) documentation of a delivery with shoulder dystocia was present before and after the simulation session, for five residents (29%) it was only present before the session, and for two residents (18%) it was only present after the session. When residents were assessed as a group, there were no differences in the proportion of residents recording items on the checklist before and after the simulation session (P > 0.05 for all). Similarly, analysis of the performance of the10 residents who had dictated documentation both before and after the session showed no differences in the number of elements recorded on dictations done before and after the simulation session (P > 0.05 for all). The teaching of shoulder dystocia documentation through simulation did not result in a measurable improvement in the quality of documentation of shoulder dystocia in actual clinical situations.

Facing the Limitations of Electronic Document Handling.

ERIC Educational Resources Information Center

Moralee, Dennis

1985-01-01

This essay addresses problems associated with technology used in the handling of high-resolution visual images in electronic document delivery. Highlights include visual fidelity, laser-driven optical disk storage, electronics versus micrographics for document storage, videomicrographics, and system configurations and peripherals. (EJS)

Smart roadside initiative : system design document.

DOT National Transportation Integrated Search

2015-09-01

This document describes the software design for the Smart Roadside Initiative (SRI) for the delivery of capabilities related to wireless roadside inspections, electronic screening/virtual weigh stations, universal electronic commercial vehicle identi...

Large-Scale Document Automation: The Systems Integration Issue.

ERIC Educational Resources Information Center

Kalthoff, Robert J.

1985-01-01

Reviews current technologies for electronic imaging and its recording and transmission, including digital recording, optical data disks, automated image-delivery micrographics, high-density-magnetic recording, and new developments in telecommunications and computers. The role of the document automation systems integrator, who will bring these…

Mechanized Packing and Delivery System for Entomopathogenic Nematodes in Infected Mealworm Cadavers

USDA-ARS?s Scientific Manuscript database

This document describes a mechanized system to pack mealworm (Tenebrio molitor) cadavers infected with entomopathogenic nematodes between two sheets of masking tape. The document is also an operation manual for the machine and provides all the machine specifications, and wiring and pneumatic diagram...

Pharmaceutical liposomal drug delivery: a review of new delivery systems and a look at the regulatory landscape.

PubMed

Zylberberg, Claudia; Matosevic, Sandro

2016-11-01

Liposomes were the first nanoscale drug to be approved for clinical use in 1995. Since then, the technology has grown considerably, and pioneering recent work in liposome-based delivery systems has brought about remarkable developments with significant clinical implications. This includes long-circulating liposomes, stimuli-responsive liposomes, nebulized liposomes, elastic liposomes for topical, oral and transdermal delivery and covalent lipid-drug complexes for improved drug plasma membrane crossing and targeting to specific organelles. While the regulatory bodies' opinion on liposomes is well-documented, current guidance that address new delivery systems are not. This review describes, in depth, the current state-of-the-art of these new liposomal delivery systems and provides a critical overview of the current regulatory landscape surrounding commercialization efforts of higher-level complexity systems, the expected requirements and the hurdles faced by companies seeking to bring novel liposome-based systems for clinical use to market.

The Apollo experiment for document delivery via satellite communication

NASA Astrophysics Data System (ADS)

1985-03-01

Dutch participation possibilities in the Apollo document delivery project, wishes and idea's of potential user and tender groups, and plans and activities of Dutch institutes and companies, are surveyed. The Apollo storage and transport system, demand and administration network, potential markets, and subject areas of the documents are investigated. Utilization areas (scientific, technical, administration, and business information) are listed. High tariffs and the lack of necessary provision make a direct participation strategy impossible. However, in the experimental phase, Dutch companies must be allowed to contribute in technical developments and availability of organizational and technical facilities must be stimulated.

Level-2 Milestone 6007: Sierra Early Delivery System Deployed to Secret Restricted Network

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

Bertsch, A. D.

This report documents the delivery and installation of Shark, a CORAL Sierra early delivery system deployed on the LLNL SRD network. Early ASC program users have run codes on the machine in support of application porting for the final Sierra system which will be deployed at LLNL in CY2018. In addition to the SRD resource, Shark, unclassified resources, Rzmanta and Ray, have been deployed on the LLNL Restricted Zone and Collaboration Zone networks in support of application readiness for the Sierra platform.

78 FR 12042 - Electric Grid Integration Technical Workshops

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-21

.... The documents are the Electricity Distribution System Workshop Discussion Summary and the Electricity... FURTHER INFORMATION CONTACT: Caitlin A. Callaghan, National Electricity Delivery Division, Office of Electricity Delivery and Energy Reliability, U.S. Department of Energy, Forrestal Building, Room 8E-032, 1000...

Improved overall delivery documentation following implementation of a standardized shoulder dystocia delivery form

PubMed Central

Moragianni, Vasiliki A.; Hacker, Michele R.; Craparo, Frank J.

2013-01-01

Objective Our objective was to evaluate whether using a standardized shoulder dystocia delivery form improved documentation. A standardized delivery form was added to our institution’s obstetrical record in August 2003. Methods A retrospective cohort study was conducted comparing 100 vaginal deliveries complicated by shoulder dystocia before, and 81 after implementation of the standardized delivery form. The two groups were compared in terms of obstetric characteristics, neonatal outcomes and documentation components. Results Charts that included the standardized delivery form were more likely to contain documentation of estimated fetal weight (82.7% vs. 39.0% without the form, P<0.001) and head-to-shoulder delivery interval (76.5% vs. 15.0% without the form, P<0.001). Both groups were statistically similar in terms of documenting estimated blood loss and fetal weight, umbilical cord pH, type and order of maneuvers utilized to relieve the shoulder dystocia, and second stage duration. Conclusions Inclusion of a standardized form in the delivery record improves the rate of documentation of both shoulder dystocia-specific and general delivery components. PMID:22017330

Technology-mediated therapy for chronic pain management: the challenges of adapting behavior change interventions for delivery with pervasive communication technology.

PubMed

Rosser, Benjamin A; McCullagh, Paul; Davies, Richard; Mountain, Gail A; McCracken, Lance; Eccleston, Christopher

2011-04-01

Adapting therapeutic practice from traditional face-to-face exchange to remote technology-based delivery presents challenges for the therapist, patient, and technical writer. This article documents the process of therapy adaptation and the resultant specification for the SMART2 project-a technology-based self-management system for assisting long-term health conditions, including chronic pain. Focus group discussions with healthcare professionals and patients were conducted to inform selection of therapeutic objectives and appropriate technology. Pertinent challenges are identified, relating to (1) reduction and definition of therapeutic objectives, and (2) how to approach adaptation of therapy to a form suited to technology delivery. The requirement of the system to provide dynamic and intelligent responses to patient experience and behavior is also emphasized. Solutions to these challenges are described in the context of the SMART2 technology-based intervention. More explicit discussion and documentation of therapy adaptation to technology-based delivery within the literature is encouraged.

Waste Feed Delivery System Phase 1 Preliminary Reliability and Availability and Maintainability Analysis [SEC 1 and 2

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

CARLSON, A.B.

The document presents updated results of the preliminary reliability, availability, maintainability analysis performed for delivery of waste feed from tanks 241-AZ-101 and 241-AN-105 to British Nuclear Fuels Limited, inc. under the Tank Waste Remediation System Privatization Contract. The operational schedule delay risk is estimated and contributing factors are discussed.

Issues in Commercial Document Delivery.

ERIC Educational Resources Information Center

Marcinko, Randall Wayne

1997-01-01

Discusses (1) the history of document delivery; (2) the delivery process--end-user request, intermediary request, vendor reference, citation verification, obtaining document and source relations, quality control, transferring document to client, customer service and status, invoicing and billing, research and development, and copyright; and (3)…

Interlending and Document Delivery. IATUL Proceedings, Vol. 16.

ERIC Educational Resources Information Center

Fjallbrant, Nancy, Ed.

1984-01-01

This issue of the IATUL (International Association of Technological University Libraries) Proceedings provides an overview of interlending and document delivery in a number of countries. The document comprises: (1) "Interlibrary Lending in the United Kingdom" (Maurice B. Line); (2) "Interlending and Document Delivery in the Federal…

The Role of Telecommunications in the Regional Delivery of Education Services: A Study of the Potential Use of Instructional Television for Vocational Education in the Appalachian States.

ERIC Educational Resources Information Center

INTASA, Inc., Menlo Park, CA.

This report documents a research project focusing on the role of telecommunications technology in the regional delivery of educational services, including assessment of needs, factors in choosing the technology for implementation, alternative delivery systems, cost analysis, and a study of possible demonstration projects in South Carolina,…

Redefining Information Access to Serials Information.

ERIC Educational Resources Information Center

Chen, Ching-chih

1992-01-01

Describes full-text document delivery services that have been introduced in conjunction with available databases in response to economic and technological changes affecting libraries: (1) CARL System's UnCover database and UnCover2 service; (2) Research Libraries Group's CitaDel delivery service; and (3) Faxon Research Service's Faxon Finder and…

Microprocessor Based Temperature Control of Liquid Delivery with Flow Disturbances.

ERIC Educational Resources Information Center

Kaya, Azmi

1982-01-01

Discusses analytical design and experimental verification of a PID control value for a temperature controlled liquid delivery system, demonstrating that the analytical design techniques can be experimentally verified by using digital controls as a tool. Digital control instrumentation and implementation are also demonstrated and documented for…

Modification of Instructional Delivery and Student Learning with the Use of Educational Technologies

ERIC Educational Resources Information Center

Rogers, Jeffrey Ray

2012-01-01

The purpose of this study was to determine if educational technologies, including LCD projectors, interactive whiteboards, tablets, document cameras, and student response systems, modify instructional delivery and student learning. This case study was researched in four classrooms, including an English, math, science and social studies classroom…

Smart roadside initiative : system requirements specifications.

DOT National Transportation Integrated Search

2015-09-01

This document describes the system requirements specifications (SyRS) for the Smart Roadside Initiative (SRI) Prototype for the delivery of capabilities related to wireless roadside inspections, electronic screening/virtual weigh stations, universal ...

The Post-Secondary Student Support Program: An Examination of Alternative Delivery Mechanisms. A Report to the Indian and Northern Affairs Canada

ERIC Educational Resources Information Center

Usher, Alex

2009-01-01

The purpose of this document is to examine the Department of Indian and Northern Affairs Canada (INAC)'s Post-Secondary Student Support Program (PSSSP) and analyse the advantages and disadvantages of both the existing system of program delivery and a trio of alternative delivery mechanisms. It does not issue any recommendation with respect to a…

A Comparison of Product Realization Frameworks

DTIC Science & Technology

1993-10-01

software (integrated FrameMaker ). Also included are BOLD for on-line documentation delivery, printer/plotter support, and 18 network licensing support. AMPLE...are built with DSS. Documentation tools include an on-line information system (BOLD), text editing (Notepad), word processing (integrated FrameMaker ...within an application. FrameMaker is fully integrated with the Falcon Framework to provide consistent documentation capabilities within engineering

Ohio Health Technology Competency Profile.

ERIC Educational Resources Information Center

Boudreau, Joyce; Miller, Lavonna F.

This document, which was jointly developed by representatives from a broad cross-section of Ohio's health care industries and educators representing Ohio's schools and colleges, is intended as a foundation for developing an integrated delivery system to prepare students for careers in health care. The document's introductory section presents…

Beyond the rhetoric: what do we mean by a 'model of care'?

PubMed

Davidson, Patricia; Halcomb, Elizabeth; Hickman, L; Phillips, J; Graham, B

2006-01-01

Contemporary health care systems are constantly challenged to revise traditional methods of health care delivery. These challenges are multifaceted and stem from: (1) novel pharmacological and non-pharmacological treatments; (2) changes in consumer demands and expectations; (3) fiscal and resource constraints; (4) changes in societal demographics in particular the ageing of society; (5) an increasing burden of chronic disease; (6) documentation of limitations in traditional health care delivery; (7) increased emphasis on transparency, accountability, evidence-based practice (EBP) and clinical governance structures; and (8) the increasing cultural diversity of the community. These challenges provoke discussion of potential alternative models of care, with scant reference to defining what constitutes a model of care. This paper aims to define what is meant by the term 'model of care' and document the pragmatic systems and processes necessary to develop, plan, implement and evaluate novel models of care delivery. Searches of electronic databases, the reference lists of published materials, policy documents and the Internet were conducted using key words including 'model*', 'framework*', 'models, theoretical' and 'nursing models, theoretical'. The collated material was then analysed and synthesised into this review. This review determined that in addition to key conceptual and theoretical perspectives, quality improvement theory (eg. collaborative methodology), project management methods and change management theory inform both pragmatic and conceptual elements of a model of care. Crucial elements in changing health care delivery through the development of innovative models of care include the planning, development, implementation, evaluation and assessment of the sustainability of the new model. Regardless of whether change in health care delivery is attempted on a micro basis (eg. ward level) or macro basis (eg. national or state system) in order to achieve sustainable, effective and efficient changes a well-planned, systematic process is essential.

Electronic availability of microgravity experiments safety and integration requirements documents

NASA Technical Reports Server (NTRS)

Hogan, Jean M.

1995-01-01

This follow-on to NASA Contractor Report 195447, Microgravity Experiments Safety and Integration Requirements Document Tree, provides the details for accessing the systems that contain the official, electronic versions of the documents initially researched in NASA Contractor Report 195447. The data in this report serves as a valuable information source for the NASA Lewis Research Center Project Documentation Center (PDC), as well as for all developers of space experiments. The PDC has acquired the hardware, software, ID's, and passwords necessary to access most of these systems and is now able to provide customers with current document information as well as immediate delivery of available documents in either electronic or hard copy format.

Wyoming Academic Libraries Resource Project: Developing a Statewide Ariel Document Delivery Network. Final Report.

ERIC Educational Resources Information Center

Lange, Karen

The Wyoming Academic Libraries Resource Project was initiated to improve cooperation and resource sharing by developing an interconnected information access and delivery system among Wyoming's academic libraries and the State Library. The goal was to formalize communication, cooperation, and resource sharing by developing an Ariel document…

ISS Crew Transportation and Services Requirements Document

NASA Technical Reports Server (NTRS)

Bayt, Robert L. (Compiler); Lueders, Kathryn L. (Compiler)

2016-01-01

The ISS Crew Transportation and Services Requirements Document (CCT-REQ-1130) contains all technical, safety, and crew health medical requirements that are mandatory for achieving a Crew Transportation System Certification that will allow for International Space Station delivery and return of NASA crew and limited cargo. Previously approved on TN23183.

Fetal laceration injury at cesarean delivery.

PubMed

Smith, J F; Hernandez, C; Wax, J R

1997-09-01

To investigate the incidence of fetal laceration injury in cesarean delivery. A retrospective review was conducted using a computer-based data coding system. All neonatal records were reviewed for infants delivered by cesarean during a 2-year period. Maternal records were reviewed in those cases of documented fetal laceration injury. The Fisher exact test was used when indicated. There were 904 cesarean deliveries performed during the study period; of these, 896 neonatal records (98.4%) were available for review. Seventeen laceration injuries were recorded (1.9%). The incidence of laceration appeared higher when the indication for cesarean was nonvertex (6.0% versus 1.4%, P = .02). One of 17 (5.9%) maternal records indicated the presence of the laceration of the fetus. Fetal laceration injury at cesarean delivery is not rare, especially when it is performed for nonvertex presentation. The minority of obstetric records show documentation of such lacerations, suggesting that this complication often may not be recognized by obstetricians.

Negotiating the Digital Library: Document Delivery.

ERIC Educational Resources Information Center

Jacobs, Neil; Morris, Anne

1999-01-01

The eLib-funded FIDDO (Focused Investigation of Document Delivery Options) project provides library managers/others with information to support policy decisions. Senior libraries were interviewed about the future of document delivery and interviews were analyzed with the support of NUD*IST (Nonnumerical Unstructured Data by Indexing, Searching and…

Calcium silicate-based drug delivery systems.

PubMed

Zhu, Ying-Jie; Guo, Xiao-Xuan; Sham, Tsun-Kong

2017-02-01

Compared with other inorganic materials such as silica, metal oxides, noble metals and carbon, calcium silicate-based materials, especially nanostructured calcium silicate materials, have high biocompatibility, bioactivity and biodegradability, high specific surface area, nanoporous/hollow structure, high drug-loading capacity, pH-responsive drug release behavior and desirable drug release properties, and thus they are promising for the application in drug delivery. Calcium silicate-based drug delivery systems have a long drug-release time, which can significantly prolong the therapeutic effect of drugs. Another advantage of calcium silicate-based drug delivery systems is their pH-responsive drug release property, which can act as an ideal platform for targeted drug delivery. Areas covered: In recent years, studies have been carried out on calcium silicate-based drug delivery systems, and important results and insights have been documented. This article is not intended to offer a comprehensive review on the research on calcium silicate-based drug delivery systems, but presents some examples reported in the literature, and includes new insights obtained by tracking the interactions between drug molecules and calcium silicate carriers on the molecular level using the synchrotron-based X-ray spectroscopy. Expert opinion: Finally, our opinions on calcium silicate-based drug delivery systems are provided, and several research directions for the future studies are proposed.

78 FR 123 - Diablo Canyon, Independent Spent Fuel Storage Installation; License Amendment Request...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-02

... receipt of the document. The E-Filing system also distributes an email notice that provides access to the...: Rulemaking and Adjudications Staff; or (2) courier, express mail, or expedited delivery service to the Office... mail as of the time of deposit in the mail, or by courier, express mail, or expedited delivery service...

78 FR 119 - Consideration of Approval of Application Containing Sensitive Unclassified Non-Safeguards...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-02

... receipt of the document. The E-Filing system also distributes an email notice that provides access to the...: Rulemaking and Adjudications Staff; or (2) courier, express mail, or expedited delivery service to the Office... mail as of the time of deposit in the mail, or by courier, express mail, or expedited delivery service...

78 FR 3454 - Prairie Island, Independent Spent Fuel Storage Installation; Notice of Docketing of Amendment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-16

...-Filing system also distributes an email notice that provides access to the document to the NRC's Office... Adjudications Staff; or (2) courier, express mail, or expedited delivery service to the Office of the Secretary... time of deposit in the mail, or by courier, express mail, or expedited delivery service upon depositing...

Adolescent Health. Volume III: Crosscutting Issues in the Delivery of Health and Related Services.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Office of Technology Assessment.

This document, the third of three volumes in the U.S. Congress Office of Technology Assessment's "Adolescent Health" series, contains chapters 15 through 19, which address issues in the delivery of health and related services to adolescents. Chapter 15 reviews research on the shortcomings of the mainstream primary health care system with…

Documentation of e-cigarette use and associations with smoking from 2012 to 2015 in an integrated healthcare delivery system.

PubMed

Young-Wolff, Kelly C; Klebaner, Daniella; Folck, Bruce; Tan, Andy S L; Fogelberg, Renee; Sarovar, Varada; Prochaska, Judith J

2018-04-01

It is unclear whether use of electronic nicotine delivery systems (ENDS) precedes cigarette smoking initiation, relapse, and/or quitting. Healthcare systems with electronic health records (EHRs) provide unique data to examine ENDS use and changes in smoking. We examined the incidence of ENDS use (2012-2015) based on clinician documentation and tested whether EHR documented ENDS use is associated with twelve-month changes in patient smoking status using a matched retrospective cohort design. The sample was Kaiser Permanente Northern California (KPNC) patients aged ≥12 with documented ENDS use (N = 7926); 57% were current smokers, 35% former smokers, and 8% never-smokers. ENDS documentation incidence peaked in 2014 for current and former smokers and in 2015 for never-smokers. We matched patients with documented ENDS use to KPNC patients without documented ENDS use (N = 7926) on age, sex, race/ethnicity, and smoking status. Documented ENDS use predicted the likelihood of smoking in the following year. Among current smokers, ENDS use was associated with greater odds of quitting smoking (OR = 1.17, 95%CI = 1.05-1.31). Among former smokers, ENDS use was associated with greater odds of smoking relapse (OR = 1.53, 95%CI = 1.22-1.92). Among never-smokers, ENDS use was associated with greater odds of initiating smoking (OR = 7.41, 95%CI = 3.14-17.5). The overall number of current smokers at 12 months was slightly higher among patients with (N = 3931) versus without (N = 3850) documented ENDS use. Results support both potential harm reduction of ENDS use (quitting combustibles among current smokers) and potential for harm (relapse to combustibles among former smokers, initiation for never-smokers). Copyright © 2018 Elsevier Inc. All rights reserved.

Shoulder dystocia documentation: an evaluation of a documentation training intervention.

PubMed

LeRiche, Tammy; Oppenheimer, Lawrence; Caughey, Sharon; Fell, Deshayne; Walker, Mark

2015-03-01

To evaluate the quality and content of nurse and physician shoulder dystocia delivery documentation before and after MORE training in shoulder dystocia management skills and documentation. Approximately 384 charts at the Ottawa Hospital General Campus involving a diagnosis of shoulder dystocia between the years of 2000 and 2006 excluding the training year of 2003 were identified. The charts were evaluated for 14 key components derived from a validated instrument. The delivery notes were then scored based on these components by 2 separate investigators who were blinded to delivery note author, date, and patient identification to further quantify delivery record quality. Approximately 346 charts were reviewed for physician and nurse delivery documentation. The average score for physician notes was 6 (maximum possible score of 14) both before and after the training intervention. The nurses' average score was 5 before and after the training intervention. Negligible improvement was observed in the content and quality of shoulder dystocia documentation before and after nurse and physician training.

Three Years of Unmediated Document Delivery: An Analysis and Consideration of Collection Development Priorities.

PubMed

Chan, Emily K; Mune, Christina; Wang, YiPing; Kendall, Susan L

2016-01-01

Like most academic libraries, San José State University Library is struggling to meet users' rising expectations for immediate information within the financial confines of a flat budget. To address acquisition of nonsubscribed article content, particularly outside of business hours, San José State University Library implemented Copyright Clearance Center's Get It Now, a document delivery service. Three academic years of analyzed data, which involves more than 10,000 requests, and the subsequent collection development actions taken by the library will be discussed. The value and challenges of patron-driven, unmediated document delivery services in conjunction with traditional document delivery services will be considered.

One small community hospital library's successful outsourcing of document delivery: an ongoing study.

PubMed

Haas, V

2000-01-01

When DOCLINE was implemented in 1985, community hospital librarians were beginning to feel the economic pressures of the changing health care arena. However, staff and resources were often sufficient or plentiful. Now, fifteen years after the creation of DOCLINE, many existing small hospitals either no longer have a librarian, an assistant is managing the library, the librarian is managing one or more libraries of an integrated system, or the number of librarians has been reduced. A system that is heavily staff dependent is no longer feasible. In addition, as the role of the community hospital librarian evolves into one of instructor and patient education liaison, a system that does not permit the librarian to expand such services will be detrimental to the entire library program. Following is a discussion of one small community hospital's decision to outsource document delivery services as a result of staffing changes and the expansion of additional library programs.

The Integrated Library System of the 1990s: The OhioLINK Experience.

ERIC Educational Resources Information Center

Hawks, Carol Pitts

1992-01-01

Discussion of integrated library systems focuses on the development of the Ohio Library and Information Network (OhioLINK). Capabilities of eight existing systems are described, including catalog creation and maintenance; the online public access catalog (OPAC); circulation, interlibrary loan, and document delivery; acquisitions and serials…

Learning Resources for Community Education: Design Notes on Delivery Systems.

ERIC Educational Resources Information Center

Bhola, H. S.

A comprehensive and adaptable system of organizational arrangements is proposed in this document that will enable educational planners in Latin American countries to develop and deliver learning resources for community education and community action programs. A three-tier system of learning resources centers for community education is described.…

Procedures for EPA Libraries to Obtain Materials through Interlibrary Loan/Document Delivery

EPA Pesticide Factsheets

The purpose of this document is to establish Agency-wide procedures by which EPA libraries obtain materials for Agency employees and authorized EPA contractors through interlibrary loan (ILL) and other document delivery methods.

Human Research Program Requirements Document

NASA Technical Reports Server (NTRS)

Rieger, Gabe

2007-01-01

The purpose of this document is to define, document, and allocate the Human Research Program (HRP) requirements to the HRP Program elements. It establishes the flow-down of requirements from Exploration Systems Mission Directorate (ESMD) and Office of the Chief Health and Medical Officer (OCHMO) to the various Program Elements of the HRP to ensure that human research and technology countermeasure investments are made to insure the delivery of countermeasures and technologies that satisfy ESMD s and OCHMO's exploration mission requirements.

Grooves to tubes: evolution of the venom delivery system in a Late Triassic "reptile"

NASA Astrophysics Data System (ADS)

Mitchell, Jonathan S.; Heckert, Andrew B.; Sues, Hans-Dieter

2010-12-01

Venom delivery systems occur in a wide range of extant and fossil vertebrates and are primarily based on oral adaptations. Teeth range from unmodified (Komodo dragons) to highly specialized fangs similar to hypodermic needles (protero- and solenoglyphous snakes). Developmental biologists have documented evidence for an infolding pathway of fang evolution, where the groove folds over to create the more derived condition. However, the oldest known members of venomous clades retain the same condition as their extant relatives, resulting in no fossil evidence for the transition. Based on a comparison of previously known specimens with newly discovered teeth from North Carolina, we describe a new species of the Late Triassic archosauriform Uatchitodon and provide detailed analyses that provide evidence for both venom conduction and document a complete structural series from shallow grooves to fully enclosed tubular canals. While known only from teeth, Uatchitodon is highly diagnostic in possessing compound serrations and for having two venom canals on each tooth in the dentition. Further, although not a snake, Uatchitodon sheds light on the evolutionary trajectory of venom delivery systems in amniotes and provide solid evidence for venom conduction in archosaur-line diapsids.

17 CFR 4.31 - Required delivery of Disclosure Document to prospective clients.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Disclosure Document to prospective clients. 4.31 Section 4.31 Commodity and Securities Exchanges COMMODITY... Advisors § 4.31 Required delivery of Disclosure Document to prospective clients. (a) Each commodity trading... prospective client a Disclosure Document containing the information set forth in §§ 4.34 and 4.35 for the...

Fee Based Document Delivery by a National Library: Publishing in the New Millennium.

ERIC Educational Resources Information Center

Smith, Malcolm D.

1996-01-01

An overview of the development of document supply relationships between libraries and publishers, based on the British Library's Document Supply Centre, reveals four areas leading to fee based (copyright) document delivery: libraries as markets for publishers; making users aware of what is published; making publications more accessible; and the…

Riding the Electronic Wave--Document Delivery: Proceedings of the Library of Congress Network Advisory Committee Meeting (Washington, D.C., November 29-December 1, 1989). Network Planning Paper Number 20.

ERIC Educational Resources Information Center

Library of Congress, Washington, DC. Network Development and MARC Standards Office.

Papers delivered at the 1989 program session of the Library of Congress Network Advisory Committee (NAC) focused on ways in which newer technologies and document delivery networks are changing current practices in document delivery and information services. Charles P. Bourne, chair of the program committee, presented an overview of document…

Project delivery acceleration tool box : improvements to the Department of Transportation's project delivery process.

DOT National Transportation Integrated Search

2004-05-01

The purpose of this document is to provide to Caltrans' employees, as well as external partners, some valuable tools that can be used to help accelerate project delivery. This document contains a compilation of all the Department's recent acceleratio...

Abstracts of SIG Sessions.

ERIC Educational Resources Information Center

Proceedings of the ASIS Annual Meeting, 1996

1996-01-01

Includes abstracts of special interest group (SIG) sessions. Highlights include digital imagery; text summarization; browsing; digital libraries; icons and the Web; information management; curricula planning; interfaces; information systems; theories; scholarly and scientific communication; global development; archives; document delivery;…

DIRECT secure messaging as a common transport layer for reporting structured and unstructured lab results to outpatient providers.

PubMed

Sujansky, Walter; Wilson, Tom

2015-04-01

This report describes a grant-funded project to explore the use of DIRECT secure messaging for the electronic delivery of laboratory test results to outpatient physicians and electronic health record systems. The project seeks to leverage the inherent attributes of DIRECT secure messaging and electronic provider directories to overcome certain barriers to the delivery of lab test results in the outpatient setting. The described system enables laboratories that generate test results as HL7 messages to deliver these results as structured or unstructured documents attached to DIRECT secure messages. The system automatically analyzes generated HL7 messages and consults an electronic provider directory to determine the appropriate DIRECT address and delivery format for each indicated recipient. The system also enables lab results delivered to providers as structured attachments to be consumed by HL7 interface engines and incorporated into electronic health record systems. Lab results delivered as unstructured attachments may be printed or incorporated into patient records as PDF files. The system receives and logs acknowledgement messages to document the status of each transmitted lab result, and a graphical interface allows searching and review of this logged information. The described system is a fully implemented prototype that has been tested in a laboratory setting. Although this approach is promising, further work is required to pilot test the system in production settings with clinical laboratories and outpatient provider organizations. Copyright © 2015 Elsevier Inc. All rights reserved.

Integrated Adult Education Data System. Policy Option Paper on Strategic Recommendation 8. First Edition.

ERIC Educational Resources Information Center

Porter, Dennis

This document addresses the recommendation contained in the 1989 California Strategic Plan for Adult Education for an integrated adult education data system. The recommendation proposes collecting and organizing community adult education information into groups of data on: program services, program delivery, learner characteristics, and learning…

IMIS: Integrated Maintenance Information System. A maintenance information delivery concept

NASA Technical Reports Server (NTRS)

Vonholle, Joseph C.

1987-01-01

The Integrated Maintenance Information System (IMIS) will optimize the use of available manpower, enhance technical performance, improve training, and reduce the support equipment and documentation needed for deployment. It will serve as the technician's single, integrated source of all the technical information required to perform modern aircraft maintenance.

[Stimulation of labour with oxytocin and ventouse deliveries are inadequately documented].

PubMed

Lindved, Birgitte Freilev; Kierkegaard, Ole; Anhøj, Jacob

2014-09-15

A retrospective sample of 180 records from four regional hospitals and five university hospitals in Denmark was collected and the documentation for use of oxytocin in augmentation of labour and ventouse deliveries according to the national guidelines was registered. Only approximately half of the elements in the national guidelines were documented. This shows that there is a potential for improvement in the ongoing Danish national quality improvement project Safe Deliveries (Sikre Fødsler).

A Taxonomy of Delivery and Documentation Deviations During Delivery of High-Fidelity Simulations.

PubMed

McIvor, William R; Banerjee, Arna; Boulet, John R; Bekhuis, Tanja; Tseytlin, Eugene; Torsher, Laurence; DeMaria, Samuel; Rask, John P; Shotwell, Matthew S; Burden, Amanda; Cooper, Jeffrey B; Gaba, David M; Levine, Adam; Park, Christine; Sinz, Elizabeth; Steadman, Randolph H; Weinger, Matthew B

2017-02-01

We developed a taxonomy of simulation delivery and documentation deviations noted during a multicenter, high-fidelity simulation trial that was conducted to assess practicing physicians' performance. Eight simulation centers sought to implement standardized scenarios over 2 years. Rules, guidelines, and detailed scenario scripts were established to facilitate reproducible scenario delivery; however, pilot trials revealed deviations from those rubrics. A taxonomy with hierarchically arranged terms that define a lack of standardization of simulation scenario delivery was then created to aid educators and researchers in assessing and describing their ability to reproducibly conduct simulations. Thirty-six types of delivery or documentation deviations were identified from the scenario scripts and study rules. Using a Delphi technique and open card sorting, simulation experts formulated a taxonomy of high-fidelity simulation execution and documentation deviations. The taxonomy was iteratively refined and then tested by 2 investigators not involved with its development. The taxonomy has 2 main classes, simulation center deviation and participant deviation, which are further subdivided into as many as 6 subclasses. Inter-rater classification agreement using the taxonomy was 74% or greater for each of the 7 levels of its hierarchy. Cohen kappa calculations confirmed substantial agreement beyond that expected by chance. All deviations were classified within the taxonomy. This is a useful taxonomy that standardizes terms for simulation delivery and documentation deviations, facilitates quality assurance in scenario delivery, and enables quantification of the impact of deviations upon simulation-based performance assessment.

Rural and urban transit district benchmarking : effectiveness and efficiency guidance document.

DOT National Transportation Integrated Search

2011-05-01

Rural and urban transit systems have sought ways to compare performance across agencies, : identifying successful service delivery strategies and applying these concepts to achieve : successful results within their agency. Benchmarking is a method us...

7 CFR 1488.8 - Documents required after delivery.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Financing of Export Sales of Agricultural Commodities From Private Stocks Under CCC Export Credit Sales Program (GSM-5) Documents Required for Financing § 1488.8 Documents required after delivery. (a) CCC will... regulations within forty-five days, or any extension thereof by the Treasurer or Assistant Treasurer, CCC...

7 CFR 1488.8 - Documents required after delivery.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Financing of Export Sales of Agricultural Commodities From Private Stocks Under CCC Export Credit Sales Program (GSM-5) Documents Required for Financing § 1488.8 Documents required after delivery. (a) CCC will... regulations within forty-five days, or any extension thereof by the Treasurer or Assistant Treasurer, CCC...

7 CFR 1488.8 - Documents required after delivery.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Financing of Export Sales of Agricultural Commodities From Private Stocks Under CCC Export Credit Sales Program (GSM-5) Documents Required for Financing § 1488.8 Documents required after delivery. (a) CCC will... regulations within forty-five days, or any extension thereof by the Treasurer or Assistant Treasurer, CCC...

Developing Effective Linkages between Job Corps and One-Stop Systems: A Technical Assistance Guide.

ERIC Educational Resources Information Center

Dickinson, Katherine; Soukamneuth, Sengsouvanh

This document is intended to help Job Corps centers and Office of Acquisition Policy contractors establish linkages with one-stop systems. Chapter 1 summarizes the requirements for linkages between Job Corps and one-stop systems that are specified in the Workforce Investment Act (WIA) of 1998 and compares one-stop delivery systems before and under…

7 CFR 1726.401 - Material contract closeout.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE ELECTRIC SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Contract Closeout § 1726.401 Material contract closeout. (a) Delivery inspection. The borrower (acting through its engineer, if applicable) will... applicable specifications. (b) Closeout documents. The borrower (acting through its engineer, if applicable...

7 CFR 1726.401 - Material contract closeout.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE ELECTRIC SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Contract Closeout § 1726.401 Material contract closeout. (a) Delivery inspection. The borrower (acting through its engineer, if applicable) will... applicable specifications. (b) Closeout documents. The borrower (acting through its engineer, if applicable...

7 CFR 1726.401 - Material contract closeout.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE ELECTRIC SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Contract Closeout § 1726.401 Material contract closeout. (a) Delivery inspection. The borrower (acting through its engineer, if applicable) will... applicable specifications. (b) Closeout documents. The borrower (acting through its engineer, if applicable...

7 CFR 1726.401 - Material contract closeout.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE ELECTRIC SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Contract Closeout § 1726.401 Material contract closeout. (a) Delivery inspection. The borrower (acting through its engineer, if applicable) will... applicable specifications. (b) Closeout documents. The borrower (acting through its engineer, if applicable...

7 CFR 1726.401 - Material contract closeout.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE ELECTRIC SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Contract Closeout § 1726.401 Material contract closeout. (a) Delivery inspection. The borrower (acting through its engineer, if applicable) will... applicable specifications. (b) Closeout documents. The borrower (acting through its engineer, if applicable...

48 CFR 43.204 - Administration.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Administration. 43.204... CONTRACT MODIFICATIONS Change Orders 43.204 Administration. (a) Change order documentation. When change... adjusting the contract delivery schedule. (3) Contracting offices and contract administration offices, as...

48 CFR 43.204 - Administration.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Administration. 43.204... CONTRACT MODIFICATIONS Change Orders 43.204 Administration. (a) Change order documentation. When change... adjusting the contract delivery schedule. (3) Contracting offices and contract administration offices, as...

48 CFR 43.204 - Administration.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Administration. 43.204... CONTRACT MODIFICATIONS Change Orders 43.204 Administration. (a) Change order documentation. When change... adjusting the contract delivery schedule. (3) Contracting offices and contract administration offices, as...

48 CFR 227.7203-8 - Deferred delivery and deferred ordering of computer software and computer software documentation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... deferred ordering of computer software and computer software documentation. 227.7203-8 Section 227.7203-8... GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Rights in Computer Software and Computer Software Documentation 227.7203-8 Deferred delivery and deferred ordering of computer software and computer...

48 CFR 227.7203-8 - Deferred delivery and deferred ordering of computer software and computer software documentation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... deferred ordering of computer software and computer software documentation. 227.7203-8 Section 227.7203-8... GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Rights in Computer Software and Computer Software Documentation 227.7203-8 Deferred delivery and deferred ordering of computer software and computer...

48 CFR 227.7203-8 - Deferred delivery and deferred ordering of computer software and computer software documentation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... deferred ordering of computer software and computer software documentation. 227.7203-8 Section 227.7203-8... GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Rights in Computer Software and Computer Software Documentation 227.7203-8 Deferred delivery and deferred ordering of computer software and computer...

48 CFR 227.7203-8 - Deferred delivery and deferred ordering of computer software and computer software documentation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... deferred ordering of computer software and computer software documentation. 227.7203-8 Section 227.7203-8... GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Rights in Computer Software and Computer Software Documentation 227.7203-8 Deferred delivery and deferred ordering of computer software and computer...

48 CFR 227.7203-8 - Deferred delivery and deferred ordering of computer software and computer software documentation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... deferred ordering of computer software and computer software documentation. 227.7203-8 Section 227.7203-8... GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Rights in Computer Software and Computer Software Documentation 227.7203-8 Deferred delivery and deferred ordering of computer software and computer...

A National Satellite-Based System for Providing Continuing Education to Engineers.

ERIC Educational Resources Information Center

Georgia Inst. of Tech., Atlanta.

This document proposes, and indicates initial reaction to, a multi-point satellite-based delivery system which will permit expansion of current programs and services of the Association for Media-based Continuing Education for Engineers, Inc. (AMCEE) consortium to a much larger aggregated audience of practicing engineers throughout the country. It…

Creating a New Definition of Library Cooperation: Past, Present, and Future Models.

ERIC Educational Resources Information Center

Lenzini, Rebecca T.; Shaw, Ward

1991-01-01

Describes the creation and purpose of the Colorado Alliance of Research Libraries (CARL), the subsequent development of CARL Systems, and its current research projects. Topics discussed include online catalogs; UnCover, a journal article database; full text data; document delivery; visual images in computer systems; networks; and implications for…

Advanced Transport Operating System (ATOPS) color displays software description microprocessor system

NASA Technical Reports Server (NTRS)

Slominski, Christopher J.; Plyler, Valerie E.; Dickson, Richard W.

1992-01-01

This document describes the software created for the Sperry Microprocessor Color Display System used for the Advanced Transport Operating Systems (ATOPS) project on the Transport Systems Research Vehicle (TSRV). The software delivery known as the 'baseline display system', is the one described in this document. Throughout this publication, module descriptions are presented in a standardized format which contains module purpose, calling sequence, detailed description, and global references. The global reference section includes procedures and common variables referenced by a particular module. The system described supports the Research Flight Deck (RFD) of the TSRV. The RFD contains eight cathode ray tubes (CRTs) which depict a Primary Flight Display, Navigation Display, System Warning Display, Takeoff Performance Monitoring System Display, and Engine Display.

Documentation of Nursing Practice Using a Computerized Medical Information System

PubMed Central

Romano, Carol

1981-01-01

This paper discusses a definition of the content of the computerized nursing data base developed by the Nursing Department for the Clinical Center Medical Information System at the National Institutes of Health in Bethesda, Maryland. The author describes the theoretical framework for the content and presents a model to describe the organization of the nursing data components in relation to the process of nursing care delivery. Nursing documentation requirements of Nurse Practice Acts, American Nurses Association Standards of Practice and the Joint Commission on Accreditation of Hospitals are also addressed as they relate to this data base. The advantages and disadvantages of such an approach to computerized documentation are discussed.

A Content Markup Language for Data Services

NASA Astrophysics Data System (ADS)

Noviello, C.; Acampa, P.; Mango Furnari, M.

Network content delivery and documents sharing is possible using a variety of technologies, such as distributed databases, service-oriented applications, and so forth. The development of such systems is a complex job, because document life cycle involves a strong cooperation between domain experts and software developers. Furthermore, the emerging software methodologies, such as the service-oriented architecture and knowledge organization (e.g., semantic web) did not really solve the problems faced in a real distributed and cooperating settlement. In this chapter the authors' efforts to design and deploy a distribute and cooperating content management system are described. The main features of the system are a user configurable document type definition and a management middleware layer. It allows CMS developers to orchestrate the composition of specialized software components around the structure of a document. In this chapter are also reported some of the experiences gained on deploying the developed framework in a cultural heritage dissemination settlement.

Extinguishing agent for magnesium fire, phases 5 and 6

NASA Astrophysics Data System (ADS)

Beeson, H. D.; Tapscott, R. E.; Mason, B. E.

1987-07-01

This report documents the validation testing of the extinguishing system for metal fires developed as part of Phases 1 to 4. The results of this validation testing form the basis of information from which draft military specifications necessary to procure the agent and the agent delivery system may be developed. The developed system was tested against a variety of large-scale metal fire scenarios and the capabilities of the system were assessed. In addition the response of the system to storage and to changes in ambient conditions was tested. Results of this testing revealed that the developed system represented a reliable metal fire extinguishing system that could control and extinguish very large metal fires. The specifications developed for the agent and for the delivery system are discussed in detail.

Extinguishing Agent for Magnesium Fire: Phases 5 and 6.

DTIC Science & Technology

1987-07-01

This report documents the validation testing of the extinguishing system for metal fires developed as part of Phases I-IV. The results of this...system represented a reliable metal fire extinguishing system that could control and extinguish very large metal fires . The specifications developed for...the agent and for the delivery system are discussed in detail. Keywords: Fire suppression, Metal fires , Fire extinguishers.

Development of TOPS

NASA Astrophysics Data System (ADS)

Tanaka, Yoshiyuki; Tsugiishi, Shigemi

The off-line patent and utility model information management system at Teijin Ltd. had been developed and operated since 1980. To achieve efficient business management through office automation and to get ready for easy access to electronic document delivery so-called Paperless project being developed by Japan Patent Office, the system was reviewed and new online system was constructed in 1985. The paper describes its details.

North Carolina: Statewide Automation and Connectivity Efforts.

ERIC Educational Resources Information Center

Christian, Elaine J., Ed.

1996-01-01

Describes statewide information automation and connectivity efforts in North Carolina. Highlights include Triangle Research Libraries Network Document Delivery System; cooperative networking projects; public library connectivity to the state library; rural access projects; community college automation; K-12 technology plans; electronic government…

Document image archive transfer from DOS to UNIX

NASA Technical Reports Server (NTRS)

Hauser, Susan E.; Gill, Michael J.; Thoma, George R.

1994-01-01

An R&D division of the National Library of Medicine has developed a prototype system for automated document image delivery as an adjunct to the labor-intensive manual interlibrary loan service of the library. The document image archive is implemented by a PC controlled bank of optical disk drives which use 12 inch WORM platters containing bitmapped images of over 200,000 pages of medical journals. Following three years of routine operation which resulted in serving patrons with articles both by mail and fax, an effort is underway to relocate the storage environment from the DOS-based system to a UNIX-based jukebox whose magneto-optical erasable 5 1/4 inch platters hold the images. This paper describes the deficiencies of the current storage system, the design issues of modifying several modules in the system, the alternatives proposed and the tradeoffs involved.

An observational study of the accuracy and completeness of an anesthesia information management system: recommendations for documentation system changes.

PubMed

Wilbanks, Bryan A; Moss, Jacqueline A; Berner, Eta S

2013-08-01

Anesthesia information management systems must often be tailored to fit the environment in which they are implemented. Extensive customization necessitates that systems be analyzed for both accuracy and completeness of documentation design to ensure that the final record is a true representation of practice. The purpose of this study was to determine the accuracy of a recently installed system in the capture of key perianesthesia data. This study used an observational design and was conducted using a convenience sample of nurse anesthetists. Observational data of the nurse anesthetists'delivery of anesthesia care were collected using a touch-screen tablet computer utilizing an Access database customized observational data collection tool. A questionnaire was also administered to these nurse anesthetists to assess perceived accuracy, completeness, and satisfaction with the electronic documentation system. The major sources of data not documented in the system were anesthesiologist presence (20%) and placement of intravenous lines (20%). The major sources of inaccuracies in documentation were gas flow rates (45%), medication administration times (30%), and documentation of neuromuscular function testing (20%)-all of the sources of inaccuracies were related to the use of charting templates that were not altered to reflect the actual interventions performed.

49 CFR 386.6 - Service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... valid as of the date and the time the document was mailed, or the date personal delivery of the document was refused. Service by delivery after 5 p.m. in the time zone in which the recipient will receive...

Instant replay.

PubMed

Rosenthal, David I

2013-06-01

With widespread adoption of electronic health records (EHRs) and electronic clinical documentation, health care organizations now have greater faculty to review clinical data and evaluate the efficacy of quality improvement efforts. Unfortunately, I believe there is a fundamental gap between actual health care delivery and what we document in the current EHR systems. This process of capturing the patient encounter, which I'll refer to as transcription, is prone to significant data loss due to inadequate methods of data capture, multiple points of view, and bias and subjectivity in the transcriptional process. Our current EHR, text-based clinical documentation systems are lossy abstractions - one sided accounts of what take place between patients and providers. Our clinical notes contain the breadcrumbs of relationships, conversations, physical exams, and procedures but often lack the ability to capture the form, the emotions, the images, the nonverbal communication, and the actual narrative of interactions between human beings. I believe that a video record, in conjunction with objective transcriptional services and other forms of data capture, may provide a closer approximation to the truth of health care delivery and may be a valuable tool for healthcare improvement. Copyright © 2013 Elsevier Inc. All rights reserved.

Medication order communication using fax and document-imaging technologies.

PubMed

Simonian, Armen I

2008-03-15

The implementation of fax and document-imaging technology to electronically communicate medication orders from nursing stations to the pharmacy is described. The evaluation of a commercially available pharmacy order imaging system to improve order communication and to make document retrieval more efficient led to the selection and customization of a system already licensed and used in seven affiliated hospitals. The system consisted of existing fax machines and document-imaging software that would capture images of written orders and send them from nursing stations to a central database server. Pharmacists would then retrieve the images and enter the orders in an electronic medical record system. The pharmacy representatives from all seven hospitals agreed on the configuration and functionality of the custom application. A 30-day trial of the order imaging system was successfully conducted at one of the larger institutions. The new system was then implemented at the remaining six hospitals over a period of 60 days. The transition from a paper-order system to electronic communication via a standardized pharmacy document management application tailored to the specific needs of this health system was accomplished. A health system with seven affiliated hospitals successfully implemented electronic communication and the management of inpatient paper-chart orders by using faxes and document-imaging technology. This standardized application eliminated the problems associated with the hand delivery of paper orders, the use of the pneumatic tube system, and the printing of traditional faxes.

Project SCS (Special Communication Services).

ERIC Educational Resources Information Center

Curtis, John A.

This extensive report describes and provides documentation on Special Communications Services for the Sensory Impaired (SCS), a Virginia-based telecommunications delivery system developed by the Center for Excellence, Inc. (CenTex), to provide information and entertainment broadcasting services to the visually handicapped, the hearing impaired,…

Document Delivery: Evaluating the Options.

ERIC Educational Resources Information Center

Ward, Suzanne M.

1997-01-01

Discusses options available to libraries for document delivery. Topics include users' needs; cost; copyright compliance; traditional interlibrary loan; types of suppliers; selection criteria, including customer service; new developments in interlibrary loan, including outsourcing arrangements; and the need to evaluate suppliers. (LRW)

Document Delivery: An Annotated Selective Bibliography.

ERIC Educational Resources Information Center

Khalil, Mounir A.; Katz, Suzanne R.

1992-01-01

Presents a selective annotated bibliography of 61 items that deal with topics related to document delivery, including networks; hypertext; interlibrary loan; computer security; electronic publishing; copyright; online catalogs; resource sharing; electronic mail; electronic libraries; optical character recognition; microcomputers; liability issues;…

Making Choices in the Virtual World: The New Model at United Technologies Information Network.

ERIC Educational Resources Information Center

Gulliford, Bradley

1998-01-01

Describes changes in services of the United Technologies Corporation Information Network from a traditional library system to a virtual system of World Wide Web sites, a document-delivery unit, telephone and e-mail reference, and desktop technical support to provide remote access. Staff time, security, and licensing issues are addressed.…

Electronic Document Delivery: Converging Standards and Technologies. UDT Series on Data Communication Technologies and Standards for Libraries, Report #2.

ERIC Educational Resources Information Center

Cleveland, Gary

The development of information technologies such as public access catalogs and online databases has greatly enhanced access to information. The lack of automation in the area of document delivery, however, has created a large disparity between the speed with which citations are found and the provision of primary documents. This imbalance can…

WITH: a system to write clinical trials using XML and RDBMS.

PubMed Central

Fazi, Paola; Luzi, Daniela; Manco, Mariarosaria; Ricci, Fabrizio L.; Toffoli, Giovanni; Vignetti, Marco

2002-01-01

The paper illustrates the system WITH (Write on Internet clinical Trials in Haematology) which supports the writing of a clinical trial (CT) document. The requirements of this system have been defined analysing the writing process of a CT and then modelling the content of its sections together with their logical and temporal relationships. The system WITH allows: a) editing the document text; b) re-using the text; and c) facilitating the cooperation and the collaborative writing. It is based on XML mark-up language, and on a RDBMS. This choice guarantees: a) process standardisation; b) process management; c) efficient delivery of information-based tasks; and d) explicit focus on process design. PMID:12463823

Progress update on cryogenic system for ARIEL E-linac at TRIUMF

NASA Astrophysics Data System (ADS)

Koveshnikov, A.; Bylinskii, I.; Hodgson, G.; Yosifov, D.

2014-01-01

TRIUMF is involved in a major upgrade. The Advanced Rare IsotopeE Laboratory (ARIEL) has become a fully funded project in July 2010. A 10 mA 50 MeV SRF electron linac (e-linac) operating CW at 1.3 GHz is the key component of this initiative. This machine will serve as a second independent photo-fission driver for Rare Isotope Beams (RIB) production at TRIUMF's Isotope Separator and Accelerator (ISAC) facility. The cryogens delivery system requirements are driven by the electron accelerator cryomodule design [1, 2]. Since commencement of the project in 2010 the cryogenic system of e-linac has moved from the conceptual design phase into engineering design and procurement stage. The present document summarizes the progress in cryogenic system development and construction. Current status of e-linac cryogenic system including details of LN2 storage and delivery systems, and helium subatmospheric (SA) system is presented. The first phase of e-linac consisting of two cryomodules, cryogens storage, delivery, and distribution systems, and a 600 W class liquid helium cryoplant is scheduled for installation and commissioning by year 2014.

Competencies for optimal practice in integrated environments: examining attributes of a consensus interprofessional practice document from the licensed integrative health disciplines.

PubMed

Goldblatt, Elizabeth; Wiles, Michael; Schwartz, Jan; Weeks, John

2013-01-01

The Academic Consortium for Complementary and Alternative Health Care (ACCAHC) is committed to advancing human health through the advancement and integration of the complementary and alternative medicine (CAM) professions within the American healthcare system. This will involve the maturation and integration of the licensed CAM professions into conventional healthcare delivery, and in turn, it will involve the development of competency in integrative healthcare and interprofessional education within the CAM professions. In 2010, ACCAHC resolved to identify the competencies necessary for this transformation, and in the process, discovered a parallel process of competency development within conventional healthcare, the Interprofessional Education Collaborative (IPEC), representing the six major conventional healthcare professions. The ACCAHC competency document, its development, and its similarity to the IPEC document are discussed. The ACCAHC competency document identified two domains of competence that were not present in the IPEC document: evidence-informed practice and institutional healthcare practices. These two domains of competency are discussed with respect to their significance in both CAM and conventional healthcare practices. ACCAHC's goal is to foster collaboration among its member professions and with conventional healthcare professions, and to use these competency documents to improve and optimize healthcare delivery, practices, and outcomes in America. It is hoped that ACCAHC's competency document will catalyze interaction with IPEC leading to the adoption of a single shared competency document that will meet the needs of all healthcare providers and educators. © 2013 Elsevier Inc. All rights reserved.

Documentation of and satisfaction with the service delivery process of electric powered scooters among adult users in different national contexts.

PubMed

Sund, Terje; Iwarsson, Susanne; Andersen, Mette C; Brandt, Åse

2013-03-01

The purpose of this study was to investigate how different service delivery systems for assistive devices were associated with the service delivery process (SDP) and user satisfaction in two national contexts when electric powered scooters were provided. The study had a follow-up design based on a consecutive inclusion of 50 Danish and 86 Norwegian adults as they were about to be provided a scooter. A study-specific structured questionnaire for documentation of the SDP was administered. The Satisfaction with Assistive Technology Services was used for documenting user satisfaction with the SDP. Besides descriptive statistics, regression analysis was used to identify contributors of variance and predictors of user satisfaction. The various steps of the SDP were carried out to a various degree. Significantly more total time was spent in the SDP in the Danish sample (p < 0.001). About 80% of the informants were satisfied/very satisfied with different aspects of the SDP. Time spent in the different steps was not associated with user satisfaction with the SDP. This study supports the assumption that structure of the service impacts on the SDP, but not that the process impacts on outcomes in terms of user satisfaction with the SDP. It may, however, be questioned whether this actually is an outcome.

Document Delivery from Full-Text Online Files: A Pilot Project.

ERIC Educational Resources Information Center

Gillikin, David P.

1990-01-01

Describes the Electronic Journal Retrieval Project (EJRP) developed at the University of Tennessee, Knoxville Libraries, to provide full-text journal articles from online systems. Highlights include costs of various search strategies; implications for library services; collection development and interlibrary loan considerations; and suggestions…

Advanced Transport Operating System (ATOPS) color displays software description: MicroVAX system

NASA Technical Reports Server (NTRS)

Slominski, Christopher J.; Plyler, Valerie E.; Dickson, Richard W.

1992-01-01

This document describes the software created for the Display MicroVAX computer used for the Advanced Transport Operating Systems (ATOPS) project on the Transport Systems Research Vehicle (TSRV). The software delivery of February 27, 1991, known as the 'baseline display system', is the one described in this document. Throughout this publication, module descriptions are presented in a standardized format which contains module purpose, calling sequence, detailed description, and global references. The global references section includes subroutines, functions, and common variables referenced by a particular module. The system described supports the Research Flight Deck (RFD) of the TSRV. The RFD contains eight Cathode Ray Tubes (CRTs) which depict a Primary Flight Display, Navigation Display, System Warning Display, Takeoff Performance Monitoring System Display, and Engine Display.

Integrating radiology information systems with healthcare delivery environments using DICOM and HL7 standards.

PubMed

Blazona, Bojan; Koncar, Miroslav

2006-01-01

Integration based on open standards, in order to achieve communication and information interoperability, is one of the key aspects of modern health care information systems. Interoperability presents data and communication layer interchange. In this context we identified the HL7 standard as the world's leading medical Information and communication technology (ICT) standard for the business layer in healthcare information systems and we tried to explore the ability to exchange clinical documents with minimal integrated healthcare information systems (IHCIS) change. We explored HL7 Clinical Document Architecture (CDA) abilities to achieve radiology information system integration (DICOM) to IHCIS (HL7). We introduced the use of WADO service interconnection to IHCIS and finally CDA rendering in widely used Internet explorers.

Use of speech-to-text technology for documentation by healthcare providers.

PubMed

Ajami, Sima

2016-01-01

Medical records are a critical component of a patient's treatment. However, documentation of patient-related information is considered a secondary activity in the provision of healthcare services, often leading to incomplete medical records and patient data of low quality. Advances in information technology (IT) in the health system and registration of information in electronic health records (EHR) using speechto- text conversion software have facilitated service delivery. This narrative review is a literature search with the help of libraries, books, conference proceedings, databases of Science Direct, PubMed, Proquest, Springer, SID (Scientific Information Database), and search engines such as Yahoo, and Google. I used the following keywords and their combinations: speech recognition, automatic report documentation, voice to text software, healthcare, information, and voice recognition. Due to lack of knowledge of other languages, I searched all texts in English or Persian with no time limits. Of a total of 70, only 42 articles were selected. Speech-to-text conversion technology offers opportunities to improve the documentation process of medical records, reduce cost and time of recording information, enhance the quality of documentation, improve the quality of services provided to patients, and support healthcare providers in legal matters. Healthcare providers should recognize the impact of this technology on service delivery.

Cross-linked β-cyclodextrin and carboxymethyl cellulose hydrogels for controlled drug delivery of acyclovir

PubMed Central

Malik, Nadia Shamshad; Ahmad, Mahmood; Minhas, Muhammad Usman

2017-01-01

To explore the potential role of polymers in the development of drug-delivery systems, this study investigated the use of β-cyclodextrin (β-CD), carboxymethyl cellulose (CMC), acrylic acid (AA) and N’ N’-methylenebis-acrylamide (MBA) in the synthesis of hydrogels for controlled drug delivery of acyclovir (ACV). Different proportions of β-CD, CMC, AA and MBA were blended with each other to fabricate hydrogels via free radical polymerization technique. Fourier transform infrared spectroscopy (FTIR) revealed successful grafting of components into the polymeric network. Thermal and morphological characterization confirmed the formation of thermodynamically stable hydrogels having porous structure. The pH-responsive behaviour of hydrogels has been documented by swelling dynamics and drug release behaviour in simulated gastrointestinal fluids. Drug release kinetics revealed controlled release behaviour of the antiviral drug acyclovir in developed polymeric network. Cross-linked β-cyclodextrin and carboxymethyl cellulose hydrogels can be used as promising candidates for the design and development of controlled drug-delivery systems. PMID:28245257

Resource Sharing: A Necessity for the '80s.

ERIC Educational Resources Information Center

Lavo, Barbara, Comp.

Papers presented at a 1981 seminar on library resource sharing covered topics related to Australasian databases, Australian and New Zealand document delivery systems, and shared acquisition and cataloging for special libraries. The papers included: (1) "AUSINET: Australasia's Information Network?" by Ian McCallum; (2) "Australia/New…

Planning Communication Networks to Deliver Educational Services.

ERIC Educational Resources Information Center

Ballard, Richard J.; Eastwood, Lester F., Jr.

As companion to the more general document Telecommunications Media for the Delivery of Educational Programming , this report concentrates on the technical and economic factors affecting the design of only one class of educational networks, dedicated coaxial cable systems. To provide illustrations, possible single and dual dedicated cable networks…

Career Information Hotlines Sampler. NOICC Occasional Paper.

ERIC Educational Resources Information Center

Nichols, Mildred, T.; McDaniels, Carl; Knobloch, Mary Anne; Watts, Gale A.; Landon-Moore, Mary; Andreas, Caesar

This document, which is intended for staff of state occupational information coordinating committees (SOICCs) and career information delivery systems (CIDS), examines the pros and cons of career information hotlines and their use in selected states. "Foreword--Career Information on Call" (Juliette N. Lester) provides a brief overview of…

IFLA General Conference, 1985. Collection and Services Division. Section: Interlending and Document Delivery. The Online System of Union Catalogues and Interlibrary Loan ('NCC/IBL') in the Netherlands.

ERIC Educational Resources Information Center

Willemsen, Arie W.

This paper describes the interlending system in the Netherlands and examines the country's union catalogs, the main instrument in the interlending procedure. An overview of the integrated interlending system is provided; the union catalogs of the Royal Library in The Hague, the Technical University Library at Delft, and the library of the…

Evaluation of Roadmap to Achieve Energy Delivery Systems Cybersecurity

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

Chavez, Adrian R.

The Department of Energy/Office of Electricity Delivery and Energy Reliability (DOE/OE) Cybersecurity for Energy Delivery Systems (CEDS) program is currently evaluating the Roadmap to Achieve Energy Delivery Systems Cybersecurity document that sets a vision and outlines a set of milestones. The milestones are divided into five strategic focus areas that include: 1. Build a Culture of Security; 2. Assess and Monitor Risk; 3. Develop and Implement New Protective Measures to Reduce Risk; 4. Manage Incidents; and 5. Sustain Security Improvements. The most current version of the roadmap was last updated in September of 2016. Sandia National Laboratories (SNL) has beenmore » tasked with revisiting the roadmap to update the current state of energy delivery systems cybersecurity protections. SNL is currently working with previous and current partners to provide feedback on which of the roadmap milestones have been met and to identify any preexisting or new gaps that are not addressed by the roadmap. The specific focus areas SNL was asked to evaluate are: 1. Develop and Implement New Protective Measures to Reduce Risk and 2. Sustain Security Improvements. SNL has formed an Industry Advisory Board (IAB) to assist in answering these questions. The IAB consists of previous partners on past CEDS funded efforts as well as new collaborators that have unique insights into the current state of cybersecurity within energy delivery systems. The IAB includes asset owners, utilities and vendors of control systems. SNL will continue to maintain regular communications with the IAB to provide various perspectives on potential future updates to further improve the breadth of cybersecurity coverage of the roadmap.« less

2001 Research Reports NASA/ASEE Summer Faculty Fellowship Program

NASA Technical Reports Server (NTRS)

2001-01-01

This document is a collection of technical reports on research conducted by the participants in the 2001 NASA/ASEE Summer Faculty Fellowship Program at the Kennedy Space Center (KSC). Research areas are broad. Some of the topics addressed include: project management, space shuttle safety risks induced by human factor errors, body wearable computers as a feasible delivery system for 'work authorization documents', gas leak detection using remote sensing technologies, a history of the Kennedy Space Center, and design concepts for collabsible cyrogenic storage vessels.

Lessons learned from the implementation of clinical messaging systems.

PubMed

Barnes, Mike

2007-10-11

The Regenstrief Institute has designed and implemented two clinical messaging systems over the past six years, both called DOCS4DOCS. These systems receive HL7 messages from data sources and deliver results to clinicians via the web, fax, or as HL7 directed to an EMR. This paper focuses on some of the lessons we have learned, both good and bad. We discuss important issues in clinical messaging including provider mapping, document delivery and duplicate prevention, creating uniform HL7 outbound feeds, user authentication, the problems of allowing Active-X controls, why automatic printing of documents is not important although a frequently requested feature, and assorted other pearls of wisdom we have acquired.

Lessons Learned from the Implementation of Clinical Messaging Systems

PubMed Central

Barnes, Mike

2007-01-01

The Regenstrief Institute has designed and implemented two clinical messaging systems over the past six years, both called DOCS4DOCS®. These systems receive HL7 messages from data sources and deliver results to clinicians via the web, fax, or as HL7 directed to an EMR. This paper focuses on some of the lessons we have learned, both good and bad. We discuss important issues in clinical messaging including provider mapping, document delivery and duplicate prevention, creating uniform HL7 outbound feeds, user authentication, the problems of allowing Active-X controls, why automatic printing of documents is not important although a frequently requested feature, and assorted other pearls of wisdom we have acquired. PMID:18693793

Evaluating Instructor Technology Integration in Community and Technical Colleges: A Performance Evaluation Matrix

ERIC Educational Resources Information Center

Del Favero, Marietta; Hinson, Janice M.

2007-01-01

The press for implementing technology based instructional delivery systems in community and technical colleges is well documented. Yet faculty face numerous challenges in integrating technology into instruction (AL-Bataineh & Brooks, 2003; Groves & Zemel, 2000; Khoury, 1997). Stimulating faculty ownership in technology, diffusion of technology use…

Computer-Assisted Instruction: Authoring Languages. ERIC Digest.

ERIC Educational Resources Information Center

Reeves, Thomas C.

One of the most perplexing tasks in producing computer-assisted instruction (CAI) is the authoring process. Authoring is generally defined as the process of turning the flowcharts, control algorithms, format sheets, and other documentation of a CAI program's design into computer code that will operationalize the simulation on the delivery system.…

The "Oprahfication" of Literacy: Reading "Oprah's Book Club."

ERIC Educational Resources Information Center

Hall, R. Mark

2003-01-01

Considers how although the influence of "Oprah's Book Club" has been well documented in the popular media, it has received little attention from the academic community. Examines the club as a literacy delivery system, asking how literacy takes its shape from the interests of both Winfrey and her readers. (SG)

Occupational Therapy and Physical Therapy Guidelines for the Public Schools.

ERIC Educational Resources Information Center

Texas Education Agency, Austin. Div. of Special Education Programs.

This document provides general guidelines to promote consistency of occupational therapy and physical therapy service delivery in the Texas educational system. These guidelines are intended to clarify the roles of occupational therapy and physical therapy as related special education services. The guidelines cover: (1) differences between the…

Formulation of consumables management models. Consumables flight planning worksheet utilization

NASA Technical Reports Server (NTRS)

Newman, C. M.

1977-01-01

The updated and reformatted consumables flight planning worksheet is documented. An instruction set for applying the worksheet, and a sample application of the worksheet is disclosed. The particular application is for the STS interfacing with sortie payloads and typifies the interfacing of the delivery system and payloads.

Focus. No. 7, Winter, 1971.

ERIC Educational Resources Information Center

National Center for Health Services Research and Development (DHEW/PHS), Rockville, MD.

One of a series of periodical reports from the Center, the document summarizes the research and development program of the Center's third year. The research program is directed at creating and testing the essential components of comprehensive community health care delivery systems that will increase the supply of services where they are most…

[Resources of information in the field of bioethics in Italy: survey of the present state and perspectives].

PubMed

Della Seta, Maurella; Sellitri, Cinzia

2004-01-01

The research project "Collection and dissemination of bioethical information through an integrated electronic system", started in 2001 by the Istituto Superiore di Sanità (ISS), had among its objectives, the realization of an integrated system for data collection and exchange of documents related to bioethics. The system should act as a reference tool for those research activities impacting on citizens' health and welfare. This paper aims at presenting some initiatives, developed in the project framework, in order to establish an Italian documentation network, among which: a) exchange of ISS publications with Italian institutions active in this field; b) survey through a questionnaire aimed at assessing Italian informative resources, state-of-the-art and holdings of documentation centres and ethical committees; c) Italian Internet resources analysis. The results of the survey, together with the analysis of web sites, show that at present in Italy there are many interesting initiatives for collecting and spreading of documentation in the bioethical fields, but there is an urgent need for an integration of such resources. Ethical committees generally speaking need a larger availability of documents, while there are good potentialities for the establishment of an electronic network for document retrieval and delivery.

Repeat cesarean delivery: what indications are recorded in the medical chart?

PubMed

Lydon-Rochelle, Mona T; Gardella, Carolyn; Cárdenas, Vicky; Easterling, Thomas R

2006-03-01

National surveillance estimates reported a troubling 63 percent decline in the rate of vaginal birth after cesarean delivery (VBAC) from 1996 (28.3%) to 2003 (10.6%), with subsequent rising rates of repeat cesarean delivery. The study objective was to examine patterns of documented indications for repeat cesarean delivery in women with and without labor. We conducted a population-based validation study of 19 nonfederal short-stay hospitals in Washington state. Of the 4,541 women who had live births in 2000, 11 percent (n = 493) had repeat cesarean without labor and 3 percent (n = 138) had repeat cesarean with labor. Incidence of medical conditions and pregnancy complications, patterns of documented indications for repeat cesarean delivery, and perioperative complications in relation to repeat cesarean delivery with and without labor were calculated. Of the 493 women who underwent a repeat cesarean delivery without labor, "elective"(36%) and "maternal request"(18%) were the most common indications. Indications for maternal medical conditions (3.0%) were uncommon. Among the 138 women with repeat cesarean delivery with labor, 60.1 percent had failure to progress, 24.6 percent a non-reassuring fetal heart rate, 8.0 percent cephalopelvic disproportion, and 7.2 percent maternal request during labor. Fetal indications were less common (5.8%). Breech, failed vacuum, abruptio placentae, maternal complications, and failed forceps were all indicated less than 5.0 percent. Women's perioperative complications did not vary significantly between women without and with labor. Regardless of a woman's labor status, nearly 10 percent of women with repeat cesarean delivery had no documented indication as to why a cesarean delivery was performed. "Elective" and "maternal request" were common indications among women undergoing repeat cesarean delivery without labor, and nearly 10 percent of women had undocumented indications for repeat cesarean delivery in their medical record. Improvements in standardization of indication nomenclature and documentation of indication are especially important for understanding falling VBAC rates. Future research should examine how clinicians and women anticipate, discuss, and make decisions about childbirth after a previous cesarean delivery within the context of actual antepartum care.

By Our Own Bootstraps: Making Document Delivery Work in Oregon.

ERIC Educational Resources Information Center

Burkholder, Sue A.

1992-01-01

Describes the development of a courier service in Oregon for document delivery between libraries to support coordinated collection development activities. Organization of the service by individual libraries without dependence on the Library Services and Construction Act is discussed, and costs and response time are considered. (two references)…

Automation of the CAS Document Delivery Service.

ERIC Educational Resources Information Center

Steensland, M. C.; Soukup, K. M.

1986-01-01

The automation of online order retrieval for Chemical Abstracts Service Document Delivery Service was accomplished by shifting to an order retrieval/dispatch process linked to a Unix network. The Unix-based environment, its terminal emulation, page-break, and user-friendly interface software, and later enhancements are reviewed. Resultant increase…

5 CFR 1201.4 - General definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... commercial or personal delivery, or by electronic filing (e-filing) in accordance with § 1201.14. (j) Date of... the document was delivered to the commercial delivery service. The date of filing by e-filing is the date of electronic submission. (m) Electronic filing (e-filing). Filing and receiving documents in...

Libraries 2000: Transforming Libraries Using Document Delivery, Needs Assessment, and Networked Resources.

ERIC Educational Resources Information Center

Kleiner, Jane P.; Hamaker, Charles A.

1997-01-01

Describes three projects at Louisiana State University libraries designed to utilize document delivery and electronic access to expand collections, identify faculty journal needs, and share resources among academic, public, special, and school libraries. Network developments, grant support, and needs assessment surveys are also discussed.…

Delivered! A Mid-Sized Academic Library's Experience with Distance Education

ERIC Educational Resources Information Center

Bartnik, Linda

2010-01-01

Murray State University (Kentucky) has been experimenting with various means of document delivery and research instruction for its online only and satellite campuses. These include ILLiad-based document delivery, Camtasia-to-UTube tutorials, a discipline-based service called Library on Blackboard, Eluminate and other virtual instructional methods.…

Environmental Fate of Soil Applied Neonicotinoid Insecticides in an Irrigated Potato Agroecosystem

PubMed Central

Huseth, Anders S.; Groves, Russell L.

2014-01-01

Since 1995, neonicotinoid insecticides have been a critical component of arthropod management in potato, Solanum tuberosum L. Recent detections of neonicotinoids in groundwater have generated questions about the sources of these contaminants and the relative contribution from commodities in U.S. agriculture. Delivery of neonicotinoids to crops typically occurs as a seed or in-furrow treatment to manage early season insect herbivores. Applied in this way, these insecticides become systemically mobile in the plant and provide control of key pest species. An outcome of this project links these soil insecticide application strategies in crop plants with neonicotinoid contamination of water leaching from the application zone. In 2011 and 2012, our objectives were to document the temporal patterns of neonicotinoid leachate below the planting furrow following common insecticide delivery methods in potato. Leaching loss of thiamethoxam from potato was measured using pan lysimeters from three at-plant treatments and one foliar application treatment. Insecticide concentration in leachate was assessed for six consecutive months using liquid chromatography-tandem mass spectrometry. Findings from this study suggest leaching of neonicotinoids from potato may be greater following crop harvest in comparison to other times during the growing season. Furthermore, this study documented recycling of neonicotinoid insecticides from contaminated groundwater back onto the crop via high capacity irrigation wells. These results document interactions between cultivated potato, different neonicotinoid delivery methods, and the potential for subsurface water contamination via leaching. PMID:24823765

78 FR 35066 - Applications and Amendments to Facility Operating Licenses and Combined Licenses Involving...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-11

... also distributes an email notice that provides access to the document to the NRC's Office of the...) courier, express mail, or expedited delivery service to the Office of the Secretary, Sixteenth Floor, One... the mail, or by courier, express mail, or expedited delivery service upon depositing the document with...

IFLA General Conference, 1985. Division on Collections and Services. Section on Interlending and Document Delivery. Papers.

ERIC Educational Resources Information Center

International Federation of Library Associations, The Hague (Netherlands).

Papers on interlibrary loans and document delivery which were presented at the 1985 International Federation of Library Associations (IFLA) conference include: (1) "The Activities of the IFLA Office for International Lending" (Richard J. Bennett, British Library Lending Division, United Kingdom); (2) "Electronic Networking for…

Global Document Delivery, User Studies, and Service Evaluation: The Gateway Experience

ERIC Educational Resources Information Center

Miller, Rush; Xu, Hong; Zou, Xiuying

2008-01-01

This study examines user and service data from 2002-2006 at the East Asian Gateway Service for Chinese and Korean Academic Journal Publications (Gateway Service), the University of Pittsburgh. Descriptive statistical analysis reveals that the Gateway Service has been consistently playing the leading role in global document delivery service as well…

43 CFR 1822.11 - What must I do to make an official filing with BLM?

Code of Federal Regulations, 2011 CFR

2011-10-01

... file your application and any other required documents during regular office hours at the appropriate BLM office having jurisdiction over the lands or records involved. You must file any document with BLM through personal delivery or by mailing via the United States Postal Service or other delivery service...

Ondigita: A Platform for the Management and Delivery of Digital Documents

ERIC Educational Resources Information Center

Mazza, Riccardo; Baldassari, Andrea; Guidi, Roberto

2013-01-01

This paper presents Ondigita, a platform developed at the University of Applied Sciences of Southern Switzerland for the management and delivery of digital documents to students enrolled in bachelor's courses in various curricula within the field of engineering. Ondigita allows our organization to have a cloud-based repository of educational…

Expanding services in a shrinking economy: desktop document delivery in a dental school library.

PubMed

Gushrowski, Barbara A

2011-07-01

How can library staff develop and promote a document delivery service and then expand the service to a wide audience? The setting is the library at the Indiana University School of Dentistry (IUSD), Indianapolis. A faculty survey and a citation analysis were conducted to determine potential use of the service. Volume of interlibrary loan transactions and staff and equipment capacity were also studied. IUSD Library staff created a desktop delivery service (DDSXpress) for faculty and then expanded the service to practicing dental professionals and graduate students. The number of faculty using DDSXpress remains consistent. The number of practicing dental professionals using the service is low. Graduate students have been quick to adopt the service. Through careful analysis of capacity and need for the service, staff successfully expanded document delivery service without incurring additional costs. Use of DDSXpress is continually monitored, and opportunities to market the service to practicing dental professionals are being investigated.

WHY DO YOU NEED TO USE A CARIES RISK ASSESSMENT PROTOCOL TO PROVIDE AN EFFECTIVE CARIES PREVENTIVE REGIME?

PubMed

Afuakwah, Charles; Welbury, Richard

2015-11-01

Clinical guidelines recommend an individual is given a caries risk status based on analysis of defined clinical and social criteria before implementing a tailored preventive plan. Improve documentation of caries risk assessment (CRA) in a general dental practice setting, using a systems-based approach to quality improvement methods. Investigate the impact of quality improvement efforts on subsequent design and delivery of preventive care. Identify barriers to delivery of CRA and provision of preventive care. Data for patients aged 0-16 years was collected over two cycles using standard audit methodology. The first cycle was a retrospective analysis (n = 400) using random sampling. The second cycle a prospective analysis (n = 513) using consecutive sampling over a 15-week period. Five staff meetings with feedback occurred between cycles. In cycle one, no specific CRA system was identified. CRA status was not stated widely, risk factors were not analysed and there was variation with respect to the prescription and delivery of preventive strategies. These discrepancies were demonstrable for all four participating dentists and at all ages. In cycle two, 100% recorded CRA. All risk factors were analysed and individual caries risk was correctly annotated. There was 100% compliance with the protocol for preventive plans. The use of CRA improved documentation of caries risk status. This has improved subsequent prescription of age specific evidence-based preventive care appropriate to the risk status of that individual. Barriers were identified to the delivery of CRA and the provision of comprehensive preventive care by the dentists and other healthcare professionals.

Delivering New Ultrasound System to International Space Station

NASA Technical Reports Server (NTRS)

Sugita, Yoshino

2011-01-01

Ultrasound has been used for medical purposes and experiments. The previous ultrasound, HDI 5000, was delivered to the ISS in 2001 and had expected its service life in February, 2012. Due to on-orbit ultrasound failure in February 2011, the delivery date of new ultrasound was moved to July 8, 2011, which is 7 months earlier than original delivery date. This report shows how the Ultrasound 2 team including myself worked to make new delivery date. Four-step approach, (1) understanding the project (literature search), (2) learning different documents, (3) performing certification tests and (4) participating crew trainings, were used to succeed my internship at NASA JSC. In addition, the participation in Summer Institution and other contributions are explained. i

78 FR 46618 - Order Prohibiting Operation of Aerotest Radiography and Research Reactor

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-01

.... ML090830578), the NRC issued a proposed denial of the license renewal because of the foreign ownership issue... notice confirming receipt of the document. The E-Filing system also distributes an email notice that... mail, or expedited delivery service addressed to the Office of the Secretary, 16th Floor, One White...

Effectiveness of Asynchronous Reference Services for Distance Learning Students within Florida's Community College System

ERIC Educational Resources Information Center

Profeta, Patricia C.

2007-01-01

The provision of equitable library services to distance learning students emerged as a critical area during the 1990s. Library services available to distance learning students included digital reference and instructional services, remote access to online research tools, database and research tutorials, interlibrary loan, and document delivery.…

Eleven Years of Primary Health Care Delivery in an Academic Nursing Center.

ERIC Educational Resources Information Center

Hildebrandt, Eugenie; Baisch, Mary Jo; Lundeen, Sally P.; Bell-Calvin, Jean; Kelber, Sheryl

2003-01-01

Client visits to an academic community nursing center (n=25,495) were coded and analyzed. Results show expansion of nursing practice and services, strong case management, and management of illness care. The usefulness of computerized clinical documentation system and of the Lundeen conceptional model of community nursing care was demonstrated.…

The Rehabilitation Process for Clients with Specific Learning Disabilities: Trainer's Manual.

ERIC Educational Resources Information Center

Gladden, Bonnie; And Others

This document presents the manual for a training workshop for rehabilitation counselors on the delivery of services to persons with learning disabilities. It describes how counselors are trained in the workshop to: (1) use five criteria to establish eligibility; (2) apply the case management system to the classification of learning disabilities as…

Online Help Systems

DTIC Science & Technology

1989-09-07

online materials (and the concomitant increase in the cost for hardcopy materials) will make online delivery the marketing choice. In sum, medium of...involved in programming, marketing , human factors research, training, and business management. Job Titles of Online Help Designers Job Title...of Company Senior Research Librarian Advisory Information Developer Research Staff Assistant Marketing Manager Manager of Online Documentation Table

Employment and Training for America's Homeless: Best Practices Guide.

ERIC Educational Resources Information Center

Beck, Susan Kessler; Trutko, John W.; Isbell, Kellie; Rothstein, Frances; Barnow, Burt S.

This document is a how-to guide to help employment and training agencies tailor their delivery systems to be more effective in training, placing, and retaining homeless individuals in gainful employment. The guide is written from the perspective of an employment and training agency and based largely on the experiences of 63 organizations from…

Discovering Who Will Be Served. Planning for Arizona's Future, Part II.

ERIC Educational Resources Information Center

O'Connell, Joanne C.; Schacht, Robert

This report is the second in a series of publications developed to assist in the planning and development of a comprehensive, coordinated service delivery system for Arizona infants and toddlers who are developmentally delayed or at risk of developing handicapping conditions, and their families. It documents the number of children in Arizona…

Transforming to a computerized system for nursing care: organizational success within Magnet idealism.

PubMed

Lindgren, Carolyn L; Elie, Leslie G; Vidal, Elizabeth C; Vasserman, Alex

2010-01-01

In reaching the goal for standardized, quality care, a not-for-profit healthcare system consisting of seven institutional entities is transforming nursing practice guidelines, patient care workflow, and patient documents into electronic, online, real-time modalities for use across departments and all healthcare delivery entities of the system. Organizational structure and a strategic plan were developed for the 2-year Clinical Transformation Project. The Siemens Patient Care Document System was adopted and adapted to the hospitals' documentation and information needs. Two fast-track sessions of more than 100 nurses and representatives from other health disciplines were held to standardize assessments, histories, care protocols, and interdisciplinary plans of care for the top 10 diagnostic regulatory groups. Education needs of the users were addressed. After the first year, a productive, functional system is evidenced. For example, the bar-coded Medication Administration Check System is in full use on the clinical units of one of the hospitals, and the other institutional entities are at substantial stages of implementation of Patient Care Documentation System. The project requires significant allocation of personnel and financial resources for a highly functional informatics system that will transform clinical care. The project exemplifies four of the Magnet ideals and serves as a model for others who may be deciding about launching a similar endeavor.

A summary of porous tube plant nutrient delivery system investigations from 1985 to 1991

NASA Technical Reports Server (NTRS)

Dreschel, T. W.; Brown, C. S.; Piastuch, W. C.; Hinkle, C. R.; Sager, J. C.; Wheeler, R. M.; Knott, W. M.

1992-01-01

The Controlled Ecological Life Support System (CELSS) Program is a research effort to evaluate biological processes at a one person scale to provide air, water, and food for humans in closed environments for space habitation. This program focuses currently on the use of conventional crop plants and the use of hydroponic systems to grow them. Because conventional hydroponic systems are dependent on gravity to conduct solution flow, they cannot be used in the microgravity of space. Thus, there is a need for a system that will deliver water and nutrients to plant roots under microgravity conditions. The Plant Space Biology Program is interested in investigating the effect that the space environment has on the growth and development of plants. Thus, there is also a need to have a standard nutrient delivery method for growing plants in space for research into plant responses to microgravity. The Porous Tube Plant Nutrient Delivery System (PTPNDS) utilizes a hydrophilic, microporous material to control water and nutrient delivery to plant roots. It has been designed and analyzed to support plant growth independent of gravity and plans are progressing to test it in microgravity. It has been used successfully to grow food crops to maturity in an earth-bound laboratory. This document includes a bibliography and summary reports from the growth trials performed utilizing the PTPNDS.

Solar cell power for field instrumentation at White Sands Missile range. Final report

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

Bond, J.W. Jr..; Reckart, D.H. Jr; Milway, W.B.

1978-01-01

The initial phase of an Instrumentation Development Project to explore and document what solar power can do for remote field instrumentation systems is described. The work scope consisted of selection, design, construction, test, and delivery of a solar cell power system for White Sands Missile Range. A Drone Formation Control System Interrogator was selected; a power supply was built and installed in the San Andres Mountain Range at WSMR in late August 1977.

Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach.

PubMed

Ralph, Anna P; Fittock, Marea; Schultz, Rosalie; Thompson, Dale; Dowden, Michelle; Clemens, Tom; Parnaby, Matthew G; Clark, Michele; McDonald, Malcolm I; Edwards, Keith N; Carapetis, Jonathan R; Bailie, Ross S

2013-12-18

Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve quality of RHD care through development and implementation of a continuous quality improvement (CQI) strategy. We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008-2010. Participatory action research methods were employed to identify system barriers to delivery of high quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (≥80% of scheduled 4-weekly penicillin injections) and quality of documentation. Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ≥40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p = 0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p = 0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p = 0.001). However, the proportion receiving ≥80% of scheduled BPG did not change. Documentation in medical files improved: ARF episode documentation increased from 31/55 (56%) to 50/62 (81%) (p = 0.004), and RHD risk category documentation from 87/154 (56%) to 103/145 (76%) (p < 0.001). Large differences in performance were noted between health centres, reflected to some extent in SAT scores. A CQI process using a systems approach and participatory action research methodology can significantly improve delivery of ARF/RHD care.

Variations in the implementation and characteristics of chiropractic services in VA.

PubMed

Lisi, Anthony J; Khorsan, Raheleh; Smith, Monica M; Mittman, Brian S

2014-12-01

In 2004, the US Department of Veterans Affairs expanded its delivery of chiropractic care by establishing onsite chiropractic clinics at select facilities across the country. Systematic information regarding the planning and implementation of these clinics and describing their features and performance is lacking. To document the planning, implementation, key features and performance of VA chiropractic clinics, and to identify variations and their underlying causes and key consequences as well as their implications for policy, practice, and research on the introduction of new clinical services into integrated health care delivery systems. Comparative case study of 7 clinics involving site visit-based and telephone-based interviews with 118 key stakeholders, including VA clinicians, clinical leaders and administrative staff, and selected external stakeholders, as well as reviews of key documents and administrative data on clinic performance and service delivery. Interviews were recorded, transcribed, and analyzed using a mixed inductive (exploratory) and deductive approach. Interview data revealed considerable variations in clinic planning and implementation processes and clinic features, as well as perceptions of clinic performance and quality. Administrative data showed high variation in patterns of clinic patient care volume over time. A facility's initial willingness to establish a chiropractic clinic, along with a higher degree of perceived evidence-based and collegial attributes of the facility chiropractor, emerged as key factors associated with higher and more consistent delivery of chiropractic services and higher perceived quality of those services.

Overview of healthcare system in the Czech Republic

PubMed Central

2012-01-01

The healthcare system in the Czech Republic underwent and still is undergoing dramatic changes since the Velvet revolution in 1989. History of the Czech healthcare system, main healthcare laws, and the current status of healthcare documented in the main healthcare indicators is described based on the several main sources as well as delivery of health services and the role of the main actors in healthcare system. The material is based mainly on Czech Health Statistics 2009, and HiT Summary, Health Care Systems in Translation, 2005, public information of Ministry of Health CR. PMID:22738178

The Cost of Interlibrary Loan Services in a Medium-Sized Academic Library.

ERIC Educational Resources Information Center

Naylor, Ted F.

1997-01-01

A one-year study of interlibrary loan expense was conducted at Wichita State University (KS) to identify areas of interlibrary loan expense, compare results of cost studies from large research libraries, and provide a reference point in determining how to best balance Interlibrary loans and commercial document delivery systems. Analyzes salary,…

Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed.

ERIC Educational Resources Information Center

Cross, Terry L.; And Others

This monograph provides a philosophical framework and practical ideas for improving service delivery to children of color who are severely emotionally disturbed. The monograph targets four sociocultural groups (African Americans, Asian Americans, Hispanic Americans, and Native Americans). The document emphasizes the cultural strengths inherent in…

Visual Links in the World-Wide Web: The Uses and Limitations of Image Maps.

ERIC Educational Resources Information Center

Cochenour, John J.; And Others

As information delivery systems on the Internet increasingly evolve into World Wide Web browsers, understanding key graphical elements of the browser interface is critical to the design of effective information display and access tools. Image maps are one such element, and this document describes a pilot study that collected, reviewed, and…

Arizona's Parents Speak Out. Planning for Arizona's Future, Part III.

ERIC Educational Resources Information Center

O'Connell, Joanne C.; And Others

This report is the final in a series designed to assist in the planning and development of a comprehensive, coordinated service delivery system for Arizona infants and toddlers who are developmentally delayed or at risk of developing handicapping conditions, and their families, as outlined in Public Law 99-457. It documents the needs of Arizona's…

A CMMI-based approach for medical software project life cycle study.

PubMed

Chen, Jui-Jen; Su, Wu-Chen; Wang, Pei-Wen; Yen, Hung-Chi

2013-01-01

In terms of medical techniques, Taiwan has gained international recognition in recent years. However, the medical information system industry in Taiwan is still at a developing stage compared with the software industries in other nations. In addition, systematic development processes are indispensable elements of software development. They can help developers increase their productivity and efficiency and also avoid unnecessary risks arising during the development process. Thus, this paper presents an application of Light-Weight Capability Maturity Model Integration (LW-CMMI) to Chang Gung Medical Research Project (CMRP) in the Nuclear medicine field. This application was intended to integrate user requirements, system design and testing of software development processes into three layers (Domain, Concept and Instance) model. Then, expressing in structural System Modeling Language (SysML) diagrams and converts part of the manual effort necessary for project management maintenance into computational effort, for example: (semi-) automatic delivery of traceability management. In this application, it supports establishing artifacts of "requirement specification document", "project execution plan document", "system design document" and "system test document", and can deliver a prototype of lightweight project management tool on the Nuclear Medicine software project. The results of this application can be a reference for other medical institutions in developing medical information systems and support of project management to achieve the aim of patient safety.

Expanding services in a shrinking economy: desktop document delivery in a dental school library

PubMed Central

Gushrowski, Barbara A

2011-01-01

Question: How can library staff develop and promote a document delivery service and then expand the service to a wide audience? Setting: The setting is the library at the Indiana University School of Dentistry (IUSD), Indianapolis. Method: A faculty survey and a citation analysis were conducted to determine potential use of the service. Volume of interlibrary loan transactions and staff and equipment capacity were also studied. Main results: IUSD Library staff created a desktop delivery service (DDSXpress) for faculty and then expanded the service to practicing dental professionals and graduate students. The number of faculty using DDSXpress remains consistent. The number of practicing dental professionals using the service is low. Graduate students have been quick to adopt the service. Conclusion: Through careful analysis of capacity and need for the service, staff successfully expanded document delivery service without incurring additional costs. Use of DDSXpress is continually monitored, and opportunities to market the service to practicing dental professionals are being investigated. PMID:21753911

Documenting quality improvement and patient safety efforts: the quality portfolio. A statement from the academic hospitalist taskforce.

PubMed

Taylor, Benjamin B; Parekh, Vikas; Estrada, Carlos A; Schleyer, Anneliese; Sharpe, Bradley

2014-01-01

Physicians increasingly investigate, work, and teach to improve the quality of care and safety of care delivery. The Society of General Internal Medicine Academic Hospitalist Task Force sought to develop a practical tool, the quality portfolio, to systematically document quality and safety achievements. The quality portfolio was vetted with internal and external stakeholders including national leaders in academic medicine. The portfolio was refined for implementation to include an outlined framework, detailed instructions for use and an example to guide users. The portfolio has eight categories including: (1) a faculty narrative, (2) leadership and administrative activities, (3) project activities, (4) education and curricula, (5) research and scholarship, (6) honors, awards, and recognition, (7) training and certification, and (8) an appendix. The authors offer this comprehensive, yet practical tool as a method to document quality and safety activities. It is relevant for physicians across disciplines and institutions and may be useful as a standalone document or as an adjunct to traditional promotion documents. As the Next Accreditation System is implemented, academic medical centers will require faculty who can teach and implement the systems-based practice requirements. The quality portfolio is a method to document quality improvement and safety activities.

Nanoscale Delivery Systems: Actual and Potential Applications in the Natural Products Industry.

PubMed

Simona, Antal Diana; Florina, Ardelean; Rodica, Chis Aimee; Evelyne, Ollivier; Maria-Corina, Serban

2017-01-01

Compounds and extracts derived from natural sources continue to stand in the spotlight of drug design owing to their versatile interaction with enzymes, receptors and metabolic pathways. Nanomedicine offers an operative tool for the efficient delivery of natural products, in terms of increased bioavailability, targeting, and controlled release while protecting active constituents against physico-chemical alterations. The interest of the scientific community in the field of nanosized delivery of natural compounds is demonstrated by the exponential growth of the publications in this field. Beyond the presentation of successful examples of nanoscale delivery systems containing natural products, the scope of this review is to point out the yet underexplored capacities of this field with relevance for the pharmaceutical and nutraceutical market. Departing from a short presentation of plant-derived natural products and strategies to obtain nanoformulations, the current work discusses nanoparticulate drug delivery systems targeting diseases of various organs and systems: skin, central nervous system, skeletal tissue, cardiovascular apparatus, and diabetes. While notable progress has been achieved in the preparation of nanomedicines containing selected dietary polyphenols, works dealing with crude extracts or standardized fractions are much less frequent. In fact, most of the plants with solidly documented therapeutic properties and registered in pharmacopoeias still wait to benefit from advances in the field of nanotechnology. At least for some of them, adequate nanoformulation shall contribute to their removal from the group of dietary supplements and pharmaceutical preparations with suboptimal bioavailability and efficacy. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

A data management life-cycle

USGS Publications Warehouse

Ferderer, David A.

2001-01-01

Documented, reliable, and accessible data and information are essential building blocks supporting scientific research and applications that enhance society's knowledge base (fig. 1). The U.S. Geological Survey (USGS), a leading provider of science data, information, and knowledge, is uniquely positioned to integrate science and natural resource information to address societal needs. The USGS Central Energy Resources Team (USGS-CERT) provides critical information and knowledge on the quantity, quality, and distribution of the Nation's and the world's oil, gas, and coal resources. By using a life-cycle model, the USGS-CERT Data Management Project is developing an integrated data management system to (1) promote access to energy data and information, (2) increase data documentation, and (3) streamline product delivery to the public, scientists, and decision makers. The project incorporates web-based technology, data cataloging systems, data processing routines, and metadata documentation tools to improve data access, enhance data consistency, and increase office efficiency

Implementation of the Zambia Electronic Perinatal Record System for comprehensive prenatal and delivery care

PubMed Central

Chi, Benjamin H.; Vwalika, Bellington; Killam, William P.; Wamalume, Chibesa; Giganti, Mark J.; Mbewe, Reuben; Stringer, Elizabeth M.; Chintu, Namwinga T.; Putta, Nande B.; Liu, Katherine C.; Chibwesha, Carla J.; Rouse, Dwight J.; Stringer, Jeffrey S.A.

2011-01-01

Objective To characterize prenatal and delivery care in an urban African setting. Methods The Zambia Electronic Perinatal Record System (ZEPRS) was implemented to record demographic characteristics, past medical and obstetric history, prenatal care, and delivery and newborn care for pregnant women across 25 facilities in the Lusaka public health sector. Results From June 1, 2007, to January 31, 2010, 115 552 pregnant women had prenatal and delivery information recorded in ZEPRS. Median gestation age at first prenatal visit was 23 weeks (interquartile range [IQR] 19–26). Syphilis screening was documented in 95 663 (83%) pregnancies: 2449 (2.6%) women tested positive, of whom 1589 (64.9%) were treated appropriately. 111 108 (96%) women agreed to HIV testing, of whom 22% were diagnosed with HIV. Overall, 112 813 (98%) of recorded pregnancies resulted in a live birth, and 2739 (2%) in a stillbirth. The median gestational age was 38 weeks (IQR 35–40) at delivery; the median birth weight of newborns was 3000 g (IQR 2700–3300 g). Conclusion The results demonstrate the feasibility of using a comprehensive electronic medical record in an urban African setting, and highlight its important role in ongoing efforts to improve clinical care. PMID:21315347

Design of a clinical notification system.

PubMed

Wagner, M M; Tsui, F C; Pike, J; Pike, L

1999-01-01

We describe the requirements and design of an enterprise-wide notification system. From published descriptions of notification schemes, our own experience, and use cases provided by diverse users in our institution, we developed a set of functional requirements. The resulting design supports multiple communication channels, third party mappings (algorithms) from message to recipient and/or channel of delivery, and escalation algorithms. A requirement for multiple message formats is addressed by a document specification. We implemented this system in Java as a CORBA object. This paper describes the design and current implementation of our notification system.

Combined lentiviral and RNAi technologies for the delivery and permanent silencing of the hsp25 gene.

PubMed

Kaur, Punit; Nagaraja, Ganachari M; Asea, Alexzander

2011-01-01

Elevated heat shock protein 27 (Hsp27) expression has been found in a number of tumors, including breast, prostate, gastric, uterine, ovarian, head and neck, and tumor arising from the nervous system and urinary system, and determined to be a predictor of poor clinical outcome. Although the mechanism of action of Hsp27 has been well documented, there are currently no available inhibitors of Hsp27 in clinical trials. RNA interference (RNAi) has the potential to offer more specificity and flexibility than traditional drugs to silence gene expression. Not surprisingly, RNAi has become a major focus for biotechnology and pharmaceutical companies, which are now in the early stages of developing RNAi therapeutics, mostly based on short interfering RNA (siRNAs), to target viral infection, cancer, hypercholesterolemia, cardiovascular disease, macular degeneration, and neurodegenerative diseases. However, the critical issues associated with RNAi as a therapeutic are delivery, specificity, and stability of the RNAi reagents. To date, the delivery is currently considered the biggest hurdle, as the introduction of siRNAs systemically into body fluids can result in their degradation, off-target effects, and immune detection. In this chapter, we discuss a method of combined lentiviral and RNAi-based technology for the delivery and permanent silencing of the hsp25 gene.

Client Functional Assessment Data as Management Information: Woodrow Wilson Rehabilitation Center's Management Information System

PubMed Central

Steidle, Ernest F.

1983-01-01

This paper describes the design of a functional assessment system, a component of a management information system (MIS) that supports a comprehensive rehabilitation facility. Products of the subsystem document the functional status of rehabilitation clients through process evaluation reporting and outcomes reporting. The purpose of this paper is to describe the design of this MIS component. The environment supported, the integration requirements and the needed development approach is unique, requiring significant input from health care professionals, medical informatics specialists, statisticians and program evaluators. Strategies for the implementation of the functional assessment system are the major results reported in this paper. They are most useful to the systems designer or management engineer in a human service delivery setting. MIS plan development, computer file structure and access methods, and approaches to scheduling applications is described. Finally, the development of functional status measures is discussed. Application of the methodologies described will facilitate similar efforts towards systems development in other human service delivery settings.

Health system changes under pay-for-performance: the effects of Rwanda's national programme on facility inputs.

PubMed

Ngo, Diana K L; Sherry, Tisamarie B; Bauhoff, Sebastian

2017-02-01

Pay-for-performance (P4P) programmes have been introduced in numerous developing countries with the goal of increasing the provision and quality of health services through financial incentives. Despite the popularity of P4P, there is limited evidence on how providers achieve performance gains and how P4P affects health system quality by changing structural inputs. We explore these two questions in the context of Rwanda's 2006 national P4P programme by examining the programme's impact on structural quality measures drawn from international and national guidelines. Given the programme's previously documented success at increasing institutional delivery rates, we focus on a set of delivery-specific and more general structural inputs. Using the programme's quasi-randomized roll-out, we apply multivariate regression analysis to short-run facility data from the 2007 Service Provision Assessment. We find positive programme effects on the presence of maternity-related staff, the presence of covered waiting areas and a management indicator and a negative programme effect on delivery statistics monitoring. We find no effects on a set of other delivery-specific physical resources, delivery-specific human resources, delivery-specific operations, general physical resources and general human resources. Using mediation analysis, we find that the positive input differences explain a small and insignificant fraction of P4P's impact on institutional delivery rates. The results suggest that P4P increases provider availability and facility operations but is only weakly linked with short-run structural health system improvements overall. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Double strand RNA delivery system for plant-sap-feeding insects

PubMed Central

Ghosh, Saikat Kumar B.; Hunter, Wayne B.; Park, Alexis L.; Gundersen-Rindal, Dawn E.

2017-01-01

Double-stranded RNA (dsRNA)-mediated gene silencing, also known as RNA interference (RNAi), has been a breakthrough technology for functional genomic studies and represents a potential tool for the management of insect pests. Since the inception of RNAi numerous studies documented successful introduction of exogenously synthesized dsRNA or siRNA into an organism triggering highly efficient gene silencing through the degradation of endogenous RNA homologous to the presented siRNA. Managing hemipteran insect pests, especially Halyomorpha halys (Stål) (Heteroptera: Pentatomidae), the brown marmorated stink bug (BMSB), is critical to food productivity. BMSB was recently introduced into North America where it is both an invasive agricultural pest of high value specialty, row, and staple crops, as well as an indoor nuisance pest. RNAi technology may serve as a viable tool to manage this voracious pest, but delivery of dsRNA to piercing-sucking insects has posed a tremendous challenge. Effective and practical use of RNAi as molecular biopesticides for biocontrol of insects like BMSB in the environment requires that dsRNAs be delivered in vivo through ingestion. Therefore, the key challenge for molecular biologists in developing insect-specific molecular biopesticides is to find effective and reliable methods for practical delivery of stable dsRNAs such as through oral ingestion. Here demonstrated is a reliable delivery system of effective insect-specific dsRNAs through oral feeding through a new delivery system to induce a significant decrease in expression of targeted genes such as JHAMT and Vg. This state-of-the-art delivery method overcomes environmental delivery challenges so that RNAi is induced through insect-specific dsRNAs orally delivered to hemipteran and other insect pests. PMID:28182760

Regulatory aspects in the pharmaceutical development of nanoparticle drug delivery systems designed to cross the intestinal epithelium and M-cells.

PubMed

Hussain, Nasir

2016-11-30

This article reviews the field of oral uptake of nanoparticles across the gastrointestinal epithelium for the period 2006-2016. Analysis is conducted from the viewpoint of i) M-cell genetics and model development, ii) drug targeting to Peyer's patches and M-cells, and iii) physicochemical interactions of nanoparticles in the intestinal milieu. In light of these recent developments, regulatory considerations in the development of orally-absorbable nanoparticle drug products are discussed and focused on Module 3.2.P sub-sections of the Common Technical Document. Particular attention is paid to novel excipients, ligands and the non-standard method of manufacture. The novelty of this drug delivery system demands not only a multi-disciplinary scientific and regulatory approach but also a risk-adjusted consideration for a system defined by both processes and specifications. Given the current state of scientific development in the field it is suggested (in the author's personal opinion) that the design of nanoparticulate drug delivery systems should be kept as simple as possible (from a regulatory and manufacturing perspective) and to target the entire gastrointestinal epithelium. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

Hydraulic Hybrid Parcel Delivery Truck Deployment, Testing & Demonstration

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

Gallo, Jean-Baptiste

2014-03-07

Although hydraulic hybrid systems have shown promise over the last few years, commercial deployment of these systems has primarily been limited to Class 8 refuse trucks. In 2005, the Hybrid Truck Users Forum initiated the Parcel Delivery Working Group including the largest parcel delivery fleets in North America. The goal of the working group was to evaluate and accelerate commercialization of hydraulic hybrid technology for parcel delivery vehicles. FedEx Ground, Purolator and United Parcel Service (UPS) took delivery of the world’s first commercially available hydraulic hybrid parcel delivery trucks in early 2012. The vehicle chassis includes a Parker Hannifin hydraulicmore » hybrid drive system, integrated and assembled by Freightliner Custom Chassis Corp., with a body installed by Morgan Olson. With funding from the U.S. Department of Energy, CALSTART and its project partners assessed the performance, reliability, maintainability and fleet acceptance of three pre-production Class 6 hydraulic hybrid parcel delivery vehicles using information and data from in-use data collection and on-road testing. This document reports on the deployment of these vehicles operated by FedEx Ground, Purolator and UPS. The results presented provide a comprehensive overview of the performance of commercial hydraulic hybrid vehicles in parcel delivery applications. This project also informs fleets and manufacturers on the overall performance of hydraulic hybrid vehicles, provides insights on how the technology can be both improved and more effectively used. The key findings and recommendations of this project fall into four major categories: -Performance, -Fleet deployment, -Maintenance, -Business case. Hydraulic hybrid technology is relatively new to the market, as commercial vehicles have been introduced only in the past few years in refuse and parcel delivery applications. Successful demonstration could pave the way for additional purchases of hydraulic hybrid vehicles throughout the trucking industry. By providing unbiased, third-party assessment of this “hybrid without batteries” technology, this report offers relevant, timely and valuable information to the industry.« less

"As Good as Your Word": Face-Threat Mitigation and the Use of Instructor Nonverbal Cues on Students' Perceptions of Digital Feedback

ERIC Educational Resources Information Center

Clark-Gordon, Cathlin V.; Bowman, Nicholas D.; Watts, Evan R.; Banks, Jaime; Knight, Jennifer M.

2018-01-01

Research has established that students often consider the delivery of instructor feedback to be a face-threatening event. To minimize the potential negative effects of feedback, verbal and nonverbal face-threat mitigation (FTM) strategies are utilized by instructors. Advances in digital feedback systems, like online documents and learning…

7 CFR 1488.8 - Documents required after delivery.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURAL COMMODITIES Financing of Export Sales of Agricultural Commodities From Private Stocks Under CCC... delivery. (a) CCC will purchase an exporter's account receivable only if the Treasurer, Commodity Credit... or Assistant Treasurer, CCC, after date of delivery of commodities exported or to be exported under...

7 CFR 1488.8 - Documents required after delivery.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURAL COMMODITIES Financing of Export Sales of Agricultural Commodities From Private Stocks Under CCC... delivery. (a) CCC will purchase an exporter's account receivable only if the Treasurer, Commodity Credit... or Assistant Treasurer, CCC, after date of delivery of commodities exported or to be exported under...

PLGA nanoparticles containing various anticancer agents and tumour delivery by EPR effect.

PubMed

Acharya, Sarbari; Sahoo, Sanjeeb K

2011-03-18

As mortality due to cancer continues to rise, advances in nanotechnology have significantly become an effective approach for achieving efficient drug targeting to tumour tissues by circumventing all the shortcomings of conventional chemotherapy. During the past decade, the importance of polymeric drug-delivery systems in oncology has grown exponentially. In this context, poly(lactic-co-glycolic acid) (PLGA) is a widely used polymer for fabricating 'nanoparticles' because of biocompatibility, long-standing track record in biomedical applications and well-documented utility for sustained drug release, and hence has been the centre of focus for developing drug-loaded nanoparticles for cancer therapy. Such PLGA nanoparticles have also been used to develop proteins and peptides for nanomedicine, and nanovaccines, as well as a nanoparticle-based drug- and gene-delivery system for cancer therapy, and nanoantigens and growth factors. These drug-loaded nanoparticles extravasate through the tumour vasculature, delivering their payload into the cells by the enhanced permeability and retention (EPR) effect, thereby increasing their therapeutic effect. Ongoing research about drug-loaded nanoparticles and their delivery by the EPR effect to the tumour tissues has been elucidated in this review with clarity. Copyright © 2010 Elsevier B.V. All rights reserved.

Drug resistance in leishmaniasis: current drug-delivery systems and future perspectives.

PubMed

Yasinzai, Masoom; Khan, Momin; Nadhman, Akhtar; Shahnaz, Gul

2013-10-01

Leishmaniasis is a complex of diseases with numerous clinical manifestations for instance harshness from skin lesions to severe disfigurement and chronic systemic infection in the liver and spleen. So far, the most classical leishmaniasis therapy, despite its documented toxicities, remains pentavalent antimonial compounds. The arvailable therapeutic modalities for leishmaniasis are overwhelmed with resistance to leishmaniasis therapy. Mechanisms of classical drug resistance are often related with the lower drug uptake, increased efflux, the faster drug metabolism, drug target modifications and over-expression of drug transporters. The high prevalence of leishmaniasis and the appearance of resistance to classical drugs reveal the demand to develop and explore novel, less toxic, low cost and more promising therapeutic modalities. The review describes the mechanisms of classical drug resistance and potential drug targets in Leishmania infection. Moreover, current drug-delivery systems and future perspectives towards Leishmaniasis treatment are also covered.

Health care delivery system reform: accountable care organizations.

PubMed

Dove, James T; Weaver, W Douglas; Lewin, Jack

2009-09-08

Health care reform is moving forward at a frantic pace. There have been 3 documents released from the Senate Finance Committee and proposed legislation from the Senate HELP Committee and the House of Representatives Tri-Committee on Health Reform. The push for legislative action has not been sidetracked by the economic conditions. Integrated health care delivery is the current favored approach to aligning resource use and cost. Accountable care organizations (ACOs), a concept included in health care reform legislation before both the House and Senate, propose to translate the efficiencies and lessons learned from large integrated systems and apply them to nonintegrated practices. The ACO design could be real or virtual integration of local delivery providers. This new structure is complicated, and clinicians, patients, and payers should have input regarding the design and function of it. Because most of health care is delivered in the ambulatory setting, it remains to be determined whether the ACOs are best developed in parallel among physician practices and hospitals or as partnerships between hospitals and physicians. Many are concerned that hospital-led ACOs will force physician employment by hospitals with possible unintended negative consequences for physicians, hospitals, and patients. Patients, physicians, other providers, and payers are in a better position to guide the redesign of the health care delivery system than government agencies, policy organizations, or elected officials, no matter how well intended. We strongly believe-and ACC has proclaimed-that change in health care delivery must be accomplished with patients and physicians at the table.

49 CFR 375.701 - May I provide for a release of liability on my delivery receipt?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 5 2010-10-01 2010-10-01 false May I provide for a release of liability on my... REGULATIONS Delivery of Shipments § 375.701 May I provide for a release of liability on my delivery receipt? (a) Your delivery receipt or shipping document must not contain any language purporting to release or...

Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach

PubMed Central

2013-01-01

Background Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve quality of RHD care through development and implementation of a continuous quality improvement (CQI) strategy. Methods We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008–2010. Participatory action research methods were employed to identify system barriers to delivery of high quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (≥80% of scheduled 4-weekly penicillin injections) and quality of documentation. Results Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ≥40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p = 0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p = 0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p = 0.001). However, the proportion receiving ≥80% of scheduled BPG did not change. Documentation in medical files improved: ARF episode documentation increased from 31/55 (56%) to 50/62 (81%) (p = 0.004), and RHD risk category documentation from 87/154 (56%) to 103/145 (76%) (p < 0.001). Large differences in performance were noted between health centres, reflected to some extent in SAT scores. Conclusions A CQI process using a systems approach and participatory action research methodology can significantly improve delivery of ARF/RHD care. PMID:24350582

Delivery of child health services in Indigenous communities: implications for the federal government's emergency intervention in the Northern Territory.

PubMed

Bailie, Ross S; Si, Damin; Dowden, Michelle C; Connors, Christine M; O'Donoghue, Lynette; Liddle, Helen E; Kennedy, Catherine M; Cox, Rhonda J; Burke, Hugh P; Thompson, Sandra C; Brown, Alex D H

2008-05-19

To describe delivery of child health services in Australian Aboriginal communities, and to identify gaps in services required to improve the health of Aboriginal children. Cross-sectional baseline audit for a quality improvement intervention. 297 children aged at least 3 months and under 5 years in 11 Aboriginal communities in the Northern Territory, Far West New South Wales and Western Australia in 2006. Adherence to guideline-scheduled services including clinical examinations, brief interventions or advice on health-related behaviour and risks, and enquiry regarding social conditions; and recorded follow-up of identified problems. Documentation of delivery of specific clinical examinations (26%-80%) was relatively good, but was poorer for brief interventions or advice on health-related behaviour and risks (5%-36%) and enquiry regarding social conditions (3%-11%). Compared with children in Far West NSW and WA, those attending NT centres were significantly more likely to have a record of growth faltering, underweight, chronic ear disease, anaemia, or chronic respiratory disease (P < 0.005). Only 11%-13% of children with identified social problems had an assessment report on file. An action plan was documented for 22% of children with growth faltering and 13% with chronic ear disease; 43% of children with chronic respiratory disease and 31% with developmental delay had an assessment report on file. Existing systems are not providing for adequate follow-up of identified medical and social problems for children living in remote Aboriginal communities; development of systems for immediate and longer-term sustainable responses to these problems should be a priority. Without effective systems for follow-up, screening children for disease and adverse social circumstances will result in little or no benefit.

Evaluation protocol to assess an integrated framework for the implementation of the Childhood Obesity Research Demonstration project at the California (CA-CORD) and Massachusetts (MA-CORD) sites.

PubMed

Chuang, Emmeline; Ayala, Guadalupe X; Schmied, Emily; Ganter, Claudia; Gittelsohn, Joel; Davison, Kirsten K

2015-02-01

The long-term success of child obesity prevention and control efforts depends not only on the efficacy of the approaches selected, but also on the strategies through which they are implemented and sustained. This study introduces the Multilevel Implementation Framework (MIF), a conceptual model of factors affecting the implementation of multilevel, multisector interventions, and describes its application to the evaluation of two of three state sites (CA and MA) participating in the Childhood Obesity Research Demonstration (CORD) project. A convergent mixed-methods design is used to document intervention activities and identify determinants of implementation effectiveness at the CA-CORD and MA-CORD sites. Data will be collected from multiple sectors and at multiple levels of influence (e.g., delivery system, academic-community partnership, and coalition). Quantitative surveys will be administered to coalition members and staff in participating delivery systems. Qualitative, semistructured interviews will be conducted with project leaders and key informants at multiple levels (e.g., leaders and frontline staff) within each delivery system. Document analysis of project-related materials and in vivo observations of training sessions will occur on an ongoing basis. Specific constructs assessed will be informed by the MIF. Results will be shared with project leaders and key stakeholders for the purposes of improving processes and informing sustainability discussions and will be used to test and refine the MIF. Study findings will contribute to knowledge about how to coordinate and implement change strategies within and across sectors in ways that effectively engage diverse stakeholders, minimize policy resistance, and maximize desired intervention outcomes.

Legal considerations for document delivery services.

PubMed

Bunting, A

1994-04-01

Health sciences libraries that provide fee-based information services must consider and develop policies and procedures for complying with legal requirements. This paper reviews the provisions of copyright law that pertain to document delivery, including two court decisions concerning copyright. Also discussed are recent actions by publishers to reinforce their view of libraries' responsibilities for royalty fees for articles copied and their use of licenses to impose additional restrictions on the use of and reproduction of materials.

Desktop document delivery using portable document format (PDF) files and the Web.

PubMed Central

Shipman, J P; Gembala, W L; Reeder, J M; Zick, B A; Rainwater, M J

1998-01-01

Desktop access to electronic full-text literature was rated one of the most desirable services in a client survey conducted by the University of Washington Libraries. The University of Washington Health Sciences Libraries (UW HSL) conducted a ten-month pilot test from August 1996 to May 1997 to determine the feasibility of delivering electronic journal articles via the Internet to remote faculty. Articles were scanned into Adobe Acrobat Portable Document Format (PDF) files and delivered to individuals using Multipurpose Internet Mail Extensions (MIME) standard e-mail attachments and the Web. Participants retrieved scanned articles and used the Adobe Acrobat Reader software to view and print files. The pilot test required a special programming effort to automate the client notification and file deletion processes. Test participants were satisfied with the pilot test despite some technical difficulties. Desktop delivery is now offered as a routine delivery method from the UW HSL. PMID:9681165

Desktop document delivery using portable document format (PDF) files and the Web.

PubMed

Shipman, J P; Gembala, W L; Reeder, J M; Zick, B A; Rainwater, M J

1998-07-01

Desktop access to electronic full-text literature was rated one of the most desirable services in a client survey conducted by the University of Washington Libraries. The University of Washington Health Sciences Libraries (UW HSL) conducted a ten-month pilot test from August 1996 to May 1997 to determine the feasibility of delivering electronic journal articles via the Internet to remote faculty. Articles were scanned into Adobe Acrobat Portable Document Format (PDF) files and delivered to individuals using Multipurpose Internet Mail Extensions (MIME) standard e-mail attachments and the Web. Participants retrieved scanned articles and used the Adobe Acrobat Reader software to view and print files. The pilot test required a special programming effort to automate the client notification and file deletion processes. Test participants were satisfied with the pilot test despite some technical difficulties. Desktop delivery is now offered as a routine delivery method from the UW HSL.

Controlled Hydrogen Fleet and Infrastructure Demonstration and Validation Project

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

Stottler, Gary

General Motors, LLC and energy partner Shell Hydrogen, LLC, deployed a system of hydrogen fuel cell electric vehicles integrated with a hydrogen fueling station infrastructure to operate under real world conditions as part of the U.S. Department of Energy's Controlled Hydrogen Fleet and Infrastructure Validation and Demonstration Project. This technical report documents the performance and describes the learnings from progressive generations of vehicle fuel cell system technology and multiple approaches to hydrogen generation and delivery for vehicle fueling.

Future of the transdermal drug delivery market--have we barely touched the surface?

PubMed

Watkinson, Adam C; Kearney, Mary-Carmel; Quinn, Helen L; Courtenay, Aaron J; Donnelly, Ryan F

2016-01-01

Transdermal drug delivery is the movement of drugs across the skin for absorption into the systemic circulation. Transfer of the drug can occur via passive or active means; passive transdermal products do not disrupt the stratum corneum to facilitate delivery whereas active technologies do. Due to the very specific physicochemical properties necessary for successful passive transdermal drug delivery, this sector of the pharmaceutical industry is relatively small. There are many well-documented benefits of this delivery route however, and as a result there is great interest in increasing the number of therapeutic substances that can be delivered transdermally. This review discusses the various transdermal products that are currently/have been marketed, and the paths that led to their success, or lack of. Both passive and active transdermal technologies are considered with the advantages and limitations of each highlighted. In addition to marketed products, technologies that are in the investigative stages by various pharmaceutical companies are reviewed. Passive transdermal drug delivery has made limited progress in recent years, however with the ongoing intense research into active technologies, there is great potential for growth within the transdermal delivery market. A number of active technologies have already been translated into marketed products, with other platforms including microneedles, rapidly progressing towards commercialisation.

Progress Made on a Plan To Integrate Planning, Budgeting, Assessment and Quality Principles To Achieve Institutional Improvement. First Year Report. AIR 1996 Annual Forum Paper.

ERIC Educational Resources Information Center

Griffith, Susan R.; And Others

This paper describes first year implementation efforts of Southwest Texas (SWT) State University to develop a system to integrate planning, budgeting, assessment, and quality to improve the delivery of education and other services to all the institution's customers. The document addresses the common situation when an organization already has…

29 CFR 1921.17 - Service; copies of documents and pleadings.

Code of Federal Regulations, 2014 CFR

2014-07-01

... service. A certificate of the person serving the pleading or other document by personal delivery or by... 29 Labor 7 2014-07-01 2014-07-01 false Service; copies of documents and pleadings. 1921.17 Section... LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT Miscellaneous § 1921.17 Service; copies of documents and...

29 CFR 1921.17 - Service; copies of documents and pleadings.

Code of Federal Regulations, 2012 CFR

2012-07-01

... service. A certificate of the person serving the pleading or other document by personal delivery or by... 29 Labor 7 2012-07-01 2012-07-01 false Service; copies of documents and pleadings. 1921.17 Section... LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT Miscellaneous § 1921.17 Service; copies of documents and...

29 CFR 1921.17 - Service; copies of documents and pleadings.

Code of Federal Regulations, 2010 CFR

2010-07-01

... service. A certificate of the person serving the pleading or other document by personal delivery or by... 29 Labor 7 2010-07-01 2010-07-01 false Service; copies of documents and pleadings. 1921.17 Section... LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT Miscellaneous § 1921.17 Service; copies of documents and...

29 CFR 1921.17 - Service; copies of documents and pleadings.

Code of Federal Regulations, 2011 CFR

2011-07-01

... service. A certificate of the person serving the pleading or other document by personal delivery or by... 29 Labor 7 2011-07-01 2011-07-01 false Service; copies of documents and pleadings. 1921.17 Section... LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT Miscellaneous § 1921.17 Service; copies of documents and...

29 CFR 1921.17 - Service; copies of documents and pleadings.

Code of Federal Regulations, 2013 CFR

2013-07-01

... service. A certificate of the person serving the pleading or other document by personal delivery or by... 29 Labor 7 2013-07-01 2013-07-01 false Service; copies of documents and pleadings. 1921.17 Section... LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT Miscellaneous § 1921.17 Service; copies of documents and...

Health-system strengthening and tuberculosis control.

PubMed

Atun, Rifat; Weil, Diana E C; Eang, Mao Tan; Mwakyusa, David

2010-06-19

Weak health systems are hindering global efforts for tuberculosis care and control, but little evidence is available on effective interventions to address system bottlenecks. This report examines published evidence, programme reviews, and case studies to identify innovations in system design and tuberculosis control to resolve these bottlenecks. We outline system bottlenecks in relation to governance, financing, supply chain management, human resources, health-information systems, and service delivery; and adverse effects from rapid introduction of suboptimum system designs. This report also documents innovative solutions for disease control and system design. Solutions pursued in individual countries are specific to the nature of the tuberculosis epidemic, the underlying national health system, and the contributors engaged: no one size fits all. Findings from countries, including Bangladesh, Cambodia, India, Tanzania, Thailand, and Vietnam, suggest that advances in disease control and system strengthening are complementary. Tuberculosis care and control are essential elements of health systems, and simultaneous efforts to innovate systems and disease response are mutually reinforcing. Highly varied and context-specific responses to tuberculosis show that solutions need to be documented and compared to develop evidence-based policies and practice. Copyright 2010 Elsevier Ltd. All rights reserved.

Legal considerations for document delivery services.

PubMed Central

Bunting, A

1994-01-01

Health sciences libraries that provide fee-based information services must consider and develop policies and procedures for complying with legal requirements. This paper reviews the provisions of copyright law that pertain to document delivery, including two court decisions concerning copyright. Also discussed are recent actions by publishers to reinforce their view of libraries' responsibilities for royalty fees for articles copied and their use of licenses to impose additional restrictions on the use of and reproduction of materials. PMID:8004023

Frito-Lay Electric Delivery Truck Testing | Transportation Research | NREL

Science.gov Websites

Frito-Lay Electric Delivery Truck Evaluation Frito-Lay Electric Delivery Truck Evaluation Photo of . The on-road portion of this 12-month evaluation, launched in 2013, focuses on collecting and analyzing . Publications The following documents provide more information about the study. Field Evaluation of Medium-Duty

75 FR 63140 - National Oil and Hazardous Substances Pollution Contingency Plan; National Priorities List...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-14

..., Denver, Colorado 80202- 1129. Hand Delivery: 1595 Wynkoop Street, Denver, Colorado 80202-1129. Such deliveries are only accepted during the Docket's normal hours of operation, and special arrangements should be made for deliveries of boxed information. Docket: All documents in the docket are listed in the...

75 FR 10508 - Duke Energy Carolinas, LLC; Notice of Consideration of Issuance of Amendment to Facility...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-08

... delivery service to the Office of the Secretary, Sixteenth Floor, One White Flint North, 11555 Rockville..., or expedited delivery service upon depositing the document with the provider of the service. A... General Counsel, Washington, DC 20555-0001. The expedited delivery or courier mail address for both...

75 FR 10513 - Duke Energy Carolinas, LLC; Notice of Consideration of Issuance of Amendment to Facility...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-08

... delivery service to the Office of the Secretary, Sixteenth Floor, One White Flint North, 11555 Rockville..., or expedited delivery service upon depositing the document with the provider of the service. A... General Counsel, Washington, DC 20555-0001. The expedited delivery or courier mail address for both...

76 FR 39136 - Applications and Amendments to Facility Operating Licenses Involving Proposed No Significant...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

...) courier, express mail, or expedited delivery service to the Office of the Secretary, Sixteenth Floor, One... the mail, or by courier, express mail, or expedited delivery service upon depositing the document with..., Office of the General Counsel, Washington, DC 20555-0001. The expedited delivery or courier mail address...

Polymer-Enhanced Subsurface Delivery and Distribution of Permanganate

DTIC Science & Technology

2013-02-01

Subsurface Delivery and Distribution of Permanganate February 2013 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for...SUBTITLE Polymer-Enhanced Subsurface Delivery and Distribution of Permanganate 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...SAMPLING RESULTS ........................................................................................ 28 5.6.1 Permanganate Distribution and Sweep

Delivery to the Wet Chemistry Laboratory

NASA Technical Reports Server (NTRS)

2008-01-01

This portion of a picture acquired by NASA's Phoenix Mars Lander's Robotic Arm Camera documents the delivery of soil to one of four Wet Chemistry Laboratory (WCL) cells on the 30th Martian day, or sol, of the mission. Approximately one cubic centimeter of this soil was then introduced into the cell and mixed with water for chemical analysis. WCL is part of the Microscopy, Electrochemistry, and Conductivity Analyzer (MECA) instrument suite on board the Phoenix lander.

The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.

Accidental fetal lacerations during cesarean delivery: experience in an Italian level III university hospital.

PubMed

Dessole, Salvatore; Cosmi, Erich; Balata, Antonio; Uras, Luisa; Caserta, Donatella; Capobianco, Giampiero; Ambrosini, Guido

2004-11-01

The purpose of this study was to investigate the incidence, type, location, and risk factors of accidental fetal lacerations during cesarean delivery. Total deliveries, cesarean deliveries, and neonatal records for documented accidental fetal lacerations were reviewed retrospectively in our level III university hospital. The gestational age, the presenting part of the fetus, the cesarean delivery indication, the type of incision, and the surgeon who performed the procedure were recorded. Cesarean deliveries were divided into scheduled, unscheduled, and emergency procedures. Fetal lacerations were divided into mild, moderate, and severe. Neonatal follow-up examinations regarding laceration sequelae were available for 6 months. Of 14926 deliveries, 3108 women were delivered by cesarean birth (20.82%). Neonatal records documented 97 accidental fetal lacerations. Of these accidental lacerations, 94 were mild; 2 were moderate, and 1 was severe. The overall rate of accidental fetal laceration per cesarean delivery was 3.12%; the accidental laceration rate in the cohort of fetuses was 2.46%. The crude odds ratios were 0.34 for scheduled procedures, 0.57 for unscheduled procedures, and 1.7 for emergency procedures. The risk for fetal accidental lacerations was higher in fetuses who underwent emergency cesarean birth and lower for unscheduled and scheduled cesarean births (P < .001). Fetal accidental laceration may occur during cesarean delivery; the incidence is significantly higher during emergency cesarean delivery compared with elective procedures. The patient should be counseled about the occurrence of fetal laceration during cesarean delivery to avoid litigation.

Assessing Service Delivery Systems for Assitive Technology in Brazil using HEART Study quality indicators.

PubMed

Maximo, Tulio; Clift, Laurence

2015-01-01

recently in Brazil, there have been investments and improvements in the service delivery system for assistive technology provision. However, there is little documentation of this process, or evidence that users are being involved appropriately. to understand how a ssistive technology service provision currently functions in Belo Horizonte city, Brazil, in order to provide context-specific interventions and recommendations to improve services. Qualitative research design, including visits to key institutions and semi-structured interviews with key stakeholders. Interview questions were divided with two purposes: 1) Exploratory, aiming to understand present service functioning; 2) Evaluative, aiming to assess staff difficulties in applying best existing best practices. Assistive Technology services in Belo Horizonte fall under the 'medical model' definition of service delivery developed by AAATE. It was also found that staff lack training and knowledge support to assess user requirements and involve them during the decision process. Additionally, there is no follow up stage after the device is delivered. The study clearly defines the service provision function and the staff difficulties at Belo Horizonte city, providing information for further studies.

Challenges And Concepts for Design of An Interaction Region With Push-Pull Arrangement of Detectors - An Interface Document

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

Parker, B.; /Brookhaven; Herve, Alain

2011-10-14

Two experimental detectors working in a push-pull mode has been considered for the Interaction Region of the International Linear Collider. The push-pull mode of operation sets specific requirements and challenges for many systems of detector and machine, in particular for the IR magnets, for the cryogenics and alignment system, for beamline shielding, for detector design and overall integration, and so on. These challenges and the identified conceptual solutions discussed in the paper intend to form a draft of the Interface Document which will be developed further in the nearest future. The authors of the present paper include the organizers andmore » conveners of working groups of the workshop on engineering design of interaction region IRENG07, the leaders of the IR Integration within Global Design Effort Beam Delivery System, and the representatives from each detector concept submitting the Letters Of Intent.« less

Time-lapse video sysem used to study nesting gyrfalcons

USGS Publications Warehouse

Booms, Travis; Fuller, Mark R.

2003-01-01

We used solar-powered time-lapse video photography to document nesting Gyrfalcon (Falco rusticolus) food habits in central West Greenland from May to July in 2000 and 2001. We collected 2677.25 h of videotape from three nests, representing 94, 87, and 49% of the nestling period at each nest. The video recorded 921 deliveries of 832 prey items. We placed 95% of the items into prey categories. The image quality was good but did not reveal enough detail to identify most passerines to species. We found no evidence that Gyrfalcons were negatively affected by the video system after the initial camera set-up. The video system experienced some mechanical problems but proved reliable. The system likely can be used to effectively document the food habits and nesting behavior of other birds, especially those delivering large prey to a nest or other frequently used site.

Delivery of Probiotics in the Space Food System

NASA Technical Reports Server (NTRS)

Castro, S. L.; Ott, C. M.; Douglas, G. L.

2014-01-01

The addition of probiotic bacteria to the space food system is expected to confer immunostimulatory benefits on crewmembers during spaceflight, counteracting the immune dysregulation that has been documented in spaceflight. Specifically, the probiotic Lactobacillus acidophilus has been shown to promote health benefits including antagonism towards and inhibition of virulence related gene expression in pathogens, mucosal stimulation of immune cells, and a reduction in the occurrence and duration of cold and flu-like symptoms. The optimum delivery system for probiotics has not been determined for spaceflight, where the food system is shelf stable and the lack of refrigeration prevents the use of traditional dairy delivery methods. This work proposes to determine whether L. acidophilus is more viable, and therefore more likely to confer immune benefit, when delivered in a capsule form or when delivered in nonfat dry milk powder with a resuscitation opportunity upon rehydration, following 0, 4, and 8 months of storage at -80degC, 4degC, and 22degC, and both prior to and after challenge with simulated gastric and intestinal juices. We hypothesize that the low moisture neutral dairy matrix provided by the nonfat dry milk, and the rehydration step prior to consumption, will extend probiotic viability and stress tolerance compared to a capsule during potential storage conditions in spaceflight and in simulated digestion conditions.

Delivery of Probiotics in the Space Food System

NASA Technical Reports Server (NTRS)

Castro, S. L.; Ott, C. M.; Douglas, G. L.

2014-01-01

The addition of probiotic bacteria to the space food system is expected to confer immunostimulatory benefits on crewmembers during spaceflight, counteracting the immune dysregulation that has been documented in spaceflight [1]. Specifically, the probiotic Lactobacillus acidophilus has been shown to promote health benefits including antagonism towards and inhibition of virulence related gene expression in pathogens, mucosal stimulation of immune cells, and a reduction in the occurrence and duration of cold and flu-like symptoms [2-5]. The optimum delivery system for probiotics has not been determined for spaceflight, where the food system is shelf stable and the lack of refrigeration prevents the use of traditional dairy delivery methods. This work proposes to determine whether L. acidophilus is more viable, and therefore more likely to confer immune benefit, when delivered in a capsule form or when delivered in nonfat dry milk powder with a resuscitation opportunity upon rehydration, following 0, 4, and 8 months of storage at -80degC, 4degC, and 22degC, and both prior to and after challenge with simulated gastric and intestinal juices. We hypothesize that the low moisture neutral dairy matrix provided by the nonfat dry milk, and the rehydration step prior to consumption, will extend probiotic viability and stress tolerance compared to a capsule during potential storage conditions in spaceflight and in simulated digestion conditions.

Perspective: “The Financial Impact of Alternative Water Project Delivery Models” in the Water Sector

EPA Pesticide Factsheets

The Water Finance Center developed this companion perspective document to a UNC EFC report on Alternative Water Project Delivery Models to broaden understanding of this alternative procurement method.

Orbital transfer vehicle concept definition and system analysis study, 1985. Volume 3: System and program trades

NASA Technical Reports Server (NTRS)

Nelson, James H.; Mohrman, Gordon W.; Callan, Daniel R.

1986-01-01

The key system and program trade studies performed to arrive at a preferred Orbital Transfer Vehicle (OTV) system concept and evolutionary approach to the acquisition of the requisite capabilites is documented. These efforts were expanded to encompass a Space Transportation Architecture Study (STAS) mission model and recommended unmanned cargo vehicle. The most important factors affecting the results presented are the mission model requirements and selection criteria. The reason for conducting the OTV concept definition and system analyses study is to select a concept and acquisition approach that meets a delivery requirement reflected by the mission model.

Desktop Access to Full-Text NACA and NASA Reports: Systems Developed by NASA Langley Technical Library

NASA Technical Reports Server (NTRS)

Ambur, Manjula Y.; Adams, David L.; Trinidad, P. Paul

1997-01-01

NASA Langley Technical Library has been involved in developing systems for full-text information delivery of NACA/NASA technical reports since 1991. This paper will describe the two prototypes it has developed and the present production system configuration. The prototype systems are a NACA CD-ROM of thirty-three classic paper NACA reports and a network-based Full-text Electronic Reports Documents System (FEDS) constructed from both paper and electronic formats of NACA and NASA reports. The production system is the DigiDoc System (DIGItal Documents) presently being developed based on the experiences gained from the two prototypes. DigiDoc configuration integrates the on-line catalog database World Wide Web interface and PDF technology to provide a powerful and flexible search and retrieval system. It describes in detail significant achievements and lessons learned in terms of data conversion, storage technologies, full-text searching and retrieval, and image databases. The conclusions from the experiences of digitization and full- text access and future plans for DigiDoc system implementation are discussed.

Using Wearable Computers in Shuttle Processing: A Feasibility Study

NASA Technical Reports Server (NTRS)

Centeno, Martha A.; Correa, Daisy; Groh-Hammond, Marcia

2001-01-01

Shuttle processing operations are performed following prescribed instructions compiled in a Work Authorization Document (WAD). Until very recently, WADs were printed so that they could be properly executed, including the buy off of each and every step by the appropriate authorizing agent. However, with the development of EPICs, Maximo, and PeopleSoft applications, some of these documents are now available in electronic format; hence, it is possible for technicians and engineers to access them on line and buy off the steps electronically. To take full advantage of these developments, technicians need access to such documents at the point of job execution. Body wearable computers present an opportunity to develop a WAD delivery system that enables access while preserving technician's mobility, safety levels, and quality of work done. The primary objectives of this project were to determine if body wearable computers are a feasible delivery system for WADs. More specifically, identify and recommend specific brands of body wearable computers readily available on the market. Thus, this effort has field-tested this technology in two areas of shuttle processing, and it has examined the usability of the technology. Results of two field tests and a Human Factors Usability Test are presented. Section 2 provides a description of the body wearable computer technology. Section 3 presents the test at the Space Shuttle Main Engine (SSME) Shop. Section 4 presents the results of the integration test at the Solid Rocket Boosters Assembly and Refurbishing Facility (SRBARF). Section 5 presents the results of the usability test done at the Operations Support Building (OSB).

Testing Orr's document delivery test on biomedical journals in South Africa.

PubMed Central

Steynberg, S; Rossouw, S F

1995-01-01

This paper describes the use of a document delivery test (DDT) to measure the availability of biomedical research journals in South African health sciences libraries. The methodology employed was developed twenty years ago by a team of researchers from the Institute for the Advancement of Medical Communication under the direction of R. H. Orr. The testing of the methodology was in itself an objective of the present research. A citation pool consisting of 307 items was constructed from references to journal articles in papers published in 1989 by South African biomedical researchers. The availability of each article was determined at each of seven medical library sites; the performance was measured and presented as an arithmetical value or document delivery capability index (CI). The results of the tests show a high level of availability, ranging from CI = 81.68 to CI = 92.97 for the journals sampled. The DDT methodology was found to be practical, applicable to such studies, and flexible. Its use is recommended for similar studies. Images PMID:7703944

Public health human resources: a comparative analysis of policy documents in two Canadian provinces

PubMed Central

2014-01-01

Background Amidst concerns regarding the capacity of the public health system to respond rapidly and appropriately to threats such as pandemics and terrorism, along with changing population health needs, governments have focused on strengthening public health systems. A key factor in a robust public health system is its workforce. As part of a nationally funded study of public health renewal in Canada, a policy analysis was conducted to compare public health human resources-relevant documents in two Canadian provinces, British Columbia (BC) and Ontario (ON), as they each implement public health renewal activities. Methods A content analysis of policy and planning documents from government and public health-related organizations was conducted by a research team comprised of academics and government decision-makers. Documents published between 2003 and 2011 were accessed (BC = 27; ON = 20); documents were either publicly available or internal to government and excerpted with permission. Documentary texts were deductively coded using a coding template developed by the researchers based on key health human resources concepts derived from two national policy documents. Results Documents in both provinces highlighted the importance of public health human resources planning and policies; this was particularly evident in early post-SARS documents. Key thematic areas of public health human resources identified were: education, training, and competencies; capacity; supply; intersectoral collaboration; leadership; public health planning context; and priority populations. Policy documents in both provinces discussed the importance of an educated, competent public health workforce with the appropriate skills and competencies for the effective and efficient delivery of public health services. Conclusion This policy analysis identified progressive work on public health human resources policy and planning with early documents providing an inventory of issues to be addressed and later documents providing evidence of beginning policy development and implementation. While many similarities exist between the provinces, the context distinctive to each province has influenced and shaped how they have focused their public health human resources policies. PMID:24564931

Public health human resources: a comparative analysis of policy documents in two Canadian provinces.

PubMed

Regan, Sandra; MacDonald, Marjorie; Allan, Diane E; Martin, Cheryl; Peroff-Johnston, Nancy

2014-02-24

Amidst concerns regarding the capacity of the public health system to respond rapidly and appropriately to threats such as pandemics and terrorism, along with changing population health needs, governments have focused on strengthening public health systems. A key factor in a robust public health system is its workforce. As part of a nationally funded study of public health renewal in Canada, a policy analysis was conducted to compare public health human resources-relevant documents in two Canadian provinces, British Columbia (BC) and Ontario (ON), as they each implement public health renewal activities. A content analysis of policy and planning documents from government and public health-related organizations was conducted by a research team comprised of academics and government decision-makers. Documents published between 2003 and 2011 were accessed (BC = 27; ON = 20); documents were either publicly available or internal to government and excerpted with permission. Documentary texts were deductively coded using a coding template developed by the researchers based on key health human resources concepts derived from two national policy documents. Documents in both provinces highlighted the importance of public health human resources planning and policies; this was particularly evident in early post-SARS documents. Key thematic areas of public health human resources identified were: education, training, and competencies; capacity; supply; intersectoral collaboration; leadership; public health planning context; and priority populations. Policy documents in both provinces discussed the importance of an educated, competent public health workforce with the appropriate skills and competencies for the effective and efficient delivery of public health services. This policy analysis identified progressive work on public health human resources policy and planning with early documents providing an inventory of issues to be addressed and later documents providing evidence of beginning policy development and implementation. While many similarities exist between the provinces, the context distinctive to each province has influenced and shaped how they have focused their public health human resources policies.

RFID Tag Helix Antenna Sensors for Wireless Drug Dosage Monitoring

PubMed Central

Huang, Haiyu; Zhao, Peisen; Chen, Pai-Yen; Ren, Yong; Liu, Xuewu; Ferrari, Mauro; Hu, Ye; Akinwande, Deji

2014-01-01

Miniaturized helix antennas are integrated with drug reservoirs to function as RFID wireless tag sensors for real-time drug dosage monitoring. The general design procedure of this type of biomedical antenna sensors is proposed based on electromagnetic theory and finite element simulation. A cost effective fabrication process is utilized to encapsulate the antenna sensor within a biocompatible package layer using PDMS material, and at the same time form a drug storage or drug delivery unit inside the sensor. The in vitro experiment on two prototypes of antenna sensor-drug reservoir assembly have shown the ability to monitor the drug dosage by tracking antenna resonant frequency shift from 2.4–2.5-GHz ISM band with realized sensitivity of 1.27 \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$\\mu~{\\rm l}/{\\rm MHz}$\\end{document} for transdermal drug delivery monitoring and 2.76-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$\\mu~{\\rm l}/{\\rm MHz}$\\end{document} sensitivity for implanted drug delivery monitoring. PMID:27170865

An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support.

PubMed

Wong, C M; Wu, S Y; Ting, W H; Ho, K H; Tong, L H; Cheung, N T

2015-01-01

Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.

Recommendations for bridge and tunnel security

DOT National Transportation Integrated Search

2000-02-01

This guide identifies worldwide document delivery suppliers who provide, upon request and usually a service fee, copies of research reports, journal articles, conference proceedings, standards and regulations, gray papers, and other types of document...

25 CFR 2.12 - Service of appeal documents.

Code of Federal Regulations, 2011 CFR

2011-04-01

... personal delivery or by mail to the record address as specified in § 2.14. Service on a tribe shall be to... 25 Indians 1 2011-04-01 2011-04-01 false Service of appeal documents. 2.12 Section 2.12 Indians... ACTIONS § 2.12 Service of appeal documents. (a) Persons filing documents in an appeal must serve copies of...

25 CFR 2.12 - Service of appeal documents.

Code of Federal Regulations, 2014 CFR

2014-04-01

... personal delivery or by mail to the record address as specified in § 2.14. Service on a tribe shall be to... 25 Indians 1 2014-04-01 2014-04-01 false Service of appeal documents. 2.12 Section 2.12 Indians... ACTIONS § 2.12 Service of appeal documents. (a) Persons filing documents in an appeal must serve copies of...

25 CFR 2.12 - Service of appeal documents.

Code of Federal Regulations, 2013 CFR

2013-04-01

... personal delivery or by mail to the record address as specified in § 2.14. Service on a tribe shall be to... 25 Indians 1 2013-04-01 2013-04-01 false Service of appeal documents. 2.12 Section 2.12 Indians... ACTIONS § 2.12 Service of appeal documents. (a) Persons filing documents in an appeal must serve copies of...

25 CFR 2.12 - Service of appeal documents.

Code of Federal Regulations, 2010 CFR

2010-04-01

... personal delivery or by mail to the record address as specified in § 2.14. Service on a tribe shall be to... 25 Indians 1 2010-04-01 2010-04-01 false Service of appeal documents. 2.12 Section 2.12 Indians... ACTIONS § 2.12 Service of appeal documents. (a) Persons filing documents in an appeal must serve copies of...

25 CFR 2.12 - Service of appeal documents.

Code of Federal Regulations, 2012 CFR

2012-04-01

... personal delivery or by mail to the record address as specified in § 2.14. Service on a tribe shall be to... 25 Indians 1 2012-04-01 2011-04-01 true Service of appeal documents. 2.12 Section 2.12 Indians... ACTIONS § 2.12 Service of appeal documents. (a) Persons filing documents in an appeal must serve copies of...

Assessing the elimination of user fees for delivery services in Laos.

PubMed

Boudreaux, Chantelle; Chanthala, Phetdara; Lindelow, Magnus

2014-01-01

A pilot eliminating user fees associated with delivery at the point of services was introduced in two districts of Laos in March 2009. Following two years of implementation, an evaluation was conducted to assess the pilot impact, as well as to document the pilot design and implementation challenges. Study results show that, even in the presence of the substantial access and cultural barriers, user fees associated with delivery at health facilities act as a serious deterrent to care seeking behavior. We find a tripling of facility-based delivery rates in the intervention areas, compared to a 40% increase in the control areas. While findings from the control region suggest that facility-based delivery rates may be on the rise across the country, the substantially higher increase in the pilot areas highlight the impact of financial burden associated with facility-based delivery fees. These fees can play an important role in rapidly increasing the uptake of facility delivery to reach the national targets and, ultimately, to improve maternal and child health outcomes. The pilot achieved important gains while relying heavily on capacity and systems already in place. However, the high cost associated with monitoring and evaluation suggest broad-scale expansion of the pilot activities is likely to necessitate targeted capacity building initiatives, especially in areas with limited district level capacity to manage funds and deliver detailed and timely reports.

Pressure-Mediated Oligonucleotide Transfection of Rat and Human Cardiovascular Tissues

NASA Astrophysics Data System (ADS)

Mann, Michael J.; Gibbons, Gary H.; Hutchinson, Howard; Poston, Robert S.; Hoyt, E. Grant; Robbins, Robert C.; Dzau, Victor J.

1999-05-01

The application of gene therapy to human disease is currently restricted by the relatively low efficiency and potential hazards of methods of oligonucleotide or gene delivery. Antisense or transcription factor decoy oligonucleotides have been shown to be effective at altering gene expression in cell culture expreriments, but their in vivo application is limited by the efficiency of cellular delivery, the intracellular stability of the compounds, and their duration of activity. We report herein the development of a highly efficient method for naked oligodeoxynucleotide (ODN) transfection into cardiovascular tissues by using controlled, nondistending pressure without the use of viral vectors, lipid formulations, or exposure to other adjunctive, potentially hazardous substances. In this study, we have documented the ability of ex vivo, pressure-mediated transfection to achieve nuclear localization of fluorescent (FITC)-labeled ODN in approximately 90% and 50% of cells in intact human saphenous vein and rat myocardium, respectively. We have further documented that pressure-mediated delivery of antisense ODN can functionally inhibited target gene expression in both of these tissues in a sequence-specific manner at the mRNA and protein levels. This oligonucleotide transfection system may represent a safe means of achieving the intraoperative genetic engineering of failure-resistant human bypass grafts and may provide an avenue for the genetic manipulation of cardiac allograft rejection, allograft vasculopathy, or other transplant diseases.

Optimizing Wartime Materiel Delivery: An Overview of DoD containerization. Volume 3. Annotated Bibliography

DOT National Transportation Integrated Search

1988-10-01

This annotated bibliography, Volume III of the study entitled, Optimizing Wartime Materiel Delivery: An overview of DOD Containerization Efforts, documents studies related to containerization. Several objectives of the study were defined. These inclu...

Clinical Opinion: "Doing Something" About the Cesarean Delivery Rate.

PubMed

Clark, S L; Garite, T J; Hamilton, E J; Belfort, M A; Hankins, G D

2018-05-04

There is a general consensus that the cesarean delivery rate in the U.S. is too high, and that practice patterns of obstetricians are largely to blame for this situation. In reality, the U.S. cesarean delivery rate is the result of 3 forces largely beyond the control of the practicing clinician: patient expectations and misconceptions regarding the safety of labor, the medical-legal system, and limitations in technology. Efforts to "do something" about the cesarean delivery rate by promulgating practice directives which are marginally evidence-based or influenced by social pressures are both ineffective and potentially harmful. We examine both the recent ACOG/SMFM Care Consensus Statement "Safe Prevention of Primary Cesarean Delivery" document and the various iterations of the ACOG guidelines for vaginal birth after cesarean delivery in this context. Adherence to arbitrary time limits for active phase or second stage arrest without incorporating other clinical factors into the decision making process is unwise. In a similar manner, ever-changing practice standards for vaginal birth after cesarean driven by factors other than changing data are unlikely to be effective in lowering the cesarean delivery rate. Whether too high or too low, the current U.S. cesarean delivery rate is the expected result of the unique demographic, geographic and social forces driving it and is unlikely to change significantly given the limitations of current technology to otherwise satisfy the demands of these forces. Copyright © 2018 Elsevier Inc. All rights reserved.

[About free delivery of therapeutical and preventive drugs to the people during Ottoman Empire].

PubMed

Cubukçu, B

2001-01-01

In this study, free delivery of medical drugs (dispensed in Ottoman Empire hospital pharmacies) to the outpatients in addition to the inpatients in Darüşşifas (patient care houses) have been investigated in the chronological order from the Vakfiye enrollments and documents of Ottoman Empire. On the other hand free delivery of drugs dispensed in the Palaces, Mesir paste delivery and other preventive drugs for the epidemic diseases have been studied.

Program Support Communications Network (PSCN) facsimile system directory

NASA Technical Reports Server (NTRS)

1992-01-01

This directory provides a system description, a station listing, and operating procedures for the Program Support Communications Network (PSCN) NASA Facsimile System. The NASA Facsimile System is a convenient and efficient means of spanning the distance, time, and cost of transmitting documents from one person to another. In the spectrum of communication techniques, facsimile bridges the gap between mail and data transmission. Facsimile can transmit in a matter of minutes or seconds what would take a day or more by mail delivery. The NASA Facsimile System is composed of several makes and models of facsimile machines. The system also supports the 3M FaxXchange network controllers located at Marshall Space Flight Center (MSFC).

The significance of transferrin receptors in oncology: the development of functional nano-based drug delivery systems.

PubMed

Tortorella, Stephanie; Karagiannis, Tom C

2014-01-01

Anticancer therapeutic research aims to improve clinical management of the disease through the development of strategies that involve currently-relevant treatment options and targeted delivery. Tumour-specific and -targeted delivery of compounds to the site of malignancy allows for enhanced cellular uptake, increased therapeutic benefit with high intratumoural drug concentrations, and decreased systemic exposure. Due to the upregulation of transferrin receptor expression in a wide variety of cancers, its function and its highly efficient recycling pathway, strategies involving the selective targeting of the receptor are well documented. Direct conjugation and immunotoxin studies using the transferrin peptide or anti-transferrin receptor antibodies as the targeting moiety have established the capacity to enhance cellular uptake, cross the blood brain barrier, limit systemic toxicity and reverse multi-drug resistance. Limitations in direct conjugation, including the difficulty in linking an adequate amount of therapeutic compound to the ligand or antibody have identified the requirement to develop novel delivery methods. The application of nanoparticulate theory in the development of functional drug delivery systems has proven to be most promising, with the ability to selectively modify size-dependent properties and surface chemistry. The transferrin modification on a range of nanoparticle formulations enhances selective cellular uptake through transferrin-mediated processes, and increases therapeutic benefit through the ability to encapsulate high concentrations of relevant drug to the tumour site. Although ineffective in crossing the blood brain barrier in its free form, chemotherapeutic compounds including doxorubicin, may be loaded into transferrin-conjugated nanocarriers and impart cytotoxic effects in glioma cells in vitro and in vivo. Additionally, transferrin-targeted nanoparticles may be used in selective diagnostic applications with enhanced selectivity and sensitivity. Four transferrin-modified nano-based drug delivery systems are currently in early phases of human clinical trials. Despite the collective promise, inconsistencies in some studies have exposed some limitations in current formulations and the difficulty in translating preliminary studies into clinically-relevant therapeutic options. The main objective of this review is to investigate the development of transferrin targeted nano-based drug delivery systems in order to establish the use of transferrin as a cancer-targeted moiety, and to ultimately evaluate the progression of cancer therapeutic strategies for future research.

Extending access to essential services against constraints: the three-tier health service delivery system in rural China (1949-1980).

PubMed

Feng, Xing Lin; Martinez-Alvarez, Melisa; Zhong, Jun; Xu, Jin; Yuan, Beibei; Meng, Qingyue; Balabanova, Dina

2017-05-23

China has made remarkable progress in scaling up essential services during the last six decades, making health care increasingly available in rural areas. This was partly achieved through the building of a three-tier health system in the 1950s, established as a linked network with health service facilities at county, township and village level, to extend services to the whole population. We developed a Theory of Change to chart the policy context, contents and mechanisms that may have facilitated the establishment of the three-tier health service delivery system in rural China. We systematically synthesized the best available evidence on how China achieved universal access to essential services in resource-scarce rural settings, with a particular emphasis on the experiences learned before the 1980s, when the country suffered a particularly acute lack of resources. The search identified only three peered-reviewed articles that fit our criteria for scientific rigor. We therefore drew extensively on government policy documents, and triangulated them with other publications and key informant interviews. We found that China's three-tier health service delivery system was established in response to acute health challenges, including high fertility and mortality rates. Health system resources were extremely low in view of the needs and insufficient to extend access to even basic care. With strong political commitment to rural health and a "health-for-all" policy vision underlying implementation, a three-tier health service delivery model connecting villages, townships and counties was quickly established. We identified several factors that contributed to the success of the three-tier system in China: a realistic health human resource development strategy, use of mass campaigns as a vehicle to increase demand, an innovative financing mechanisms, public-private partnership models in the early stages of scale up, and an integrated approach to service delivery. An implementation process involving gradual adaptation and incorporation of the lessons learnt was also essential. China's 60 year experience in establishing a de-professionalized, community-based, health service delivery model that is economically feasible, institutionally and culturally appropriate mechanism can be useful to other low- and middle-income countries (LMICs) seeking to extend essential services. Lessons can be drawn from both reform content and from its implementation pathway, identifying the political, institutional and contextual factors shaping the three-tier delivery model over time.

"When We Learn Better, We Do Better": Describing Changes in Empowerment through Photovoice among Community Health Advisors in a Breast and Cervical Cancer Health Promotion Program in Mississippi and Alabama

ERIC Educational Resources Information Center

Mayfield-Johnson, Susan; Rachal, John R.; Butler, James, III.

2014-01-01

As change agents in the community, community health advisors (CHAs) are a viable solution to bridge the gap between health service delivery systems and the community. With many CHAs members of the underserved and minority populations they serve, change and empowerment experienced by CHAs should be documented. This phenomenological study describes…

Potential for off-peak freight deliveries to commercial areas : implementation plan

DOT National Transportation Integrated Search

2007-12-21

This document discusses three groups of policies to foster off-peak deliveries. The first group, Industry wide policies, considers policies that target specific industry segments, e.g., tax incentives to restaurants in exchange for their commitment t...

ModSAF Software Architecture Design and Overview Document

DTIC Science & Technology

1993-12-20

ADVANCED DISTRIBUTED SIMULATIONTECHNOLOGY AD-A282 740 ModSAF SOFTWARE ARCHITECTURE DESIGN AND OVERVIEW DOCUMENT Ver 1.0 - 20 December 1993 D T...AND SUBTITLE 5. FUNDING NUMBERS MOdSAF SOFTWARE ARCHITECTURE DESIGN AND OVERVIEW DOCUMENT C N61339-91-D-O00, Delivery Order (0021), ModSAF (CDRL A004) 6

An ideal-typical model for comparing interprofessional relations and skill mix in health care.

PubMed

Schönfelder, Walter; Nilsen, Elin Anita

2016-11-08

Comparisons of health system performance, including the regulations of interprofessional relations and the skill mix between health professions are challenging. National strategies for regulating interprofessional relations vary widely across European health care systems. Unambiguously defined and generally accepted performance indicators have to remain generic, with limited power for recognizing the organizational structures regulating interprofessional relations in different health systems. A coherent framework for in-depth comparisons of different models for organizing interprofessional relations and the skill mix between professional groups is currently not available. This study aims to develop an ideal-typical framework for categorizing skill mix and interprofessional relations in health care, and to assess the potential impact for different ideal types on care coordination and integrated service delivery. A document analysis of the Health Systems in Transition (HiT) reports published by the European Observatory on Health Systems and Policies was conducted. The HiT reports to 31 European health systems were analyzed using a qualitative content analysis and a process of meaning condensation. The educational tracks available to nurses have an impact on the professional autonomy for nurses, the hierarchy between professional groups, the emphasis given to negotiating skill mix, interdisciplinary teamwork and the extent of cooperation across the health and social service interface. Based on the results of the document analysis, three ideal types for regulating interprofessional relations and skill mix in health care are delimited. For each ideal type, outcomes on service coordination and holistic service delivery are described. Comparisons of interprofessional relations are necessary for proactive health human resource policies. The proposed ideal-typical framework provides the means for in-depth comparisons of interprofessional relations in the health care workforce beyond of what is possible with directly comparable, but generic performance indicators.

NGNP Data Management and Analysis System Analysis and Web Delivery Capabilities

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

Cynthia D. Gentillon

2011-09-01

Projects for the Very High Temperature Reactor (VHTR) Technology Development Office provide data in support of Nuclear Regulatory Commission licensing of the very high temperature reactor. Fuel and materials to be used in the reactor are tested and characterized to quantify performance in high-temperature and high-fluence environments. The NGNP Data Management and Analysis System (NDMAS) at the Idaho National Laboratory has been established to ensure that VHTR data are (1) qualified for use, (2) stored in a readily accessible electronic form, and (3) analyzed to extract useful results. This document focuses on the third NDMAS objective. It describes capabilities formore » displaying the data in meaningful ways and for data analysis to identify useful relationships among the measured quantities. The capabilities are described from the perspective of NDMAS users, starting with those who just view experimental data and analytical results on the INL NDMAS web portal. Web display and delivery capabilities are described in detail. Also the current web pages that show Advanced Gas Reactor, Advanced Graphite Capsule, and High Temperature Materials test results are itemized. Capabilities available to NDMAS developers are more extensive, and are described using a second series of examples. Much of the data analysis efforts focus on understanding how thermocouple measurements relate to simulated temperatures and other experimental parameters. Statistical control charts and correlation monitoring provide an ongoing assessment of instrument accuracy. Data analysis capabilities are virtually unlimited for those who use the NDMAS web data download capabilities and the analysis software of their choice. Overall, the NDMAS provides convenient data analysis and web delivery capabilities for studying a very large and rapidly increasing database of well-documented, pedigreed data.« less

Combining Solar Electric Propulsion and Chemical Propulsion for Crewed Missions to Mars

NASA Technical Reports Server (NTRS)

Percy, Tom; McGuire, Melissa; Polsgrove, Tara

2015-01-01

This paper documents the results of an investigation of human Mars mission architectures that leverage near-term technology investments and infrastructures resulting from the planned Asteroid Redirect Robotic Mission (ARRM), including high-power Solar Electric Propulsion (SEP) and a human presence in Lunar Distant Retrograde Orbit (LDRO). The architectures investigated use a combination of SEP and chemical propulsion elements. Through this combination of propulsion technologies, these architectures take advantage of the high efficiency SEP propulsion system to deliver cargo, while maintaining the faster trip times afforded by chemical propulsion for crew transport. Evolved configurations of the Asteroid Redirect Vehicle (ARV) are considered for cargo delivery. Sensitivities to SEP system design parameters, including power level and propellant quantity, are presented. For the crew delivery, liquid oxygen and methane stages were designed using engines common to future human Mars landers. Impacts of various Earth departure orbits, Mars loiter orbits, and Earth return strategies are presented. The use of the Space Launch System for delivery of the various architecture elements was also investigated and launch vehicle manifesting, launch scheduling and mission timelines are also discussed. The study results show that viable Mars architecture can be constructed using LDRO and SEP in order to take advantage of investments made in the ARRM mission.

Combining Solar Electric and Chemical Propulsion for Crewed Missions to Mars

NASA Technical Reports Server (NTRS)

Percy, Tom; McGuire, Melissa; Polsgrove, Tara

2015-01-01

This paper documents the results of an investigation of human Mars mission architectures that leverage near-term technology investments and infrastructures resulting from the planned Asteroid Redirect Mission, including high-power Solar Electric Propulsion (SEP) and a human presence in Lunar Distant Retrograde Orbit (LDRO). The architectures investigated use a combination of SEP and chemical propulsion elements. Through this combination of propulsion technologies, these architectures take advantage of the high efficiency SEP propulsion system to deliver cargo, while maintaining the faster trip times afforded by chemical propulsion for crew transport. Evolved configurations of the Asteroid Redirect Vehicle (ARV) are considered for cargo delivery. Sensitivities to SEP system design parameters, including power level and propellant quantity, are presented. For the crew delivery, liquid oxygen and methane stages were designed using engines common to future human Mars landers. Impacts of various Earth departure orbits, Mars loiter orbits, and Earth return strategies are presented. The use of the Space Launch System for delivery of the various architecture elements was also investigated and launch vehicle manifesting, launch scheduling and mission timelines are also discussed. The study results show that viable Mars architecture can be constructed using LDRO and SEP in order to take advantage of investments made in the ARM mission.

Solar-powered oxygen delivery: proof of concept.

PubMed

Turnbull, H; Conroy, A; Opoka, R O; Namasopo, S; Kain, K C; Hawkes, M

2016-05-01

A resource-limited paediatric hospital in Uganda. Pneumonia is a leading cause of child mortality worldwide. Access to life-saving oxygen therapy is limited in many areas. We designed and implemented a solar-powered oxygen delivery system for the treatment of paediatric pneumonia. Proof-of-concept pilot study. A solar-powered oxygen delivery system was designed and piloted in a cohort of children with hypoxaemic illness. The system consisted of 25 × 80 W photovoltaic solar panels (daily output 7.5 kWh [range 3.8-9.7kWh]), 8 × 220 Ah batteries and a 300 W oxygen concentrator (output up to 5 l/min oxygen at 88% [±2%] purity). A series of 28 patients with hypoxaemia were treated with solar-powered oxygen. Immediate improvement in peripheral blood oxygen saturation was documented (median change +12% [range 5-15%], P < 0.0001). Tachypnoea, tachycardia and composite illness severity score improved over the first 24 h of hospitalisation (P < 0.01 for all comparisons). The case fatality rate was 6/28 (21%). The median recovery times to sit, eat, wean oxygen and hospital discharge were respectively 7.5 h, 9.8 h, 44 h and 4 days. Solar energy can be used to concentrate oxygen from ambient air and oxygenate children with respiratory distress and hypoxaemia in a resource-limited setting.

Project W-211 initial tank retrieval systems year 2000 compliance assessment project plan

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

BUSSELL, J.H.

1999-08-24

This assessment describes the potential Year 2000 (Y2K) problems and describes the methods for achieving Y2K Compliance for Project W-211, Initial Tank Retrieval Systems (ITRS). The purpose of this assessment is to give an overview of the project. This document will not be updated and any dates contained in this document are estimates and may change. The scope of project W-211 is to provide systems for retrieval of radioactive wastes from ten double-shell tanks (DST). systems will be installed in tanks 102-AP, 104-AP, 105-AN, 104-AN, 102-AZ, 101-AW, 103-AN, 107-AN, 102-AY, and 102-SY. The current tank selection and sequence supports phasemore » I feed delivery to privatized processing plants. A detailed description of system dates, functions, interfaces, potential Y2K problems, and date resolutions can not be described since the project is in the definitive design phase. This assessment will describe the methods, protocols, and practices to assure that equipment and systems do not have Y2K problems.« less

Learning From Experience: Development of a Cognitive Task List to Perform a Safe and Successful Non-Rotational Forceps Delivery.

PubMed

Simpson, Andrea N; Gurau, David; Secter, Michael; Mocarski, Eva; Pittini, Richard; Snelgrove, John; Hodges, Ryan; Windrim, Rory; Higgins, Mary

2015-07-01

Increased rates of delivery by Caesarean section have resulted in a reduction in rates of instrumental deliveries. This has led to a new educational challenge for teaching and development of skills. In teaching trainees, there are subconscious tasks that the supervising staff may not review because they are automatic. This study aimed to create a new tool to meet this challenge: to identify the core steps required to perform a non-rotational forceps delivery safely and successfully. Labour and delivery nursing staff of three large teaching hospitals were asked to identify clinicians they considered to be particularly skilled in non-rotational forceps deliveries. Obstetricians who were identified consistently in this way were invited to participate in the study. After providing written consent, participants were then filmed performing a non-rotational forceps delivery on a model. Two clinicians reviewed all videos and documented verbal and non-verbal components of the assessment. Thematic analysis combined findings into an integrated summary. The initial summary was then circulated to all participants for their approval. Seventeen clinicians were identified and consented. Themes identified included the need for careful assessment of suitability for operative delivery, the role of the multidisciplinary team, the need for careful and appropriate communication with the parents, the technique of delivery itself, and postpartum care and documentation. In the core steps identified, the clinicians balanced respect for the "elegant technique" of non-rotational forceps deliveries with careful assessment and knowing when to stop if safety criteria were not met.

Is documentation of TOLAC counseling a good measure of quality of care?

PubMed

Friedman, Alexander Michael; Srinivas, Sindhu K

2016-01-01

The objective of this study is to determine whether chart documentation of patient counseling on trial of labor after cesarean (TOLAC) during prenatal care is associated with patient knowledge of risks and benefits of TOLAC and repeat cesarean delivery (RCD). Prenatal patients eligible for TOLAC completed a questionnaire that assessed their knowledge of basic maternal and neonatal risks and benefits of TOLAC versus planned repeat cesarean delivery. Patient electronic medical records were reviewed for documentation of TOLAC counseling. Women were included at both early and late time points in pregnancy to include those who both had and had not undergone counseling. Patients with documented completed TOLAC counseling did not perform better on the knowledge survey. Patients who had documentation of counseling on specific subjects such as TOLAC success rates, risk of uterine rupture, and downstream health risks of cesarean section were no more likely to answer questions on these topics correctly than patients without counseling. However, patients with documented completed counseling generally felt that they were well informed. Chart documentation of TOLAC counseling was not correlated with patient knowledge. Patients may not be gaining the knowledge from counseling that providers believe is important for informed decision making.

Globe Teachers Guide and Photographic Data on the Web

NASA Technical Reports Server (NTRS)

Kowal, Dan

2004-01-01

The task of managing the GLOBE Online Teacher s Guide during this time period focused on transforming the technology behind the delivery system of this document. The web application transformed from a flat file retrieval system to a dynamic database access approach. The new methodology utilizes Java Server Pages (JSP) on the front-end and an Oracle relational database on the backend. This new approach allows users of the web site, mainly teachers, to access content efficiently by grade level and/or by investigation or educational concept area. Moreover, teachers can gain easier access to data sheets and lab and field guides. The new online guide also included updated content for all GLOBE protocols. The GLOBE web management team was given documentation for maintaining the new application. Instructions for modifying the JSP templates and managing database content were included in this document. It was delivered to the team by the end of October, 2003. The National Geophysical Data Center (NGDC) continued to manage the school study site photos on the GLOBE website. 333 study site photo images were added to the GLOBE database and posted on the web during this same time period for 64 schools. Documentation for processing study site photos was also delivered to the new GLOBE web management team. Lastly, assistance was provided in transferring reference applications such as the Cloud and LandSat quizzes and Earth Systems Online Poster from NGDC servers to GLOBE servers along with documentation for maintaining these applications.

22 CFR 201.13 - Eligibility of delivery services.

Code of Federal Regulations, 2011 CFR

2011-04-01

... COMMODITY TRANSACTIONS FINANCED BY USAID Conditions Governing the Eligibility of Procurement Transactions... commodities may be financed under the implementing document provided the delivery services meet the.... USAID will finance inspection of USAID-financed commodities when inspection is required by USAID, or in...

Tablet-based cardiac arrest documentation: a pilot study.

PubMed

Peace, Jack M; Yuen, Trevor C; Borak, Meredith H; Edelson, Dana P

2014-02-01

Conventional paper-based resuscitation transcripts are notoriously inaccurate, often lacking the precision that is necessary for recording a fast-paced resuscitation. The aim of this study was to evaluate whether a tablet computer-based application could improve upon conventional practices for resuscitation documentation. Nurses used either the conventional paper code sheet or a tablet application during simulated resuscitation events. Recorded events were compared to a gold standard record generated from video recordings of the simulations and a CPR-sensing defibrillator/monitor. Events compared included defibrillations, medication deliveries, and other interventions. During the study period, 199 unique interventions were observed in the gold standard record. Of these, 102 occurred during simulations recorded by the tablet application, 78 by the paper code sheet, and 19 during scenarios captured simultaneously by both documentation methods These occurred over 18 simulated resuscitation scenarios, in which 9 nurses participated. The tablet application had a mean sensitivity of 88.0% for all interventions, compared to 67.9% for the paper code sheet (P=0.001). The median time discrepancy was 3s for the tablet, and 77s for the paper code sheet when compared to the gold standard (P<0.001). Similar to prior studies, we found that conventional paper-based documentation practices are inaccurate, often misreporting intervention delivery times or missing their delivery entirely. However, our study also demonstrated that a tablet-based documentation method may represent a means to substantially improve resuscitation documentation quality, which could have implications for resuscitation quality improvement and research. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Probiotics in the Space Food System: Delivery, Microgravity Effects, and the Potential Benefit to Crew Health

NASA Technical Reports Server (NTRS)

Castro, S. L.; Ott, C. M.; Douglas, G. L.

2014-01-01

As mission distance and duration increase, the need grows for non-invasive disease prevention and immunomodulation, especially given the limited medical response capability expected for these missions and the immune dysregulation documented in crew. Additionally, changes in diet, lifestyle, antibiotic usage, and the environmental stresses during spaceflight may alter crewmembers' intestinal microbiome. The addition of probiotic bacteria to the space food system is expected to confer immunostimulatory benefits on crewmembers, with the potential to counteract the immune dysregulation that has been documented in spaceflight. Based on previous studies that demonstrated unique microbiological responses to the low shear environment of spaceflight, probiotic organisms hold the potential to induce enhanced beneficial responses through mechanisms, such as beneficial interactions with human immune cells and repression of colonization of pathogens on the mucosa. The work presented here will begin to address two research gaps related to providing probiotics in spaceflight: 1) delivery, and 2) the effect of the low shear microgravity environment on probiotic attributes. The probiotic Lactobacillus acidophilus was selected for investigation due to its wide commercial use and documented benefits that include inhibition of virulence related gene expression in pathogens and mucosal stimulation of immune cells. The delivery system for probiotics has not been determined for spaceflight, where the food system is shelf stable and the lack of refrigeration prevents the use of traditional dairy delivery methods. In order to demonstrate the potential of the space food system to deliver viable probiotic bacteria to crewmembers, the probiotic L. acidophilus was packaged in high barrier flight packaging in nonfat dry milk (NFDM) or retained in commercial capsule form. Viable cells were enumerated over 8 months of storage at 22, 4, and -80ºC. The survival of L. acidophilus rehydrated in NFDM, in a PBS control, and directly from the capsule was also evaluated following stress challenge with simulated gastric and intestinal juices to determine the method that would deliver the most viable cells to the intestine, where they would be expected to confer beneficial effects. L. acidophilus was found to be stable to gastric and intestinal juice challenge when delivered in rehydrated NFDM, even after two hours of exposure. In comparison, L. acidophilus was reduced by 1-5 logs when exposed to gastric and intestinal juice directly and when rehydrated in a PBS control. Shelf life data indicated that L. acidophilus would require refrigerated or frozen storage to remain viable at adequate levels over the multi-year storage periods required for spaceflight. This study suggests that the protective effect provided by the dairy matrix, and not merely rehydration prior to consumption, extends probiotic viability and stress tolerance during storage in spaceflight and in simulated digestion conditions more adequately than a capsule. In addition to effective delivery, it is essential to understand the microgravity effects on the stress tolerances and genetic expression of probiotic bacteria to enable optimization of growth, survival, strain selection, and conferred benefits in spaceflight. In our current study, ground-based characterization of the growth, stress response, and transcriptomic response of L. acidophilus will be accomplished using the low shear modeled microgravity (LSMMG) culture environment in the rotating wall vessel (RWV). We hypothesize that L. acidophilus will maintain or improve its growth and stress response following culture in the LSMMG environment, and that transcriptomic analysis will define the associated molecular mechanism(s), resulting in the ability to optimize strain selection.

Integration of research and practice to improve public health and healthcare delivery through a collaborative 'Health Integration Team' model - a qualitative investigation.

PubMed

Redwood, Sabi; Brangan, Emer; Leach, Verity; Horwood, Jeremy; Donovan, Jenny L

2016-06-22

Economic considerations and the requirement to ensure the quality, safety and integration of research with health and social care provision have given rise to local developments of collaborative organisational forms and strategies to span the translational gaps. One such model - the Health Integration Team (HIT) model in Bristol in the United Kingdom (UK) - brings together National Health Service (NHS) organisations, universities, local authorities, patients and the public to facilitate the systematic application of evidence to promote integration across healthcare pathways. This study aimed to (1) provide empirical evidence documenting the evolution of the model; (2) to identify the social and organisational processes and theory of change underlying healthcare knowledge and practice; and (3) elucidate the key aspects of the HIT model for future development and translation to other localities. Contemporaneous documents were analysed, using procedures associated with Framework Analysis to produce summarised data for descriptive accounts. In-depth interviews were undertaken with key informants and analysed thematically. Comparative methods were applied to further analyse the two data sets. One hundred forty documents were analysed and 10 interviews conducted with individuals in leadership positions in the universities, NHS commissioning and provider organisations involved in the design and implementation of the HIT model. Data coalesced around four overarching themes: 'Whole system' engagement, requiring the active recruitment of all those who have a stake in the area of practice being considered, and 'collaboration' to enable coproduction were identified as 'process' themes. System-level integration and innovation were identified as potential 'outcomes' with far-reaching impacts on population health and service delivery. The HIT model emerged as a particular response to the perceived need for integration of research and practice to improve public health and healthcare delivery at a time of considerable organisational turmoil and financial constraints. The concept gained momentum and will likely be of interest to those involved in setting up similar arrangements, and researchers in the social and implementation sciences with an interest in their evaluation.

Milestone M3FT-15OR0203112. Build redesigned HFIR rabbit capsules and make ready for insertion for irradiation in HFIR

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

Howard, Richard H; McDuffee, Joel Lee; Okuniewski, Maria A.

2015-09-01

This report details the fabrication and delivery of two Fuel Cycle Research and Development irradiation capsules (FCRP20 and FCRP03), with associated quality assurance documentation, to the High Flux Isotope Reactor. The capsules and documentation were delivered by September 30, 2015, thus meeting the deadline for milestone M3FT-15OR0203112. These irradiation experiments irradiate metal parallelepiped specimens that may consist of various compositions including uranium metal, steel, etc. This document contains a copy of the completed capsule fabrication request sheets, which detail all constituent components, pertinent drawings, etc., along with a detailed summary of the capsule assembly process performed by the Thermal Hydraulicsmore » and Irradiation Engineering Group (THIEG) in the Reactor and Nuclear Systems Division. A complete fabrication package record is maintained by THIEG and is available upon request.« less

The Marriage of Fax and Online.

ERIC Educational Resources Information Center

Basch, Reva

1995-01-01

Discusses the use of fax transmissions. Highlights include searching by fax, including online service, print and electronic publishing, and database producers; customer service, including documentation updates, new product announcements, and marketing materials; document delivery; problems; and fax messaging. (four references) (LRW)

Annual Review of Database Developments: 1993.

ERIC Educational Resources Information Center

Basch, Reva

1993-01-01

Reviews developments in the database industry for 1993. Topics addressed include scientific and technical information; environmental issues; social sciences; legal information; business and marketing; news services; documentation; databases and document delivery; electronic bulletin boards and the Internet; and information industry organizational…

Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines.

PubMed

Hung, Dorothy; Martinez, Meghan; Yakir, Maayan; Gray, Caroline

2015-01-01

Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers. This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care. Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts. Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery.

14 CFR 13.43 - Service and filing of pleadings, motions, and documents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... date of personal delivery shall be the date of service. (e) The date of filing is the date the document... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Service and filing of pleadings, motions... Hearings § 13.43 Service and filing of pleadings, motions, and documents. (a) Copies of all pleadings...

Transportation systems analyses. Volume 2: Technical/programmatics

NASA Astrophysics Data System (ADS)

1993-05-01

The principal objective of this study is to accomplish a systems engineering assessment of the nation's space transportation infrastructure. This analysis addresses the necessary elements to perform man delivery and return, cargo transfer, cargo delivery, payload servicing, and the exploration of the Moon and Mars. Specific elements analyzed, but not limited to, include the Space Exploration Initiative (SEI), the National Launch System (NLS), the current expendable launch vehicle (ELV) fleet, ground facilities, the Space Station Freedom (SSF), and other civil, military and commercial payloads. The performance of this study entails maintaining a broad perspective on the large number of transportation elements that could potentially comprise the U.S. space infrastructure over the next several decades. To perform this systems evaluation, top-level trade studies are conducted to enhance our understanding of the relationships between elements of the infrastructure. This broad 'infrastructure-level perspective' permits the identification of preferred infrastructures. Sensitivity analyses are performed to assure the credibility and usefulness of study results. This report documents the three principal transportation systems analyses (TSA) efforts during the period 7 November 92 - 6 May 93. The analyses are as follows: Mixed-Fleet (STS/ELV) strategies for SSF resupply; Transportation Systems Data Book - overview; and Operations Cost Model - overview/introduction.

Leveraging the trusted clinician: documenting disease management program enrollment.

PubMed

Frazee, Sharon Glave; Kirkpatrick, Patricia; Fabius, Raymond; Chimera, Joseph

2007-02-01

The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard TDM with a worksite-based primary care and pharmacy delivery protocol led by trusted clinicians. This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols, and compares them on contact and enrollment efficiency. The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Integrating a worksite-based primary care and pharmacy delivery system led by trusted clinicians with traditional TDM increases contact and enrollment rates, resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment in disease management programming.

Extent of Integration of Priority Interventions into General Health Systems: A Case Study of Neglected Tropical Diseases Programme in the Western Region of Ghana.

PubMed

Mensah, Ernest O; Aikins, Moses K; Gyapong, Margaret; Anto, Francis; Bockarie, Moses J; Gyapong, John O

2016-05-01

The global health system has a large arsenal of interventions, medical products and technologies to address current global health challenges. However, identifying the most effective and efficient strategies to deliver these resources to where they are most needed has been a challenge. Targeted and integrated interventions have been the main delivery strategies. However, the health system discourse increasingly favours integrated strategies in the context of functionally merging targeted interventions with multifunctional health care delivery systems with a focus on strengthening country health systems to deliver needed interventions. Neglected Tropical Diseases (NTD) have been identified to promote and perpetuate poverty hence there has been global effort to combat these diseases. The Neglected Tropical Diseases Programme (NTDP) in Ghana has a national programme team and office, however, it depends on the multifunctional health delivery system at the regional and district level to implement interventions. The NTDP seeks further health system integration to accelerate achievement of coverage targets. The study estimated the extent of integration of the NTDP at the national, regional and district levels to provide evidence to guide further integration. The research design was a descriptive case study that interviewed key persons involved in the programme at the three levels of the health system as well as extensive document review. Integration was assessed on two planes-across health system functions-stewardship and governance, financing, planning, service delivery, monitoring and evaluation and demand generation; and across three administrative levels of the health system-national, regional and district. A composite measure of integration designated Cumulative Integration Index (CII) with a range of 0.00-1.00 was used to estimate extent of integration at the three levels of the health system. Service delivery was most integrated while financing and planning were least integrated. Extent of integration was partial at all levels of the health system with a CII of 0.48-0.68; however it was higher at the district compared to the national and regional levels. To ensure further integration of the NTDP, planning and finance management activities must be decentralized to involve regional and district levels of the health system. The study provides an empirical measure of extent of integration and indicators to guide further integration.

Applying object-oriented software engineering at the BaBar collaboration

NASA Astrophysics Data System (ADS)

Jacobsen, Bob; BaBar Collaboration Reconstruction Software Group

1997-02-01

The BaBar experiment at SLAC will start taking data in 1999. We are attempting to build its reconstruction software using good software engineering practices, including the use of object-oriented technology. We summarize our experience to date with analysis and design activities, training, CASE and documentation tools, C++ programming practice and similar topics. The emphasis is on the practical issues of simultaneously introducing new techniques to a large collaboration while under a deadline for system delivery.

Helicopter Antitank Weapons System: AH-1Q or OH-58Q?

DTIC Science & Technology

1975-06-06

CLASSIFICATION OF THIS PAGT fWhnn Dal» F.nlartid) REPORT DOCUMENTATION PAGE 1. REPORT NUMBER Z. GOVT ACCESSION NO 4. TITLE (and Sublltl...reverse. S.V -x .■’■ O ) ( s VCNMVK ^ X? DD 73^^73 EDITIOHOr » MOVBSlSOBSOLEt! Unclassified SECURITY CLASSIFICATION OF THIS PAGE...Iroquois in December I960 and received the first delivery in December 1961. It was designed with universal pylons to serve as mounts for weapons

Computerized clinical documentation system in the pediatric intensive care unit

PubMed Central

2001-01-01

Background To determine whether a computerized clinical documentation system (CDS): 1) decreased time spent charting and increased time spent in patient care; 2) decreased medication errors; 3) improved clinical decision making; 4) improved quality of documentation; and/or 5) improved shift to shift nursing continuity. Methods Before and after implementation of CDS, a time study involving nursing care, medication delivery, and normalization of serum calcium and potassium values was performed. In addition, an evaluation of completeness of documentation and a clinician survey of shift to shift reporting were also completed. This was a modified one group, pretest-posttest design. Results With the CDS there was: improved legibility and completeness of documentation, data with better accessibility and accuracy, no change in time spent in direct patient care or charting by nursing staff. Incidental observations from the study included improved management functions of our nurse manager; improved JCAHO documentation compliance; timely access to clinical data (labs, vitals, etc); a decrease in time and resource use for audits; improved reimbursement because of the ability to reconstruct lost charts; limited human data entry by automatic data logging; eliminated costs of printing forms. CDS cost was reasonable. Conclusions When compared to a paper chart, the CDS provided a more legible, compete, and accessible patient record without affecting time spent in direct patient care. The availability of the CDS improved shift to shift reporting. Other observations showed that the CDS improved management capabilities; helped physicians deliver care; improved reimbursement; limited data entry errors; and reduced costs. PMID:11604105

Extent of Integration of Priority Interventions into General Health Systems: A Case Study of Neglected Tropical Diseases Programme in the Western Region of Ghana

PubMed Central

Mensah, Ernest O.; Aikins, Moses K.; Gyapong, Margaret; Anto, Francis; Bockarie, Moses J.; Gyapong, John O.

2016-01-01

Background The global health system has a large arsenal of interventions, medical products and technologies to address current global health challenges. However, identifying the most effective and efficient strategies to deliver these resources to where they are most needed has been a challenge. Targeted and integrated interventions have been the main delivery strategies. However, the health system discourse increasingly favours integrated strategies in the context of functionally merging targeted interventions with multifunctional health care delivery systems with a focus on strengthening country health systems to deliver needed interventions. Neglected Tropical Diseases (NTD) have been identified to promote and perpetuate poverty hence there has been global effort to combat these diseases. The Neglected Tropical Diseases Programme (NTDP) in Ghana has a national programme team and office, however, it depends on the multifunctional health delivery system at the regional and district level to implement interventions. The NTDP seeks further health system integration to accelerate achievement of coverage targets. The study estimated the extent of integration of the NTDP at the national, regional and district levels to provide evidence to guide further integration. Methodology/Principal Findings The research design was a descriptive case study that interviewed key persons involved in the programme at the three levels of the health system as well as extensive document review. Integration was assessed on two planes—across health system functions–stewardship and governance, financing, planning, service delivery, monitoring and evaluation and demand generation; and across three administrative levels of the health system–national, regional and district. A composite measure of integration designated Cumulative Integration Index (CII) with a range of 0.00–1.00 was used to estimate extent of integration at the three levels of the health system. Service delivery was most integrated while financing and planning were least integrated. Extent of integration was partial at all levels of the health system with a CII of 0.48–0.68; however it was higher at the district compared to the national and regional levels. Conclusions/Significance To ensure further integration of the NTDP, planning and finance management activities must be decentralized to involve regional and district levels of the health system. The study provides an empirical measure of extent of integration and indicators to guide further integration. PMID:27203854

Operating manual for coaxial injection combustion model. [for the space shuttle main engine

NASA Technical Reports Server (NTRS)

Sutton, R. D.; Schuman, M. D.; Chadwick, W. D.

1974-01-01

An operating manual for the coaxial injection combustion model (CICM) is presented as the final report for an eleven month effort designed to provide improvement, to verify, and to document the comprehensive computer program for analyzing the performance of thrust chamber operation with gas/liquid coaxial jet injection. The effort culminated in delivery of an operation FORTRAN IV computer program and associated documentation pertaining to the combustion conditions in the space shuttle main engine. The computer program is structured for compatibility with the standardized Joint Army-Navy-NASA-Air Force (JANNAF) performance evaluation procedure. Use of the CICM in conjunction with the JANNAF procedure allows the analysis of engine systems using coaxial gas/liquid injection.

Intermediate load modules for test and evaluation

NASA Technical Reports Server (NTRS)

1984-01-01

Photovoltaic modules were tested for qualification. Tests involved the following: (1) delivery of 20 solar cells for use as reference cells; (2) module documentation and inspection plans specifying the 10 Group I modules; (3) design review of module documentation from Group I modules; (4) revise module documentation to overcome any problems of deficiencies associated with the Group I modules; (5) delivery of 10 Group II modules built to revised specifications; (6) testing of Group II modules to the criteria as outlined in qualification specification. It is found that the solarvolt MSP43E40B satisfies the design criteria of qualification specification for intermediate load modules. Design changes were made in the Group I modules to overcome the deficiencies which allowed Group II modules to pass the qualification tests.

Hot conditioning equipment conceptual design report

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

Bradshaw, F.W., Westinghouse Hanford

1996-08-06

This report documents the conceptual design of the Hot Conditioning System Equipment. The Hot conditioning System will consist of two separate designs: the Hot Conditioning System Equipment; and the Hot Conditioning System Annex. The Hot Conditioning System Equipment Design includes the equipment such as ovens, vacuum pumps, inert gas delivery systems, etc.necessary to condition spent nuclear fuel currently in storage in the K Basins of the Hanford Site. The Hot Conditioning System Annex consists of the facility of house the Hot Conditioning System. The Hot Conditioning System will be housed in an annex to the Canister Storage Building. The Hotmore » Conditioning System will consist of pits in the floor which contain ovens in which the spent nuclear will be conditioned prior to interim storage.« less

SAGA: A project to automate the management of software production systems

NASA Technical Reports Server (NTRS)

Campbell, R. H.

1983-01-01

The current work in progress for the SAGA project are described. The highlights of this research are: a parser independent SAGA editor, design for the screen editing facilities of the editor, delivery to NASA of release 1 of Olorin, the SAGA parser generator, personal workstation environment research, release 1 of the SAGA symbol table manager, delta generation in SAGA, requirements for a proof management system, documentation for and testing of the cyber pascal make prototype, a prototype cyber-based slicing facility, a June 1984 demonstration plan, SAGA utility programs, summary of UNIX software engineering support, and theorem prover review.

SU-F-T-471: Simulated External Beam Delivery Errors Detection with a Large Area Ion Chamber Transmission Detector

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

Hoffman, D; Dyer, B; Kumaran Nair, C

Purpose: The Integral Quality Monitor (IQM), developed by iRT Systems GmbH (Koblenz, Germany) is a large-area, linac-mounted ion chamber used to monitor photon fluence during patient treatment. Our previous work evaluated the change of the ion chamber’s response to deviations from static 1×1 cm2 and 10×10 cm2 photon beams and other characteristics integral to use in external beam detection. The aim of this work is to simulate two external beam radiation delivery errors, quantify the detection of simulated errors and evaluate the reduction in patient harm resulting from detection. Methods: Two well documented radiation oncology delivery errors were selected formore » simulation. The first error was recreated by modifying a wedged whole breast treatment, removing the physical wedge and calculating the planned dose with Pinnacle TPS (Philips Radiation Oncology Systems, Fitchburg, WI). The second error was recreated by modifying a static-gantry IMRT pharyngeal tonsil plan to be delivered in 3 unmodulated fractions. A radiation oncologist evaluated the dose for simulated errors and predicted morbidity and mortality commiserate with the original reported toxicity, indicating that reported errors were approximately simulated. The ion chamber signal of unmodified treatments was compared to the simulated error signal and evaluated in Pinnacle TPS again with radiation oncologist prediction of simulated patient harm. Results: Previous work established that transmission detector system measurements are stable within 0.5% standard deviation (SD). Errors causing signal change greater than 20 SD (10%) were considered detected. The whole breast and pharyngeal tonsil IMRT simulated error increased signal by 215% and 969%, respectively, indicating error detection after the first fraction and IMRT segment, respectively. Conclusion: The transmission detector system demonstrated utility in detecting clinically significant errors and reducing patient toxicity/harm in simulated external beam delivery. Future work will evaluate detection of other smaller magnitude delivery errors.« less

Intrathecal Pump Exposure to Electromagnetic Interference: A Report of Device Interrogation following Multiple ECT Sessions.

PubMed

Bicket, Mark C; Hanna, George M

2016-02-01

Intrathecal drug delivery systems represent an increasingly common treatment modality for patients with a variety of conditions, including chronic pain and spasticity. Pumps rely on electronic programming to properly control and administer highly concentrated medications. Electromagnetic interference (EMI) is a known exposure that may cause a potential patient safety issue stemming from direct patient injury, pump damage, or changes to pump operation or flow rate. The objective of our case report was to describe an approach to evaluating a patient with a pump prior to and following exposure to EMI from electroconvulsive therapy (ECT), as well as to document findings from device interrogations associated with this event. Case report. Academic university-based pain management center. We present the case of a patient with an intrathecal pump who underwent multiple exposures to EMI in the form of 42 ECT sessions. Interrogation of the intrathecal drug delivery system revealed no safety issues following ECT sessions. At no time were error messages, unintentional changes in event logs, unintentional changes in pump settings, or evidence of pump stall or over-infusion noted. Communication with multiple entities (patient, family, consulting physicians, and device manufacturer) and maintaining vigilance through device interrogation both before and after EMI exposure are appropriate safeguards to mitigate the risk and detect potential adverse events of EMI with intrathecal drug delivery systems. Given the infrequent reports of device exposure to ECT, best practices may be derived from experience with EMI exposure from magnetic resonance imaging (MRI). Although routine EMI exposure to intrathecal drug delivery systems should be avoided, we describe one patient with repeated exposure to ECT without apparent complication.

29 CFR 500.267 - Filing and service.

Code of Federal Regulations, 2011 CFR

2011-07-01

... SEASONAL AGRICULTURAL WORKER PROTECTION Administrative Proceedings Modification Or Vacation of Order of... copies. An original and two copies of all documents shall be filed. (c) Computation of time for delivery... by personal delivery or by mail. Service by mail is deemed effected at the time of mailing to the...

29 CFR 500.267 - Filing and service.

Code of Federal Regulations, 2010 CFR

2010-07-01

... SEASONAL AGRICULTURAL WORKER PROTECTION Administrative Proceedings Modification Or Vacation of Order of... copies. An original and two copies of all documents shall be filed. (c) Computation of time for delivery... by personal delivery or by mail. Service by mail is deemed effected at the time of mailing to the...

Challenging the Courtesy Bias Interpretation of Favorable Clients' Perceptions of Family Planning Delivery

ERIC Educational Resources Information Center

Len, Federico R.; Lundgren, Rebecka; Huapaya, Ana; Sinai, Irit; Jennings, Victoria

2007-01-01

Favorable client perceptions of provider's interpersonal behavior in contraceptive delivery, documented in clinic exit questionnaires, appear to contradict results from qualitative evaluations and are attributed to clients' courtesy bias. In this study, trained simulated clients requested services from Ministry of Health providers in three…

Physical Access in ARL Libraries. SPEC Kit 27.

ERIC Educational Resources Information Center

Association of Research Libraries, Washington, DC. Office of Management Studies.

Resulting from the Association of Research Libraries' (ARL) 1975 survey on user services, this kit presents documentation on and discusses developments in physical access services--services which facilitate the actual delivery of information sources to the user--including circulation, interlibrary loan, book delivery, and new media services. As…

Distance Delivery of Vocational Education Technologies and Planning Matrixes.

ERIC Educational Resources Information Center

Norenberg, Curtis D.; Lundblad, Larry

This document presents a general review of distance education as it currently pertains to secondary, postsecondary, and adult education. Chapter I discusses the general concepts of distance education. It addresses the nature of distance education and distance delivery, the distance learner, the distance instructor, and distance education learning…

76 FR 52561 - Timely Mailing Treated as Timely Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-23

... to the only ways to establish prima facie evidence of delivery of documents that have a filing... (PDS) designated under criteria established by the IRS, will constitute prima facie evidence of... taxpayers to be able to establish the postmark date and prima facie evidence of delivery when using...

Development of New Immunogens and a Controlled Release Delivery System for Oral Immunization Against Staphylococcal Enterotoxin B

DTIC Science & Technology

1991-12-06

DSN 343-7322. N fjGARX\\R. GILBERT COL, MS Deputy Chief of Staff for Information Management REPRODUCTION QUALITY NOTICE This document is the best quality...1976. 35. Ogre, P.L.: Karzon, D.T. Distribution of poliovirus antibody in serum, nasopharymrt and alimentary tract folloving segmental limunization...sysemst, In.- Hisholl, DAI. ; Advances in human fertility and reproductive endocrinology. NWe York, Raven Press Books. Ltd; Vol. 2. 1963: 175-199. 52. Tic

Vocational Education Trends and Priorities: A Study of Vocational Education in Missouri. Reaching for Excellence in Missouri Schools. A Collection of Reports and Other Documents Provided by Consultants and Staff of State Agencies under the Direction of the UMC Research Team.

ERIC Educational Resources Information Center

Missouri Univ., Columbia. Coll. of Education.

As part of a multiphased study of trends and priorities in vocational education in Missouri, four project consultants were hired to write reports on labor market needs in Missouri, vocational education delivery systems in the state, and fiscal resources available for Missouri vocational education programs. These individual reports were synthesized…

Analysing the Stewardship Function in Botswana’s Health System: Reflecting on the Past, Looking to the Future

PubMed Central

Seitio-Kgokgwe, Onalenna; Gauld, Robin DC; Hill, Philip C.; Barnett, Pauline

2016-01-01

Background: In many parts of the world, ongoing deficiencies in health systems compromise the delivery of health interventions. The World Health Organization (WHO) identified four functions that health systems need to perform to achieve their goals: Efforts to strengthen health systems focus on the way these functions are carried out. While a number of studies on health systems functions have been conducted, the stewardship function has received limited attention. In this article, we evaluate the extent to which the Botswana Ministry of Health (MoH) undertook its stewardship role. Methods: We used the WHO Health Systems Performance Assessment Frame (HSPAF) to guide analysis of the stewardship function of the Botswana’s MoH focusing on formulation of national health policies, exerting influence through health regulation, and coalition building. Data were abstracted from published and unpublished documents. We interviewed 54 key informants comprising staff of the MoH (N = 40) and stakeholder organizations (N = 14). Data from documents was analyzed through content analysis. Interviews were transcribed and analyzed through thematic analysis. Results: A lack of capacity for health policy development was identified. Significant policy gaps existed in some areas. Challenges were reported in policy implementation. While the MoH made efforts in developing various statutes that regulated different aspects of the health system, some gaps existed in the regulatory framework. Poor enforcement of legislation was a challenge. Although the MoH had a high number of stakeholders, the mechanisms for stakeholder engagement in the planning processes were weak. Conclusion: Problems in the exercise of the stewardship function posed challenges in ensuring accountability and limited the health system’s ability to benefit from its stakeholders. Ongoing efforts to establish a District Health System under control of the MoH, attempts to improve service delivery at a national level and political will to strengthen public-private engagement mechanisms are some of the prospects that can improve the MoH’s stewardship function. PMID:28005550

A modified emulsion gelation technique to improve buoyancy of hydrogel tablets for floating drug delivery systems.

PubMed

Yom-Tov, Ortal; Seliktar, Dror; Bianco-Peled, Havazelet

2015-10-01

The use of buoyant or floating hydrogel tablets is of particular interest in the sustained release of drugs to the stomach. They have an ability to slow the release rates of drugs by prolonging their absorption window in the upper part of the gastrointestinal (GI) tract. In this study we synthesized bioactive hydrogels that have sustainable release rates for drugs in the stomach based on a hydrogel preparation technique that employs emulsifying surfactants. The emulsion gelation technique, which encapsulates oil droplets within the hydrogels during crosslinking, was used to decrease their specific gravity in aqueous environments, resulting in floating drug release depots. Properties such as swelling, buoyancy, density and drug release were manipulated by changing the polymer concentrations, surfactant percentages and the oil:polymer ratios. The relationship between these properties and the hydrogel's floating lag time was documented. The potential for this material to be used as a floating drug delivery system was demonstrated. Copyright © 2015 Elsevier B.V. All rights reserved.

Exploring and validating physicochemical properties of mangiferin through GastroPlus® software

PubMed Central

Khurana, Rajneet Kaur; Kaur, Ranjot; Kaur, Manninder; Kaur, Rajpreet; Kaur, Jasleen; Kaur, Harpreet; Singh, Bhupinder

2017-01-01

Aim: Mangiferin (Mgf), a promising therapeutic polyphenol, exhibits poor oral bioavailability. Hence, apt delivery systems are required to facilitate its gastrointestinal absorption. The requisite details on its physicochemical properties have not yet been well documented in literature. Accordingly, in order to have explicit insight into its physicochemical characteristics, the present work was undertaken using GastroPlus™ software. Results: Aqueous solubility (0.38 mg/ml), log P (-0.65), Peff (0.16 × 10-4 cm/s) and ability to act as P-gp substrate were defined. Potency to act as a P-gp substrate was verified through Caco-2 cells, while Peff was estimated through single pass intestinal perfusion studies. Characterization of Mgf through transmission electron microscopy, differential scanning calorimetry, infrared spectroscopy and powder x-ray diffraction has also been reported. Conclusion: The values of physicochemical properties for Mgf reported in the current manuscript would certainly enable the researchers to develop newer delivery systems for Mgf. PMID:28344830

An audit of level two and level three checks of anaesthesia delivery systems performed at three hospitals in South Australia.

PubMed

Sweeney, N; Owen, H; Fronsko, R; Hurlow, E

2012-11-01

Anaesthetists may subject patients to unnecessary risk by not checking anaesthetic equipment thoroughly before use. Numerous adverse events have been associated with failure to check equipment. The Australian and New Zealand College of Anaesthetists and anaesthetic delivery system manufactures have made recommendations on how anaesthetic equipment should be maintained and checked before use and for the training required for staff who use such equipment. These recommendations are made to minimise the risk to patients undergoing anaesthesia. This prospective audit investigated the adherence of anaesthetic practitioners to a selection of those recommendations. Covert observations of anaesthetic practitioners were made while they were checking their designated anaesthetic machine, either at the beginning of a day's list or between cases. Structured interviews with staff who check the anaesthetic machine were carried out to determine the training they had received. The results indicated poor compliance with recommendations: significantly, the backup oxygen cylinders' pressure/contents were not checked in 45% of observations; the emergency ventilation device was not checked in 67% of observations; the breathing circuit was not tested between patients in 79% of observations; no documentation of the checks performed was done in any cases; and no assessment or accreditation of the staff who performed these checks was performed. It was concluded that the poor compliance was a system failing and that patient safety might be increased with training and accrediting staff responsible for checking equipment, documenting the checks performed, and the formulation and use of a checklist.

The Dynamics of Community Health Care Consolidation: Acquisition of Physician Practices

PubMed Central

Christianson, Jon B; Carlin, Caroline S; Warrick, Louise H

2014-01-01

Context Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems. Methods We used key informant interviews, supplemented by document analysis. Findings The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future. Conclusions In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices. PMID:25199899

The dynamics of community health care consolidation: acquisition of physician practices.

PubMed

Christianson, Jon B; Carlin, Caroline S; Warrick, Louise H

2014-09-01

Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems. We used key informant interviews, supplemented by document analysis. The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future. In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices. © 2014 Milbank Memorial Fund.

Expanding Alternative Delivery Systems.

ERIC Educational Resources Information Center

Baltzer, Jan A.

Alternative educational delivery systems that might be useful to community colleges are considered. The following categories of delivery systems are covered: broadcast delivery systems; copy delivery systems, print delivery systems, computer delivery systems, telephone delivery systems, and satellites. Among the applications for broadcast…

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

PubMed

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

2014-12-01

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

Research Area 14.3 Microbiology and Biodegradation: Development of RNA-based Vectors for in vivo Delivery of siRNAs

DTIC Science & Technology

2014-09-08

P.O. Box 12211 Research Triangle Park, NC 27709-2211 Vector, RNAi, delivery REPORT DOCUMENTATION PAGE 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 10...suggesstions for reducing this burden, to Washington Headquarters Services , Directorate for Information Operations and Reports, 1215 Jefferson Davis...Shapiro, Alissa M Pham, Benjamin R tenOever. In Vivo Delivery of Cytoplasmic RNA Virus-derived miRNAs, Molecular Therapy, (11 2011): 0. doi

29 CFR 801.71 - Filing and service.

Code of Federal Regulations, 2011 CFR

2011-07-01

... EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Modification Or Vacation of Decision... of time for delivery by mail. Documents are not deemed filed with the Secretary until actually... Secretary either on or before the due date. No additional time shall be added where service of a document...

29 CFR 801.71 - Filing and service.

Code of Federal Regulations, 2010 CFR

2010-07-01

... EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Modification Or Vacation of Decision... of time for delivery by mail. Documents are not deemed filed with the Secretary until actually... Secretary either on or before the due date. No additional time shall be added where service of a document...

48 CFR 1446.671 - Inspection, receiving and acceptance certification.

Code of Federal Regulations, 2012 CFR

2012-10-01

... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports § 1446.671... documentation shall be completed via manual or electronic means for each delivery of supplies or services in... except as noted below or on attached documents. ______ Signature and typed name of authorized Government...

48 CFR 1446.671 - Inspection, receiving and acceptance certification.

Code of Federal Regulations, 2014 CFR

2014-10-01

... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports § 1446.671... documentation shall be completed via manual or electronic means for each delivery of supplies or services in... except as noted below or on attached documents. ______ Signature and typed name of authorized Government...

48 CFR 1446.671 - Inspection, receiving and acceptance certification.

Code of Federal Regulations, 2010 CFR

2010-10-01

... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports § 1446.671... documentation shall be completed via manual or electronic means for each delivery of supplies or services in... except as noted below or on attached documents. ______ Signature and typed name of authorized Government...

43 CFR 1822.13 - May I file electronically?

Code of Federal Regulations, 2011 CFR

2011-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) APPLICATION PROCEDURES Filing a Document... electronic filing if an original signature is not required. If BLM requires your signature, you must file your application or document by delivery or by mailing. If you have any questions regarding which types...

48 CFR 1446.671 - Inspection, receiving and acceptance certification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports § 1446.671... documentation shall be completed via manual or electronic means for each delivery of supplies or services in... except as noted below or on attached documents. ______ Signature and typed name of authorized Government...

48 CFR 1446.671 - Inspection, receiving and acceptance certification.

Code of Federal Regulations, 2013 CFR

2013-10-01

... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports § 1446.671... documentation shall be completed via manual or electronic means for each delivery of supplies or services in... except as noted below or on attached documents. ______ Signature and typed name of authorized Government...

43 CFR 1822.13 - May I file electronically?

Code of Federal Regulations, 2012 CFR

2012-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) APPLICATION PROCEDURES Filing a Document... electronic filing if an original signature is not required. If BLM requires your signature, you must file your application or document by delivery or by mailing. If you have any questions regarding which types...

43 CFR 1822.13 - May I file electronically?

Code of Federal Regulations, 2014 CFR

2014-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) APPLICATION PROCEDURES Filing a Document... electronic filing if an original signature is not required. If BLM requires your signature, you must file your application or document by delivery or by mailing. If you have any questions regarding which types...

43 CFR 1822.13 - May I file electronically?

Code of Federal Regulations, 2013 CFR

2013-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) APPLICATION PROCEDURES Filing a Document... electronic filing if an original signature is not required. If BLM requires your signature, you must file your application or document by delivery or by mailing. If you have any questions regarding which types...

34 CFR 300.196 - Filing requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... written submission under § 300.194 must be filed by hand-delivery, by mail, or by facsimile transmission...) The filing date under paragraph (a) of this section is the date the document is— (1) Hand-delivered..., may require the filing of a follow-up hard copy by hand-delivery or by mail within a reasonable period...

43 CFR 4.413 - Service of notice of appeal and of other documents.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 25007 (D-105), Denver Federal Center, Denver, CO 80225; Other Delivery Services: Regional Solicitor..., Lakewood, CO 80215; (v) BLM Eastern States Office, including all District and Area Offices within its area... Interior, P.O. Box 31394, Billings, MT 59107-1394; Other Delivery Services: Field Solicitor, U.S...

78 FR 51808 - 34th Meeting: RTCA Special Committee 206, Aeronautical Information and Meteorological Data Link...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-21

... to Support ATC Winds SC-214 Briefing TOR Changes Other business Sub-Groups meetings Sep 24-26... MET Delivery Architecture Recommendations review Sep 27, Friday, Closing Plenary Sub-Groups reports Appoval for AIS and MET Delivery Architecture Recommendations document to enter FRAC Action item review...

Energy Theft in the Advanced Metering Infrastructure

NASA Astrophysics Data System (ADS)

McLaughlin, Stephen; Podkuiko, Dmitry; McDaniel, Patrick

Global energy generation and delivery systems are transitioning to a new computerized "smart grid". One of the principle components of the smart grid is an advanced metering infrastructure (AMI). AMI replaces the analog meters with computerized systems that report usage over digital communication interfaces, e.g., phone lines. However, with this infrastructure comes new risk. In this paper, we consider adversary means of defrauding the electrical grid by manipulating AMI systems. We document the methods adversaries will use to attempt to manipulate energy usage data, and validate the viability of these attacks by performing penetration testing on commodity devices. Through these activities, we demonstrate that not only is theft still possible in AMI systems, but that current AMI devices introduce a myriad of new vectors for achieving it.

CLIPS: A tool for the development and delivery of expert systems

NASA Technical Reports Server (NTRS)

Riley, Gary

1991-01-01

The C Language Integrated Production System (CLIPS) is a forward chaining rule-based language developed by the Software Technology Branch at the Johnson Space Center. CLIPS provides a complete environment for the construction of rule-based expert systems. CLIPS was designed specifically to provide high probability, low cost, and easy integration with external systems. Other key features of CLIPS include a powerful rule syntax, an interactive development environment, high performance, extensibility, a verification/validation tool, extensive documentation, and source code availability. The current release of CLIPS, version 4.3, is being used by over 2,500 users throughout the public and private community including: all NASA sites and branches of the military, numerous Federal bureaus, government contractors, 140 universities, and many companies.

Directed Differentiation of Embryonic Stem Cells Into Cardiomyocytes by Bacterial Injection of Defined Transcription Factors.

PubMed

Bai, Fang; Ho Lim, Chae; Jia, Jingyue; Santostefano, Katherine; Simmons, Chelsey; Kasahara, Hideko; Wu, Weihui; Terada, Naohiro; Jin, Shouguang

2015-10-09

Forced expression of defined transcriptional factors has been well documented as an effective method for cellular reprogramming or directed differentiation. However, transgene expression is not amenable for therapeutic application due to potential insertional mutagenesis. Here, we have developed a bacterial type III secretion system (T3SS)-based protein delivery tool and shown its application in directing pluripotent stem cell differentiation by a controlled delivery of transcription factors relevant to early heart development. By fusing to an N-terminal secretion sequence for T3SS-dependent injection, three transcriptional factors, namely Gata4, Mef2c, and Tbx5 (abbreviated as GMT), were translocated into murine embryonic stem cells (ESCs), where the proteins are effectively targeted to the nucleus with an average intracellular half-life of 5.5 hours. Exogenous GMT protein injection activated the cardiac program, and multiple rounds of GMT protein delivery significantly improved the efficiency of ESC differentiation into cardiomyocytes. Combination of T3SS-mediated GMT delivery and Activin A treatment showed an additive effect, resulting in on average 60% of the ESCs differentiated into cardiomyocytes. ESC derived cardiomyocytes displayed spontaneous rhythmic contractile movement as well as normal hormonal responses. This work serves as a foundation for the bacterial delivery of multiple transcription factors to direct cell fate without jeopardizing genomic integrity.

Directed Differentiation of Embryonic Stem Cells Into Cardiomyocytes by Bacterial Injection of Defined Transcription Factors

PubMed Central

Bai, Fang; Ho Lim, Chae; Jia, Jingyue; Santostefano, Katherine; Simmons, Chelsey; Kasahara, Hideko; Wu, Weihui; Terada, Naohiro; Jin, Shouguang

2015-01-01

Forced expression of defined transcriptional factors has been well documented as an effective method for cellular reprogramming or directed differentiation. However, transgene expression is not amenable for therapeutic application due to potential insertional mutagenesis. Here, we have developed a bacterial type III secretion system (T3SS)-based protein delivery tool and shown its application in directing pluripotent stem cell differentiation by a controlled delivery of transcription factors relevant to early heart development. By fusing to an N-terminal secretion sequence for T3SS-dependent injection, three transcriptional factors, namely Gata4, Mef2c, and Tbx5 (abbreviated as GMT), were translocated into murine embryonic stem cells (ESCs), where the proteins are effectively targeted to the nucleus with an average intracellular half-life of 5.5 hours. Exogenous GMT protein injection activated the cardiac program, and multiple rounds of GMT protein delivery significantly improved the efficiency of ESC differentiation into cardiomyocytes. Combination of T3SS-mediated GMT delivery and Activin A treatment showed an additive effect, resulting in on average 60% of the ESCs differentiated into cardiomyocytes. ESC derived cardiomyocytes displayed spontaneous rhythmic contractile movement as well as normal hormonal responses. This work serves as a foundation for the bacterial delivery of multiple transcription factors to direct cell fate without jeopardizing genomic integrity. PMID:26449528

49 CFR 236.1037 - Records retention.

Code of Federal Regulations, 2010 CFR

2010-10-01

... railroad shall: (1) Report the inconsistency in writing by mail, facsimile, e-mail, or hand delivery to the... approved Type Approval, if any, PTCDP, and PTCSP that it holds; (2) Adequate documentation to demonstrate..., DC 20590, within 15 days of discovery. Documents that are hand delivered must not be enclosed in an...

33 CFR 20.304 - Service of documents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... other filed document (i) Mail.(ii) Personal delivery. (iii) Express-courier service. (iv) Fax. (v) Other... representative. Is not represented The last known address of the residence or principal place of business of the...) Delivered to the person's office during business hours. (iii) Delivered to the person's residence and...

Prostate Dose Escalation by Innovative Inverse Planning-Driven IMRT

DTIC Science & Technology

2005-11-01

Galvin, J. M.; Low, D.; Palta , J. R.; Rosen, I.; Sharpe, M. B.; Xia, P.; Xiao, Y.; Xing, L.; Yu, C. X., Guidance document on delivery, treatment planning... Palta , J., Implementing IMRT in clinical practice: ajoint document of the American Society for Therapeutic Radiology and Oncology and the American

IFLA General Conference, 1986. Pre-Session Seminar, Kanasawa. Papers.

ERIC Educational Resources Information Center

International Federation of Library Associations and Institutions, The Hague (Netherlands).

The two papers in this document were presented at a pre-session held before the IFLA general conference in 1986. In "Problems of Document Delivery in the Science and Technology Information Environment--An African View," Lucilda Hunter (Sierra Leone) discusses typical difficulties encountered in the process of information retrieval in…

STATS SRS v11.0

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

Piscotty, M A; Nazario, O L

2007-06-20

The objective of this project is the delivery of an application that will provide a unified, web-based system for collecting, verifying and analyzing the achievements for Laboratory employees. The application will enable individual Directorates to manage and report achievement record data for their employees using an LLNL standard web browser. In addition, cross directorate data reporting and analysis will be available for such organizations as LSTO and programmatic directorates. This system is intended to store reference data and metadata for employee achievements. Abstracts and entire publications will not be stored in this system.Directorates are expected to use this system atmore » all levels of management in preparing for Annual Self-Assessments, peer reviews, LDRD reviews, work force reviews, performance appraisals, and requests from sponsors. This document represents the primary deliverable for the Requirements Definition stage of system development. As part of a successful Requirements Definition, this document provides the development staff, the project sponsor, and the user community with a clear understanding of the product's operational, data, and other requirements. With this understanding, the development staff will take the opportunity to refine estimates regarding the cost, schedule, and deliverables reflected in it.« less

Final Report: MaRSPlus Sensor System Electrical Cable Management and Distributed Motor Control Computer Interface

NASA Technical Reports Server (NTRS)

Reil, Robin

2011-01-01

The success of JPL's Next Generation Imaging Spectrometer (NGIS) in Earth remote sensing has inspired a follow-on instrument project, the MaRSPlus Sensor System (MSS). One of JPL's responsibilities in the MSS project involves updating the documentation from the previous JPL airborne imagers to provide all the information necessary for an outside customer to operate the instrument independently. As part of this documentation update, I created detailed electrical cabling diagrams to provide JPL technicians with clear and concise build instructions and a database to track the status of cables from order to build to delivery. Simultaneously, a distributed motor control system is being developed for potential use on the proposed 2018 Mars rover mission. This system would significantly reduce the mass necessary for rover motor control, making more mass space available to other important spacecraft systems. The current stage of the project consists of a desktop computer talking to a single "cold box" unit containing the electronics to drive a motor. In order to test the electronics, I developed a graphical user interface (GUI) using MATLAB to allow a user to send simple commands to the cold box and display the responses received in a user-friendly format.

Summary of Research: Study of Substrates in Microgravity

NASA Technical Reports Server (NTRS)

Bingham, Gail E.; Yendler, Boris S.; Kliss, Mark

1996-01-01

An upcoming series of joint US-Russian plant experiments will use the granular Substrate Nutrient Delivery System (NDS) equipment developed by Russian and Bulgarian scientists for the Mir Space Station's Svet greenhouse. The purpose of this study was to develop a better understanding of granular substrate water relations and to provide the ability to document water distribution in the Svet NDS during the space experiments. To this end, we conducted a study to expanded our understanding of substrate water behavior in granular substrates in microgravity. This report documents the results of our experiments with the Svet substrate water content sensor, explains the results observed in the Svet NDS during the 1990 Greenhouse experiment; describes the development of a miniature version of the Svet type (heat pulse) sensor that has been used to measure the distribution of water content inside the Svet NDS in space, and documents the calibration of these sensors and measurements conducted in both ground and space experiments,

Crossing the "digital divide:" implementing an electronic medical record system in a rural Kenyan health center to support clinical care and research.

PubMed

Tierney, William M; Rotich, Joseph K; Smith, Faye E; Bii, John; Einterz, Robert M; Hannan, Terry J

2002-01-01

To improve care, one must measure it. In the US, electronic medical record systems have been installed in many institutions to support health care management, quality improvement, and research. Developing countries lack such systems and thus have difficulties managing scarce resources and investigating means of improving health care delivery and outcomes. We describe the implementation and use of the first documented electronic medical record system in ambulatory care in sub-Saharan Africa. After one year, it has captured data for more than 13,000 patients making more than 26,000 visits. We present lessons learned and modifications made to this system to improve its capture of data and ability to support a comprehensive clinical care and research agenda.

49 CFR 1548.7 - Approval, amendment, annual renewal, and withdrawal of approval of the security program.

Code of Federal Regulations, 2011 CFR

2011-10-01

... behalf of it and other indirect air carriers that co-sign the proposal. (1) Within 30 calendar days after... accomplished by personal delivery, certified mail, or express courier. Documents served on an indirect air... personal delivery; (ii) If served by certified mail, the mailing date shown on the certificate of service...

Evaluation of Evidence-Based Nursing Pain Management Practice

PubMed Central

Song, Wenjia; Eaton, Linda H.; Gordon, Debra B.; Hoyle, Christine; Doorenbos, Ardith Z.

2014-01-01

Background It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. Aims This study aimed to (a) modify and test an evaluation tool for nursing cancer pain documentation, and (b) describe the frequency and quality of nursing pain documentation in one oncology unit via electronic medical system. Design and Setting A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Methods Medical records were examined for 37 adults hospitalized during April and May of 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. Results The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. Conclusions The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. PMID:26256215

Generation of Multiple Metadata Formats from a Geospatial Data Repository

NASA Astrophysics Data System (ADS)

Hudspeth, W. B.; Benedict, K. K.; Scott, S.

2012-12-01

The Earth Data Analysis Center (EDAC) at the University of New Mexico is partnering with the CYBERShARE and Environmental Health Group from the Center for Environmental Resource Management (CERM), located at the University of Texas, El Paso (UTEP), the Biodiversity Institute at the University of Kansas (KU), and the New Mexico Geo- Epidemiology Research Network (GERN) to provide a technical infrastructure that enables investigation of a variety of climate-driven human/environmental systems. Two significant goals of this NASA-funded project are: a) to increase the use of NASA Earth observational data at EDAC by various modeling communities through enabling better discovery, access, and use of relevant information, and b) to expose these communities to the benefits of provenance for improving understanding and usability of heterogeneous data sources and derived model products. To realize these goals, EDAC has leveraged the core capabilities of its Geographic Storage, Transformation, and Retrieval Engine (Gstore) platform, developed with support of the NSF EPSCoR Program. The Gstore geospatial services platform provides general purpose web services based upon the REST service model, and is capable of data discovery, access, and publication functions, metadata delivery functions, data transformation, and auto-generated OGC services for those data products that can support those services. Central to the NASA ACCESS project is the delivery of geospatial metadata in a variety of formats, including ISO 19115-2/19139, FGDC CSDGM, and the Proof Markup Language (PML). This presentation details the extraction and persistence of relevant metadata in the Gstore data store, and their transformation into multiple metadata formats that are increasingly utilized by the geospatial community to document not only core library catalog elements (e.g. title, abstract, publication data, geographic extent, projection information, and database elements), but also the processing steps used to generate derived modeling products. In particular, we discuss the generation and service delivery of provenance, or trace of data sources and analytical methods used in a scientific analysis, for archived data. We discuss the workflows developed by EDAC to capture end-to-end provenance, the storage model for those data in a delivery format independent data structure, and delivery of PML, ISO, and FGDC documents to clients requesting those products.

Quality of nursing documentation: Paper-based health records versus electronic-based health records.

PubMed

Akhu-Zaheya, Laila; Al-Maaitah, Rowaida; Bany Hani, Salam

2018-02-01

To assess and compare the quality of paper-based and electronic-based health records. The comparison examined three criteria: content, documentation process and structure. Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organised within the system known as the electronic health records. Nursing documentation must be completed at the highest standards, to ensure the safety and quality of healthcare services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus electronic health records is more qualified. A retrospective, descriptive, comparative design was used to address the study's purposes. A convenient number of patients' records, from two public hospitals, were audited using the Cat-ch-Ing audit instrument. The sample size consisted of 434 records for both paper-based health records and electronic health records from medical and surgical wards. Electronic health records were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than electronic health records. The study affirmed the poor quality of nursing documentation and lack of nurses' knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. Both forms of documentation revealed drawbacks in terms of content, process and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nursing practice to improve the quality of nursing care and patients' outcomes. © 2017 John Wiley & Sons Ltd.

Using systems thinking to identify workforce enablers for a whole systems approach to urgent and emergency care delivery: a multiple case study.

PubMed

Manley, Kim; Martin, Anne; Jackson, Carolyn; Wright, Toni

2016-08-09

Overcrowding in emergency departments is a global issue, which places pressure on the shrinking workforce and threatens the future of high quality, safe and effective care. Healthcare reforms aimed at tackling this crisis have focused primarily on structural changes, which alone do not deliver anticipated improvements in quality and performance. The purpose of this study was to identify workforce enablers for achieving whole systems urgent and emergency care delivery. A multiple case study design framed around systems thinking was conducted in South East England across one Trust consisting of five hospitals, one community healthcare trust and one ambulance trust. Data sources included 14 clinical settings where upstream or downstream pinch points are likely to occur including discharge planning and rapid response teams; ten regional stakeholder events (n = 102); a qualitative survey (n = 48); and a review of literature and analysis of policy documents including care pathways and protocols. The key workforce enablers for whole systems urgent and emergency care delivery identified were: clinical systems leadership, a single integrated career and competence framework and skilled facilitation of work based learning. In this study, participants agreed that whole systems urgent and emergency care allows for the design and implementation of care delivery models that meet complexity of population healthcare needs, reduce duplication and waste and improve healthcare outcomes and patients' experiences. For this to be achieved emphasis needs to be placed on holistic changes in structures, processes and patterns of the urgent and emergency care system. Often overlooked, patterns that drive the thinking and behavior in the workplace directly impact on staff recruitment and retention and the overall effectiveness of the organization. These also need to be attended to for transformational change to be achieved and sustained. Research to refine and validate a single integrated career and competence framework and to develop standards for an integrated approach to workplace facilitation to grow the capacity of facilitators that can use the workplace as a resource for learning is needed.

Feasibility of a knowledge translation CME program: Courriels Cochrane.

PubMed

Pluye, Pierre; Grad, Roland; Granikov, Vera; Theriault, Guyléne; Frémont, Pierre; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Arroll, Bruce; Luconi, Francesca; Légaré, France; Labrecque, Michel; Ladouceur, Roger; Bouthillier, France; Sridhar, Soumya Bindiganavile; Moscovici, Jonathan

2012-01-01

Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews (Courriels Cochrane) were disseminated by e-mail. Program participants automatically received CME credit for each Courriel Cochrane they rated. The feasibility of this program is reported (delivery, participation, and participant evaluation). We recruited French-speaking physicians through the Canadian Medical Association. Program delivery and participation were documented. Participants rated the informational value of Courriels Cochrane using the Information Assessment Method (IAM), which documented their reflective learning (relevance, cognitive impact, use for a patient, expected health benefits). IAM responses were aggregated and analyzed. The program was delivered as planned. Thirty Courriels Cochrane were delivered to 985 physicians, and 127 (12.9%) completed at least one IAM questionnaire. Out of 1109 Courriels Cochrane ratings, 973 (87.7%) conta-ined 1 or more types of positive cognitive impact, while 835 (75.3%) were clinically relevant. Participants reported the use of information for a patient and expected health benefits in 595 (53.7%) and 569 (51.3%) ratings, respectively. Program delivery required partnering with 5 organizations. Participants valued Courriels Cochrane. IAM ratings documented their reflective learning. The aggregation of IAM ratings documented 3 levels of CME outcomes: participation, learning, and performance. This evaluation study demonstrates the feasibility of the Courriels Cochrane as an approach to further disseminate Cochrane systematic literature reviews to clinicians and document self-reported knowledge translation associated with Cochrane reviews. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Translational medicine in the field of ablative fractional laser (AFXL)-assisted drug delivery: A critical review from basics to current clinical status.

PubMed

Haedersdal, Merete; Erlendsson, Andrés M; Paasch, Uwe; Anderson, R Rox

2016-05-01

Ablative fractional lasers enhance uptake of topical therapeutics and the concept of fractional laser-assisted drug delivery has now been taken into clinical practice. We systematically reviewed preclinical data and clinical evidence for fractional lasers to enhance drug uptake and improve clinical efficacy. We searched PubMed and Embase databases; 34 articles met the inclusion criteria. Studies were categorized into experimental preclinical studies and clinical trials, the latter graded according to level of evidence. All preclinical trials (n = 16) documented enhanced topical drug uptake into skin after ablative fractional laser treatment. Clinical evidence encompassed 18 studies, of which 9 were randomized controlled trials and 2 were controlled trials, examining neoplastic lesions, photodamaged skin, scars, onychomycosis, and topical anesthetics. The highest level of evidence was reached for actinic keratoses treated with methylaminolevulinate for photodynamic therapy (level IB, 5 randomized controlled trials), substantiating superior and long-lasting efficacy versus conventional photodynamic therapy. No adverse events were reported, but ablative fractional laser-assisted drug delivery implies risks of systemic drug absorption, especially when performed over large skin areas. Fractional laser-assisted drug delivery is beneficial in enhancing preclinical and clinical outcomes for certain skin conditions. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

The Role of NASA's Planetary Data System in the Planetary Spatial Data Infrastructure Initiative

NASA Astrophysics Data System (ADS)

Arvidson, R. E.; Gaddis, L. R.

2017-12-01

An effort underway in NASA's planetary science community is the Mapping and Planetary Spatial Infrastructure Team (MAPSIT, http://www.lpi.usra.edu/mapsit/). MAPSIT is a community assessment group organized to address a lack of strategic spatial data planning for space science and exploration. Working with MAPSIT, a new initiative of NASA and USGS is the development of a Planetary Spatial Data Infrastructure (PSDI) that builds on extensive knowledge on storing, accessing, and working with terrestrial spatial data. PSDI is a knowledge and technology framework that enables the efficient discovery, access, and exploitation of planetary spatial data to facilitate data analysis, knowledge synthesis, and decision-making. NASA's Planetary Data System (PDS) archives >1.2 petabytes of digital data resulting from decades of planetary exploration and research. The PDS charter focuses on the efficient collection, archiving, and accessibility of these data. The PDS emphasis on data preservation and archiving is complementary to that of the PSDI initiative because the latter utilizes and extends available data to address user needs in the areas of emerging technologies, rapid development of tailored delivery systems, and development of online collaborative research environments. The PDS plays an essential PSDI role because it provides expertise to help NASA missions and other data providers to organize and document their planetary data, to collect and maintain the archives with complete, well-documented and peer-reviewed planetary data, to make planetary data accessible by providing online data delivery tools and search services, and ultimately to ensure the long-term preservation and usability of planetary data. The current PDS4 information model extends and expands PDS metadata and relationships between and among elements of the collections. The PDS supports data delivery through several node services, including the Planetary Image Atlas (https://pds-imaging.jpl.nasa.gov/search/), the Orbital Data Explorers (http://ode.rsl.wustl.edu/), and the Planetary Image Locator Tool (PILOT, https://pilot.wr.usgs.gov/); the latter offers ties to the Integrated Software for Imagers and Spectrometers (ISIS), the premier planetary cartographic software package from USGS's Astrogeology Science Team.

A qualitative analysis of health professionals' job descriptions for surgical service delivery in Uganda.

PubMed

Buwembo, William; Munabi, Ian G; Galukande, Moses; Kituuka, Olivia; Luboga, Samuel A

2014-01-01

The ever increasing demand for surgical services in sub-Saharan Africa is creating a need to increase the number of health workers able to provide surgical care. This calls for the optimisation of all available human resources to provide universal access to essential and emergency surgical services. One way of optimising already scarce human resources for health is by clarifying job descriptions to guide the scope of practice, measuring rewards/benefits for the health workers providing surgical care, and informing education and training for health professionals. This study set out to determine the scope of the mandate to perform surgical procedures in current job descriptions of surgical care health professionals in Uganda. A document review was conducted of job descriptions for the health professionals responsible for surgical service delivery in the Ugandan Health care system. The job descriptions were extracted and subjected to a qualitative content data analysis approach using a text based RQDA package of the open source R statistical computing software. It was observed that there was no explicit mention of assignment of delivery of surgical services to a particular cadre. Instead the bulk of direct patient related care, including surgical attention, was assigned to the lower cadres, in particular the medical officer. Senior cadres were assigned to perform predominantly advisory and managerial roles in the health care system. In addition, a no cost opportunity to task shift surgical service delivery to the senior clinical officers was identified. There is a need to specifically assign the mandate to provide surgical care tasks, according to degree of complexity, to adequately trained cadres of health workers. Health professionals' current job descriptions are not explicit, and therefore do not adequately support proper training, deployment, defined scope of practice, and remuneration for equitable surgical service delivery in Uganda. Such deliberate assignment of mandates will provide a means of increasing surgical service delivery through further optimisation of the available human resources for health.

The Importance of Clinical Phenotype in Understanding and Preventing Spontaneous Preterm Birth.

PubMed

Esplin, M Sean

2016-02-01

Spontaneous preterm birth (SPTB) is a well-known cause of maternal and neonatal morbidity. The search for the underlying pathways, documentation of the genetic causes, and identification of markers of spontaneous PTB have been marginally successful due to the fact that it is highly complex, with numerous processes that lead to a final common pathway. There is a great need for a comprehensive, consistent, and uniform classification system, which will be useful in identifying mechanisms, assigning prognosis, aiding in clinical management, and can identify areas of interest for intervention and future study. Effective classification systems must overcome obstacles including the lack of widely accepted definitions and uncertainty about inclusion of classifying features (e.g., presentation at delivery and multiple gestations) and levels of detail of these features. The optimal classification system should be based on the clinical phenotype, including characteristics of the mother, fetus, placenta, and the presentation for delivery. We present a proposed phenotyping system for spontaneous PTB. Future classification systems must establish a universally accepted set of definitions and a standardized clinical workup for all PTBs including the minimum clinical data to be collected and the laboratory and pathologic evaluation that should be completed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

76 FR 77670 - Retail Commodity Transactions Under Commodity Exchange Act

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-14

... were characterized as spot sales in contract documents, but in which, in practice, customer positions... but were ``in form, spot sales for delivery within 48 hours.'' \\10\\ In so ruling, the court focused... documents, held them to be spot contracts outside of CFTC jurisdiction. The CFTC Reauthorization Act of 2008...

The Intended Curriculum in Co-operative Education in Ontario Secondary Schools: An Analysis of School District Documents.

ERIC Educational Resources Information Center

Hutchinson, Nancy L.; Munby, Hugh; Chin, Peter; Edwards, Karol Lyn; Steiner-Bell, Karin; Chapman, Christine; Ho, Katherine; de Espana, Wendy Mills

2001-01-01

Analysis of cooperative education policy documents from nine Ontario school districts indicated that statements about evaluation, remediation, equity, and teacher qualifications were inconsistent. Although the Ministry of Education and Training prescribes co-op for delivery of academic subjects. districts focus exclusively on career preparation…

10 CFR 50.4 - Written communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

...: Document Control Desk, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001; by hand delivery to... NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected] otherwise specified in paragraphs (b)(2) through (b)(7) of this section: to the NRC's Document Control Desk...

49 CFR 1104.6 - Timely filing required.

Code of Federal Regulations, 2010 CFR

2010-10-01

... offers next day delivery to Washington, DC. If the e-filing option is chosen (for those pleadings and documents that are appropriate for e-filing, as determined by reference to the information on the Board's Web site), then the e-filed pleading or document is timely filed if the e-filing process is completed...

Testing the Integrity of a Psychotherapy Protocol: Assessment of Adherence and Competence.

ERIC Educational Resources Information Center

Waltz, Jennifer; And Others

1993-01-01

Treatment manuals and protocols have made delivery of particular therapies purer and more consistent, initiating a demand that researchers not only use treatment manuals to improve purity of their therapy but document that their efforts to achieve purity have been successful. Strategies that have been used to document treatment integrity are…

Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.

PubMed

Bose-Brill, Seuli; Feeney, Michelle; Prater, Laura; Miles, Laura; Corbett, Angela; Koesters, Stephen

2018-06-26

Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39). Among eligible patients aged between 50 and 60 years at the intervention site, advance care planning documentation rates increased by 37% (27/96 to 37/96). Advance care planning documentation rates increased 34% among high users (27/67 to 36/67). Advance care planning previsit planning using a secure electronic health record-supported patient portal framework yielded improvement in the presence of advance care planning documentation, with highest improvement in active patient portal users and patients aged between 50 and 60 years. Targeted previsit patient portal advance care planning delivery in these populations can potentially improve the quality of care in these populations. ©Seuli Bose-Brill, Michelle Feeney, Laura Prater, Laura Miles, Angela Corbett, Stephen Koesters. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.06.2018.

Views of the United States healthcare system: Findings from documentary analysis of an interprofessional education course.

PubMed

Bultas, Margaret W; Ruebling, Irma; Breitbach, Anthony; Carlson, Judy

2016-11-01

As the healthcare system of the United States becomes more complex, collaboration among health professionals is becoming an essential aspect in improving the health of individuals and populations. An interprofessional education course entitled "Health Care System and Health Promotion" was developed to allow health profession students to work and learn together about issues related to healthcare delivery, health promotion, and the effect of policy issues on key stakeholders in the system. A qualitative document analysis research design was used to evaluate the effect of this interprofessional course on students' views of the current healthcare system of the United States. Fifty-nine student articles were analysed using document analysis. Health professions represented in the sample included occupational therapy, physical therapy, athletic training, nursing, and radiation therapy, nuclear medicine technology, and magnetic resonance imaging. Eight themes were identified including: increased personal awareness, the need for a system change, concern for access, affordability of healthcare, vision for future practice role, need for quality care, the value of interprofessional collaboration (IPC), and the importance of disease prevention. The results of the study suggest that healthcare education can benefit from the integration of Interprofessional Education (IPE) courses into their curriculum especially when teaching content common to all healthcare professions such as healthcare systems and health promotion.

Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.

PubMed

Sasnett, Bonita; Harris, Susie T; White, Shelly

Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

Biomedical applications of nano-titania in theranostics and photodynamic therapy.

PubMed

Rehman, F U; Zhao, C; Jiang, H; Wang, X

2016-01-01

Titanium dioxide (TiO2) is one of the most abundantly used nanomaterials for human life. It is used in sunscreen, photovoltaic devices, biomedical applications and as a food additive and environmental scavenger. Nano-TiO2 in biomedical applications is well documented. It is used in endoprosthetic implants and early theranostics of neoplastic and non-neoplastic maladies as a photodynamic therapeutic agent and as vehicles in nano-drug delivery systems. Herein, we focus on the recent advancements and applications of nano-TiO2 in bio-nanotechnology, nanomedicine and photodynamic therapy (PDT).

Proceedings of the 2000 U.S. DOE Hydrogen Program Review

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

NREL

2000-11-01

The 2000 US Department of Energy (DOE) Hydrogen Program Review was sponsored by the Office of Power Delivery Systems, Office of Power Technologies, US Department of Energy. The proceedings from this meeting serve as an important technology reference for the DOE Hydrogen Program. This document contains technical progress reports on research and technology validation projects funded by the DOE Hydrogen Program in Fiscal Year 2000. The growth of fuel cell technology will provide a basis for the establishment of the hydrogen option into both transportation and electricity supply markets.

Web-based document image processing

NASA Astrophysics Data System (ADS)

Walker, Frank L.; Thoma, George R.

1999-12-01

Increasing numbers of research libraries are turning to the Internet for electron interlibrary loan and for document delivery to patrons. This has been made possible through the widespread adoption of software such as Ariel and DocView. Ariel, a product of the Research Libraries Group, converts paper-based documents to monochrome bitmapped images, and delivers them over the Internet. The National Library of Medicine's DocView is primarily designed for library patrons are beginning to reap the benefits of this new technology, barriers exist, e.g., differences in image file format, that lead to difficulties in the use of library document information. To research how to overcome such barriers, the Communications Engineering Branch of the Lister Hill National Center for Biomedical Communications, an R and D division of NLM, has developed a web site called the DocMorph Server. This is part of an ongoing intramural R and D program in document imaging that has spanned many aspects of electronic document conversion and preservation, Internet document transmission and document usage. The DocMorph Server Web site is designed to fill two roles. First, in a role that will benefit both libraries and their patrons, it allows Internet users to upload scanned image files for conversion to alternative formats, thereby enabling wider delivery and easier usage of library document information. Second, the DocMorph Server provides the design team an active test bed for evaluating the effectiveness and utility of new document image processing algorithms and functions, so that they may be evaluated for possible inclusion in other image processing software products being developed at NLM or elsewhere. This paper describes the design of the prototype DocMorph Server and the image processing functions being implemented on it.

Chitosan-based multifunctional nanomedicines and theranostics for targeted therapy of cancer.

PubMed

Fathi, Marziyeh; Majidi, Sima; Zangabad, Parham Sahandi; Barar, Jaleh; Erfan-Niya, Hamid; Omidi, Yadollah

2018-05-30

Nanotechnology as an emerging field has established inevitable impacts on nano-biomedicine and treatment of formidable diseases, inflammations, and malignancies. In this regard, substantial advances in the design of systems for delivery of therapeutic agents have emerged magnificent and innovative pathways in biomedical applications. Chitosan (CS) is derived via deacetylation of chitin as the second most abundant polysaccharide. Owing to the unique properties of CS (e.g., biocompatibility, biodegradability, bioactivity, mucoadhesion, cationic nature and functional groups), it is an excellent candidate for diverse biomedical and pharmaceutical applications such as drug/gene delivery, transplantation of encapsulated cells, tissue engineering, wound healing, antimicrobial purposes, etc. In this review, we will document, discuss, and provide some key insights toward design and application of miscellaneous nanoplatforms based on CS. The CS-based nanosystems (NSs) can be employed as advanced drug delivery systems (DDSs) in large part due to their remarkable physicochemical and biological characteristics. The abundant functional groups of CS allow the facile functionalization in order to engineer multifunctional NSs, which can simultaneously incorporate therapeutic agents, molecular targeting, and diagnostic/imaging capabilities in particular against malignancies. These multimodal NSs can be literally translated into clinical applications such as targeted diagnosis and therapy of cancer because they offer minimal systemic toxicity and maximal cytotoxicity against cancer cells and tumors. The recent developments in the CS-based NSs functionalized with targeting and imaging agents prove CS as a versatile polymer in targeted imaging and therapy. © 2018 Wiley Periodicals, Inc.

Making strides in women’s mental health care delivery in rural Ethiopia: demographics of a female outpatient psychiatric cohort at Jimma University Specialized Hospital (2006–2008)

PubMed Central

Chemali, Zeina N; Borba, Christina PC; Henderson, Tanya E; Tesfaye, Markos

2013-01-01

This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women’s mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services. PMID:23901297

Community care for people who are homeless and mentally ill.

PubMed

Drury, Lin J

2003-05-01

This qualitative longitudinal study documents the experiences of 60 people who are homeless and mentally ill from their state mental hospital discharge through their first two years in community housing. The study explores the personal, cultural, and environmental contexts of life for adults who are homeless and mentally ill and examines the interaction between an individual's needs and community resources. The research identifies forces that perpetuate homelessness and traces the struggles that people who are homeless and mentally ill encounter during the transition from the streets to stable housing. The findings describe a culturally based pattern of mutual avoidance between homeless mentally ill clients and caregivers, which limits delivery of services to the population. Recommendations include development of alternative systems of care delivery, expansion of educational experiences with underserved populations, and increased funding for service or research with people who are homeless and mentally ill.

Increased Utilization of Primary Health Care Centers for Birthing Care in Tamil Nadu, India: A Visible Impact of Policies, Initiatives, and Innovations.

PubMed

Pandian, Jayanthi; Suresh, Saradha; Desikachari, B R; Padmanaban, P

2013-01-01

Tamil Nadu has been showing an increasing trend in institutional deliveries since early 1990's and has now achieved near 100%. Among the institutional deliveries, a change was observed since 2006, wherein primary health centers (PHCs) showed a four-fold increase in deliveries, while other public and private health facilities showed a decline, despite equal access to all categories of health facilities. What led to this increased utilization of PHCs for birthing care? Policies, documents, and published reports of the Government of Tamil Nadu (GoTN) were reviewed and interviews were conducted with the various stakeholders involved in providing birthing care in the PHCs. This study analyzes the impact of the policies and supply side initiatives and innovations which led to increase utilization of the PHCs for birthing care. Scaling up of 24 × 7 services in all PHCs, upgrading PHCs with good infrastructure, human resources, and women friendly services have helped to boost the image of the PHCs. Pro-women policies like maternity benefit schemes, birth companionship, providing food, and compulsory stay for 48 h following delivery have attracted women towards PHC. Innovative strategies like maternity picnics and use of expected date of delivery (EDD) chart for follow-up have made women choose PHCs, while periodic reviews and support to staff has improved service delivery. Women centered policies, efficient managerial systems, quality care, and innovative marketing of services have together contributed to increased utilization of PHCs for birthing. Other states could explore the possibility of replicating this model to make optimal use the PHC facilities.

Comparison of intrapulmonary and systemic pharmacokinetics of colistin methanesulfonate (CMS) and colistin after aerosol delivery and intravenous administration of CMS in critically ill patients.

PubMed

Boisson, Matthieu; Jacobs, Matthieu; Grégoire, Nicolas; Gobin, Patrice; Marchand, Sandrine; Couet, William; Mimoz, Olivier

2014-12-01

Colistin is an old antibiotic that has recently gained a considerable renewal of interest for the treatment of pulmonary infections due to multidrug-resistant Gram-negative bacteria. Nebulization seems to be a promising form of administration, but colistin is administered as an inactive prodrug, colistin methanesulfonate (CMS); however, differences between the intrapulmonary concentrations of the active moiety as a function of the route of administration in critically ill patients have not been precisely documented. In this study, CMS and colistin concentrations were measured on two separate occasions within the plasma and epithelial lining fluid (ELF) of critically ill patients (n = 12) who had received 2 million international units (MIU) of CMS by aerosol delivery and then intravenous administration. The pharmacokinetic analysis was conducted using a population approach and completed by pharmacokinetic-pharmacodynamic (PK-PD) modeling and simulations. The ELF colistin concentrations varied considerably (9.53 to 1,137 mg/liter), but they were much higher than those in plasma (0.15 to 0.73 mg/liter) after aerosol delivery but not after intravenous administration of CMS. Following CMS aerosol delivery, typically, 9% of the CMS dose reached the ELF, and only 1.4% was presystemically converted into colistin. PK-PD analysis concluded that there was much higher antimicrobial efficacy after CMS aerosol delivery than after intravenous administration. These new data seem to support the use of aerosol delivery of CMS for the treatment of pulmonary infections in critical care patients. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Comparison of Intrapulmonary and Systemic Pharmacokinetics of Colistin Methanesulfonate (CMS) and Colistin after Aerosol Delivery and Intravenous Administration of CMS in Critically Ill Patients

PubMed Central

Boisson, Matthieu; Jacobs, Matthieu; Grégoire, Nicolas; Gobin, Patrice; Marchand, Sandrine; Mimoz, Olivier

2014-01-01

Colistin is an old antibiotic that has recently gained a considerable renewal of interest for the treatment of pulmonary infections due to multidrug-resistant Gram-negative bacteria. Nebulization seems to be a promising form of administration, but colistin is administered as an inactive prodrug, colistin methanesulfonate (CMS); however, differences between the intrapulmonary concentrations of the active moiety as a function of the route of administration in critically ill patients have not been precisely documented. In this study, CMS and colistin concentrations were measured on two separate occasions within the plasma and epithelial lining fluid (ELF) of critically ill patients (n = 12) who had received 2 million international units (MIU) of CMS by aerosol delivery and then intravenous administration. The pharmacokinetic analysis was conducted using a population approach and completed by pharmacokinetic-pharmacodynamic (PK-PD) modeling and simulations. The ELF colistin concentrations varied considerably (9.53 to 1,137 mg/liter), but they were much higher than those in plasma (0.15 to 0.73 mg/liter) after aerosol delivery but not after intravenous administration of CMS. Following CMS aerosol delivery, typically, 9% of the CMS dose reached the ELF, and only 1.4% was presystemically converted into colistin. PK-PD analysis concluded that there was much higher antimicrobial efficacy after CMS aerosol delivery than after intravenous administration. These new data seem to support the use of aerosol delivery of CMS for the treatment of pulmonary infections in critical care patients. PMID:25267660

Designing and assessing a sustainable networked delivery (SND) system: hybrid business-to-consumer book delivery case study.

PubMed

Kim, Junbeum; Xu, Ming; Kahhat, Ramzy; Allenby, Braden; Williams, Eric

2009-01-01

We attempted to design and assess an example of a sustainable networked delivery (SND) system: a hybrid business-to-consumer book delivery system. This system is intended to reduce costs, achieve significant reductions in energy consumption, and reduce environmental emissions of critical local pollutants and greenhouse gases. The energy consumption and concomitant emissions of this delivery system compared with existing alternative delivery systems were estimated. We found that regarding energy consumption, an emerging hybrid delivery system which is a sustainable networked delivery system (SND) would consume 47 and 7 times less than the traditional networked delivery system (TND) and e-commerce networked delivery system (END). Regarding concomitant emissions, in the case of CO2, the SND system produced 32 and 7 times fewer emissions than the TND and END systems. Also the SND system offer meaningful economic benefit such as the costs of delivery and packaging, to the online retailer, grocery, and consumer. Our research results show that the SND system has a lot of possibilities to save local transportation energy consumption and delivery costs, and reduce environmental emissions in delivery system.

Perceptions of the effect of information and communication technology on the quality of care delivered in emergency departments: a cross-site qualitative study.

PubMed

Callen, Joanne; Paoloni, Richard; Li, Julie; Stewart, Michael; Gibson, Kathryn; Georgiou, Andrew; Braithwaite, Jeffrey; Westbrook, Johanna

2013-02-01

We identify and describe emergency physicians' and nurses' perceptions of the effect of an integrated emergency department (ED) information system on the quality of care delivered in the ED. A qualitative study was conducted in 4 urban EDs, with each site using the same ED information system. Participants (n=97) were physicians and nurses with data collected by 69 detailed interviews, 5 focus groups (28 participants), and 26 hours of structured observations. Results revealed new perspectives on how an integrated ED information system was perceived to affect incentives for use, awareness of colleagues' activities, and workflow. A key incentive was related to the positive effect of the ED information system on clinical decisionmaking because of improved and quicker access to patient-specific and knowledge-base information compared with the previous stand-alone ED information system. Synchronous access to patient data was perceived to lead to enhanced awareness by individual physicians and nurses of what others were doing within and outside the ED, which participants claimed contributed to improved care coordination, communication, clinical documentation, and the consultation process. There was difficulty incorporating the use of the ED information system with clinicians' work, particularly in relation to increased task complexity; duplicate documentation, and computer issues related to system usability, hardware, and individuals' computer skills and knowledge. Physicians and nurses perceived that the integrated ED information system contributed to improvements in the delivery of patient care, enabling faster and better-informed decisionmaking and specialty consultations. The challenge of electronic clinical documentation and balancing data entry demands with system benefits necessitates that new methods of data capture, suited to busy clinical environments, be developed. Copyright © 2012. Published by Mosby, Inc.

Web-based continuing medical education. (II): Evaluation study of computer-mediated continuing medical education.

PubMed

Curran, V R; Hoekman, T; Gulliver, W; Landells, I; Hatcher, L

2000-01-01

Over the years, various distance learning technologies and methods have been applied to the continuing medical education needs of rural and remote physicians. They have included audio teleconferencing, slow scan imaging, correspondence study, and compressed videoconferencing. The recent emergence and growth of Internet, World Wide Web (Web), and compact disk read-only-memory (CD-ROM) technologies have introduced new opportunities for providing continuing education to the rural medical practitioner. This evaluation study assessed the instructional effectiveness of a hybrid computer-mediated courseware delivery system on dermatologic office procedures. A hybrid delivery system merges Web documents, multimedia, computer-mediated communications, and CD-ROMs to enable self-paced instruction and collaborative learning. Using a modified pretest to post-test control group study design, several evaluative criteria (participant reaction, learning achievement, self-reported performance change, and instructional transactions) were assessed by various qualitative and quantitative data collection methods. This evaluation revealed that a hybrid computer-mediated courseware system was an effective means for increasing knowledge (p < .05) and improving self-reported competency (p < .05) in dermatologic office procedures, and that participants were very satisfied with the self-paced instruction and use of asynchronous computer conferencing for collaborative information sharing among colleagues.

Improving delivery of health care to Aboriginal and Torres Strait Islander children.

PubMed

Attwood, Lucy; Rodrigues, Sarah; Winsor, Josephine; Warren, Shirley; Biviano, Lyn; Gunasekera, Hasantha

2015-05-01

To identify opportunities to improve health-care delivery for urban Aboriginal and Torres Strait Islander children requiring hospital admission and to determine their characteristics. We analysed all documentation of admissions of Aboriginal and/or Torres Strait Islander children to a tertiary paediatric hospital in 2010. We reviewed the medical records to determine whether the Aboriginal status of patients was known, whether Aboriginal and/or Torres Strait Islander children and their families were reviewed by Aboriginal staff during admission and whether basic health-care quality indicators were met, including documentation of anthropometry, ear examination findings, immunisation status and catch-up immunisation delivery. In 2010, 543 (2%) patients admitted to the institution were identified as Aboriginal and/or Torres Strait Islander: 140/538 (26.0%) were from the first decile (most disadvantaged) on Socio-Economic Indexes for Areas index. Of all admitted children, 148/543 (27.3%) were referred to Aboriginal health professionals during admission, more when length of stay was greater than 7 days (61% vs. 23%, P < 0.001). There was documentation of weight in 533/543 (98.2%), ear examinations in 64/543 (11.8%), immunisations being not up to date in 126/543 (23%), catch-up immunisation given in 7/126 (5.6%), Aboriginal and/or Torres Strait Islander status in 8/543 (1.5%) medical and 1/543 (0.2%) nursing discharge summaries. We have identified several opportunities to improve culturally appropriate health-care delivery for Aboriginal and Torres Strait Islander children admitted to hospital, including improved recognition of Aboriginal and/or Torres Strait Islander status of patients, improved access to Aboriginal health professionals and increased performance and documentation of basic anthropometry, ear examination and immunisation catch-up. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation.

PubMed

Rochester, Carolyn L; Vogiatzis, Ioannis; Holland, Anne E; Lareau, Suzanne C; Marciniuk, Darcy D; Puhan, Milo A; Spruit, Martijn A; Masefield, Sarah; Casaburi, Richard; Clini, Enrico M; Crouch, Rebecca; Garcia-Aymerich, Judith; Garvey, Chris; Goldstein, Roger S; Hill, Kylie; Morgan, Michael; Nici, Linda; Pitta, Fabio; Ries, Andrew L; Singh, Sally J; Troosters, Thierry; Wijkstra, Peter J; Yawn, Barbara P; ZuWallack, Richard L

2015-12-01

Pulmonary rehabilitation (PR) has demonstrated physiological, symptom-reducing, psychosocial, and health economic benefits for patients with chronic respiratory diseases, yet it is underutilized worldwide. Insufficient funding, resources, and reimbursement; lack of healthcare professional, payer, and patient awareness and knowledge; and additional patient-related barriers all contribute to the gap between the knowledge of the science and benefits of PR and the actual delivery of PR services to suitable patients. The objectives of this document are to enhance implementation, use, and delivery of pulmonary rehabilitation to suitable individuals worldwide. Members of the American Thoracic Society (ATS) Pulmonary Rehabilitation Assembly and the European Respiratory Society (ERS) Rehabilitation and Chronic Care Group established a Task Force and writing committee to develop a policy statement on PR. The document was modified based on feedback from expert peer reviewers. After cycles of review and revisions, the statement was reviewed and formally approved by the Board of Directors of the ATS and the Science Council and Executive Committee of the ERS. This document articulates policy recommendations for advancing healthcare professional, payer, and patient awareness and knowledge of PR, increasing patient access to PR, and ensuring quality of PR programs. It also recommends areas of future research to establish evidence to support the development of an updated funding and reimbursement policy regarding PR. The ATS and ERS commit to undertake actions that will improve access to and delivery of PR services for suitable patients. They call on their members and other health professional societies, payers, patients, and patient advocacy groups to join in this commitment.

Human Research Program Requirements Document. Human Research Program Revision E

NASA Technical Reports Server (NTRS)

Vargas, Paul

2011-01-01

This document defines, documents, and allocates the Human Research Program (HRP) requirements to the HRP Program Elements. It also establishes the flow of requirements from the Human Exploration and Operations Mission Directorate (HEOMD) and the Office of the Chief Health and Medical Officer (OCHMO) down to the various HRP Program Elements to ensure that human research and technology countermeasure investments support the delivery of countermeasures and technologies that satisfy HEOMD's and OCHMO's exploration mission requirements.

Evolving health information technology and the timely availability of visit diagnoses from ambulatory visits: a natural experiment in an integrated delivery system.

PubMed

Bardach, Naomi S; Huang, Jie; Brand, Richard; Hsu, John

2009-07-17

Health information technology (HIT) may improve health care quality and outcomes, in part by making information available in a timelier manner. However, there are few studies documenting the changes in timely availability of data with the use of a sophisticated electronic medical record (EMR), nor a description of how the timely availability of data might differ with different types of EMRs. We hypothesized that timely availability of data would improve with use of increasingly sophisticated forms of HIT. We used an historical observation design (2004-2006) using electronic data from office visits in an integrated delivery system with three types of HIT: Basic, Intermediate, and Advanced. We calculated the monthly percentage of visits using the various types of HIT for entry of visit diagnoses into the delivery system's electronic database, and the time between the visit and the availability of the visit diagnoses in the database. In January 2004, when only Basic HIT was available, 10% of office visits had diagnoses entered on the same day as the visit and 90% within a week; 85% of office visits used paper forms for recording visit diagnoses, 16% used Basic at that time. By December 2006, 95% of all office visits had diagnoses available on the same day as the visit, when 98% of office visits used some form of HIT for entry of visit diagnoses (Advanced HIT for 67% of visits). Use of HIT systems is associated with dramatic increases in the timely availability of diagnostic information, though the effects may vary by sophistication of HIT system. Timely clinical data are critical for real-time population surveillance, and valuable for routine clinical care.

Petition to Object to the Williams Four Corners, LLC - Sims Mesa Central Delivery Point natural gas processing plant and compressor station, Rio Arriba County, New Mexico, Title V Operating Permit

EPA Pesticide Factsheets

This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Challenges in using electronic health record data for CER: experience of 4 learning organizations and solutions applied.

PubMed

Bayley, K Bruce; Belnap, Tom; Savitz, Lucy; Masica, Andrew L; Shah, Nilay; Fleming, Neil S

2013-08-01

To document the strengths and challenges of using electronic health records (EHRs) for comparative effectiveness research (CER). A replicated case study of comparative effectiveness in hypertension treatment was conducted across 4 health systems, with instructions to extract data and document problems encountered using a specified list of required data elements. Researchers at each health system documented successes and challenges, and suggested solutions for addressing challenges. Data challenges fell into 5 categories: missing data, erroneous data, uninterpretable data, inconsistencies among providers and over time, and data stored in noncoded text notes. Suggested strategies to address these issues include data validation steps, use of surrogate markers, natural language processing, and statistical techniques. A number of EHR issues can hamper the extraction of valid data for cross-health system comparative effectiveness studies. Our case example cautions against a blind reliance on EHR data as a single definitive data source. Nevertheless, EHR data are superior to administrative or claims data alone, and are cheaper and timelier than clinical trials or manual chart reviews. All 4 participating health systems are pursuing pathways to more effectively use EHR data for CER.A partnership between clinicians, researchers, and information technology specialists is encouraged as a way to capitalize on the wealth of information contained in the EHR. Future developments in both technology and care delivery hold promise for improvement in the ability to use EHR data for CER.

Linear feature extraction from radar imagery: SBIR (Small Business Innovative Research), phase 2, option 2

NASA Astrophysics Data System (ADS)

Milgram, David L.; Kahn, Philip; Conner, Gary D.; Lawton, Daryl T.

1988-12-01

The goal of this effort is to develop and demonstrate prototype processing capabilities for a knowledge-based system to automatically extract and analyze features from Synthetic Aperture Radar (SAR) imagery. This effort constitutes Phase 2 funding through the Defense Small Business Innovative Research (SBIR) Program. Previous work examined the feasibility of and technology issues involved in the development of an automated linear feature extraction system. This final report documents this examination and the technologies involved in automating this image understanding task. In particular, it reports on a major software delivery containing an image processing algorithmic base, a perceptual structures manipulation package, a preliminary hypothesis management framework and an enhanced user interface.

New anabolic therapies in osteoporosis.

PubMed

Rubin, Mishaela R; Bilezikian, John P

2003-03-01

Anabolic agents represent an important new advance in the therapy of osteoporosis. Their potential might be substantially greater than the anti-resorptives. Because the anti-resorptives and anabolic agents work by completely distinct mechanisms of action, it is possible that the combination of agents could be significantly more potent than either agent alone. Recent evidence suggests that a plateau in BMD might occur after prolonged exposure to PTH. Anti-resorptive therapy during or after anabolic therapy might prevent this skeletal adaptation. Protocols to consider anabolic agents as intermittent recycling therapy would be of interest. Of all the anabolics, PTH is the most promising. However, there are unanswered questions about PTH. More studies are needed to document an anabolic effect on cortical bone. More large-scale studies are needed to further determine the reduction in nonvertebral fractures with PTH, especially at the hip. In the future, PTH is likely to be modified for easier and more targeted delivery. Oral or transdermal delivery systems may become available. Recently, Gowen et al have described an oral calcilytic molecule that antagonizes the parathyroid cell calcium receptor, thus stimulating the endogenous release of PTH. This approach could represent a novel endogenous delivery system for intermittent PTH administration. Rising expectations that anabolic therapies for osteoporosis will soon play a major role in treating this disease are likely to fuel further studies and the development of even more novel approaches to therapy.

Engineering strategies for the design of plant nutrient delivery systems for use in space: approaches to countering microbiological contamination

NASA Technical Reports Server (NTRS)

Gonzales, A. A.; Schuerger, A. C.; Barford, C.; Mitchell, R.

1996-01-01

Microbiological contamination of crops within space-based plant growth research chambers has been postulated as a potentially significant problem. Microbial infestations; fouling of Nutrient Delivery System (NDS) fluid loops; and the formation of biofilms have been suggested as the most obvious and important manifestations of the problem. Strict sanitation and quarantine procedures will reduce, but not eliminate, microbial species introduced into plant growth systems in space habitats. Microorganisms transported into space most likely will occur as surface contaminants on spacecraft components, equipment, the crew, and plant-propagative materials. Illustrations of the potential magnitude of the microbiological contamination issue will be drawn from the literature and from documentation of laboratory and commercial field experience. Engineering strategies for limiting contamination and for the development of countermeasures will be described. Microbiological control technologies and NDS hardware will be discussed. Configurations appropriate for microgravity research facilities, as well as anticipated bio-regenerative life support system implementations, will be explored. An efficiently designed NDS, capable of adequately meeting the environmental needs of crop plants in space, is considered to be critical in both the research and operational domains. Recommended experiments, tests, and technology developments, structured to allow the development of prudent engineering solutions also will be presented.

Engineering Strategies for the Design of Plant Nutrient Delivery Systems for Use in Space: Approaches to Countering Microbiological Contamination

NASA Technical Reports Server (NTRS)

Gonzales, A. A.; Schuerger, A. C.; Mitchell, R.; Harper, Lynn D. (Technical Monitor)

1994-01-01

Microbiological contamination of crops within space-based crop growth research chambers has been postulated as a potentially significant problem. Microbial infestations; fouling of Nutrient Delivery System (NDS) fluid loops; and the formation of biofilms, have been suggested as the most obvious and important manifestations of the problem. Strict sanitation and quarantine procedures will reduce, but not eliminate, microbial species introduced into plant growing systems in space habitats. Microorganisms transported into space will most likely occur as contaminants on spacecraft components, equipment, the crew, and plant-propagative materials. Illustrations of the potential magnitude of the microbiological contamination issue will be drawn from the literature and from documentation of laboratory and commercial field experience. Engineering strategies for limiting contamination and for the development of countermeasures will be described. Microbiological control technologies and NDS hardware will be discussed. Configurations appropriate for microgravity research facilities, as well as anticipated bio-regenerative life support system implementations, will be explored. An efficiently designed NDS, capable of adequately meeting the environmental needs of crop plants in space, is considered to be critical in both the research and operational domains. Recommended experiments, tests and technology developments, structured to allow the development of prudent engineering solutions, will also be presented.

Interlibrary loan in U.S. health sciences libraries: journal article use.

PubMed Central

Lacroix, E M

1994-01-01

Health sciences libraries in the United States use the National Library of Medicine (NLM) DOCLINE system to request more than two million items annually through interlibrary loan (ILL). Ninety-seven percent of all ILL requests are for journal articles. In this study, NLM analyzed four million ILL requests entered into the DOCLINE system during two twelve-month periods ending September 30, 1992. The requests were analyzed at both the journal title level and article level. Data for the two years were found to be remarkably similar. Results showed that a large number of journals are required to fill ILL requests and that there is a relatively low number of repeat requests for most journal articles. Seventy-six percent of journal articles analyzed were requested only once, and fewer than 1% were requested more than ten times. About 39% of journals used to fill ILL requests were indexed in MEDLINE at some time, while 84% of the articles supplied were indexed in MEDLINE. Ninety-two percent of articles supplied were from English-language journals. Sixty-seven percent of articles were published in the most recent five years, and 85% in the most recent ten years. The 100 most frequently requested articles for each of the two years were examined to determine characteristics such as language, where they were indexed, and the subject matter. This study has provided valuable information for planning of NLM's interlibrary document delivery services and also should have significance for libraries and other organizations involved in document delivery. Images PMID:7841903

Architecting for Sustainable Software Delivery

DTIC Science & Technology

2012-06-01

14 CrossTalk—May/June 2012 RAPID AND AGILE STABILITY Architecting for Sustainable Software Delivery Ronald J. Koontz , Boeing Robert L. Nord...Figure 2, and additional architecture documentation can be found in the work of Koontz [9, 10, 11]. Designing for extensibility promotes continued...Mapping of Practices to Agile and Architecture Criteria CrossTalk—May/June 2012 19 RAPID AND AGILE STABILITY ABOUT THE AUTHORS Ronald J. Koontz

Alternatives Generation and Analysis for Heat Removal from High Level Waste Tanks

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

WILLIS, W.L.

This document addresses the preferred combination of design and operational configurations to provide heat removal from high-level waste tanks during Phase 1 waste feed delivery to prevent the waste temperature from exceeding tank safety requirement limits. An interim decision for the preferred method to remove the heat from the high-level waste tanks during waste feed delivery operations is presented herein.

The Delivery and Content of Training for Adult Education Teachers and Volunteer Instructors. Study of ABE/ESL Instructor Training Approaches.

ERIC Educational Resources Information Center

Tibbetts, John; And Others

The delivery and content of training for teachers and volunteer instructors in adult basic education (ABE) and English as a Second Language (ESL) were documented in a study. Two sources of information were the research literature and extant data from states on training activities. Findings indicated that training for adult education teachers and…

Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia.

PubMed

Zulu, Joseph Mumba; Hurtig, Anna-Karin; Kinsman, John; Michelo, Charles

2015-01-28

To address the huge human resources for health gap in Zambia, the Ministry of Health launched the National Community Health Assistant Strategy in 2010. The strategy aims to integrate community-based health workers into the health system by creating a new group of workers, called community health assistants (CHAs). However, literature suggests that the integration process of national community-based health worker programmes into health systems has not been optimal. Conceptually informed by the diffusion of innovations theory, this paper qualitatively aimed to explore the factors that shaped the acceptability and adoption of CHAs into the health system at district level in Zambia during the pilot phase. Data gathered through review of documents, 6 focus group discussions with community leaders, and 12 key informant interviews with CHA trainers, supervisors and members of the District Health Management Team were analysed using thematic analysis. The perceived relative advantage of CHAs over existing community-based health workers in terms of their quality of training and scope of responsibilities, and the perceived compatibility of CHAs with existing groups of health workers and community healthcare expectations positively facilitated the integration process. However, limited integration of CHAs in the district health governance system hindered effective programme trialability, simplicity and observability at district level. Specific challenges at this level included a limited information flow and sense of programme ownership, and insufficient documentation of outcomes. The district also had difficulties in responding to emergent challenges such as delayed or non-payment of CHA incentives, as well as inadequate supervision and involvement of CHAs in the health posts where they are supposed to be working. Furthermore, failure of the health system to secure regular drug supplies affected health service delivery and acceptability of CHA services at community level. The study has demonstrated that implementation of policy guidelines for integrating community-based health workers in the health system may not automatically guarantee successful integration at the local or district level, at least at the start of the process. The study reiterates the need for fully integrating such innovations into the district health governance system if they are to be effective.

Acute dissociative reaction to spontaneous delivery in a case of total denial of pregnancy: Diagnostic and forensic aspects.

PubMed

Şar, Vedat; Aydın, Nazan; van der Hart, Onno; Steven Frankel, A; Şar, Meriç; Omay, Oğuz

2017-01-01

This article presents the history of a 21-year-old female college student with total denial of pregnancy who experienced an acute dissociative reaction during the spontaneous delivery at home without medical assistance where the newborn died immediately. Psychiatric examination, self-report questionnaires, legal documents, and witness reports have been reviewed in evaluation of the case. Evidence pointed to total denial of pregnancy, that is, until delivery. The diagnoses of an acute dissociative reaction to stress (remitted) and a subsequent PTSD were established in a follow-up examination conducted 7 months after the delivery. Notwithstanding the inherently dissociative nature of total denial of pregnancy, no other evidence has been found about pre-existing psychopathology. For causing the newborn's death, the patient faced charges for "aggravated murder," which were later on reduced into "involuntary manslaughter." Given the physical incapacity to perform voluntary acts due to the loss of control over her actions during the delivery, and the presence of an acute dissociative reaction to unexpected delivery, the legal case represents an intricate overlap between "insanity" and "incapacitation" defenses. The rather broad severity spectrum of acute dissociative conditions requires evaluation of the limits and conditions of appropriate legal defenses by mental health experts and lawyers. Denial of pregnancy as a source of potential stress has attracted little interest in psychiatric literature although solid research exists which documented that it is not infrequent. Arguments are presented to introduce this condition as a diagnostic category of female reproductive psychiatry with a more neutral label: "unperceived pregnancy."

Evaluation of Evidence-based Nursing Pain Management Practice.

PubMed

Song, Wenjia; Eaton, Linda H; Gordon, Debra B; Hoyle, Christine; Doorenbos, Ardith Z

2015-08-01

It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. The aim of this study was to modify and test an evaluation tool for nursing cancer pain documentation, and describe the frequency and quality of nursing pain documentation in one oncology unit via the electronic medical system. A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Medical records were examined for 37 adults hospitalized during April and May 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score ranging from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

TU-B-19A-01: Image Registration II: TG132-Quality Assurance for Image Registration

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

Brock, K; Mutic, S

2014-06-15

AAPM Task Group 132 was charged with a review of the current approaches and solutions for image registration in radiotherapy and to provide recommendations for quality assurance and quality control of these clinical processes. As the results of image registration are always used as the input of another process for planning or delivery, it is important for the user to understand and document the uncertainty associate with the algorithm in general and the Result of a specific registration. The recommendations of this task group, which at the time of abstract submission are currently being reviewed by the AAPM, include themore » following components. The user should understand the basic image registration techniques and methods of visualizing image fusion. The disclosure of basic components of the image registration by commercial vendors is critical in this respect. The physicists should perform end-to-end tests of imaging, registration, and planning/treatment systems if image registration is performed on a stand-alone system. A comprehensive commissioning process should be performed and documented by the physicist prior to clinical use of the system. As documentation is important to the safe implementation of this process, a request and report system should be integrated into the clinical workflow. Finally, a patient specific QA practice should be established for efficient evaluation of image registration results. The implementation of these recommendations will be described and illustrated during this educational session. Learning Objectives: Highlight the importance of understanding the image registration techniques used in their clinic. Describe the end-to-end tests needed for stand-alone registration systems. Illustrate a comprehensive commissioning program using both phantom data and clinical images. Describe a request and report system to ensure communication and documentation. Demonstrate an clinically-efficient patient QA practice for efficient evaluation of image registration.« less

Alternative Strategies to Improve and Expand the Delivery of Vocational Education in Small, Rural, and/or Isolated Secondary Schools in Hawaii.

ERIC Educational Resources Information Center

Hawaii State Dept. of Education, Honolulu. Office of the Director for Vocational Education.

Intended for administrators of schools within the Hawaii Department of Education, this document provides descriptions of 34 alternative strategies implemented by small, rural, and/or isolated secondary schools across the nation to improve the quality of their vocational programs. Introductory materials discuss the document's purpose, the need for…

Anesthetic and Obstetric Management of Syringomyelia During Labor and Delivery: A Case Series and Systematic Review.

PubMed

Garvey, Gráinne Patricia; Wasade, Vibhangini S; Murphy, Kellie E; Balki, Mrinalini

2017-09-01

Syringomyelia is a rare, slowly progressive neurological condition characterized by the presence of a syrinx within the spinal cord. Consensus regarding the safest mode of delivery and anesthetic management in patients with syringomyelia remains controversial and presents management dilemmas. This study reviews the cases of syringomyelia at our institution and provides a systematic review of the literature to guide decisions regarding labor and delivery management. A retrospective review of cases at our hospital from 2002 to 2014 and a systematic review of the literature from 1946 to 2014 were undertaken. Hospital records and electronic databases were interrogated using International Classification of Diseases, 10th Revision codes and the keywords "syringomyelia," "syringobulbia," and "pregnancy." Data regarding demographics, diagnosis, radiology reports, neurological symptoms, mode of delivery, anesthetic management, and maternal-fetal outcomes were collected. We collected and analyzed data on a total of 43 pregnancies in 39 patients. The most common location for syrinx was in the cervicothoracic region (41.9%). The large majority of patients (n = 34; 87%) demonstrated signs and symptoms associated with syringomyelia before delivery. Syringomyelia associated with Arnold Chiari malformation was documented in 49% (n = 21) cases. General anesthesia was the most commonly used (n = 21/30, 70%) anesthetic technique for cesarean delivery. The majority (n = 9/13, 69%) of patients had an epidural sited for labor analgesia. There were no maternal or neonatal complications associated with neuraxial anesthesia; however, 3 cases (14%) raised concerns regarding general anesthesia including difficult intubation, transient worsening of neurological symptoms postpartum, and prolonged muscle paralysis after atracurium. Despite concerns regarding aggravation of the syrinx with vaginal delivery, this mode of delivery has never caused any documented long-term worsening of neurological condition. All techniques of anesthesia have been performed successfully without major lasting complications. All cases necessitate patient counseling and individualized multidisciplinary involvement to ensure maternal safety.

Engineering host-derived resistance against plant parasites through RNA interference: challenges and opportunities.

PubMed

Runo, Steven

2011-01-01

RNA interference (RNAi) has rapidly advanced to become a powerful genetic tool and holds promise to revolutionizing agriculture by providing a strategy for controlling a wide array of crop pests. Numerous studies document RNAi efficacy in achieving silencing in viruses, insects, nematodes and weeds parasitizing crops. In general, host derived pest resistance through RNAi is achieved by genetically transforming host plants with double stranded RNA constructs targeted at essential parasite genes leading to generation of small interfering RNAs (siRNAs). Small interfering RNAs formed in the host are then delivered to the parasite and transported to target cells. Delivery can be oral - worms and insects, viral infections, viruses - or through a vascular connections - parasitic plants, while delivery to target cells is by cell to cell systemic movement of the silencing signal. Despite the overall optimism in generating pest resistant crops through RNAi-mediated silencing, some hurdles have recently begun to emerge. Presently, the main challenge is delivery of sufficient siRNAs, in the right cells, and at the right time to mount; a strong, durable, and broad-spectrum posttranscriptional gene silencing (PTGS) signal. This review highlights the novel strategies available for improving host derived RNAi resistance in downstream applied agriculture.

Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care

PubMed Central

Simon, Melissa A.; Samaras, Athena T.; Nonzee, Narissa J.; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S.; Dong, XinQi

2016-01-01

Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients’ interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus–community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented. PMID:27594792

Order Granting the Petition to Object to Williams Four Corners, LLC - Sims Mesa Central Delivery Point natural gas processing plant and compressor station, Rio Arriba County, New Mexico, Title V Operating Permit

EPA Pesticide Factsheets

This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Transportable educational programs for scientific and technical professionals: More effective utilization of automated scientific and technical data base systems

NASA Technical Reports Server (NTRS)

Dominick, Wayne D.

1987-01-01

This grant final report executive summary documents a major, long-term program addressing innovative educational issues associated with the development, administration, evaluation, and widespread distribution of transportable educational programs for scientists and engineers to increase their knowledge of, and facilitate their utilization of automated scientific and technical information storage and retrieval systems. This educational program is of very broad scope, being targeted at Colleges of Engineering and Colleges of Physical sciences at a large number of colleges and universities throughout the United States. The educational program is designed to incorporate extensive hands-on, interactive usage of the NASA RECON system and is supported by a number of microcomputer-based software systems to facilitate the delivery and usage of the educational course materials developed as part of the program.

NASA Glenn Wind Tunnel Model Systems Criteria

NASA Technical Reports Server (NTRS)

Soeder, Ronald H.; Roeder, James W.; Stark, David E.; Linne, Alan A.

2004-01-01

This report describes criteria for the design, analysis, quality assurance, and documentation of models that are to be tested in the wind tunnel facilities at the NASA Glenn Research Center. This report presents two methods for computing model allowable stresses on the basis of the yield stress or ultimate stress, and it defines project procedures to test models in the NASA Glenn aeropropulsion facilities. Both customer-furnished and in-house model systems are discussed. The functions of the facility personnel and customers are defined. The format for the pretest meetings, safety permit process, and model reviews are outlined. The format for the model systems report (a requirement for each model that is to be tested at NASA Glenn) is described, the engineers responsible for developing the model systems report are listed, and the timetable for its delivery to the project engineer is given.

CELSS Program Meeting

NASA Technical Reports Server (NTRS)

Tremor, John W.; Macelroy, Robert D.

1987-01-01

A meeting on the potential contributions of plant science to the goals of Controlled Ecological Life Support System (CELSS) research produced discussions that helped to focus on a variety of topics. In the area of volatiles and soluble organics, microbial activity, disease, and productivity, participants emphasized the need to know more about the consequences of closure for the growth of plants. Under nutrient delivery systems, the problems focus on the need to maintain a stable, optimum nutrient system. Lighting systems discussions emphasized unique methods of direct lighting and development of improved irradiation sources. Flight experiment opportunities were outlined by one speaker. Documentation of the Plant Growth Module was discussed. The last day's discussion focused on the organization of the research group to be involved in the development and use of a two to three cubic meter sealed chamber and ancillary equipment.

Increased Utilization of Primary Health Care Centers for Birthing Care in Tamil Nadu, India: A Visible Impact of Policies, Initiatives, and Innovations

PubMed Central

Pandian, Jayanthi; Suresh, Saradha; Desikachari, B. R.; Padmanaban, P.

2013-01-01

Background: Tamil Nadu has been showing an increasing trend in institutional deliveries since early 1990's and has now achieved near 100%. Among the institutional deliveries, a change was observed since 2006, wherein primary health centers (PHCs) showed a four-fold increase in deliveries, while other public and private health facilities showed a decline, despite equal access to all categories of health facilities. What led to this increased utilization of PHCs for birthing care? Material and Methods: Policies, documents, and published reports of the Government of Tamil Nadu (GoTN) were reviewed and interviews were conducted with the various stakeholders involved in providing birthing care in the PHCs. This study analyzes the impact of the policies and supply side initiatives and innovations which led to increase utilization of the PHCs for birthing care. Results: Scaling up of 24 × 7 services in all PHCs, upgrading PHCs with good infrastructure, human resources, and women friendly services have helped to boost the image of the PHCs. Pro-women policies like maternity benefit schemes, birth companionship, providing food, and compulsory stay for 48 h following delivery have attracted women towards PHC. Innovative strategies like maternity picnics and use of expected date of delivery (EDD) chart for follow-up have made women choose PHCs, while periodic reviews and support to staff has improved service delivery. Conclusion: Women centered policies, efficient managerial systems, quality care, and innovative marketing of services have together contributed to increased utilization of PHCs for birthing. Other states could explore the possibility of replicating this model to make optimal use the PHC facilities. PMID:26664836

Waste-efficient materials procurement for construction projects: A structural equation modelling of critical success factors.

PubMed

Ajayi, Saheed O; Oyedele, Lukumon O

2018-05-01

Albeit the understanding that construction waste is caused by activities ranging from all stages of project delivery process, research efforts have been concentrated on design and construction stages, while the possibility of reducing waste through materials procurement process is widely neglected. This study aims at exploring and confirming strategies for achieving waste-efficient materials procurement in construction activities. The study employs sequential exploratory mixed method approach as its methodological framework, using focus group discussion, statistical analysis and structural equation modelling. The study suggests that for materials procurement to enhance waste minimisation in construction projects, the procurement process would be characterised by four features. These include suppliers' commitment to low waste measures, low waste purchase management, effective materials delivery management and waste-efficient Bill of Quantity, all of which have significant impacts on waste minimisation. This implies that commitment of materials suppliers to such measures as take back scheme and flexibility in supplying small materials quantity, among others, are expected of materials procurement. While low waste purchase management stipulates the need for such measures as reduced packaging and consideration of pre-assembled/pre-cut materials, efficient delivery management entails effective delivery and storage system as well as adequate protection of materials during the delivery process, among others. Waste-efficient specification and bill of quantity, on the other hand, requires accurate materials take-off and ordering of materials based on accurately prepared design documents and bill of quantity. Findings of this study could assist in understanding a set of measures that should be taken during materials procurement process, thereby corroborating waste management practices at other stages of project delivery process. Copyright © 2018. Published by Elsevier Ltd.

Practice Bulletin No. 161 Summary: External Cephalic Version.

PubMed

2016-02-01

In the United States, there is a widespread belief that the overall cesarean delivery rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean delivery, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.

Practice Bulletin No. 161: External Cephalic Version.

PubMed

2016-02-01

In the United States, there is a widespread belief that the overall cesarean delivery rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean delivery, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.

48 CFR 14.201-9 - Simplified contract format.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... (6) Inspection and acceptance, quality assurance, and reliability requirements. (7) Place of delivery... particular acquisition. (d) List of documents and attachments. Include if necessary. (e) Representations and...

48 CFR 14.201-9 - Simplified contract format.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (6) Inspection and acceptance, quality assurance, and reliability requirements. (7) Place of delivery... particular acquisition. (d) List of documents and attachments. Include if necessary. (e) Representations and...

Analysis of time series for postal shipments in Regional VII East Java Indonesia

NASA Astrophysics Data System (ADS)

Kusrini, DE; Ulama, B. S. S.; Aridinanti, L.

2018-03-01

The change of number delivery goods through PT. Pos Regional VII East Java Indonesia indicates that the trend of increasing and decreasing the delivery of documents and non-documents in PT. Pos Regional VII East Java Indonesia is strongly influenced by conditions outside of PT. Pos Regional VII East Java Indonesia so that the prediction the number of document and non-documents requires a model that can accommodate it. Based on the time series plot monthly data fluctuations occur from 2013-2016 then the model is done using ARIMA or seasonal ARIMA and selected the best model based on the smallest AIC value. The results of data analysis about the number of shipments on each product sent through the Sub-Regional Postal Office VII East Java indicates that there are 5 post offices of 26 post offices entering the territory. The largest number of shipments is available on the PPB (Paket Pos Biasa is regular package shipment/non-document ) and SKH (Surat Kilat Khusus is Special Express Mail/document) products. The time series model generated is largely a Random walk model meaning that the number of shipment in the future is influenced by random effects that are difficult to predict. Some are AR and MA models, except for Express shipment products with Malang post office destination which has seasonal ARIMA model on lag 6 and 12. This means that the number of items in the following month is affected by the number of items in the previous 6 months.

Electronic document delivery using the Internet.

PubMed Central

Bennett, V M; Palmer, E M

1994-01-01

The Health Sciences Libraries Consortium (HSLC) was established in 1985 by thirteen founding member institutions in Pennsylvania and Delaware. In 1989, the Interlibrary Loan, Document Delivery, and Union List Task Force, appointed by the HSLC Board of Directors, successfully demonstrated the feasibility of supplying 94% of all interlibrary loan (ILL) photocopy requests in forty-eight hours or less by a network application of group 3-level memory telefacsimiles. However, the expenses associated with the telefacsimile operation and the limitations associated with network polling protocols challenged participants to seek new alternatives for ILL. In 1990, the HSLC introduced HSLC HealthNET, an online wide-area network linking eleven of the thirteen institutions and their resources while providing access to the Internet. The HSLC HealthNET additionally supports a centralized shared library system, several locally mounted databases, and consortiumwide electronic mail. In 1991, a project was initiated to evaluate Ariel software, pioneered by the Research Libraries Group (RLG), compared to the existing network application of group 3-level telefacsimiles. Factors identified as critical to Ariel's potential to replace the telefacsimile network were the proprietary software specifications for Internet access, the use of HSLC's existing wide-area network (WAN), and a hardware platform that was optimal for an ILL environment. This article describes the Ariel project history, the transition to Ariel from the telefacsimile network, evaluation of equipment features for processing efficiency, and operational issues affecting ILL policy. PMID:8004018

Policy implementation in wheelchair service delivery in a rural South African setting.

PubMed

Visagie, Surona; Scheffler, Elsje; Schneider, Marguerite

2013-01-01

Wheelchairs allow users to realise basic human rights and improved quality of life. South African and international documents guide rehabilitation service delivery and thus the provision of wheelchairs. Evidence indicates that rehabilitation policy implementation gaps exist in rural South Africa. The aim of this article was to explore the extent to which wheelchair service delivery in a rural, remote area of South Africa was aligned with the South African National Guidelines on Provision of Assistive Devices, The United Nations Convention on the Rights of Persons with Disabilities and The World Health Organization Guidelines on Provision of Wheelchairs in Less-Resourced Settings. Qualitative methods were used. Data were collected through semi-structured interviews with 22 participants who were identified through purposive sampling. Content analysis of data was preformed around the construct of wheelchair service delivery. Study findings identified gaps between the guiding documents and wheelchair service delivery. Areas where gaps were identified included service aspects such as referral, assessment, prescription, user and provider training, follow up, maintenance and repair as well as management aspects such as staff support, budget and monitoring. Positive findings related to individual assessments, enthusiastic and caring staff and the provision of wheelchairs at no cost. The gaps in policy implementation can have a negative impact on users and the service provider. Inappropriate or no wheelchairs limit user function, participation and quality of life. In addition, an inappropriate wheelchair will have a shorter lifespan, requiring frequent repairs and replacements with cost implications for the service provider.

Impacts of EHR Certification and Meaningful Use Implementation on an Integrated Delivery Network.

PubMed

Bowes, Watson A

2014-01-01

Three years ago Intermountain Healthcare made the decision to participate in the Medicare and Medicaid Electronic Heath Record (EHR) Incentive Program which required that hospitals and providers use a certified EHR in a meaningful way. At that time, the barriers to enhance our home grown system, and change clinician workflows were numerous and large. This paper describes the time and effort required to enhance our legacy systems in order to pass certification, including filling 47 gaps in (EHR) functionality. We also describe the processes and resources that resulted in successful changes to many clinical workflows required by clinicians to meet meaningful use requirements. In 2011 we set meaningful use targets of 75% of employed physicians and 75% of our hospitals to meet Stage 1 of meaningful use by 2013. By the end of 2013, 87% of 696 employed eligible professionals and 100% of 22 Intermountain hospitals had successfully attested for Stage 1. This paper describes documented and perceived costs to Intermountain including time, effort, resources, postponement of other projects, as well as documented and perceived benefits of attainment of meaningful use.

Systems and Components Fuel Delivery System, Water Delivery System, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Systems and Components - Fuel Delivery System, Water Delivery System, Derrick Crane System, and Crane System Details - Marshall Space Flight Center, F-1 Engine Static Test Stand, On Route 565 between Huntsville and Decatur, Huntsville, Madison County, AL

MO-F-CAMPUS-T-03: Continuous Dose Delivery with Gamma Knife Perfexion

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

Ghobadi,; Li, W; Chung, C

2015-06-15

Purpose: We propose continuous dose delivery techniques for stereotactic treatments delivered by Gamma Knife Perfexion using inverse treatment planning system that can be applied to various tumour sites in the brain. We test the accuracy of the plans on Perfexion’s planning system (GammaPlan) to ensure the obtained plans are viable. This approach introduces continuous dose delivery for Perefxion, as opposed to the currently employed step-and-shoot approaches, for different tumour sites. Additionally, this is the first realization of automated inverse planning on GammaPlan. Methods: The inverse planning approach is divided into two steps of identifying a quality path inside the target,more » and finding the best collimator composition for the path. To find a path, we select strategic regions inside the target volume and find a path that visits each region exactly once. This path is then passed to a mathematical model which finds the best combination of collimators and their durations. The mathematical model minimizes the dose spillage to the surrounding tissues while ensuring the prescribed dose is delivered to the target(s). Organs-at-risk and their corresponding allowable doses can also be added to the model to protect adjacent organs. Results: We test this approach on various tumour sizes and sites. The quality of the obtained treatment plans are comparable or better than forward plans and inverse plans that use step- and-shoot technique. The conformity indices in the obtained continuous dose delivery plans are similar to those of forward plans while the beam-on time is improved on average (see Table 1 in supporting document). Conclusion: We employ inverse planning for continuous dose delivery in Perfexion for brain tumours. The quality of the obtained plans is similar to forward and inverse plans that use conventional step-and-shoot technique. We tested the inverse plans on GammaPlan to verify clinical relevance. This research was partially supported by Elekta, Sweden (vendor of Gamma Knife Perfexion)« less

NASA Lewis Wind Tunnel Model Systems Criteria

NASA Technical Reports Server (NTRS)

Soeder, Ronald H.; Haller, Henry C.

1994-01-01

This report describes criteria for the design, analysis, quality assurance, and documentation of models or test articles that are to be tested in the aeropropulsion facilities at the NASA Lewis Research Center. The report presents three methods for computing model allowable stresses on the basis of the yield stress or ultimate stress, and it gives quality assurance criteria for models tested in Lewis' aeropropulsion facilities. Both customer-furnished model systems and in-house model systems are discussed. The functions of the facility manager, project engineer, operations engineer, research engineer, and facility electrical engineer are defined. The format for pretest meetings, prerun safety meetings, and the model criteria review are outlined Then, the format for the model systems report (a requirement for each model that is to be tested at NASA Lewis) is described, the engineers that are responsible for developing the model systems report are listed, and the time table for its delivery to the facility manager is given.

Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers.

PubMed

Tsiachristas, Apostolos; Hipple-Walters, Bethany; Lemmens, Karin M M; Nieboer, Anna P; Rutten-van Mölken, Maureen P M H

2011-07-01

Chronic non-communicable diseases are a major threat to population health and have a major economic impact on health care systems. Worldwide, integrated chronic care delivery systems have been developed to tackle this challenge. In the Netherlands, the recently introduced integrated payment system--the chain-DTC--is seen as the cornerstone of a policy stimulating the development of a well-functioning integrated chronic care system. The purpose of this paper is to describe the recent attempts in the Netherlands to stimulate the delivery of integrated chronic care, focusing specifically on the new integrated payment scheme and the barriers to introducing this scheme. We also highlight possible threats and identify necessary conditions to the success of the system. This paper is based on a combination of methods and sources including literature, government documents, personal communications and site visits to disease management programs (DMPs). The most important conditions for the success of the new payment system are: complete care protocols describing both general (e.g. smoking cessation, physical activity) and disease-specific chronic care modules, coverage of all components of a DMP by basic health care insurance, adequate information systems that facilitate communication between caregivers, explicit links between the quality and the price of a DMP, expansion of the amount of specialized care included in the chain-DTC, inclusion of a multi-morbidity factor in the risk equalization formula of insurers, and thorough economic evaluation of DMPs. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Effectiveness of Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Methods in Medicaid-Supported Prenatal Care: Trial III

ERIC Educational Resources Information Center

Windsor, Richard; Woodby, Lesa; Miller, Thomas; Hardin, Michael

2011-01-01

This two-phase evaluation documented the delivery and effectiveness of evidence-based health education methods by regular staff to pregnant smokers. During Phase 1, a total of 436 Medicaid patients were screened and 416 (95%) gave consent: 334 nonsmokers and 102 smokers. This historical Comparison (C) group was assessed to document the "normal"…

Use of Documentary and Face to Face Interaction in Working Toward School Improvement. Draft. Documentation and Technical Assistance in Urban Schools.

ERIC Educational Resources Information Center

Holmes, Manford

This paper compares the usefulness of documentary (written materials) versus face to face delivery of information in helping to bring about urban school improvement. The paper is based on the experiences of the Documentation and Technical Assistance Project (DTA) of the Center for New Schools (Chicago, Illinois), a program that aims to increase…

Label-free CEST MRI Detection of Citicoline-Liposome Drug Delivery in Ischemic Stroke

PubMed Central

Liu, Huanling; Jablonska, Anna; Li, Yuguo; Cao, Suyi; Liu, Dexiang; Chen, Hanwei; Van Zijl, Peter CM; Bulte, Jeff W.M.; Janowski, Miroslaw; Walczak, Piotr; Liu, Guanshu

2016-01-01

ABSTRACT Citicoline (CDPC) is a natural supplement with well-documented neuroprotective effects in the treatment of neurodegenerative diseases. In the present study, we sought to exploit citicoline as a theranostic agent with its inherent chemical exchange saturation transfer (CEST) MRI signal, which can be directly used as an MRI guidance in the citicoline drug delivery. Our in vitro CEST MRI results showed citicoline has two inherent CEST signals at +1 and +2 ppm, attributed to exchangeable hydroxyl and amine protons, respectively. To facilitate the targeted drug delivery of citicoline to ischemic regions, we prepared liposomes encapsulating citicoline (CDPC-lipo) and characterized the particle properties and CEST MRI properties. The in vivo CEST MRI detection of liposomal citicoline was then examined in a rat brain model of unilateral transient ischemia induced by a two-hour middle cerebral artery occlusion. The results showed that the delivery of CPDC-lipo to the brain ischemic areas could be monitored and quantified by CEST MRI. When administered intra-arterially, CDPC-lipo clearly demonstrated a detectable CEST MRI contrast at 2 ppm. CEST MRI revealed that liposomes preferentially accumulated in the areas of ischemia with a disrupted blood-brain-barrier. We furthermore used CEST MRI to detect the improvement in drug delivery using CDPC-lipo targeted against vascular cell adhesion molecule (VCAM)-1 in the same animal model. The MRI findings were validated using fluorescence microscopy. Hence, liposomal citicoline represents a prototype theranostic system, where the therapeutic agent can be detected directly by CEST MRI in a label-free fashion. PMID:27446492

Exploration of Global Trend on Biomedical Application of Polyhydroxyalkanoate (PHA): A Patent Survey.

PubMed

Ponnaiah, Paulraj; Vnoothenei, Nagiah; Chandramohan, Muruganandham; Thevarkattil, Mohamed Javad Pazhayakath

2018-01-30

Polyhydroxyalkanoates are bio-based, biodegradable naturally occurring polymers produced by a wide range of organisms, from bacteria to higher mammals. The properties and biocompatibility of PHA make it possible for a wide spectrum of applications. In this context, we analyze the potential applications of PHA in biomedical science by exploring the global trend through the patent survey. The survey suggests that PHA is an attractive candidate in such a way that their applications are widely distributed in the medical industry, drug delivery system, dental material, tissue engineering, packaging material as well as other useful products. In our present study, we explored patents associated with various biomedical applications of polyhydroxyalkanoates. Patent databases of European Patent Office, United States Patent and Trademark Office and World Intellectual Property Organization were mined. We developed an intensive exploration approach to eliminate overlapping patents and sort out significant patents. We demarcated the keywords and search criterions and established search patterns for the database request. We retrieved documents within the recent 6 years, 2010 to 2016 and sort out the collected data stepwise to gather the most appropriate documents in patent families for further scrutiny. By this approach, we retrieved 23,368 patent documents from all the three databases and the patent titles were further analyzed for the relevance of polyhydroxyalkanoates in biomedical applications. This ensued in the documentation of approximately 226 significant patents associated with biomedical applications of polyhydroxyalkanoates and the information was classified into six major groups. Polyhydroxyalkanoates has been patented in such a way that their applications are widely distributed in the medical industry, drug delivery system, dental material, tissue engineering, packaging material as well as other useful products. There are many avenues through which PHA & PHB could be used. Our analysis shows patent information can be used to identify various applications of PHA and its representatives in the biomedical field. Upcoming studies can focus on the application of PHA in the different field to discover the related topics and associate to this study. We believe that this approach of analysis and findings can initiate new researchers to undertake similar kind of studies in their represented field to fill the gap between the patent articles and researchpublications. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

SSE software test management STM capability: Using STM in the Ground Systems Development Environment (GSDE)

NASA Technical Reports Server (NTRS)

Church, Victor E.; Long, D.; Hartenstein, Ray; Perez-Davila, Alfredo

1992-01-01

This report is one of a series discussing configuration management (CM) topics for Space Station ground systems software development. It provides a description of the Software Support Environment (SSE)-developed Software Test Management (STM) capability, and discusses the possible use of this capability for management of developed software during testing performed on target platforms. This is intended to supplement the formal documentation of STM provided by the SEE Project. How STM can be used to integrate contractor CM and formal CM for software before delivery to operations is described. STM provides a level of control that is flexible enough to support integration and debugging, but sufficiently rigorous to insure the integrity of the testing process.

Linear feature extraction from radar imagery: SBIR (Small Business Innovative Research) phase 2, option 1

NASA Astrophysics Data System (ADS)

Conner, Gary D.; Milgram, David L.; Lawton, Daryl T.; McConnell, Christopher C.

1988-04-01

The goal of this effort is to develop and demonstrate prototype processing capabilities for a knowledge-based system to automatically extract and analyze linear features from synthetic aperture radar (SAR) imagery. This effort constitutes Phase 2 funding through the Defense Small Business Innovative Research (SBIR) Program. Previous work examined the feasibility of the technology issues involved in the development of an automatedlinear feature extraction system. This Option 1 Final Report documents this examination and the technologies involved in automating this image understanding task. In particular, it reports on a major software delivery containing an image processing algorithmic base, a perceptual structures manipulation package, a preliminary hypothesis management framework and an enhanced user interface.

Independent Orbiter Assessment (IOA): Analysis of the extravehicular mobility unit

NASA Technical Reports Server (NTRS)

Raffaelli, Gary G.

1986-01-01

The results of the Independent Orbiter Assessment (IOA) of the Failure Modes and Effects Analysis (FMEA) and Critical Items List (CIL) are presented. The IOA approach features a top-down analysis of the hardware to determine failure modes, criticality, and potential critical items (PCIs). To preserve independence, this analysis was accomplished without reliance upon the results contained within the NASA FMEA/CIL documentation. This report documents the independent analysis results corresponding to the Extravehicular Mobility Unit (EMU) hardware. The EMU is an independent anthropomorphic system that provides environmental protection, mobility, life support, and communications for the Shuttle crewmember to perform Extravehicular Activity (EVA) in Earth orbit. Two EMUs are included on each baseline Orbiter mission, and consumables are provided for three two-man EVAs. The EMU consists of the Life Support System (LSS), Caution and Warning System (CWS), and the Space Suit Assembly (SSA). Each level of hardware was evaluated and analyzed for possible failure modes and effects. The majority of these PCIs are resultant from failures which cause loss of one or more primary functions: pressurization, oxygen delivery, environmental maintenance, and thermal maintenance. It should also be noted that the quantity of PCIs would significantly increase if the SOP were to be treated as an emergency system rather than as an unlike redundant element.

Accuracy of outpatient service data for activity-based funding in New South Wales, Australia.

PubMed

Munyisia, Esther N; Reid, David; Yu, Ping

2017-05-01

Despite increasing research on activity-based funding (ABF), there is no empirical evidence on the accuracy of outpatient service data for payment. This study aimed to identify data entry errors affecting ABF in two drug and alcohol outpatient clinic services in Australia. An audit was carried out on healthcare workers' (doctors, nurses, psychologists, social workers, counsellors, and aboriginal health education officers) data entry errors in an outpatient electronic documentation system. Of the 6919 data entries in the electronic documentation system, 7.5% (518) had errors, 68.7% of the errors were related to a wrong primary activity, 14.5% were due to a wrong activity category, 14.5% were as a result of a wrong combination of primary activity and modality of care, 1.9% were due to inaccurate information on a client's presence during service delivery and 0.4% were related to a wrong modality of care. Data entry errors may affect the amount of funding received by a healthcare organisation, which in turn may affect the quality of treatment provided to clients due to the possibility of underfunding the organisation. To reduce errors or achieve an error-free environment, there is a need to improve the naming convention of data elements, their descriptions and alignment with the national standard classification of outpatient services. It is also important to support healthcare workers in their data entry by embedding safeguards in the electronic documentation system such as flags for inaccurate data elements.

Diabetes Patient Tracker, a personal digital assistant-based diabetes management system for primary care practices in Oklahoma.

PubMed

Nagykaldi, Zsolt; Mold, James W

2003-01-01

It has been demonstrated that electronic patient registries combined with a clinical decision support system have a significant positive impact on the documentation and delivery of services provided by health care professionals. While implementation of available commercial systems has not always been proven effective in a number of primary care practices, development and implementation of such a system in a practice-based research network might enhance successful implementation. Physicians in our practice-based research network (Oklahoma Physicians Resource/Research Network) initiated a project that aimed at designing, testing, and implementing a personal digital assistant-based diabetes management system. We utilized the "best practice" approach to determine the principles on which the application must operate. System development and beta testing were also accomplished based on the direct feedback of user clinicians. Practice Enhancement Assistants (PEAs) were available in the practices for assistance with implementation. Implementation of the Diabetes Patient Tracker (DPT) resulted in a significant improvement (p<0.05) in nine of 10 diabetic quality of care measures compared with pre-intervention levels in 20 primary care practices. Regular PEA visits similarly increased the number of foot exams and retinal exams performed in the last year (p=0.03 and 0.02, respectively). DPT is a low-cost, feasible, easily implementable, and very effective paper-less tool that significantly improves patient care and documentation in primary care practices.

Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status.

PubMed

Attanasio, Laura B; Hardeman, Rachel R; Kozhimannil, Katy B; Kjerulff, Kristen H

2017-12-01

Researchers documenting persistent racial/ethnic and socioeconomic status disparities in chances of cesarean delivery have speculated that women's birth attitudes and preferences may partially explain these differences, but no studies have directly tested this hypothesis. We examined whether women's prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. Data were from the First Baby Study, a cohort of 3006 women who gave birth to a first baby in Pennsylvania between 2009 and 2011. We used regression models to examine (1) predictors of prenatal attitudes toward vaginal delivery, and (2) the association between prenatal attitudes and actual delivery mode. To assess moderation, we estimated models adding interaction terms. Prenatal attitudes toward vaginal delivery were not associated with race/ethnicity or socioeconomic status. Positive attitudes toward vaginal delivery were associated with lower odds of cesarean delivery (AOR=0.60, P < .001). However, vaginal delivery attitudes were only related to delivery mode among women who were white, highly educated, and privately insured. There are racial/ethnic differences in chances of cesarean delivery, and these differences are not explained by birth attitudes. Furthermore, our findings suggest that white and high-socioeconomic status women may be more able to realize their preferences in childbirth. © 2017 Wiley Periodicals, Inc.

Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research.

PubMed

Hanson, Janice L; Stephens, Mark B; Pangaro, Louis N; Gimbel, Ronald W

2012-11-19

There are no empirically-grounded criteria or tools to define or benchmark the quality of outpatient clinical documentation. Outpatient clinical notes document care, communicate treatment plans and support patient safety, medical education, medico-legal investigations and reimbursement. Accurately describing and assessing quality of clinical documentation is a necessary improvement in an increasingly team-based healthcare delivery system. In this paper we describe the quality of outpatient clinical notes from the perspective of multiple stakeholders. Using purposeful sampling for maximum diversity, we conducted focus groups and individual interviews with clinicians, nursing and ancillary staff, patients, and healthcare administrators at six federal health care facilities between 2009 and 2011. All sessions were audio-recorded, transcribed and qualitatively analyzed using open, axial and selective coding. The 163 participants included 61 clinicians, 52 nurse/ancillary staff, 31 patients and 19 administrative staff. Three organizing themes emerged: 1) characteristics of quality in clinical notes, 2) desired elements within the clinical notes and 3) system supports to improve the quality of clinical notes. We identified 11 codes to describe characteristics of clinical notes, 20 codes to describe desired elements in quality clinical notes and 11 codes to describe clinical system elements that support quality when writing clinical notes. While there was substantial overlap between the aspects of quality described by the four stakeholder groups, only clinicians and administrators identified ease of translation into billing codes as an important characteristic of a quality note. Only patients rated prioritization of their medical problems as an aspect of quality. Nurses included care and education delivered to the patient, information added by the patient, interdisciplinary information, and infection alerts as important content. Perspectives of these four stakeholder groups provide a comprehensive description of quality in outpatient clinical documentation. The resulting description of characteristics and content necessary for quality notes provides a research-based foundation for assessing the quality of clinical documentation in outpatient health care settings.

40 CFR 53.9 - Conditions of designation.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-specific standard operating procedure documents shall be readily available to any users. (b) Any method... after delivery and acceptance when maintained and operated in accordance with the manual referred to in...

40 CFR 53.9 - Conditions of designation.

Code of Federal Regulations, 2011 CFR

2011-07-01

...-specific standard operating procedure documents shall be readily available to any users. (b) Any method... after delivery and acceptance when maintained and operated in accordance with the manual referred to in...

Prospective study of determinants and costs of home births in Mumbai slums

PubMed Central

2010-01-01

Background Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth. Methods As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280 000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models. Results We described 1708 (16%) home deliveries among 10 754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai), and 6% by skilled health personnel. The median cost of a home delivery was US$ 21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted multivariable regression model, the odds of home delivery increased with illiteracy, parity, socioeconomic poverty, poorer housing, lack of water supply, population transience, and hazardous location. Conclusions We estimate 32 000 annual home births to residents of Mumbai's slums. These are unevenly distributed and cluster with other markers of vulnerability. Since cost does not appear to be a dominant disincentive to institutional delivery, efforts are needed to improve the client experience at public sector institutions. It might also be productive to concentrate on intensive outreach in vulnerable areas by community-based health workers, who could play a greater part in helping women plan their deliveries and making sure that they get help in time. PMID:20670456

WE-G-BRA-01: Patient Safety and Treatment Quality Improvement Through Incident Learning: Experience of a Non-Academic Proton Therapy Center

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

Zheng, Y; Johnson, R; Zhao, L

2015-06-15

Purpose: Incident learning has been proven to improve patient safety and treatment quality in conventional radiation therapy. However, its application in proton therapy has not been reported yet to our knowledge. In this study, we report our experience in developing and implementation of an in-house incident learning system. Methods: An incident learning system was developed based on published principles and tailored for our clinical practice and available resource about 18 months ago. The system includes four layers of error detection and report: 1) dosimetry peer review; 2) physicist plan quality assurance (QA); 3) treatment delivery issue on call and record;more » and 4) other incident report. The first two layers of QA and report were mandatory for each treatment plan through easy-to-use spreadsheets that are only accessible by the dosimetry and physicist departments. The treatment delivery issues were recorded case by case by the on call physicist. All other incidents were reported through an online incident report system, which can be anonymous. The incident report includes near misses on planning and delivery, process deviation, machine issues, work flow and documentation. Periodic incident reviews were performed. Results: In total, about 116 errors were reported through dosimetry review, 137 errors through plan QA, 83 treatment issues through physics on call record, and 30 through the online incident report. Only 8 incidents (2.2%) were considered to have a clinical impact to patients, and the rest of errors were either detected before reaching patients or had negligible dosimetric impact (<5% dose variance). Personnel training & process improvements were implemented upon periodic incident review. Conclusion: An incident learning system can be helpful in personnel training, error reduction, and patient safety and treatment quality improvement. The system needs to be catered for each clinic’s practice and available resources. Incident and knowledge sharing among proton centers are encouraged.« less

Use of image registration and fusion algorithms and techniques in radiotherapy: Report of the AAPM Radiation Therapy Committee Task Group No. 132.

PubMed

Brock, Kristy K; Mutic, Sasa; McNutt, Todd R; Li, Hua; Kessler, Marc L

2017-07-01

Image registration and fusion algorithms exist in almost every software system that creates or uses images in radiotherapy. Most treatment planning systems support some form of image registration and fusion to allow the use of multimodality and time-series image data and even anatomical atlases to assist in target volume and normal tissue delineation. Treatment delivery systems perform registration and fusion between the planning images and the in-room images acquired during the treatment to assist patient positioning. Advanced applications are beginning to support daily dose assessment and enable adaptive radiotherapy using image registration and fusion to propagate contours and accumulate dose between image data taken over the course of therapy to provide up-to-date estimates of anatomical changes and delivered dose. This information aids in the detection of anatomical and functional changes that might elicit changes in the treatment plan or prescription. As the output of the image registration process is always used as the input of another process for planning or delivery, it is important to understand and communicate the uncertainty associated with the software in general and the result of a specific registration. Unfortunately, there is no standard mathematical formalism to perform this for real-world situations where noise, distortion, and complex anatomical variations can occur. Validation of the software systems performance is also complicated by the lack of documentation available from commercial systems leading to use of these systems in undesirable 'black-box' fashion. In view of this situation and the central role that image registration and fusion play in treatment planning and delivery, the Therapy Physics Committee of the American Association of Physicists in Medicine commissioned Task Group 132 to review current approaches and solutions for image registration (both rigid and deformable) in radiotherapy and to provide recommendations for quality assurance and quality control of these clinical processes. © 2017 American Association of Physicists in Medicine.

Do Health Care Delivery System Reforms Improve Value? The Jury Is Still Out.

PubMed

Korenstein, Deborah; Duan, Kevin; Diaz, Manuel J; Ahn, Rosa; Keyhani, Salomeh

2016-01-01

Widespread restructuring of health delivery systems is underway in the United States to reduce costs and improve the quality of health care. To describe studies evaluating the impact of system-level interventions (incentives and delivery structures) on the value of US health care, defined as the balance between quality and cost. We identified articles in PubMed (2003 to July 2014) using keywords identified through an iterative process, with reference and author tracking. We searched tables of contents of relevant journals from August 2014 through 11 August 2015 to update our sample. We included prospective or retrospective studies of system-level changes, with a control, reporting both quality and either cost or utilization of resources. Data about study design, study quality, and outcomes was extracted by one reviewer and checked by a second. Thirty reports of 28 interventions were included. Interventions included patient-centered medical home implementations (n=12), pay-for-performance programs (n=10), and mixed interventions (n=6); no other intervention types were identified. Most reports (n=19) described both cost and utilization outcomes. Quality, cost, and utilization outcomes varied widely; many improvements were small and process outcomes predominated. Improved value (improved quality with stable or lower cost/utilization or stable quality with lower cost/utilization) was seen in 23 reports; 1 showed decreased value, and 6 showed unchanged, unclear, or mixed results.Study limitations included variability among specific endpoints reported, inconsistent methodologies, and lack of full adjustment in some observational trials. Lack of standardized MeSH terms was also a challenge in the search. On balance, the literature suggests that health system reforms can improve value. However, this finding is tempered by the varying outcomes evaluated across studies with little documented improvement in outcome quality measures. Standardized measures of value would facilitate assessment of the impact of interventions across studies and better estimates of the broad impact of system change.

A situation analysis of public health interventions, barriers, and opportunities for improving maternal nutrition in Bihar, India.

PubMed

Noznesky, Elizabeth A; Ramakrishnan, Usha; Martorell, Reynaldo

2012-06-01

Maternal underweight and anemia are highly prevalent in Bihar, especially among adolescent girls aged 15 to 19 years. Although numerous programs and platforms exist for delivering efficacious interventions for improving maternal nutrition, the coverage and quality of these interventions are low. To examine existing interventions for reducing maternal undernutrition in Bihar and identify barriers to and opportunities for expanding their coverage and quality. The research was conducted in New Delhi and Bihar between May and August 2010. Forty-eight key informant interviews were conducted with policy makers, program managers, and service providers at multiple levels. Secondary data were collected from survey reports and program documents. All data were analyzed thematically. Barriers to the delivery and uptake of interventions to improve maternal nutrition include the shortage of essential inputs, low prioritization of maternal undernutrition, sterilization bias within the family planning program, weak management systems, poverty, gender inequality, caste discrimination, and flooding. In order to overcome barriers and improve service delivery, the current government and its partners have introduced structural reforms within the public health system, launched new programs for underserved groups, developed innovative approaches, and experimented with new technologies. Since coming to power, the Government of Bihar has achieved impressive increases in the coverage of prioritized health services, such as institutional deliveries and immunization. This success presents it with an excellent opportunity to further reduce maternal and infant mortality by turning its attention to the serious problem of maternal undernutrition and low birthweight.

The safety of magnetic resonance imaging in patients with programmable implanted intrathecal drug delivery systems: a 3-year prospective study.

PubMed

De Andres, Jose; Villanueva, Vicente; Palmisani, Stefano; Cerda-Olmedo, German; Lopez-Alarcon, Maria Dolores; Monsalve, Vicente; Minguez, Ana; Martinez-Sanjuan, Vicente

2011-05-01

It is common clinical practice to perform magnetic resonance imaging (MRI) in patients with indwelling programmable intrathecal drug delivery (IDD) systems, although the safety of the procedure has never been documented. We performed a single-center, 3-year, prospective evaluation in patients with a programmable implanted IDD to assess patient discomfort, IDD technical failures, and adverse effects during and after exposure to MRI. Forty-three consecutive patients with an implanted programmable IDD system (SynchroMed® EL Implantable Infusion Pump, Model 8626L-18, and SynchroMed® II Model 8637-20, 8637-40; Medtronic, Inc., Minneapolis, MN) requiring a scheduled MRI evaluation were studied during a 3-year period. All MRI scans were performed with a 1.5-tesla clinical use magnet and a specific absorption rate of no more than 0.9 W/kg. Radiograph control was used to confirm postexposure pump rotor movement and detect system dislocations. IDD system failures, patient satisfaction, and discomfort were recorded. None of the patients experienced signs of drug overinfusion that could lead to hemodynamic, respiratory, or neurologic alterations. Radiologic evaluation after MRI revealed no spatial displacements of the intrathecal catheter tip or body pump, and programmer telemetry confirmed the infusion recovery. Patients' satisfaction after the procedure was high. Performing an MRI scan with the proposed protocol in patients with an implanted Medtronic programmable IDD system resulted in virtually no technical or medical complications. © 2011 International Anesthesia Research Society

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

Guidebook for value for money assessment.

DOT National Transportation Integrated Search

2013-12-01

The Federal Highway Administrations (FHWA) Office of Innovative Program Delivery (OIPD) has developed a Public-Private Partnership (P3) Toolkit comprising tools and guidance documents to assist in educating public sector policymakers, legislative ...

The 10 Conditions That Increased Vermont's Readiness to Implement Statewide Health System Transformation.

PubMed

Grembowski, David; Marcus-Smith, Miriam

2018-06-01

Following an arduous, 6-year policy-making process, Vermont is the first state implementing a unified, statewide all-payer integrated delivery system with value-based payment, along with aligned medical and social service reforms, for almost all residents and providers in a state. Commercial, Medicare, and Medicaid value-based payment for most Vermonters will be administered through a new statewide accountable care organization in 2018-2022. The purpose of this article is to describe the 10 conditions that increased Vermont's readiness to implement statewide system transformation. The authors reviewed documents, conducted internet searches of public information, interviewed key informants annually in 2014-2016, cross-validated factual and narrative interpretation, and performed content analyses to derive conditions that increased readiness and their implications for policy and practice. Four social conditions (leadership champions; a common vision; collaborative culture; social capital and collective efficacy) and 6 support conditions (money; statewide data; legal infrastructure; federal policy promoting payment reform; delivery system transformation aligned with payment reform; personnel skilled in system reform) increased Vermont's readiness for system transformation. Vermont's experience indicates that increasing statewide readiness for reform is slow, incremental, and exhausting to overcome the sheer inertia of large fee-based systems. The new payments may work because statewide, uniform population-based payment will affect the health care of almost all Vermonters, creating statewide, uniform provider incentives to reduce volume and making the current fee-based system less viable. The conditions for readiness and statewide system transformation may be more likely in states with regulated markets, like Vermont, than in states with highly competitive markets.

Hypoxia Responsive Drug Delivery Systems in Tumor Therapy.

PubMed

Alimoradi, Houman; Matikonda, Siddharth S; Gamble, Allan B; Giles, Gregory I; Greish, Khaled

2016-01-01

Hypoxia is a common characteristic of solid tumors. It is mainly determined by low levels of oxygen resulting from imperfect vascular networks supplying most tumors. In an attempt to improve the present chemotherapeutic treatment and reduce associated side effects, several prodrug strategies have been introduced to achieve hypoxia-specific delivery of cytotoxic anticancer agents. With the advances in nanotechnology, novel delivery systems activated by the consequent outcomes of hypoxia have been developed. However, developing hypoxia responsive drug delivery systems (which only depend on low oxygen levels) is currently naïve. This review discusses four main hypoxia responsive delivery systems: polymeric based drug delivery systems, oxygen delivery systems combined with radiotherapy and chemotherapy, anaerobic bacteria which are used for delivery of genes to express anticancer proteins such as tumor necrosis alpha (TNF-α) and hypoxia-inducible transcription factors 1 alpha (HIF1α) responsive gene delivery systems.

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

Widergren, Steven E.; Knight, Mark R.; Melton, Ronald B.

The Interoperability Strategic Vision whitepaper aims to promote a common understanding of the meaning and characteristics of interoperability and to provide a strategy to advance the state of interoperability as applied to integration challenges facing grid modernization. This includes addressing the quality of integrating devices and systems and the discipline to improve the process of successfully integrating these components as business models and information technology improve over time. The strategic vision for interoperability described in this document applies throughout the electric energy generation, delivery, and end-use supply chain. Its scope includes interactive technologies and business processes from bulk energy levelsmore » to lower voltage level equipment and the millions of appliances that are becoming equipped with processing power and communication interfaces. A transformational aspect of a vision for interoperability in the future electric system is the coordinated operation of intelligent devices and systems at the edges of grid infrastructure. This challenge offers an example for addressing interoperability concerns throughout the electric system.« less

RESEARCH ON ROBUST METHODS FOR EXTRACTING AND RECOGNIZING PHOTOGRAPHY MANAGEMENT ITEMS FROM VARIOUS IMAGE DATA Of CONSTRUCTION

NASA Astrophysics Data System (ADS)

Kitagawa, Etsuji; Tanaka, Shigenori; Abiko, Satoshi; Wakabayashi, Katsuma; Jiang, Wenyuan

Recently, an electronic delivery for various documents is carried out by Ministry of Land, Infrastructure, Transport and Tourism in construction fields. One of them is image data of construction photography that must be delivered with information of photography management items such as construction name or type of works, etc. However, there is a problem that a lot of cost is needed to treat contents of these items from characters printed and handwritten on blackboard into these image data. In this research, we develop the system which can treat contents of these items by extracting contents of these items from the image data of construction photography taken in various scenes with preprocessing the image, recognizing characters with OCR and correcting error with natural language process. And we confirm the effectiveness of the system, by experimenting in each function of system and in entire system.

Anticholinergics and Central Nervous System Effects: Are We Confused?

PubMed Central

Staskin, David R; Zoltan, Edward

2007-01-01

The central nervous system (CNS) effects of anticholinergic agents have been documented in various patient populations and to varying degrees in case reports, brain-activity surrogates, and computerized cognitive testing. The older patient population with overactive bladder represents a group at increased risk of cognitive impairment and other CNS side effects associated with antimuscarinic agents. The complexity of the effect of anticholinergic agents on CNS function requires an increased level of careful investigation. Studies need to be performed in the at-risk population with multiple, validated tests at clinically prescribed doses in acute and chronic situations. These studies need to take into account the effect of commonly prescribed dosing regimens, with doses selected to represent with equivalent bladder potency. The alterations in the serum levels and parent/metabolite effects contributed by metabolic issues or drug delivery systems require special attention. PMID:18231615

Implementation of Electronic Checklists in an Oncology Medical Record: Initial Clinical Experience

PubMed Central

Albuquerque, Kevin V.; Miller, Alexis A.; Roeske, John C.

2011-01-01

Purpose: The quality of any medical treatment depends on the accurate processing of multiple complex components of information, with proper delivery to the patient. This is true for radiation oncology, in which treatment delivery is as complex as a surgical procedure but more dependent on hardware and software technology. Uncorrected errors, even if small or infrequent, can result in catastrophic consequences for the patient. We developed electronic checklists (ECLs) within the oncology electronic medical record (EMR) and evaluated their use and report on our initial clinical experience. Methods: Using the Mosaiq EMR, we developed checklists within the clinical assessment section. These checklists are based on the process flow of information from one group to another within the clinic and enable the processing, confirmation, and documentation of relevant patient information before the delivery of radiation therapy. The clinical use of the ECL was documented by means of a customized report. Results: Use of ECL has reduced the number of times that physicians were called to the treatment unit. In particular, the ECL has ensured that therapists have a better understanding of the treatment plan before the initiation of treatment. An evaluation of ECL compliance showed that, with additional staff training, > 94% of the records were completed. Conclusion: The ECL can be used to ensure standardization of procedures and documentation that the pretreatment checks have been performed before patient treatment. We believe that the implementation of ECLs will improve patient safety and reduce the likelihood of treatment errors. PMID:22043184

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care.

PubMed

Cifuentes, Maribel; Davis, Melinda; Fernald, Doug; Gunn, Rose; Dickinson, Perry; Cohen, Deborah J

2015-01-01

This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews. Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs. Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators. © Copyright 2015 by the American Board of Family Medicine.

An emerging occupational rehabilitation system in the People's Republic of China.

PubMed

Tang, Dan; Chen, Gang; Xu, Yan-Wen; Hui-Lo, Karen Y L; Luo, Xiao-Yuan; Chan, Chetwyn C H

2011-03-01

China has become a major economic influence in Asia and globally. The country is in the position to further develop its workers' insurance and compensation system. This paper aims to introduce the existing workers' compensation policies, explain how these policies guide the operation of the occupational rehabilitation system for injured workers, and suggest ways to further develop an effective and sustainable system for the country. Major government policies and initiative documents and existing literature on occupational rehabilitation were critically reviewed. Shortfalls in our current system were identified and potential further development regimes were propose. Since 2004, China has implemented its national policy on providing timely and comprehensive rehabilitation and return-to-work interventions for workers who are injured at work. The three-tier medical and occupational rehabilitation system appears effective for enabling injured workers to access these services. Such a system is regarded as the most optimal for the country in spearheading the development of quality occupational rehabilitation services, and at the same time incorporating the existing expertise in acute medical care and rehabilitation within the public medical and health system. Problems encountered in the system can be classified under the culture, system and competence building aspects. The future workers' insurance and compensation system can probably put more emphasis on using bio-psychosocial and work disability prevention models in guiding its service development and delivery. Efforts need to be placed on building the competence of professionals in the system who provide services for injured workers. The empowerment of important stakeholders in the workers' insurance and compensation system and their inclusion in the planning of service delivery are crucial for developing a sustainable and effective system for China.

Modeling Standards of Care for an Online Environment

PubMed Central

Jones-Schenk, Jan; Rossi, Julia

1998-01-01

At Intermountain Health Care in Salt Lake City a team was created to develop core standards for clinical practice that would enhance consistency of care across the care continuum. The newly developed Standards of Care had to meet the following criteria: electronic delivery, research-based, and support an interdisciplinary care environment along with an exception-based documentation system. The process has slowly evolved and the team has grown to include clinicians from multiple sites and disciplines who have met on a regular basis for over a year. The first challenge was to develop a model for the standards of care that would be suitable for an online environment.

Enhancing point of care vigilance using computers.

PubMed

St Jacques, Paul; Rothman, Brian

2011-09-01

Information technology has the potential to provide a tremendous step forward in perioperative patient safety. Through automated delivery of information through fixed and portable computer resources, clinicians may achieve improved situational awareness of the overall operation of the operating room suite and the state of individual patients in various stages of surgical care. Coupling the raw, but integrated, information with decision support and alerting algorithms enables clinicians to achieve high reliability in documentation compliance and response to care protocols. Future studies and outcomes analysis are needed to quantify the degree of benefit of these new components of perioperative information systems. Copyright © 2011 Elsevier Inc. All rights reserved.

Patient Perceptions About Data Sharing & Privacy: Insights from ActionADE.

PubMed

Small, Serena S; Peddie, David; Ackerley, Christine; Hohl, Corinne M; Balka, Ellen

2017-01-01

Information communication technologies (ICTs) may improve health delivery by enhancing informational continuity of care and enabling secondary use of health data including public health surveillance and research. ICTs also introduce concerns related to privacy. In this paper, we examine and address this tension in the context of the development and implementation of a novel platform that will enable the documentation and communication of patient-specific ADE information, titled ActionADE. We explored privacy concerns qualitatively from the perspective of patients. Our findings will inform a series of recommendations for system design that seek to balance the need to both share and protect personal health information.

Value in Pediatric Orthopaedic Surgery Health Care: the Role of Time-driven Activity-based Cost Accounting (TDABC) and Standardized Clinical Assessment and Management Plans (SCAMPs).

PubMed

Waters, Peter M

2015-01-01

The continuing increases in health care expenditures as well as the importance of providing safe, effective, timely, patient-centered care has brought government and commercial payer pressure on hospitals and providers to document the value of the care they deliver. This article introduces work at Boston Children's Hospital on time-driven activity-based accounting to determine cost of care delivery; combined with Systemic Clinical Assessment and Management Plans to reduce variation and improve outcomes. The focus so far has been on distal radius fracture care for children and adolescents.

Advanced Materials and Processing for Drug Delivery: The Past and the Future

PubMed Central

Zhang, Ying; Chan, Hon Fai; Leong, Kam W.

2012-01-01

Design and synthesis of efficient drug delivery systems are of vital importance for medicine and healthcare. Materials innovation and nanotechnology have synergistically fueled the advancement of drug delivery. Innovation in material chemistry allows the generation of biodegradable, biocompatible, environment-responsive, and targeted delivery systems. Nanotechnology enables control over size, shape and multi-functionality of particulate drug delivery systems. In this review, we focus on the materials innovation and processing of drug delivery systems and how these advances have shaped the past and may influence the future of drug delivery. PMID:23088863

Document Delivery Capabilities of Major Biomedical Libraries in 1968: Results of a National Survey Employing Standardized Tests *

PubMed Central

Orr, Richard H.; Schless, Arthur P.

1972-01-01

The standardized Document Delivery Tests (DDT's) developed earlier (Bulletin 56: 241-267, July 1968) were employed to assess the capability of ninety-two medical school libraries for meeting the document needs of biomedical researchers, and the capability of fifteen major resource libraries for filling I-L requests from biomedical libraries. The primary test data are summarized as statistics on the observed availability status of the 300 plus documents in the test samples, and as measures expressing capability as a function of the mean time that would be required for users to obtain test sample documents. A mathematical model is developed in which the virtual capability of a library, as seen by its users, equals the algebraic sum of the basic capability afforded by its holdings; the combined losses attributable to use of its collection, processing, relative inacessibility, and housekeeping problems; and the gain realized by coupling with other resources (I-L borrowing). For a particular library, or group of libraries, empirical values for each of these variables can be calculated easily from the capability measures and the status statistics. Regression equations are derived that provide useful predictions of basic capability from collection size. The most important result of this work is that cost-effectiveness analyses can now be used as practical decision aids in managing a basic library service. A program of periodic surveys and further development of DDT's is recommended as appropriate for the Medical Library Association. PMID:5054305

Guidebook for risk assessment in public private partnerships.

DOT National Transportation Integrated Search

2013-12-01

The Federal Highway Administrations (FHWA) Office of Innovative Program Delivery (OIPD) has developed a P3 Toolkit comprising tools and guidance documents to assist in educating public sector policymakers, legislative and executive staff, and tran...

Reporting of feasibility factors in publications on integrated treatment programs for women with substance abuse issues and their children: a systematic review and analysis.

PubMed

Henderson, Joanna; Milligan, Karen; Niccols, Alison; Thabane, Lehana; Sword, Wendy; Smith, Ainsley; Rosenkranz, Susan

2012-12-07

Implementation of evidence-based practices in real-world settings is a complex process impacted by many factors, including intervention, dissemination, service provider, and organizational characteristics. Efforts to improve knowledge translation have resulted in greater attention to these factors. Researcher attention to the applicability of findings to applied settings also has increased. Much less attention, however, has been paid to intervention feasibility, an issue important to applied settings. In a systematic review of 121 documents regarding integrated treatment programs for women with substance abuse issues and their children, we examined the presence of feasibility-related information. Specifically, we analysed study descriptions for information regarding feasibility factors in six domains (intervention, practitioner, client, service delivery, organizational, and service system). On average, fewer than half of the 25 feasibility details assessed were included in the documents. Most documents included some information describing the participating clients, the services offered as part of the intervention, the location of services, and the expected length of stay or number of sessions. Only approximately half of the documents included specific information about the treatment model. Few documents indicated whether the intervention was manualized or whether the intervention was preceded by a standardized screening or assessment process. Very few provided information about the core intervention features versus the features open to local adaptation, or the staff experience or training required to deliver the intervention. As has been found in reviews of intervention studies in other fields, our findings revealed that most documents provide some client and intervention information, but few documents provided sufficient information to fully evaluate feasibility. We consider possible explanations for the paucity of feasibility information and provide suggestions for better reporting to promote diffusion of evidence-based practices.

Health promotion in South Africa.

PubMed

Onya, Hans

2007-01-01

Health promotion first entered the South African health system in 1990. Today, Health Promotion is a Directorate located within the Social Sector Cluster (SSC) within Primary Health Care (PHC), District and Development operations which falls under the Deputy Director General for Health Service Delivery in the National Department of Health (DoH). The first significant piece of new policy for health promotion in South Africa appeared in the African National Congress (ANC) health policy document, health care services including reproductive health care. At the moment, health promotion service delivery is the responsibility of the national, provincial and local governments with provincial and local governments mainly implementing and the National Health Promotion Directorate offering support. Funding for health promotion activities comes from the Department of Health budget allocation by the National Treasury. One major problem for Health Promotion development is infrastructure. There is significant community participation in South Africa including health promotion policy and strategy document development. Health Promotion research and evaluation is limited. The National Department of Health considers the settings approach to be crucial in driving the progress of health promotion. There are very few trained health promotion specialists either capable or in the position to inform politicians and opinion leaders about the relationship between health and social determinants, and the evidence of effectiveness of health promotion action. Mechanisms for demonstrating evidence of health promotion effectiveness in terms of health, social, economic and political impact are lacking and occupational standards for health promotion education and training are needed.

Local sustained delivery of acetylsalicylic acid via hybrid stent with biodegradable nanofibers reduces adhesion of blood cells and promotes reendothelialization of the denuded artery

PubMed Central

Lee, Cheng-Hung; Lin, Yu-Huang; Chang, Shang-Hung; Tai, Chun-Der; Liu, Shih-Jung; Chu, Yen; Wang, Chao-Jan; Hsu, Ming-Yi; Chang, Hung; Chang, Gwo-Jyh; Hung, Kuo-Chun; Hsieh, Ming-Jer; Lin, Fen-Chiung; Hsieh, I-Chang; Wen, Ming-Shien; Huang, Yenlin

2014-01-01

Incomplete endothelialization, blood cell adhesion to vascular stents, and inflammation of arteries can result in acute stent thromboses. The systemic administration of acetylsalicylic acid decreases endothelial dysfunction, potentially reducing thrombus, enhancing vasodilatation, and inhibiting the progression of atherosclerosis; but, this is weakened by upper gastrointestinal bleeding. This study proposes a hybrid stent with biodegradable nanofibers, for the local, sustained delivery of acetylsalicylic acid to injured artery walls. Biodegradable nanofibers are prepared by first dissolving poly(D,L)-lactide-co-glycolide and acetylsalicylic acid in 1,1,1,3,3,3-hexafluoro-2-propanol. The solution is then electrospun into nanofibrous tubes, which are then mounted onto commercially available bare-metal stents. In vitro release rates of pharmaceuticals from nanofibers are characterized using an elution method, and a highperformance liquid chromatography assay. The experimental results suggest that biodegradable nanofibers release high concentrations of acetylsalicylic acid for three weeks. The in vivo efficacy of local delivery of acetylsalicylic acid in reducing platelet and monocyte adhesion, and the minimum tissue inflammatory reaction caused by the hybrid stents in treating denuded rabbit arteries, are documented. The proposed hybrid stent, with biodegradable acetylsalicylic acid-loaded nanofibers, substantially contributed to local, sustained delivery of drugs to promote re-endothelialization and reduce thrombogenicity in the injured artery. The stents may have potential applications in the local delivery of cardiovascular drugs. Furthermore, the use of hybrid stents with acetylsalicylic acid-loaded nanofibers that have high drug loadings may provide insight into the treatment of patients with high risk of acute stent thromboses. PMID:24421640

Implementation of a web-based medication tracking system in a large academic medical center.

PubMed

Calabrese, Sam V; Williams, Jonathan P

2012-10-01

Pharmacy workflow efficiencies achieved through the use of an electronic medication-tracking system are described. Medication dispensing turnaround times at the inpatient pharmacy of a large hospital were evaluated before and after transition from manual medication tracking to a Web-based tracking process involving sequential bar-code scanning and real-time monitoring of medication status. The transition was carried out in three phases: (1) a workflow analysis, including the identification of optimal points for medication scanning with hand-held wireless devices, (2) the phased implementation of an automated solution and associated hardware at a central dispensing pharmacy and three satellite locations, and (3) postimplementation data collection to evaluate the impact of the new tracking system and areas for improvement. Relative to the manual tracking method, electronic medication tracking allowed the capture of far more data points, enabling the pharmacy team to delineate the time required for each step of the medication dispensing process and to identify the steps most likely to involve delays. A comparison of baseline and postimplementation data showed substantial reductions in overall medication turnaround times with the use of the Web-based tracking system (time reductions of 45% and 22% at the central and satellite sites, respectively). In addition to more accurate projections and documentation of turnaround times, the Web-based tracking system has facilitated quality-improvement initiatives. Implementation of an electronic tracking system for monitoring the delivery of medications provided a comprehensive mechanism for calculating turnaround times and allowed the pharmacy to identify bottlenecks within the medication distribution system. Altering processes removed these bottlenecks and decreased delivery turnaround times.

SEASAT study documentation

NASA Technical Reports Server (NTRS)

1974-01-01

The proposed spacecraft consists of a bus module, containing all subsystems required for support of the sensors, and a payload module containing all of the sensor equipment. The two modules are bolted together to form the spacecraft, and electrical interfaces are accomplished via mated connectors at the interface plane. This approach permits independent parallel assembly and test operations on each module up until mating for final spacecraft integration and test operations. Proposed program schedules recognize the need to refine sensor/spacecraft interfaces prior to proceeding with procurement, reflect the lead times estimated by suppliers for delivery of equipment, reflect a comprehensive test program, and provide flexibility for unanticipated problems. The spacecraft systems are described in detail along with aerospace ground equipment, ground handling equipment, the launch vehicle, imaging radar incorporation, and systems tests.

Blunting the Talons. The Impact of Peace Operations Deployments on USAF Fighter Crew Combat Skills

DTIC Science & Technology

1999-01-01

Bomb Accuracy 74 Figure 5.16 - Typical Medium Altitude LGB Delivery 75 Figure 6.1 - Graph of Air-to-air Missile Shot Groups Showing Number of Shots...Between F-16C LGB and LALD/HD Practice Deliveries October 1997 Through February 1998 77 XI SUMMARY This document presents an analysis of the impact...intensive training promoted acted as a deterrent that reduced the chances war would occur - enhancing global stability. Thus, for the first 40

Delivery and postpartum practices among new mothers in Laputta, Myanmar: intersecting traditional and modern practices and beliefs.

PubMed

Diamond-Smith, Nadia; Thet, May Me; Khaing, Ei Ei; Sudhinaraset, May

2016-09-01

Myanmar is witnessing increased access to modern maternity care, along with shifting norms and practices. Past research has documented low rates of facility-based deliveries in the country, along with adverse maternal and child health outcomes. Research has also documented diverse traditional practices in the postpartum period, related to maternity care and maternal food intake. Through 34 qualitative interviews with women who recently gave birth and their mothers-in-law in one township in Myanmar (Laputta), we explore factors influencing decision-making around postpartum care and the practices that women engage in. We find that women use both modern and traditional providers because different types of providers play particular roles in the delivery and postpartum period. Despite knowledge of about healthy foods to eat postpartum, many women restrict the intake of certain foods, and mothers-in-laws' beliefs in these practices are particularly strong. Findings suggest that women and their families are balancing two different sets of practices and beliefs, which at times come in conflict. Educational campaigns and programmes should address both modern and traditional beliefs and practices to help women be better able to access safe care and improve their own and their children's health.

Continuing Professional Education Delivery Systems.

ERIC Educational Resources Information Center

Weeks, James P.

This investigation of delivery systems for continuing professional education provides an overview of current operational delivery systems in continuing professional education, drawing on experience as found in the literature. Learning theories and conclusions are woven into the descriptive text. Delivery systems profiled in the paper include the…

Interpreting Field-based Observations of Complex Fluvial System Behavior through Theory and Numerical Models: Examples from the Ganges-Brahmaputra-Meghna Delta

NASA Astrophysics Data System (ADS)

Sincavage, R.; Goodbred, S. L., Jr.; Pickering, J.; Diamond, M. S.; Paola, C.; Liang, M.

2016-12-01

Field observations of depositional systems using outcrop, borehole, and geophysical data stimulate ideas regarding process-based creation of the sedimentary record. Theory and numerical modeling provide insight into the often perplexing nature of these systems by isolating the processes responsible for the observed response. An extensive dataset of physical and chemical sediment properties from field data in the Ganges-Brahmaputra-Meghna Delta (GBMD) indicate the presence of complex, multi-dimensional fluvial system behaviors. Paleodischarges during the last lowstand were insufficient to generate paleovalley geometries and transport boulder-sized basal gravel as observed in densely-spaced (3-5 km) borehole data and a 255 km long fluvial multichannel seismic survey. Instead, uniform flow-derived flood heights and Shields-derived flow velocities based on measured field observations support the conclusion that previously documented megafloods conveyed through the Tsangpo Gorge created the antecedent topography upon which the Holocene sediment dispersal system has since evolved. In the fault-bounded Sylhet Basin east of the main valley system, borehole data reveal three principal mid-Holocene sediment delivery pathways; two that terminate in the basin interior and exhibit rapid mass extraction, and one located along the western margin of Sylhet Basin that serves to bypass the basin interior to downstream depocenters. In spite of topographically favorable conditions and enhanced subsidence rates for delivery into the basin, the fluvial system has favored the bypass-dominated pathway, leaving the central basin perennially underfilled. A "hydrologic barrier" effect from seasonally high monsoon-lake levels has been proposed as a mechanism that precludes sediment delivery to Sylhet Basin. However, numerical models with varying lake level heights indicate that the presence or absence of a seasonal lake has little effect on channel path selection. Rather, it appears that pre-existing topography, such as the megaflood-related scours, are a first order control on sediment routing patterns within Sylhet Basin. Applying observational data to numerical models and theory have helped us gain insight into complex fluvial system behavior in this high discharge, tectonically-influenced delta.

Failure mode and effect analysis-based quality assurance for dynamic MLC tracking systems

PubMed Central

Sawant, Amit; Dieterich, Sonja; Svatos, Michelle; Keall, Paul

2010-01-01

Purpose: To develop and implement a failure mode and effect analysis (FMEA)-based commissioning and quality assurance framework for dynamic multileaf collimator (DMLC) tumor tracking systems. Methods: A systematic failure mode and effect analysis was performed for a prototype real-time tumor tracking system that uses implanted electromagnetic transponders for tumor position monitoring and a DMLC for real-time beam adaptation. A detailed process tree of DMLC tracking delivery was created and potential tracking-specific failure modes were identified. For each failure mode, a risk probability number (RPN) was calculated from the product of the probability of occurrence, the severity of effect, and the detectibility of the failure. Based on the insights obtained from the FMEA, commissioning and QA procedures were developed to check (i) the accuracy of coordinate system transformation, (ii) system latency, (iii) spatial and dosimetric delivery accuracy, (iv) delivery efficiency, and (v) accuracy and consistency of system response to error conditions. The frequency of testing for each failure mode was determined from the RPN value. Results: Failures modes with RPN≥125 were recommended to be tested monthly. Failure modes with RPN<125 were assigned to be tested during comprehensive evaluations, e.g., during commissioning, annual quality assurance, and after major software∕hardware upgrades. System latency was determined to be ∼193 ms. The system showed consistent and accurate response to erroneous conditions. Tracking accuracy was within 3%–3 mm gamma (100% pass rate) for sinusoidal as well as a wide variety of patient-derived respiratory motions. The total time taken for monthly QA was ∼35 min, while that taken for comprehensive testing was ∼3.5 h. Conclusions: FMEA proved to be a powerful and flexible tool to develop and implement a quality management (QM) framework for DMLC tracking. The authors conclude that the use of FMEA-based QM ensures efficient allocation of clinical resources because the most critical failure modes receive the most attention. It is expected that the set of guidelines proposed here will serve as a living document that is updated with the accumulation of progressively more intrainstitutional and interinstitutional experience with DMLC tracking. PMID:21302802

A retrospective review of performance and utility of routine clinical pelvimetry.

PubMed

Blackadar, Charles S; Viera, Anthony J

2004-01-01

Some authorities have questioned the utility of performing clinical pelvimetry as part of routine prenatal care. This study determined the frequency with which clinical pelvimetry is still performed at two military hospitals and whether the results of pelvimetry influence the management of labor and delivery. We conducted a retrospective review of prenatal records at two military hospitals. One was an overseas hospital, and one was a family medicine teaching hospital in the United States. The records of 660 pregnant women were reviewed to identify documentation that pelvimetry was performed during prenatal care and whether there was evidence that the physician managing labor and delivery altered management based on pelvimetry results. Seventy percent (461) of the 660 records reviewed had all pelvimetry measurements documented as normal, or the provider had written "good for TOL (trial of labor)," "proven to XX pounds," or similar annotation that pelvimetry was normal. Nine percent (58 records) had no documentation of pelvimetry (pelvimetry section left blank). The remaining 21% (141 charts) had at least one pelvimetry measurement listed as abnormal on the initial prenatal exam. No admission note, progress note, or operative note recorded during labor and delivery made reference to clinical pelvimetry results. No abnormal pelvimetry result was referenced in follow-up visits or appeared to make any difference in mode of delivery or treatment in labor. Two women (one at each institution) had initial visit notes indicating the need to consider radiographic pelvimetry based on the results of clinical exam, but this test was not done in either case, and both women delivered vaginally. Our study indicates that clinical pelvimetry does not change management of pregnant patients. Current practice is to allow all women a trial of labor regardless of pelvimetry results. This makes the routine performance and recording of clinical pelvimetry a waste of time, a potential liability, and an unnecessary discomfort for patients.

Comparative health systems research among Kaiser Permanente and other integrated delivery systems: a systematic literature review.

PubMed

Maeda, Jared Lane K; Lee, Karen M; Horberg, Michael

2014-01-01

Because of rising health care costs, wide variations in quality, and increased patient complexity, the US health care system is undergoing rapid changes that include payment reform and movement toward integrated delivery systems. Well-established integrated delivery systems, such as Kaiser Permanente (KP), should work to identify the specific system-level factors that result in superior patient outcomes in response to policymakers' concerns. Comparative health systems research can provide insights into which particular aspects of the integrated delivery system result in improved care delivery. To provide a baseline understanding of comparative health systems research related to integrated delivery systems and KP. Systematic literature review. We conducted a literature search on PubMed and the KP Publications Library. Studies that compared KP as a system or organization with other health care systems or across KP facilities internally were included. The literature search identified 1605 articles, of which 65 met the study inclusion criteria and were examined by 3 reviewers. Most comparative health systems studies focused on intra-KP comparisons (n = 42). Fewer studies compared KP with other US (n = 15) or international (n = 12) health care systems. Several themes emerged from the literature as possible factors that may contribute to improved care delivery in integrated delivery systems. Of all studies published by or about KP, only a small proportion of articles (4%) was identified as being comparative health systems research. Additional empirical studies that compare the specific factors of the integrated delivery system model with other systems of care are needed to better understand the "system-level" factors that result in improved and/or diminished care delivery.

42 CFR 35.51 - Manner of delivery; costs, receipts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... to him at the expense of the United States in the most economical manner available. The records of..., and other valuable papers and documents shall be sent by registered mail (or other safe means). (c...

International Guide to Highway Transportation Information: Volume 3 - Document Delivery Suppliers

DOT National Transportation Integrated Search

2013-08-01

In 2007, the Road Weather Management Program (RWMP) conducted a study with stakeholders from the transportation and meteorological communities to define eleven performance measures that would enable the Federal Highway Administration (FHWA) to determ...

12 CFR 7.1016 - Independent undertakings to pay against documents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Publishing Co., 1/800/328-4880); the Uniform Customs and Practice for Documentary Credits (International..., operational, and market risk: (i) In the event that the undertaking is to honor by delivery of an item of...

Docster: The Future of Document Delivery?

ERIC Educational Resources Information Center

Chudnov, Daniel

2000-01-01

Considers the possibility of a bibliographic management tool that combines file storage with a Napster-like communications protocol, called docster. Explains Napster and discusses copyright issues, interlibrary loans, infrastructure, security concerns, the library's role, and online publishing. (LRW)

Modeling the Distribution of Nursing Effort Using Structured Labor and Delivery Documentation

PubMed Central

Hall, Eric S.; Poynton, Mollie R.; Narus, Scott P.; Thornton, Sidney N.

2008-01-01

Our study objectives included the development and evaluation of models for representing the distribution of shared unit-wide nursing care resources among individual Labor and Delivery patients using quantified measurements of nursing care, referred to as Nursing Effort. The models were intended to enable discrimination between the amounts of care delivered to patient subsets defined by attributes such as patient acuity. For each of five proposed models, scores were generated using an analysis set of 686,402 computerized nurse-documented events associated with 1,093 patients at three hospitals during January and February 2006. Significant differences were detected in Nursing Effort scores according to patient acuity, care facility, and in scores generated during shift-change versus non shift-change hours. The development of nursing care quantification strategies proposed in this study supports outcomes analysis by establishing a foundation for measuring the effect of patient-level nursing care on individual patient outcomes. PMID:18495549

Communications data delivery system analysis task 2 report : high-level options for secure communications data delivery systems.

DOT National Transportation Integrated Search

2012-05-16

This Communications Data Delivery System Analysis Task 2 report describes and analyzes options for Vehicle to Vehicle (V2V) and Vehicle to Infrastructure (V2I) communications data delivery systems using various communication media (Dedicated Short Ra...

Drug delivery systems with modified release for systemic and biophase bioavailability.

PubMed

Leucuta, Sorin E

2012-11-01

This review describes the most important new generations of pharmaceutical systems: medicines with extended release, controlled release pharmaceutical systems, pharmaceutical systems for the targeted delivery of drug substances. The latest advances and approaches for delivering small molecular weight drugs and other biologically active agents such as proteins and nucleic acids require novel delivery technologies, the success of a drug being many times dependent on the delivery method. All these dosage forms are qualitatively superior to medicines with immediate release, in that they ensure optimal drug concentrations depending on specific demands of different disease particularities of the body. Drug delivery of these pharmaceutical formulations has the benefit of improving product efficacy and safety, as well as patient convenience and compliance. This paper describes the biopharmaceutical, pharmacokinetic, pharmacologic and technological principles in the design of drug delivery systems with modified release as well as the formulation criteria of prolonged and controlled release drug delivery systems. The paper presents pharmaceutical prolonged and controlled release dosage forms intended for different routes of administration: oral, ocular, transdermal, parenteral, pulmonary, mucoadhesive, but also orally fast dissolving tablets, gastroretentive drug delivery systems, colon-specific drug delivery systems, pulsatile drug delivery systems and carrier or ligand mediated transport for site specific or receptor drug targeting. Specific technologies are given on the dosage forms with modified release as well as examples of marketed products, and current research in these areas.

Acquisition plan for Digital Document Storage (DDS) prototype system

NASA Technical Reports Server (NTRS)

1990-01-01

NASA Headquarters maintains a continuing interest in and commitment to exploring the use of new technology to support productivity improvements in meeting service requirements tasked to the NASA Scientific and Technical Information (STI) Facility, and to support cost effective approaches to the development and delivery of enhanced levels of service provided by the STI Facility. The DDS project has been pursued with this interest and commitment in mind. It is believed that DDS will provide improved archival blowback quality and service for ad hoc requests for paper copies of documents archived and serviced centrally at the STI Facility. It will also develop an operating capability to scan, digitize, store, and reproduce paper copies of 5000 NASA technical reports archived annually at the STI Facility and serviced to the user community. Additionally, it will provide NASA Headquarters and field installations with on-demand, remote, electronic retrieval of digitized, bilevel, bit mapped report images along with branched, nonsequential retrieval of report subparts.

Strengthening primary healthcare through community involvement in Cross River State, Nigeria: a descriptive study

PubMed Central

Adie, Hilary; Igbang, Thomas; Otu, Akaninyene; Braide, Ekanem; Okon, Okpok; Ikpi, Edet; Joseph, Charles; Desousa, Alexander; Sommerfeld, Johannes

2014-01-01

Introduction In preparation for implementation of primary healthcare (PHC) services in Cross River State, a study to identify perceptions of communities and health systems concerning such interventions was conducted. Methods Existing PHC practices were documented through observation and document reviews, including facility checklists at frontline levels. Perceptions of consumers and providers on PHC were elucidated through 32 Focus Group Discussions (FGDs) and 78 semi-structured questionnaires. Results There was some level of implementation of the Nigerian PHC policy in the study districts. However, this policy emphasized curative instead of preventive services. Private partners perceived healthcare programmes as largely donor driven with poor release of allocations for health by government. Conclusion Both providers and consumers presented similar perceptions on the current PHC implementation and similar perspectives on services to be prioritized. These common views together with their on-going participatory experience are important platforms for strengthening community participation in the delivery of PHC. PMID:25237418

Evidence for overuse of medical services around the world.

PubMed

Brownlee, Shannon; Chalkidou, Kalipso; Doust, Jenny; Elshaug, Adam G; Glasziou, Paul; Heath, Iona; Nagpal, Somil; Saini, Vikas; Srivastava, Divya; Chalmers, Kelsey; Korenstein, Deborah

2017-07-08

Overuse, which is defined as the provision of medical services that are more likely to cause harm than good, is a pervasive problem. Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries. Overuse of unneeded services can harm patients physically and psychologically, and can harm health systems by wasting resources and deflecting investments in both public health and social spending, which is known to contribute to health. Although harms from overuse have not been well quantified and trends have not been well described, overuse is likely to be increasing worldwide. Copyright © 2017 Elsevier Ltd. All rights reserved.

Tanzania Health Information Technology (T-HIT) System: Pilot Test of a Tablet-Based System to Improve Prevention of Mother-to-Child Transmission of HIV.

PubMed

Bull, Sheana; Thomas, Deborah Sk; Nyanza, Elias C; Ngallaba, Sospatro E

2018-01-15

The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention compared with a traditional system of paper logs, suggesting potential for improvements in antenatal care for women at risk for HIV. ©Sheana Bull, Deborah SK Thomas, Elias C Nyanza, Sospatro E Ngallaba. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 15.01.2018.

Tanzania Health Information Technology (T-HIT) System: Pilot Test of a Tablet-Based System to Improve Prevention of Mother-to-Child Transmission of HIV

PubMed Central

Bull, Sheana; Nyanza, Elias C; Ngallaba, Sospatro E

2018-01-01

Background The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. Objective The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. Methods We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Results Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. Conclusions T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention compared with a traditional system of paper logs, suggesting potential for improvements in antenatal care for women at risk for HIV. PMID:29335236

The impact of a preloaded intraocular lens delivery system on operating room efficiency in routine cataract surgery.

PubMed

Jones, Jason J; Chu, Jeffrey; Graham, Jacob; Zaluski, Serge; Rocha, Guillermo

2016-01-01

The aim of this study was to evaluate the operational impact of using preloaded intraocular lens (IOL) delivery systems compared with manually loaded IOL delivery processes during routine cataract surgeries. Time and motion data, staff and surgery schedules, and cost accounting reports were collected across three sites located in the US, France, and Canada. Time and motion data were collected for manually loaded IOL processes and preloaded IOL delivery systems over four surgery days. Staff and surgery schedules and cost accounting reports were collected during the 2 months prior and after introduction of the preloaded IOL delivery system. The study included a total of 154 routine cataract surgeries across all three sites. Of these, 77 surgeries were performed using a preloaded IOL delivery system, and the remaining 77 surgeries were performed using a manual IOL delivery process. Across all three sites, use of the preloaded IOL delivery system significantly decreased mean total case time by 6.2%-12.0% (P<0.001 for data from Canada and the US and P<0.05 for data from France). Use of the preloaded delivery system also decreased surgeon lens time, surgeon delays, and eliminated lens touches during IOL preparation. Compared to a manual IOL delivery process, use of a preloaded IOL delivery system for cataract surgery reduced total case time, total surgeon lens time, surgeon delays, and eliminated IOL touches. The time savings provided by the preloaded IOL delivery system provide an opportunity for sites to improve routine cataract surgery throughput without impacting surgeon or staff capacity.

Assessment of umbilical artery flow and fetal heart rate to predict delivery time in bitches.

PubMed

Giannico, Amália Turner; Garcia, Daniela Aparecida Ayres; Gil, Elaine Mayumi Ueno; Sousa, Marlos Gonçalves; Froes, Tilde Rodrigues

2016-10-15

The aim of this study was to quantitatively investigate the oscillation of the fetal heart rate (HR) in advance of normal delivery and whether this index could be used to indicate impending delivery. In addition, fetal HR oscillation and umbilical artery resistive index (RI) were correlated to determine if the combination of these parameters provided a more accurate prediction of the time of delivery. Sonographic evaluation was performed in 11 pregnant bitches to evaluate the fetal HR and umbilical artery RI at the following antepartum times: 120 to 96 hours, 72 to 48 hours, 24 to 12 hours, and 12 to 1 hours. Statistical analysis indicated a correlation between the oscillation of fetal HR and the umbilical artery RI. As delivery approached a considerable reduction in the umbilical artery RI was documented and greater oscillations between maximum and minimum HRs occurred. We conclude that the quantitative analysis of fetal HR oscillations may be used to predict the time of delivery in bitches. The combination of fetal HR and umbilical artery RI together may provide more accurate predictions of time of delivery. Copyright © 2016 Elsevier Inc. All rights reserved.

Improving iSC performance through outsourcing - Considerations for using third-party service providers to increase innovation, capacity and efficiency.

PubMed

Wright, Martin; Forster, Gary; Beale, John

2017-04-19

Development partners and donors have encouraged and incentivized governments in developing countries to explore ways of working with third-party service suppliers to reduce costs and increase service delivery capacity. The distribution of vaccines and medicines has for a long time shown demand for outsourcing but public health systems have struggled to develop the expertise and capital assets necessary to manage such ventures. Existing transport and logistics capacity within public health systems, in particular, is well documented as being insufficient to support existing, let alone future immunization needs. Today, a number of countries are contracting party logistics providers (3PLs) to supplement the in-house distribution operations of public health systems. This commentary reflects on recent, leading examples of outsourcing initiatives to address critical gaps in transport and logistics. Copyright © 2017. Published by Elsevier Ltd.

Recommendations resulting from the SPDS Community-Wide Workshop

NASA Technical Reports Server (NTRS)

1993-01-01

The Data Systems Panel identified three critical functionalities of a Space Physics Data System (SPDS): the delivery of self-documenting data, the existence of a matrix of translators between various standard formats (IDFS, CDF, netCDF, HDF, TENNIS, UCLA flat file, and FITS), and a network-based capability for browsing and examining inventory records for the system's data holdings. The recommendations resulting from the workshop include the philosophy, funding, and objectives of a SPDS. Access to quality data is seen as the most important objective by the Policy Panel, with curation and information about the data being integral parts of any accessible data set. The Data Issues Panel concluded that the SPDS can supply encouragement, guidelines, and ultimately provide a mechanism for financial support for data archiving, restoration, and curation. The Software Panel of the SPDS focused on defining the requirements and priorities for SPDS to support common data analysis and data visualization tools and packages.

Commentary: is CIT today's lobotomy?

PubMed

Geller, Jeffrey L

2008-01-01

Birthed in Memphis, Tennessee, in 1988, Crisis Intervention Teams (CITs) have had remarkable growth spurts with few, if any, developmental milestones to document their progress. Compton and colleagues investigated the evidence basis for CIT and found very little. They perhaps found even more than there actually is. There are contributions to CIT outcomes that are rooted in local variations in mental health services and regional culture. These are considered in this commentary, using Memphis as the example. None of us should be surprised that reform is evidence-absent. The mental illness delivery system and the criminal justice system have been instituting reform, and these reforms have had reverberating changes between the two systems, with little or no data to support the changes, for centuries. That there would be unexpected consequences should be obvious. But apparently not so evident that we don't continue to take one blind step after another. Is CIT on firm footing, or just another fool's journey?

Erythrocytes-based synthetic delivery systems: transition from conventional to novel engineering strategies.

PubMed

Bhateria, Manisha; Rachumallu, Ramakrishna; Singh, Rajbir; Bhatta, Rabi Sankar

2014-08-01

Erythrocytes (red blood cells [RBCs]) and artificial or synthetic delivery systems such as liposomes, nanoparticles (NPs) are the most investigated carrier systems. Herein, progress made from conventional approach of using RBC as delivery systems to novel approach of using synthetic delivery systems based on RBC properties will be reviewed. We aim to highlight both conventional and novel approaches of using RBCs as potential carrier system. Conventional approaches which include two main strategies are: i) directly loading therapeutic moieties in RBCs; and ii) coupling them with RBCs whereas novel approaches exploit structural, mechanical and biological properties of RBCs to design synthetic delivery systems through various engineering strategies. Initial attempts included coupling of antibodies to liposomes to specifically target RBCs. Knowledge obtained from several studies led to the development of RBC membrane derived liposomes (nanoerythrosomes), inspiring future application of RBC or its structural features in other attractive delivery systems (hydrogels, filomicelles, microcapsules, micro- and NPs) for even greater potential. In conclusion, this review dwells upon comparative analysis of various conventional and novel engineering strategies in developing RBC based drug delivery systems, diversifying their applications in arena of drug delivery. Regardless of the challenges in front of us, RBC based delivery systems offer an exciting approach of exploiting biological entities in a multitude of medical applications.

The delivery of injury prevention exercise programmes in professional youth soccer: Comparison to the FIFA 11.

PubMed

O'Brien, James; Young, Warren; Finch, Caroline F

2017-01-01

Injury prevention exercise programmes for amateur soccer have gained considerable attention, but little is known about their relevance and adaptability to professional soccer settings. The first aim of this study was to evaluate the delivery and content of injury prevention exercise programmes used by professional youth soccer teams, compared to the industry standard injury prevention exercise programme for soccer, the Fédération Internationale de Football Association's FIFA 11+. The second aim was to document specific challenges to implementing injury prevention exercise programmes in this context. Prospective observational study. The participants were soccer coaches, fitness coaches and physiotherapists (n=18) from four teams in a professional youth soccer academy. Each team's chosen injury prevention exercise programmes were observed weekly across an entire soccer season (160 sessions). The delivery and content of the programmes were documented on a standardised worksheet and compared to the FIFA 11+. Specific implementation challenges were recorded. Fitness coaches were the primary deliverers of injury prevention exercise programmes, with support from physiotherapists. Multiple delivery formats and locations were employed, along with the extensive use of equipment. Across all injury prevention exercise programme sessions, a median of one FIFA 11+ exercise was performed in its original form and a further four in a modified form. Implementation challenges included poor staff communication, competing training priorities and heavy game schedules. Although the basic components of the FIFA 11+ hold relevance for professional youth male teams, the delivery and content of injury prevention exercise programmes require considerable tailoring for this context. Recognising this will inform the development of improved, context-specific injury prevention exercise programmes, along with corresponding strategies to enhance their implementation. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Recent developments in solid lipid nanoparticle and surface-modified solid lipid nanoparticle delivery systems for oral delivery of phyto-bioactive compounds in various chronic diseases

PubMed Central

Ko, Young Tag; Choi, Dong-Kug

2018-01-01

Solid lipid nanoparticle (SLN) delivery systems have a wide applicability in the delivery of phyto-bioactive compounds to treat various chronic diseases, including diabetes, cancer, obesity and neurodegenerative diseases. The multiple benefits of SLN delivery include improved stability, smaller particle size, leaching prevention and enhanced lymphatic uptake of the bioactive compounds through oral delivery. However, the burst release makes the SLN delivery systems inadequate for the oral delivery of various phyto-bioactive compounds that can treat such chronic diseases. Recently, the surface-modified SLN (SMSLN) was observed to overcome this limitation for oral delivery of phyto-bioactive compounds, and there is growing evidence of an enhanced uptake of curcumin delivered orally via SMSLNs in the brain. This review focuses on different SLN and SMSLN systems that are useful for oral delivery of phyto-bioactive compounds to treat various chronic diseases. PMID:29588585

Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study.

PubMed

Oku, Afiong; Oyo-Ita, Angela; Glenton, Claire; Fretheim, Atle; Eteng, Glory; Ames, Heather; Muloliwa, Artur; Kaufman, Jessica; Hill, Sophie; Cliff, Julie; Cartier, Yuri; Bosch-Capblanch, Xavier; Rada, Gabriel; Lewin, Simon

2017-02-15

The role of health communication in vaccination programmes cannot be overemphasized: it has contributed significantly to creating and sustaining demand for vaccination services and improving vaccination coverage. In Nigeria, numerous communication approaches have been deployed but these interventions are not without challenges. We therefore aimed to explore factors affecting the delivery of vaccination communication in Nigeria. We used a qualitative approach and conducted the study in two states: Bauchi and Cross River States in northern and southern Nigeria respectively. We identified factors affecting the implementation of communication interventions through interviews with relevant stakeholders involved in vaccination communication in the health services. We also reviewed relevant documents. Data generated were transcribed verbatim and analysed using thematic analysis. We used the SURE framework to organise the identified factors (barriers and facilitators) affecting vaccination communication delivery. We then grouped these into health systems and community level factors. Some of the commonly reported health system barriers amongst stakeholders interviewed included: funding constraints, human resource factors (health worker shortages, training deficiencies, poor attitude of health workers and vaccination teams), inadequate infrastructure and equipment and weak political will. Community level factors included the attitudes of community stakeholders and of parents and caregivers. We also identified factors that appeared to facilitate communication activities. These included political support, engagement of traditional and religious institutions and the use of organised communication committees. Communication activities are a crucial element of immunization programmes. It is therefore important for policy makers and programme managers to understand the barriers and facilitators affecting the delivery of vaccination communication so as to be able to implement communication interventions more effectively.

Tip-enhanced Raman scattering of bacillus subtilis spores

NASA Astrophysics Data System (ADS)

Rusciano, G.; Zito, G.; Pesce, G.; Sasso, A.; Isticato, R.; Ricca, E.

2015-07-01

Understanding of the complex interactions of molecules at biological interfaces is a fundamental issue in biochemistry, biotechnology as well as biomedicine. A plethora of biological processes are ruled by the molecular texture of cellular membrane: cellular communications, drug transportations and cellular recognition are just a few examples of such chemically-mediated processes. Tip-Enhanced Raman Scattering (TERS) is a novel, Raman-based technique which is ideally suited for this purpose. TERS relies on the combination of scanning probe microscopy and Raman spectroscopy. The basic idea is the use of a metalled tip as a sort of optical nano-antenna, which gives place to SERS effect close to the tip end. Herein, we present the application of TERS to analyze the surface of Bacillus subtilis spores. The choice of this biological systems is related to the fact that a number of reasons support the use of spores as a mucosal delivery system. The remarkable and well-documented resistance of spores to various environmental and toxic effects make them clear potentials as a novel, surface-display system. Our experimental outcomes demonstrate that TERS is able to provide a nano-scale chemical imaging of spore surface. Moreover, we demonstrate that TERS allows differentiation between wilde-type spore and genetically modified strains. These results hold promise for the characterization and optimization of spore surface for drug-delivery applications.

Integrated delivery systems focus on service delivery after capitation efforts stall.

PubMed

2005-03-01

Integrated delivery systems focus on service delivery after capitation efforts stall. Integrated delivery systems are going through changes that are focusing the provider organizations more on delivering care than managing risk, says Dean C. Coddington, one of the leading researchers into capitated organizations and a senior consultant with McManis Consulting in Denver.

Telemedicine and security. Confidentiality, integrity, and availability: a Canadian perspective.

PubMed

Jennett, P; Watanabe, M; Igras, E; Premkumar, K; Hall, W

1996-01-01

The health care system is undergoing major reform, characterized by organized delivery systems (regionalization, decentralization, devolution, etc); shifts in care delivery sites; changing health provider roles; increasing consumer responsibilities; and accountability. Rapid advances in information technology and telecommunications have led to a new type of information infrastructure which can play a major role in this reform. Compatible health information systems are now being integrated and connected across institutional, regional, and sectorial boundaries. In the near future, these information systems will readily be accessed and shared by health providers, researchers, policy makers, health consumers, and the public. SECURITY is a critical characteristic of any health information system. This paper will address three fields associated with SECURITY: confidentiality, integrity, and availability. These will be defined and examined as they relate to specific aspects of Telemedicine, such as electronic integrated records and clinical databases; electronic transfer of documents; as well as data storage and disposal. The guiding principles, standards, and safeguards being considered and put in place to ensure that telemedicine information intrastructures can protect and benefit all stakeholders' rights and needs in both primary and secondary uses of information will be reviewed. Implemented, proposed, and tested institutional, System, and Network solutions will be discussed; for example, encryption-decryption methods; data transfer standards; individual and terminal access and entry I.D. and password levels; smart card access and PIN number control; data loss prevention strategies; interference alerts; information access keys; algorithm safeguards; and active marketing to users of standards and principles. Issues such as policy, implementation, and ownership will be addressed.

Biomaterials for drug delivery systems.

PubMed

Buckles, R G

1983-01-01

Drug delivery systems have unusual materials requirements which derive mainly from their therapeutic role: to administer drugs over prolonged periods of time at rates that are independent of patient-to-patient variables. The chemical nature of the surfaces of such devices may stimulate biorejection processes which can be enhanced or suppressed by the simultaneous presence of the drug that is being administered. Selection of materials for such systems is further complicated by the need for compatibility with the drug contained within the system. A review of selected drug delivery systems is presented. This leads to a definition of the technologies required to develop successfully such systems as well as to categorize the classes of drug delivery systems available to the therapist. A summary of the applications of drug delivery systems will also be presented. There are five major challenges to the biomaterials scientist: (1) how to minimize the influence on delivery rate of the transient biological response that accompanies implantation of any object; (2) how to select a composition, size, shape, and flexibility that optimizes biocompatibility; (3) how to make an intravascular delivery system that will retain long-term functionality; (4) how to make a percutaneous lead for those delivery systems that cannot be implanted but which must retain functionality for extended periods; and (5) how to make biosensors of adequate compatibility and stability to use with the ultimate drug delivery system-a system that operates with feedback control.

Influence of processing parameters on morphology of polymethoxyflavone in emulsions.

PubMed

Ting, Yuwen; Li, Colin C; Wang, Yin; Ho, Chi-Tang; Huang, Qingrong

2015-01-21

Polymethoxyflavones (PMFs) are groups of compounds isolated from citrus peels that have been documented with wide arrays of health-promoting bioactivities. Because of their hydrophobic structure and high melting point, crystallized PMFs usually have poor systemic bioavailability when consumed orally. To improve the oral efficiency of PMFs, a viscoelastic emulsion system was formulated. Because of the crystalline nature, the inclusion of PMFs into the emulsion system faces great challenges in having sufficient loading capacity and stabilities. In this study, the process of optimizing the quality of emulsion-based formulation intended for PMF oral delivery was systematically studied. With alteration of the PMF loading concentration, processing temperature, and pressure, the emulsion with the desired droplet and crystal size can be effectively fabricated. Moreover, storage temperatures significantly influenced the stability of the crystal-containing emulsion system. The results from this study are a good illustration of system optimization and serve as a great reference for future formulation design of other hydrophobic crystalline compounds.

Nanoparticle-Hydrogel: A Hybrid Biomaterial System for Localized Drug Delivery

PubMed Central

Gao, Weiwei; Zhang, Yue; Zhang, Qiangzhe; Zhang, Liangfang

2016-01-01

Nanoparticles have offered a unique set of properties for drug delivery including high drug loading capacity, combinatorial delivery, controlled and sustained drug release, prolonged stability and lifetime, and targeted delivery. To further enhance therapeutic index, especially for localized application, nanoparticles have been increasingly combined with hydrogels to form a hybrid biomaterial system for controlled drug delivery. Herein, we review recent progresses in engineering such nanoparticle-hydrogel hybrid system (namely ‘NP-gel’) with a particular focus on its application for localized drug delivery. Specifically, we highlight four research areas where NP-gel has shown great promises, including (1) passively controlled drug release, (2) stimuli-responsive drug delivery, (3) site-specific drug delivery, and (4) detoxification. Overall, integrating therapeutic nanoparticles with hydrogel technologies creates a unique and robust hybrid biomaterial system that enables effective localized drug delivery. PMID:26951462

First Look--The Aerospace Database.

ERIC Educational Resources Information Center

Kavanagh, Stephen K.; Miller, Jay G.

1986-01-01

Presents overview prepared by producer of database newly available in 1985 that covers 10 subject categories: engineering, geosciences, chemistry and materials, space sciences, aeronautics, astronautics, mathematical and computer sciences, physics, social sciences, and life sciences. Database development, unique features, document delivery, sample…

Variable dynamic testbed vehicle : safety plan

DOT National Transportation Integrated Search

1997-02-01

This safety document covers the entire safety process from inception to delivery of the Variable Dynamic Testbed Vehicle. In addition to addressing the process of safety on the vehicle , it should provide a basis on which to build future safety proce...

Community mental health nurses' perspectives of recovery-oriented practice.

PubMed

Gale, J; Marshall-Lucette, S

2012-05-01

Recovery-oriented practice, an approach aligned towards the service user perspective, has dominated the mental health care arena. Numerous studies have explored service users' accounts of the purpose, meaning and importance of 'recovery'; however, far less is known about healthcare staff confidence in its application to care delivery. A self-efficacy questionnaire and content analysis of nursing course documents were used to investigate a cohort of community mental health nurses' recovery-oriented practice and to determine the extent to which the current continuing professional development curriculum met their educational needs in this regard. Twenty-three community mental health nurses completed a self-efficacy questionnaire and 28 course documents were analysed. The findings revealed high levels of nurses' confidence in their understanding and ability to apply the recovery model and low levels of confidence were found in areas of social inclusion. The content analysis found only one course document that used the whole term 'recovery model'. The findings suggest a gap in the nurses' perceived ability and confidence in recovery-oriented practice with what is taught academically. Hence, nursing education needs to be more explicitly focused on the recovery model and its application to care delivery. © 2011 Blackwell Publishing.

Brand differences of free‐base nicotine delivery in cigarette smoke: the view of the tobacco industry documents

PubMed Central

Wayne, G Ferris; Connolly, G N; Henningfield, J E

2006-01-01

The recent availability of internal tobacco industry documents provides significant insight into industry knowledge and manipulation of tobacco smoke delivery. One critical area of research is the role of smoke chemistry in determining the absorption and effects of smoke constituents, especially harm producing or pharmacologically active compounds. Independent scientific research has suggested that the nicotine dosing characteristics, hence the addiction potential of cigarettes, may be determined in part by the amount of free‐base nicotine in cigarette smoke and its effects on the location, route, and speed of absorption in the body and on the sensory perception effects of the inhaled smoke. Tobacco industry documents describe the use of a number of methods internally for measuring free‐base nicotine delivery. These include the common use of cigarette “smoke pH” as a means to estimate the fraction of free‐base nicotine in the particulate matter (PM) in cigarette smoke, as well as efforts to measure free‐base nicotine directly. Although these methods do not provide accurate absolute measures of free‐base nicotine in smoke, consistencies observed in the findings across the various manufacturers indicate: (1) real relative differences in the acid/base chemistry of the smoke from different brands of cigarettes; (2) a connection between differences in free‐base levels and brand‐dependent differences in sensory perception and smoke “impact”; and (3) levels of free‐base nicotine that are greater than have typically been publicly discussed by the industry. Furthermore, the results of these methods are generally consistent with those of a recent study from the Centers for Disease Control and Prevention which directly measured the free‐base fraction of nicotine across a range of cigarette types. Consideration of the likely fundamental importance of free‐base nicotine levels in cigarette smoke, together with the efforts discussed in the tobacco industry documents to measure such levels, indicates that the public health community would benefit from additional research to assess directly the delivery of free‐base nicotine in cigarette smoke across brands. This may be especially useful for those products (“light”, “ultralight”, “reduced carcinogen”, etc) that have been promoted, either explicitly or implicitly, as “harm reducing”. PMID:16728749

CO2 laser myringotomy with a hand-held otoscope and fiber optic delivery system: animal experimentation and preclinical trials

NASA Astrophysics Data System (ADS)

DeRowe, Ari; Ophir, Dov; Finkelstein, Y.; Katzir, Abraham

1993-07-01

CO2 laser myringotomy has previously been proven effective in patients with serous otitis media for short term aeration of the middle ear. However, the system based on a microscope and a coaxially aligned laser is cumbersome and expensive. Also, conventional optical fibers do not transmit CO2 laser energy ((lambda) equals 10.6 micrometers ). We have developed a silver halide optical fiber of diameter 0.9 mm and lengths of several meters, with high transmission at 10.6 micrometers . Using a hand held otoscope coupled to a fiberoptic delivery system CO2 laser myringotomies were performed first in guinea pigs and then in humans. In the animal model the feasibility of the procedure was proven. Different irradiation parameters were studied and a `dose dependent' relationship was found between the total energy used and the duration of a patent myringotomy. This system was used to perform CO2 laser myringotomies under local anesthesia in five patients with serous otitis media and conductive hearing loss. None of the patients complained of discomfort and no scarring was noted. All patients had subjective and audiometric documentation of hearing improvement. The average duration of a patent myringotomy was 21 days. In two patients the effusion recurred. CO2 laser myringotomy utilizing a hand held otoscope coupled to an optical fiber capable of transmitting CO2 laser energy may prove simple and effective in the treatment of serous otitis media.

Energy Deposition in the Body from External Sources to Chemically Trigger Cellular Responses in Desired Localized Regions

NASA Astrophysics Data System (ADS)

Ibsen, Stuart Duncan

One of the major challenges of modern chemotherapy is to deliver a therapeutic dose of active drug to the tumor tissue without causing systemic exposure. The realization of this goal could considerably reduce the negative side effects experienced by patients. The work conducted in this thesis looks at two different approaches to trigger drug activation with the use of external energy sources. This avoids the challenges of relying solely on biochemical and environmental differences as triggers. The two triggers used were low intensity focused ultrasound and 365 nm light delivered with a custom designed needle UV LED fiber optic system. Both can be localized within the body to spatially highlight just the tumor tissue creating a stark differentiation between it and the healthy tissue. The 365nm light based delivery scheme developed here was the first demonstration of a photoactivatable doxorubicin (DOX) prodrug called DOX-PCB. DOX-PCB was shown to be 200 times less toxic than DOX and could be activated to a fully therapeutic form upon exposure to 365nm light. The pharmacokinetics showed a circulation half life comparable to that of DOX and stability against in vivo metabolic degradation. The 365 nm light was shown to adequately irradiate a centimeter of tumor tissue and cause localized activation. In vivo tumors exposed to the light had significantly higher doses of DOX than unexposed control tumors in the same individual. The second delivery scheme made use of focused ultrasound to activate echogenic drug delivery vehicles. These vehicles were the first demonstration of encapsulating microbubbles within liposomes. Specially designed optical equipment documented that the microbubble was ultrasound responsive. The microbubble was shown to violently cavitate and rupture the outer liposome membrane releasing the payload contents. The three dimensional localization of activation was demonstrated in tissue phantoms. The strengths of these two delivery schemes could complement each other when used together. The delivery vehicle could achieve high doses of DOX-PCB within the tumor while the low toxicity prevents harm to the liver and spleen. The 365 nm light could then activate just the DOX-PCB found within the tumor itself causing localized cell death.

Rumen-stable delivery systems.

PubMed

Papas; Wu

1997-12-08

Ruminants have a distinct digestive system which serves a unique symbiotic relationship between the host animal and predominantly anaerobic rumen bacteria and protozoa. Rumen fermentation can be both beneficial by enabling utilization of cellulose and non-protein nitrogen and detrimental by reducing the nutritive value of some carbohydrates, high biological value proteins and by hydrogenating unsaturated lipids. In addition it can also result in the modification and inactivation of many pharmacologically active ingredients administered to the host animal via the oral route. The advances in ruminant nutrition and health demand a rumen-stable delivery system which can deliver the active ingredient post-ruminally while simultaneously meet efficacy, safety and cost criteria. In contrast to drug delivery systems for humans, the demand for low-cost has hindered the development of effective rumen-stable delivery systems. Historically, heat and chemical treatment of feed components, low solubility analogues or lipid-based formulations have been used to achieve some degree of rumen-stability, and products have been developed accordingly. Recently, a polymeric pH-dependent rumen-stable delivery system has been developed and commercialized. The rationale of this delivery system is based on the pH difference between ruminal and abomasal fluids. The delivery system is composed of a basic polymer, a hydrophobic substance and a pigment material. It can be applied as a coating to solid particles via a common encapsulation method such as air-suspension coating. In the future, the delivery system could be used to deliver micronutrients and pharmaceuticals post-ruminally to ruminant animals. A further possible application of the delivery system is that it could also be combined with other controlled delivery devices/systems in order to enhance slow release or to achieve targeted delivery needs for ruminants. This paper discusses the rumen protection and the abomasal release mechanism of the polymeric coating. It also reviews other rumen stable delivery systems and methods for evaluating their in vitro and in vivo performance.

Design strategies and applications of circulating cell-mediated drug delivery systems.

PubMed

Su, Yixue; Xie, Zhiwei; Kim, Gloria B; Dong, Cheng; Yang, Jian

2015-01-01

Drug delivery systems, particularly nanomaterial-based drug delivery systems, possess a tremendous amount of potential to improve diagnostic and therapeutic effects of drugs. Controlled drug delivery targeted to a specific disease is designed to significantly improve the pharmaceutical effects of drugs and reduce their side effects. Unfortunately, only a few targeted drug delivery systems can achieve high targeting efficiency after intravenous injection, even with the development of numerous surface markers and targeting modalities. Thus, alternative drug and nanomedicine targeting approaches are desired. Circulating cells, such as erythrocytes, leukocytes, and stem cells, present innate disease sensing and homing properties. Hence, using living cells as drug delivery carriers has gained increasing interest in recent years. This review highlights the recent advances in the design of cell-mediated drug delivery systems and targeting mechanisms. The approaches of drug encapsulation/conjugation to cell-carriers, cell-mediated targeting mechanisms, and the methods of controlled drug release are elaborated here. Cell-based "live" targeting and delivery could be used to facilitate a more specific, robust, and smart payload distribution for the next-generation drug delivery systems.

A cost comparison of introducing and delivering pneumococcal, rotavirus and human papillomavirus vaccines in Rwanda.

PubMed

Ngabo, Fidèle; Levin, Ann; Wang, Susan A; Gatera, Maurice; Rugambwa, Celse; Kayonga, Celestin; Donnen, Philippe; Lepage, Philippe; Hutubessy, Raymond

2015-12-16

Detailed cost evaluations of delivery of new vaccines such as pneumococcal conjugate, human papillomavirus (HPV), and rotavirus vaccines in low and middle-income countries are scarce. This paper differs from others by comparing the costs of introducing multiple vaccines in a single country and then assessing the financial and economic impact at the time and implications for the future. The objective of the analysis was to understand the introduction and delivery cost per dose or per child of the three new vaccines in Rwanda to inform domestic and external financial resource mobilization. Start-up, recurrent, and capital costs from a government perspective were collected in 2012. Since pneumococcal conjugate and HPV vaccines had already been introduced, cost data for those vaccines were collected retrospectively while prospective (projected) costing was done for rotavirus vaccine. The financial unit cost per fully immunized child (or girl for HPV vaccine) of delivering 3 doses of each vaccine (without costs related to vaccine procurement) was $0.37 for rotavirus (RotaTeq(®)) vaccine, $0.54 for pneumococcal (Prevnar(®)) vaccine in pre-filled syringes, and $10.23 for HPV (Gardasil (®)) vaccine. The financial delivery costs of Prevnar(®) and RotaTeq(®) were similar since both were delivered using existing health system infrastructure to deliver infant vaccines at health centers. The total financial cost of delivering Gardasil(®) was higher than those of the two infant vaccines due to greater resource requirements associated with creating a new vaccine delivery system in for a new target population of 12-year-old girls who have not previously been served by the existing routine infant immunization program. The analysis indicates that service delivery strategies have an important influence on costs of introducing new vaccines and costs per girl reached with HPV vaccine are higher than the other two vaccines because of its delivery strategy. Documented information on financial commitments for new vaccines, particularly from government sources, is a useful input into country policy dialogue on sustainable financing and co-financing of new vaccines, as well as for policy decisions by donors such as Gavi, the Vaccine Alliance. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Project Delivery System Mode Decision Based on Uncertain AHP and Fuzzy Sets

NASA Astrophysics Data System (ADS)

Kaishan, Liu; Huimin, Li

2017-12-01

The project delivery system mode determines the contract pricing type, project management mode and the risk allocation among all participants. Different project delivery system modes have different characteristics and applicable scope. For the owners, the selection of the delivery mode is the key point to decide whether the project can achieve the expected benefits, it relates to the success or failure of project construction. Under the precondition of comprehensively considering the influence factors of the delivery mode, the model of project delivery system mode decision was set up on the basis of uncertain AHP and fuzzy sets, which can well consider the uncertainty and fuzziness when conducting the index evaluation and weight confirmation, so as to rapidly and effectively identify the most suitable delivery mode according to project characteristics. The effectiveness of the model has been verified via the actual case analysis in order to provide reference for the construction project delivery system mode.

Association of head circumference and shoulder dystocia in macrosomic neonates.

PubMed

Larson, Austin; Mandelbaum, David E

2013-04-01

To determine whether asymmetric macrosomia (disproportionately large body size in comparison to head circumference) could be demonstrated in a population of infants suffering shoulder dystocia during delivery relative to those that did not suffer from shoulder dystocia. A case-control study was conducted as a retrospective chart review over 3 years at a large maternity hospital in an urban setting. Among infants over 4,000 g, those that suffered from shoulder dystocia during delivery had a smaller mean head circumference than infants of a similar size that did not suffer from shoulder dystocia. A statistically significant difference was also present when cases of documented gestational diabetes were excluded. Asymmetric macrosomia is more likely to be present in a population of infants who suffered shoulder dystocia during delivery. This knowledge could be used in designing tools to predict which pregnancies are at highest risk for shoulder dystocia during delivery.

Approaches to Neural Tissue Engineering Using Scaffolds for Drug Delivery

PubMed Central

Willerth, Stephanie M.; Sakiyama-Elbert, Shelly E.

2007-01-01

This review seeks to give an overview of the current approaches to drug delivery from scaffolds for neural tissue engineering applications. The challenges presented by attempting to replicate the three types of nervous tissue (brain, spinal cord, and peripheral nerve) are summarized. Potential scaffold materials (both synthetic and natural) and target drugs are discussed with the benefits and drawbacks given. Finally, common methods of drug delivery, including degradable/diffusion-based delivery systems, affinity-based delivery systems, immobilized drug delivery systems, and electrically controlled drug delivery systems, are examined and critiqued. Based on the current body of work, suggestions for future directions of research in the field of neural tissue engineering are presented. PMID:17482308

Modeling the Delivery Physiology of Distributed Learning Systems.

ERIC Educational Resources Information Center

Paquette, Gilbert; Rosca, Ioan

2003-01-01

Discusses instructional delivery models and their physiology in distributed learning systems. Highlights include building delivery models; types of delivery models, including distributed classroom, self-training on the Web, online training, communities of practice, and performance support systems; and actors (users) involved, including experts,…

Learning from Health Information Exchange Technical Architecture and Implementation in Seven Beacon Communities

PubMed Central

McCarthy, Douglas B.; Propp, Karen; Cohen, Alexander; Sabharwal, Raj; Schachter, Abigail A.; Rein, Alison L.

2014-01-01

As health care providers adopt and make “meaningful use” of health information technology (health IT), communities and delivery systems must set up the infrastructure to facilitate health information exchange (HIE) between providers and numerous other stakeholders who have a role in supporting health and care. By facilitating better communication and coordination between providers, HIE has the potential to improve clinical decision-making and continuity of care, while reducing unnecessary use of services. When implemented as part of a broader strategy for health care delivery system and payment reform, HIE capability also can enable the use of analytic tools needed for population health management, patient engagement in care, and continuous learning and improvement. The diverse experiences of seven communities that participated in the three-year federal Beacon Community Program offer practical insight into factors influencing the technical architecture of exchange infrastructure and its role in supporting improved care, reduced cost, and a healthier population. The case studies also document challenges faced by the communities, such as significant time and resources required to harmonize variations in the interpretation of data standards. Findings indicate that their progress developing community-based HIE strategies, while driven by local needs and objectives, is also influenced by broader legal, policy, and market conditions. PMID:25848591

Integrating the healthcare enterprise in radiation oncology plug and play--the future of radiation oncology?

PubMed

Abdel-Wahab, May; Rengan, Ramesh; Curran, Bruce; Swerdloff, Stuart; Miettinen, Mika; Field, Colin; Ranjitkar, Sunita; Palta, Jatinder; Tripuraneni, Prabhakar

2010-02-01

To describe the processes and benefits of the integrating healthcare enterprises in radiation oncology (IHE-RO). The IHE-RO process includes five basic steps. The first step is to identify common interoperability issues encountered in radiation treatment planning and the delivery process. IHE-RO committees partner with vendors to develop solutions (integration profiles) to interoperability problems. The broad application of these integration profiles across a variety of vender platforms is tested annually at the Connectathon event. Demonstration of the seamless integration and transfer of patient data to the potential users are then presented by vendors at the public demonstration event. Users can then integrate these profiles into requests for proposals and vendor contracts by institutions. Incorporation of completed integration profiles into requests for proposals can be done when purchasing new equipment. Vendors can publish IHE integration statements to document the integration profiles supported by their products. As a result, users can reference integration profiles in requests for proposals, simplifying the systems acquisition process. These IHE-RO solutions are now available in many of the commercial radiation oncology-related treatment planning, delivery, and information systems. They are also implemented at cancer care sites around the world. IHE-RO serves an important purpose for the radiation oncology community at large. Copyright 2010 Elsevier Inc. All rights reserved.

Learning from health information exchange technical architecture and implementation in seven beacon communities.

PubMed

McCarthy, Douglas B; Propp, Karen; Cohen, Alexander; Sabharwal, Raj; Schachter, Abigail A; Rein, Alison L

2014-01-01

As health care providers adopt and make "meaningful use" of health information technology (health IT), communities and delivery systems must set up the infrastructure to facilitate health information exchange (HIE) between providers and numerous other stakeholders who have a role in supporting health and care. By facilitating better communication and coordination between providers, HIE has the potential to improve clinical decision-making and continuity of care, while reducing unnecessary use of services. When implemented as part of a broader strategy for health care delivery system and payment reform, HIE capability also can enable the use of analytic tools needed for population health management, patient engagement in care, and continuous learning and improvement. The diverse experiences of seven communities that participated in the three-year federal Beacon Community Program offer practical insight into factors influencing the technical architecture of exchange infrastructure and its role in supporting improved care, reduced cost, and a healthier population. The case studies also document challenges faced by the communities, such as significant time and resources required to harmonize variations in the interpretation of data standards. Findings indicate that their progress developing community-based HIE strategies, while driven by local needs and objectives, is also influenced by broader legal, policy, and market conditions.

Reservoir-Based Drug Delivery Systems Utilizing Microtechnology

PubMed Central

Stevenson, Cynthia L.; Santini, John T.; Langer, Robert

2012-01-01

This review covers reservoir-based drug delivery systems that incorporate microtechnology, with an emphasis on oral, dermal, and implantable systems. Key features of each technology are highlighted such as working principles, fabrication methods, dimensional constraints, and performance criteria. Reservoir-based systems include a subset of microfabricated drug delivery systems and provide unique advantages. Reservoirs, whether external to the body or implanted, provide a well-controlled environment for a drug formulation, allowing increased drug stability and prolonged delivery times. Reservoir systems have the flexibility to accommodate various delivery schemes, including zero order, pulsatile, and on demand dosing, as opposed to a standard sustained release profile. Furthermore, the development of reservoir-based systems for targeted delivery for difficult to treat applications (e.g., ocular) has resulted in potential platforms for patient therapy. PMID:22465783

Micro injector sample delivery system for charged molecules

DOEpatents

Davidson, James C.; Balch, Joseph W.

1999-11-09

A micro injector sample delivery system for charged molecules. The injector is used for collecting and delivering controlled amounts of charged molecule samples for subsequent analysis. The injector delivery system can be scaled to large numbers (>96) for sample delivery to massively parallel high throughput analysis systems. The essence of the injector system is an electric field controllable loading tip including a section of porous material. By applying the appropriate polarity bias potential to the injector tip, charged molecules will migrate into porous material, and by reversing the polarity bias potential the molecules are ejected or forced away from the tip. The invention has application for uptake of charged biological molecules (e.g. proteins, nucleic acids, polymers, etc.) for delivery to analytical systems, and can be used in automated sample delivery systems.

Prototype system of secure VOD

NASA Astrophysics Data System (ADS)

Minemura, Harumi; Yamaguchi, Tomohisa

1997-12-01

Secure digital contents delivery systems are to realize copyright protection and charging mechanism, and aim at secure delivery service of digital contents. Encrypted contents delivery and history (log) management are means to accomplish this purpose. Our final target is to realize a video-on-demand (VOD) system that can prevent illegal usage of video data and manage user history data to achieve a secure video delivery system on the Internet or Intranet. By now, mainly targeting client-server systems connected with enterprise LAN, we have implemented and evaluated a prototype system based on the investigation into the delivery method of encrypted video contents.

47 CFR 63.02 - Exemptions for extensions of lines and for systems for the delivery of video programming.

Code of Federal Regulations, 2011 CFR

2011-10-01

... systems for the delivery of video programming. 63.02 Section 63.02 Telecommunication FEDERAL... systems for the delivery of video programming. (a) Any common carrier is exempt from the requirements of... with respect to the establishment or operation of a system for the delivery of video programming. [64...

47 CFR 63.02 - Exemptions for extensions of lines and for systems for the delivery of video programming.

Code of Federal Regulations, 2010 CFR

2010-10-01

... systems for the delivery of video programming. 63.02 Section 63.02 Telecommunication FEDERAL... systems for the delivery of video programming. (a) Any common carrier is exempt from the requirements of... with respect to the establishment or operation of a system for the delivery of video programming. [64...

47 CFR 63.02 - Exemptions for extensions of lines and for systems for the delivery of video programming.

Code of Federal Regulations, 2013 CFR

2013-10-01

... systems for the delivery of video programming. 63.02 Section 63.02 Telecommunication FEDERAL... systems for the delivery of video programming. (a) Any common carrier is exempt from the requirements of... with respect to the establishment or operation of a system for the delivery of video programming. [64...

47 CFR 63.02 - Exemptions for extensions of lines and for systems for the delivery of video programming.

Code of Federal Regulations, 2014 CFR

2014-10-01

... systems for the delivery of video programming. 63.02 Section 63.02 Telecommunication FEDERAL... systems for the delivery of video programming. (a) Any common carrier is exempt from the requirements of... with respect to the establishment or operation of a system for the delivery of video programming. [64...

47 CFR 63.02 - Exemptions for extensions of lines and for systems for the delivery of video programming.

Code of Federal Regulations, 2012 CFR

2012-10-01

... systems for the delivery of video programming. 63.02 Section 63.02 Telecommunication FEDERAL... systems for the delivery of video programming. (a) Any common carrier is exempt from the requirements of... with respect to the establishment or operation of a system for the delivery of video programming. [64...

Clinical benchmarking for the office practitioner enabled by the online health record

PubMed Central

Ricciardi, TN; Masarie, FE; Landholt, T; Middleton, B

2000-01-01

Payer organizations, regulatory entities, and delivery networks are placing increasing pressure on physicians to report aggregate information about their patients and practice of medicine. Historically, clinicians have been ill-equipped to respond to these pressures when their practices have relied upon payer records for clinical information management. Key Industry Drivers: Physicians need specific information from their practices for the purposes of contract management, preventive care, office productivity, and utilization reviews. Value Statement: Clinical data captured at the point of care can support reporting requirements, and supplement or replace laboriously-collected data derived from billing and other administrative systems. Information from the Online Health Record can empower the individual physician to assess what is going on in their practice of medicine, as opposed to being "profiled" by an external entity. We created a secure web-based system that provides access to a clinical data mart, to allow online benchmarking for the individual or office practitioner. Providers used a web-enabled documentation system to document the clinical facts of the encounter. A nightly set of routines extracts data from the online chart into the clinical data mart built in a relational database. The system uses a clinical vocabulary server to map provider-entered strings to normalized clinical concepts. The system loads chart data into a dimensional data model, to simplify data representation and ensure fast query performance. Providers can access their own profiles from a secure web browser. PMID:11080030

Ebola virus disease and pregnancy - A review of the current knowledge of Ebola virus pathogenesis, maternal and neonatal outcomes

PubMed Central

Bebell, Lisa M.; Oduyebo, Titilope; Riley, Laura E.

2016-01-01

The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa devastated local health systems and caused thousands of deaths. Historical reports from Zaire ebolavirus outbreaks suggested pregnancy was associated with an increased risk of severe illness and death, with mortality rates from 74-100%. In total, 111 cases of pregnant patients with EVD are reported in the literature, with an aggregate maternal mortality of 86%. Pregnancy-specific data published from the recent outbreak include four small descriptive cohort studies and five case reports. Despite limitations including reporting bias and small sample size, these studies suggest mortality in pregnant women may be lower than previously reported, with five of 13(39%) infected women dying. Optimal treatments for pregnant women, and differences in EVD course between pregnant women and non-pregnant individuals are major scientific gaps that have not yet been systematically addressed. Ebola virus may be transmitted from mother to baby in utero, during delivery, or through contact with maternal body fluids after birth including breast milk. EVD is almost universally fatal to the developing fetus, and limited fetal autopsy data prevent inferences on risk of birth defects. Decisions about delivery mode and other obstetric interventions should be individualized. WHO recommends close monitoring of survivors who later become pregnant, but does not recommend enhanced precautions at subsequent delivery. Though sexual transmission of Ebola virus has been documented, birth outcomes among survivors have not been published and will be important to appropriately counsel women on pregnancy outcomes and inform delivery precautions for healthcare providers. PMID:28398679

Sediment delivery after a wildfire

USGS Publications Warehouse

Reneau, Steven L.; Katzman, D.; Kuyumjian, G.A.; Lavine, A.; Malmon, D.V.

2007-01-01

We use a record of sedimentation a small reservoir within the Cerro Grande burn area, New Mexico, to document postfire delivery of ash, other fine-grained sediment carried in suspension within floods, and coarse-grained sediment transported as bedload over a five-year period. Ash content of sediment layers is estimated using fallout 137Cs as a tracer, and ash concentrations are shown to rapidly decrease through a series of moderate-intensity convective storms in the first rainy season after the fire. Over 90% of the ash was delivered to the reservoir in the first year, and ash concentrations in suspended sediment were negligible after the second year. Delivery of the remainder of the fine sediment also declined rapidly after the first year despite the occurrence of higher-intensity storms in the second year. Fine sediment loads after five years remained significantly above prefire averages. Deposition of coarse-grained sediment was irregular in time and was associated with transport by snowmelt runoff of sediment stored along the upstream channel during short-duration summer floods. Coarse sediment delivery in the first four years was strongly correlated with snowmelt volume, suggesting a transport-limited system with abundant available sediment. Transport rates of coarse sediment declined in the fifth year, consistent with a transition to a more stable channel as the accessible sediment supply was depleted and the channel bed coarsened. Maximum impacts from ash and other fine-grained sediment therefore occurred soon after the fire, whereas the downstream impacts from coarse-grained sediment were attenuated by the more gradual process of bedload sediment transport. ?? 2007 Geological Society of America.

Toxicology study for magnetic injection of prednisolone into the rat cochlea.

PubMed

Shimoji, M; Ramaswamy, B; Shukoor, M I; Benhal, P; Broda, A; Kulkarni, S; Malik, P; McCaffrey, B; Lafond, J-F; Nacev, A; Weinberg, I N; Shapiro, B; Depireux, D A

2018-06-19

This paper investigates the safety of a novel 'magnetic injection' method of delivering therapy to the cochlea, in a rodent model. In this method of administration, a magnetic field is employed to actively transport drug-eluting iron oxide-core nanoparticles into the cochlea, where they then release their drug payload (we delivered the steroid prednisolone). Our study design and selection of control groups was based on published regulatory guidance for safety studies that involve local drug delivery. We tested for both single and multiple delivery doses to the cochlea, and found that magnetic delivery did not harm hearing. There was no statistical difference in hearing between magnetically treated ears versus ears that received intra-tympanic steroid (a mimic of a standard-of-care for sudden sensorineural hearing loss), both 2 and 30 days after treatment. Since our treatment is local to the ear, the levels of steroid and iron circulating systemically after our treatment were low, below mass-spectrometry detection limits for the steroid and no different from normal for iron. No adverse findings were observed in ear tissue histopathology or in animal gross behavior. At 2 and 30 days after treatment, inflammatory changes in the ear were limited to the middle ear, were very mild in severity, and by day 90 there was ongoing and almost complete reversibility of these changes. There were no ear tissue scarring or hemorrhage trends associated with magnetic delivery. In summary, after conducting a pre-clinical safety study based on FDA guidance documents, no adverse safety issues were observed. Copyright © 2017. Published by Elsevier B.V.

Daily Orthogonal Kilovoltage Imaging Using a Gantry-Mounted On-Board Imaging System Results in a Reduction in Radiation Therapy Delivery Errors

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

Russo, Gregory A., E-mail: gregory.russo@bmc.org; Qureshi, Muhammad M.; Truong, Minh-Tam

2012-11-01

Purpose: To determine whether the use of routine image guided radiation therapy (IGRT) using pretreatment on-board imaging (OBI) with orthogonal kilovoltage X-rays reduces treatment delivery errors. Methods and Materials: A retrospective review of documented treatment delivery errors from 2003 to 2009 was performed. Following implementation of IGRT in 2007, patients received daily OBI with orthogonal kV X-rays prior to treatment. The frequency of errors in the pre- and post-IGRT time frames was compared. Treatment errors (TEs) were classified as IGRT-preventable or non-IGRT-preventable. Results: A total of 71,260 treatment fractions were delivered to 2764 patients. A total of 135 (0.19%) TEsmore » occurred in 39 (1.4%) patients (3.2% in 2003, 1.1% in 2004, 2.5% in 2005, 2% in 2006, 0.86% in 2007, 0.24% in 2008, and 0.22% in 2009). In 2007, the TE rate decreased by >50% and has remained low (P = .00007, compared to before 2007). Errors were classified as being potentially preventable with IGRT (e.g., incorrect site, patient, or isocenter) vs. not. No patients had any IGRT-preventable TEs from 2007 to 2009, whereas there were 9 from 2003 to 2006 (1 in 2003, 2 in 2004, 2 in 2005, and 4 in 2006; P = .0058) before the implementation of IGRT. Conclusions: IGRT implementation has a patient safety benefit with a significant reduction in treatment delivery errors. As such, we recommend the use of IGRT in routine practice to complement existing quality assurance measures.« less

Daily orthogonal kilovoltage imaging using a gantry-mounted on-board imaging system results in a reduction in radiation therapy delivery errors.

PubMed

Russo, Gregory A; Qureshi, Muhammad M; Truong, Minh-Tam; Hirsch, Ariel E; Orlina, Lawrence; Bohrs, Harry; Clancy, Pauline; Willins, John; Kachnic, Lisa A

2012-11-01

To determine whether the use of routine image guided radiation therapy (IGRT) using pretreatment on-board imaging (OBI) with orthogonal kilovoltage X-rays reduces treatment delivery errors. A retrospective review of documented treatment delivery errors from 2003 to 2009 was performed. Following implementation of IGRT in 2007, patients received daily OBI with orthogonal kV X-rays prior to treatment. The frequency of errors in the pre- and post-IGRT time frames was compared. Treatment errors (TEs) were classified as IGRT-preventable or non-IGRT-preventable. A total of 71,260 treatment fractions were delivered to 2764 patients. A total of 135 (0.19%) TEs occurred in 39 (1.4%) patients (3.2% in 2003, 1.1% in 2004, 2.5% in 2005, 2% in 2006, 0.86% in 2007, 0.24% in 2008, and 0.22% in 2009). In 2007, the TE rate decreased by >50% and has remained low (P = .00007, compared to before 2007). Errors were classified as being potentially preventable with IGRT (e.g., incorrect site, patient, or isocenter) vs. not. No patients had any IGRT-preventable TEs from 2007 to 2009, whereas there were 9 from 2003 to 2006 (1 in 2003, 2 in 2004, 2 in 2005, and 4 in 2006; P = .0058) before the implementation of IGRT. IGRT implementation has a patient safety benefit with a significant reduction in treatment delivery errors. As such, we recommend the use of IGRT in routine practice to complement existing quality assurance measures. Copyright © 2012 Elsevier Inc. All rights reserved.

Development and evaluation of camptothecin loaded polymer stabilized nanoemulsion: Targeting potential in 4T1-breast tumour xenograft model.

PubMed

Sugumaran, Abimanyu; Ponnusamy, Chandrasekar; Kandasamy, Palanivel; Krishnaswami, Venkateshwaran; Palanichamy, Rajaguru; Kandasamy, Ruckmani; Lakshmanan, Manikandan; Natesan, Subramanian

2018-04-30

Targeted delivery of anticancer agents is poised to improve cancer therapy, for which polymers can serve as targeting ligands or nanocarriers for chemotherapeutic agents. In this study, we have developed and evaluated the efficacy of a camptothecin (CPT)-loaded polymer stabilized nanoemulsion (PSNE) for the passive targeted delivery to breast cancer. Based on the pseudo-ternary phase diagrams, PSNEs were developed using capmul MCM:poloxamer 407 (4:1), solutol HS 15:simulsol P23 (1:2) and water. CPT polymer mixture was developed by solvent evaporation technique. The PSNEs were characterized for droplet size distribution, plasma protein adsorption, drug release, in-vivo targeting potential, hemolytic potential, cytotoxicity, genotoxicity, in-vivo biodistribution and CPT lactone ring stability. The developed PSNEs showed uniform droplet distribution, extended drug release (76.59±6.12% at 24h), acceptable hemolytic potential, significant cytotoxicity (IC 50 =176±4.3ng/mL) and genotoxicity against MCF-7 cancer cells but low DNA damage potential in human peripheral blood lymphocytes. The efficiency of PSNEs for the targeted delivery of CPT into the tumour regions was documented in 4T1-breast tumour xenografted BALB/c mice. In-vivo biodistribution study shows that 7105.84±568.46ng/g of CPT was passively targeted from PSNE to breast cancer tissue. About 80% of the lactone form was stable for 24h. Taken together, our study provides a promising strategy for developing PSNE-targeted drug delivery system for the breast cancer therapy. Copyright © 2017 Elsevier B.V. All rights reserved.

A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam

PubMed Central

2012-01-01

Background The global initiative ‘Treatment 2.0’ calls for expanding the evidence base of optimal HIV service delivery models to maximize HIV case detection and retention in care. However limited systematic assessment has been conducted in countries with concentrated HIV epidemic. We aimed to assess HIV service availability and service connectedness in Vietnam. Methods We developed a new analytical framework of the continuum of prevention and care (COPC). Using the framework, we examined HIV service delivery in Vietnam. Specifically, we analyzed HIV service availability including geographical distribution and decentralization and service connectedness across multiple services and dimensions. We then identified system-related strengths and constraints in improving HIV case detection and retention in care. This was accomplished by reviewing related published and unpublished documents including existing service delivery data. Results Identified strengths included: decentralized HIV outpatient clinics that offer comprehensive care at the district level particularly in high HIV burden provinces; functional chronic care management for antiretroviral treatment (ART) with the involvement of people living with HIV and the links to community- and home-based care; HIV testing and counseling integrated into tuberculosis and antenatal care services in districts supported by donor-funded projects, and extensive peer outreach networks that reduce barriers for the most-at-risk populations to access services. Constraints included: fragmented local coordination mechanisms for HIV-related health services; lack of systems to monitor the expansion of HIV outpatient clinics that offer comprehensive care; underdevelopment of pre-ART care; insufficient linkage from HIV testing and counseling to pre-ART care; inadequate access to HIV-related services in districts not supported by donor-funded projects particularly in middle and low burden provinces and in mountainous remote areas; and no systematic monitoring of referral services. Conclusions Our COPC analytical framework was instrumental in identifying system-related strengths and constraints that contribute to HIV case detection and retention in care. The national HIV program plans to strengthen provincial programming by re-defining various service linkages and accelerate the transition from project-based approach to integrated service delivery in line with the ‘Treatment 2.0’ initiative. PMID:23272730

A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam.

PubMed

Fujita, Masami; Poudel, Krishna C; Do, Thi Nhan; Bui, Duc Duong; Nguyen, Van Kinh; Green, Kimberly; Nguyen, Thi Minh Thu; Kato, Masaya; Jacka, David; Cao, Thi Thanh Thuy; Nguyen, Thanh Long; Jimba, Masamine

2012-12-29

The global initiative 'Treatment 2.0' calls for expanding the evidence base of optimal HIV service delivery models to maximize HIV case detection and retention in care. However limited systematic assessment has been conducted in countries with concentrated HIV epidemic. We aimed to assess HIV service availability and service connectedness in Vietnam. We developed a new analytical framework of the continuum of prevention and care (COPC). Using the framework, we examined HIV service delivery in Vietnam. Specifically, we analyzed HIV service availability including geographical distribution and decentralization and service connectedness across multiple services and dimensions. We then identified system-related strengths and constraints in improving HIV case detection and retention in care. This was accomplished by reviewing related published and unpublished documents including existing service delivery data. Identified strengths included: decentralized HIV outpatient clinics that offer comprehensive care at the district level particularly in high HIV burden provinces; functional chronic care management for antiretroviral treatment (ART) with the involvement of people living with HIV and the links to community- and home-based care; HIV testing and counseling integrated into tuberculosis and antenatal care services in districts supported by donor-funded projects, and extensive peer outreach networks that reduce barriers for the most-at-risk populations to access services. Constraints included: fragmented local coordination mechanisms for HIV-related health services; lack of systems to monitor the expansion of HIV outpatient clinics that offer comprehensive care; underdevelopment of pre-ART care; insufficient linkage from HIV testing and counseling to pre-ART care; inadequate access to HIV-related services in districts not supported by donor-funded projects particularly in middle and low burden provinces and in mountainous remote areas; and no systematic monitoring of referral services. Our COPC analytical framework was instrumental in identifying system-related strengths and constraints that contribute to HIV case detection and retention in care. The national HIV program plans to strengthen provincial programming by re-defining various service linkages and accelerate the transition from project-based approach to integrated service delivery in line with the 'Treatment 2.0' initiative.