Data That Drive: Closing the Loop in the Learning Hospital System

PubMed Central

Liu, Vincent X.; Morehouse, John W.; Baker, Jennifer M.; Greene, John D.; Kipnis, Patricia; Escobar, Gabriel J.

2017-01-01

The learning healthcare system describes a vision of US healthcare that capitalizes on science, information technology, incentives, and care culture to drive improvements in the quality of health care. The inpatient setting, one of the most costly and impactful domains of healthcare, is an ideal setting in which to use data and information technology to foster continuous learning and quality improvement. The rapid digitization of inpatient medicine offers incredible new opportunities to use data from routine care to generate new discovery and thus close the virtuous cycle of learning. We use an object lesson—sepsis care within the 21 hospitals of the Kaiser Permanente Northern California integrated healthcare delivery system—to offer insight into the critical elements necessary for developing a learning hospital system. We then describe how a hospital-wide data-driven approach to inpatient care can facilitate improvements in the quality of hospital care. PMID:27805797

The history of quality measurement in home health care.

PubMed

Rosati, Robert J

2009-02-01

Quality improvement is as central to home health care as to any other field of health care. With the mandated addition in 2000 of Outcome Assessment and Information Set (OASIS) and outcome-based quality improvement (OBQI), Medicare home health agencies entered a new era of documenting, tracking, and systematically improving quality. OBQI is augmented by the Medicare Quality Improvement Organization (QIO) program, which is now entering the ninth in a series of work assignments, with the tenth scope in the planning stages. Evidence has shown that applied quality improvement methods can drive better outcomes using important metrics, such as acute care hospitalization. This article reviews key findings from the past 2 decades of home care quality improvement research and public policy advances, describes specific examples of local and regional programmatic approaches to quality improvement, and forecasts near-future trends in this vital arena of home health care.

Transforming administrative data into real-time information in the Department of Surgery.

PubMed

Beaulieu, Peter A; Higgins, John H; Dacey, Lawrence J; Nugent, William C; DeFoe, Gordon R; Likosky, Donald S

2010-10-01

Cardiothoracic surgical programmes face increasingly more complex procedures performed on evermore challenging patients. Public and private stakeholders are demanding these programmes report process-level and clinical outcomes as a mechanism for enabling quality assurance and informed clinical decision-making. Increasingly these measures are being tied to reimbursement and institutional accreditation. The authors developed a system for linking administrative and clinical registries, in real-time, to track performance in satisfying the needs of the patients and stakeholders, as well as helping to drive continuous quality improvement. A relational surgical database was developed to link prospectively collected clinical data to administrative data sources at Dartmouth-Hitchcock Medical Center. Institutional performance was displayed over time using process control charts, and compared with both internal and regional benchmarks. Quarterly reports have been generated and automated for five surgical cohorts. Data are displayed externally on our dedicated website, and internally in the cardiothoracic surgical office suites, operating room theatre and nursing units. Monthly discussions are held with the clinical staff and have resulted in the development of quality-improvement projects. The delivery of clinical care in isolation of data and information is no longer prudent or acceptable. The present study suggests that an automated and real-time computer system may provide rich sources of data that may be used to drive improvements in the quality of care. Current and future work will be focused on identifying opportunities to integrate these data into the fabric of the delivery of care to drive process improvement.

National BTS bronchiectasis audit 2012: is the quality standard being adhered to in adult secondary care?

PubMed

Hill, Adam T; Routh, Chris; Welham, Sally

2014-03-01

A significant step towards improving care of patients with non-cystic fibrosis bronchiectasis was the creation of the British Thoracic Society (BTS) national guidelines and the quality standard. A BTS bronchiectasis audit was conducted between 1 October and 30 November 2012, in adult patients with bronchiectasis attending secondary care, against the BTS quality standard. Ninety-eight institutions took part, submitting a total of 3147 patient records. The audit highlighted the variable adoption of the quality standard. It will allow the host institutions to benchmark against UK figures and drive quality improvement programmes to promote the quality standard and improve patient care.

Conceptions of Early Childhood Leadership: Driving New Professionalism?

ERIC Educational Resources Information Center

Sims, Margaret; Forrest, Rhonda; Semann, Anthony; Slattery, Colin

2015-01-01

This study reports the understandings of leadership held by 351 Victorian early childhood leaders (ECLs). Internationally, ECLs are expected to drive quality improvement through mentoring and modelling: a concept associated with distributive leadership. However, ECLs often move into leadership positions by accident and are ill-prepared for their…

Demystifying Data: Designing and Implementing Data-Driven Systems and Practices for Continuous Quality Improvement

ERIC Educational Resources Information Center

Krugly, Andrew; Stein, Amanda; Centeno, Maribel G.

2014-01-01

Data-based decision making should be the driving force in any early care and education setting. Data usage compels early childhood practitioners and leaders to make decisions on the basis of more than just professional instinct. This article explores why early childhood schools should be using data for continuous quality improvement at various…

Parameters for the Design of Group Randomized Studies for Teacher Professional Development

ERIC Educational Resources Information Center

Kelcey, Ben; Phelps, Geoffrey; Jones, Nathan

2013-01-01

Teacher professional development (PD) is seen as critical to improving the quality of US schools (National Commission on Teaching and America's Future, 1997). PD is increasingly viewed as one of the primary levers for improving teaching quality and ultimately student achievement (Correnti, 2007). One factor that is driving interest in PD is…

Virtual reality exposure therapy for fear of driving: analysis of clinical characteristics, physiological response, and sense of presence.

PubMed

Costa, Rafael T da; Carvalho, Marcele R de; Ribeiro, Pedro; Nardi, Antonio E

2018-01-01

To investigate the reactions of women with driving phobia to a therapeutic program of scheduled virtual reality exposure treatment (VRET) sessions. The study intervention consisted of a computer game with car-driving scenarios that included several traffic situations. We investigated the participants' sense of presence, subjective distress, and physiological responses during eight virtual-reality exposures. We also evaluated clinical characteristics, driving cognitions, and quality of life in the participants. Thirteen women were selected. Eight were able to complete the protocol. After VRET, there was a decrease in the frequency of distorted thoughts and state anxiety scores, as well as a slight improvement in quality of life. Subjective discomfort scores, heart rate variation, and sense of presence scores confirmed that there was sense of presence in the virtual reality environment. All patients showed some degree of improvement and demonstrated different levels of anxiety in subsequent in vivo driving experiences. Our findings suggest that VRET could be used to facilitate in vivo exposure, because it can induce presence/immersion and reduce anxiety in patients with specific phobia. Furthermore, VRET is not associated with any type of risk.

Driving Control for Electric Power Assisted Wheelchair Based on Regenerative Brake

NASA Astrophysics Data System (ADS)

Seki, Hirokazu; Takahashi, Kazuki; Tadakuma, Susumu

This paper describes a novel safety driving control scheme for electric power assisted wheelchairs based on the regenerative braking system. “Electric power assisted wheelchair” which assists the driving force by electric motors is expected to be widely used as a mobility support system for elderly people and disabled people, however, the safe and secure driving performance especially on downhill roads must be further improved because electric power assisted wheelchairs have no braking devices. The proposed control system automatically switches the driving mode, from “assisting mode” to “braking mode”, based on the wheelchair's velocity and the declined angle and smoothly suppresses the wheelchair's acceleration based on variable duty ratio control in order to realize the safety driving and to improve the ride quality. Some experiments on the practical roads and subjective evaluation show the effectiveness of the proposed control system.

Consequent use of IT tools as a driver for cost reduction and quality improvements

NASA Astrophysics Data System (ADS)

Hein, Stefan; Rapp, Roberto; Feustel, Andreas

2013-10-01

The semiconductor industry drives a lot of efforts in the field of cost reductions and quality improvements. The consequent use of IT tools is one possibility to support these goals. With the extensions of its 150mm Fab to 200mm Robert Bosch increased the systematic use of data analysis and Advanced Process Control (APC).

Towards Quality Technical Vocational Education and Training (Tvet) Programmes in Nigeria: Challenges and Improvement Strategies

ERIC Educational Resources Information Center

Ayonmike, Chinyere Shirley; Okwelle, P. Chijioke; Okeke, Benjamin Chukwumaijem

2015-01-01

Technical Vocational Education and Training (TVET) is widely recognized as a vital driving force for the socio-economic growth and technological development of nations. In achieving the goals and objectives of TVET in Nigeria, the quality of the programme needs to be improved and sustained. The purpose of this study is to ascertain the challenges…

Driving technology for improving motion quality of active-matrix organic light-emitting diode display

NASA Astrophysics Data System (ADS)

Kim, Jongbin; Kim, Minkoo; Kim, Jong-Man; Kim, Seung-Ryeol; Lee, Seung-Woo

2014-09-01

This paper reports transient response characteristics of active-matrix organic light emitting diode (AMOLED) displays for mobile applications. This work reports that the rising responses look like saw-tooth waveform and are not always faster than those of liquid crystal displays. Thus, a driving technology is proposed to improve the rising transient responses of AMOLED based on the overdrive (OD) technology. We modified the OD technology by combining it with a dithering method because the conventional OD method cannot successfully enhance all the rising responses. Our method can improve all the transitions of AMOLED without modifying the conventional gamma architecture of drivers. A new artifact is found when OD is applied to certain transitions. We propose an optimum OD selection method to mitigate the artifact. The implementation results show the proposed technology can successfully improve motion quality of scrolling texts as well as moving pictures in AMOLED displays.

From Planning to Improvement: Monash University Library's Quality Review

ERIC Educational Resources Information Center

Pernat, Marie

2004-01-01

During 2003, Monash University Library conducted a comprehensive quality review as part of the university's program of reviews. A quality management group was established in September 2002 to drive the process. All staff were given the opportunity to contribute input to the initial self-review. Methods of collecting data, collating responses and…

Behavioral Impact of Graduated Driver Licensing on Teenage Driving Risk and Exposure1

PubMed Central

Karaca-Mandic, Pinar; Ridgeway, Greg

2009-01-01

Graduated Driver Licensing (GDL) is a critical policy tool for potentially improving teenage driving while reducing teen accident exposure. While previous studies demonstrated that GDL reduces teenage involvement in fatal crashes, much remains unanswered. We explore the mechanisms through which GDL influences accident rates as well as its long term effectiveness on teen driving. In particular, we investigate; 1) whether GDL policies improve teenage driving behavior, or simply reduce teenage prevalence on the roads; 2) whether GDL exposed teens become better drivers in later years. We employ a unique data source, the State Data System, which contains all police reported accidents (fatal and non-fatal) during 1990–2005 for twelve states. We estimate a structural model that separately identifies GDL s effect on relative teenage prevalence and relative teenage riskiness. Identification of the model is driven by the relative numbers of crashes between two teenagers, two adults, or a teenager and an adult. We find that the GDL policies reduce the number of 15–17 year-old accidents by limiting the amount of teenage driving rather than by improving teenage driving. This prevalence reduction primarily occurs at night and stricter GDL policies, especially those with nighttime driving restrictions, are the most effective. Finally, we find that teen driving quality does not improve ex-post GDL exposure. PMID:19942310

Data that drive: Closing the loop in the learning hospital system.

PubMed

Liu, Vincent X; Morehouse, John W; Baker, Jennifer M; Greene, John D; Kipnis, Patricia; Escobar, Gabriel J

2016-11-01

The learning healthcare system describes a vision of US healthcare that capitalizes on science, information technology, incentives, and care culture to drive improvements in the quality of health care. The inpatient setting, one of the most costly and impactful domains of healthcare, is an ideal setting in which to use data and information technology to foster continuous learning and quality improvement. The rapid digitization of inpatient medicine offers incredible new opportunities to use data from routine care to generate new discovery and thus close the virtuous cycle of learning. We use an object lesson-sepsis care within the 21 hospitals of the Kaiser Permanente Northern California integrated healthcare delivery system-to offer insight into the critical elements necessary for developing a learning hospital system. We then describe how a hospital-wide data-driven approach to inpatient care can facilitate improvements in the quality of hospital care. Journal of Hospital Medicine 2016;11:S11-S17. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Setting Quality Improvement Priorities for Women Receiving Systemic Therapy for Early-Stage Breast Cancer by Using Population-Level Administrative Data.

PubMed

Enright, Katherine A; Taback, Nathan; Powis, Melanie Lynn; Gonzalez, Alejandro; Yun, Lingsong; Sutradhar, Rinku; Trudeau, Maureen E; Booth, Christopher M; Krzyzanowska, Monika K

2017-10-01

Purpose Routine evaluation of quality measures (QMs) can drive improvement in cancer systems by highlighting gaps in care. Targeting quality improvement at QMs that demonstrate substantial variation has the potential to make the largest impact at the population level. We developed an approach that uses both variation in performance and number of patients affected by the QM to set priorities for improving the quality of systemic therapy for women with early-stage breast cancer (EBC). Patients and Methods Patients with EBC diagnosed from 2006 to 2010 in Ontario, Canada, were identified in the Ontario Cancer Registry and linked deterministically to multiple health care databases. Individual QMs within a panel of 15 QMs previously developed to assess the quality of systemic therapy across four domains (access, treatment delivery, toxicity, and safety) were ranked on interinstitutional variation in performance (using interquartile range) and the number of patients who were affected; then the two rankings were averaged for a summative priority ranking. Results We identified 28,427 patients with EBC who were treated at 84 institutions. The use of computerized physician electronic order entry for chemotherapy, emergency room visits or hospitalizations during chemotherapy, and timely receipt of chemotherapy were identified as the QMs that had the largest potential to improve quality of care at a system level within this cohort. Conclusion A simple ranking system based on interinstitutional variation in performance and patient volume can be used to identify high-priority areas for quality improvement from a population perspective. This approach is generalizable to other health care systems that use QMs to drive improvement.

Empirical Study on the Sustainability of China's Grain Quality Improvement: The Role of Transportation, Labor, and Agricultural Machinery.

PubMed

Zhang, Ming; Duan, Fang; Mao, Zisen

2018-02-05

As a major part of farming sustainability, the issues of grain production and its quality improvement have been important in many countries. This paper aims to address these issues in China. Based on the data from the main production provinces and by applying the stochastic frontier analysis methodology, we find that the improvement of transportation and the use of agricultural machinery have become the main driving forces for grain quality improvement in China. After further studying different provinces' potentials of grain quality improvement, we show that grain quality has increased steadily. Therefore, we can conclude China's grain quality improvement is indeed sustainable. Furthermore, different grains like rice, wheat, and corn share similar characteristics in terms of quality improvement, but the improvement rate for rice is relatively low, while those of corn and wheat are relatively high. Moreover, the overall change of efficiency gain of grain quality improvement is not significant for different provinces. The efficiency gains of the quality improvements for rice and wheat even decrease slightly. In addition, we find that only expanding grain quality improvement potential can simultaneously achieve the dual objectives of improving grain quality and increasing yield.

Empirical Study on the Sustainability of China’s Grain Quality Improvement: The Role of Transportation, Labor, and Agricultural Machinery

PubMed Central

Zhang, Ming; Duan, Fang; Mao, Zisen

2018-01-01

As a major part of farming sustainability, the issues of grain production and its quality improvement have been important in many countries. This paper aims to address these issues in China. Based on the data from the main production provinces and by applying the stochastic frontier analysis methodology, we find that the improvement of transportation and the use of agricultural machinery have become the main driving forces for grain quality improvement in China. After further studying different provinces’ potentials of grain quality improvement, we show that grain quality has increased steadily. Therefore, we can conclude China’s grain quality improvement is indeed sustainable. Furthermore, different grains like rice, wheat, and corn share similar characteristics in terms of quality improvement, but the improvement rate for rice is relatively low, while those of corn and wheat are relatively high. Moreover, the overall change of efficiency gain of grain quality improvement is not significant for different provinces. The efficiency gains of the quality improvements for rice and wheat even decrease slightly. In addition, we find that only expanding grain quality improvement potential can simultaneously achieve the dual objectives of improving grain quality and increasing yield. PMID:29401727

Design and simulation of the direct drive servo system

NASA Astrophysics Data System (ADS)

Ren, Changzhi; Liu, Zhao; Song, Libin; Yi, Qiang; Chen, Ken; Zhang, Zhenchao

2010-07-01

As direct drive technology is finding their way into telescope drive designs for its many advantages, it would push to more reliable and cheaper solutions for future telescope complex motion system. However, the telescope drive system based on the direct drive technology is one high integrated electromechanical system, which one complex electromechanical design method is adopted to improve the efficiency, reliability and quality of the system during the design and manufacture circle. The telescope is one ultra-exact, ultra-speed, high precision and huge inertial instrument, which the direct torque motor adopted by the telescope drive system is different from traditional motor. This paper explores the design process and some simulation results are discussed.

Compound management beyond efficiency.

PubMed

Burr, Ian; Winchester, Toby; Keighley, Wilma; Sewing, Andreas

2009-06-01

Codeveloping alongside chemistry and in vitro screening, compound management was one of the first areas in research recognizing the need for efficient processes and workflows. Material management groups have centralized, automated, miniaturized and, importantly, found out what not to do with compounds. While driving down cost and improving quality in storage and processing, researchers still face the challenge of interfacing optimally with changing business processes, in screening groups, and with external vendors and focusing on biologicals in many companies. Here we review our strategy to provide a seamless link between compound acquisition and screening operations and the impact of material management on quality of the downstream processes. Although this is driven in part by new technologies and improved quality control within material management, redefining team structures and roles also drives job satisfaction and motivation in our teams with a subsequent positive impact on cycle times and customer feedback.

The Quest for Quality: How YoungStar Is Affecting Child Care in Milwaukee County

ERIC Educational Resources Information Center

Mueller, Betsy; Peterangelo, Joe; Henken, Rob

2016-01-01

The State of Wisconsin's YoungStar system was created by the Legislature and Governor in 2010 to "drive quality improvement in child care throughout the state." YoungStar uses a five-star system to rate child care providers based on several measures of quality, including staff education levels, learning environment, business methods, and…

QUANTIFYING THE CLIMATE, AIR QUALITY AND HEALTH BENEFITS OF IMPROVED COOKSTOVES: AN INTEGRATED LABORATORY, FIELD AND MODELING STUDY

EPA Science Inventory

Expected results and outputs include: extensive dataset of in-field and laboratory emissions data for traditional and improved cookstoves; parameterization to predict cookstove emissions from drive cycle data; indoor and personal exposure data for traditional and improved cook...

Utility of NCEP Operational and Emerging Meteorological Models for Driving Air Quality Prediction

NASA Astrophysics Data System (ADS)

McQueen, J.; Huang, J.; Huang, H. C.; Shafran, P.; Lee, P.; Pan, L.; Sleinkofer, A. M.; Stajner, I.; Upadhayay, S.; Tallapragada, V.

2017-12-01

Operational air quality predictions for the United States (U. S.) are provided at NOAA by the National Air Quality Forecasting Capability (NAQFC). NAQFC provides nationwide operational predictions of ozone and particulate matter twice per day (at 06 and 12 UTC cycles) at 12 km resolution and 1 hour time intervals through 48 hours and distributed at http://airquality.weather.gov. The NOAA National Centers for Environmental Prediction (NCEP) operational North American Mesoscale (NAM) 12 km weather prediction is used to drive the Community Multiscale Air Quality (CMAQ) model. In 2017, the NAM was upgraded in part to reduce a warm 2m temperature bias in Summer (V4). At the same time CMAQ was updated to V5.0.2. Both versions of the models were run in parallel for several months. Therefore the impact of improvements from the atmospheric chemistry model versus upgrades with the weather prediction model could be assessed. . Improvements to CMAQ were related to improvements to improvements in NAM 2 m temperature bias through increasing the opacity of clouds and reducing downward shortwave radiation resulted in reduced ozone photolysis. Higher resolution operational NWP models have recently been introduced as part of the NCEP modeling suite. These include the NAM CONUS Nest (3 km horizontal resolution) run four times per day through 60 hours and the High Resolution Rapid Refresh (HRRR, 3 km) run hourly out to 18 hours. In addition, NCEP with other NOAA labs has begun to develop and test the Next Generation Global Prediction System (NGGPS) based on the FV3 global model. This presentation also overviews recent developments with operational numerical weather prediction and evaluates the ability of these models for predicting low level temperatures, clouds and capturing boundary layer processes important for driving air quality prediction in complex terrain. The assessed meteorological model errors could help determine the magnitude of possible pollutant errors from CMAQ if used for driving meteorology. The NWP models will be evaluated against standard and mesonet fields averaged for various regions during the summer 2017. An evaluation of meteorological fields important to air quality modeling (eg: near surface winds, temperatures, moisture and boundary layer heights, cloud cover) will be reported on.

Electronic Health Record Tools to Care for At-Risk Older Drivers: A Quality Improvement Project.

PubMed

Casey, Colleen M; Salinas, Katherine; Eckstrom, Elizabeth

2015-06-01

Evaluating driving safety of older adults is an important health topic, but primary care providers (PCP) face multiple barriers in addressing this issue. The study's objectives were to develop an electronic health record (EHR)-based Driving Clinical Support Tool, train PCPs to perform driving assessments utilizing the tool, and systematize documentation of assessment and management of driving safety issues via the tool. The intervention included development of an evidence-based Driving Clinical Support Tool within the EHR, followed by training of internal medicine providers in the tool's content and use. Pre- and postintervention provider surveys and chart review of driving-related patient visits were conducted. Surveys included self-report of preparedness and knowledge to evaluate at-risk older drivers and were analyzed using paired t-test. A chart review of driving-related office visits compared documentation pre- and postintervention including: completeness of appropriate focused history and exam, identification of deficits, patient education, and reporting to appropriate authorities when indicated. Data from 86 providers were analyzed. Pre- and postintervention surveys showed significantly increased self-assessed preparedness (p < .001) and increased driving-related knowledge (p < .001). Postintervention charts showed improved documentation of correct cognitive testing, more referrals/consults, increased patient education about community resources, and appropriate regulatory reporting when deficits were identified. Focused training and an EHR-based clinical support tool improved provider self-reported preparedness and knowledge of how to evaluate at-risk older drivers. The tool improved documentation of driving-related issues and led to improved access to interdisciplinary care coordination. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

What Drives Teachers to Improve? The Role of Teacher Mindset in Professional Learning

ERIC Educational Resources Information Center

Gero, Greg Philip

2013-01-01

Teacher quality has received increasing focus over the past decade, yet, by some measures, teachers rarely improve after their first few years of teaching, and not all teachers seem driven to improve. Traditional models of professional learning have emphasized the processes that teachers take part in as a facilitator of their improvement. Research…

77 FR 66470 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-05

... provided by grantees under the SCDTDP and monitor and drive improvement on quality measures; (2) collect... review by the Office of Management and Budget (OMB), in compliance with the Paperwork Reduction Act of... Act of 1995: Proposed Project: Sickle Cell Disease Treatment Demonstration Program-- Quality...

Total Quality Management in Libraries: A Sourcebook.

ERIC Educational Resources Information Center

O'Neil, Rosanna M., Comp.

Total Quality Management (TQM) brings together the best aspects of organizational excellence by driving out fear, offering customer-driven products and services, doing it right the first time by eliminating error, and maintaining inventory control without waste. Libraries are service organizations which are constantly trying to improve service.…

A Novel and Intelligent Home Monitoring System for Care Support of Elders with Cognitive Impairment.

PubMed

Lazarou, Ioulietta; Karakostas, Anastasios; Stavropoulos, Thanos G; Tsompanidis, Theodoros; Meditskos, Georgios; Kompatsiaris, Ioannis; Tsolaki, Magda

2016-10-18

Assistive technology, in the form of a smart home environment, is employed to support people with dementia. To propose a system for continuous and objective remote monitoring of problematic daily living activity areas and design personalized interventions based on system feedback and clinical observations for improving cognitive function and health-related quality of life. The assistive technology of the proposed system, including wearable, sleep, object motion, presence, and utility usage sensors, was methodically deployed at four different home installations of people with cognitive impairment. Detection of sleep patterns, physical activity, and activities of daily living, based on the collected sensor data and analytics, was available at all times through comprehensive data visualization solutions. Combined with clinical observation, targeted psychosocial interventions were introduced to enhance the participants' quality of life and improve their cognitive functions and daily functionality. Meanwhile, participants and their caregivers were able to visualize a reduced set of information tailored to their needs. Overall, paired-sample t-test analysis of monitored qualities revealed improvement for all participants in neuropsychological assessment. Moreover, improvement was detected from the beginning to the end of the trial, in physical condition and in the domains of sleep. Detecting abnormalities via the system, for example in sleep quality, such as REM sleep, has proved to be critical to assess current status, drive interventions, and evaluate improvements in a reliable manner. It has been proved that the proposed system is suitable to support clinicians to reliably drive and evaluate clinical interventions toward quality of life improvement of people with cognitive impairment.

Motorized mobility scooters – The use of training/intervention and technology for improving driving skills in aging adults - A Mini-Review

PubMed Central

Toosizadeh, Nima; Bunting, Matthew; Howe, Carol; Mohler, Jane; Sprinkle, Jonathan; Najafi, Bijan

2014-01-01

Background Motorized mobility scooters (MMS) have become the most acceptable powered assistive device for those with impaired mobility, who have sufficient upper body strength and dexterity, and postural stability. Although several benefits have been attributed to MMS usage, there are likewise risks of use, including injuries and even deaths. Objective The aim of the current review was to summarize results from clinical studies regarding the enhancement of MMS driver safety with a primary focus on improving driving skills/performance using clinical approaches. We addressed three main objectives: 1) to identify and summarize any available evidence (strong, moderate, or weak evidence based on the quality of studies) regarding improved driving skills/performance following training/intervention; 2) to identify types of driving skills/performance that might be improved by training/intervention; and 3) to identify the use of technology in improving MMS performance or training procedure. Methods Articles were searched for in the following medical and engineering electronic databases: PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, PsycINFO, CINAHL, ERIC, EI Compendix, IEEE Explore, and REHABDATA. Inclusion criteria included: aging adults or those with ambulatory problems; intervention or targeted training; and clinical trial. Outcomes included: MMS skills/performance. Results Six articles met the inclusion criteria and are analyzed in this review. Four of the six articles contained training approaches for MMS drivers including skill trainings using real MMS inside and outside (i.e., in community) and in a 3D virtual environment. The other two studies contain infrastructural assessments (i.e., the minimum space required for safe maneuverability of MMS users) and additional mobility assistance tools to improve maneuverability and to enhance driving performance. Conclusions Results from the current review showed improved driving skills/performance by training, infrastructural assessments, and incorporating mobility assistance tools. MMS driving skills that can be improved through driver training include: weaving, negotiating with and avoiding pedestrian interference, simultaneous reading of signs and obstacle avoidance in path, level driving, forward and reverse driving, figure 8s, turning in place, crossing left slope, maneuvering down a 2-inch curb, and driving up and down inclines. However, several limitations exist in the available literature regarding evidence of improved driving skills/performance following training/intervention, such as small sample sizes, lack of control groups and statistical analysis. PMID:24481257

Factors influencing quality of patient interaction at community pharmacy drive-through and walk-in counselling areas.

PubMed

Odukoya, Olufunmilola K; Chui, Michelle A; Pu, Jia

2014-08-01

To examine factors influencing the amount of time and information pharmacy personnel provide to patients at drive-through and walk-in counselling areas. On-site observational data collection in 22 community pharmacies by pharmacy students. Information included observable patient characteristics such as gender, age range, English proficiency and mobility impairment; encounter characteristics included type of prescription and whether the patient was acknowledged; and counselling characteristics included types of counselling information conveyed and length of time for each encounter. Patient-pharmacist encounters were documented at the drive-through and walk-in counselling areas 961 and 1098 times respectively. Pharmacists spent less time, and technicians more time, with patients at the drive-through counselling area. The amount of information provided to patients was significantly affected by whether the patient was receiving new versus refill prescriptions. Patients with a new prescription were twice as likely to receive more information from pharmacy personnel. There was a significant difference between the amount of counselling provided to patients at the drive-through and walk-in counselling area (rate ratio (RR) 0.92, 95% confidence interval (CI): 0.86-1.00). Patients at the drive-through received a lower amount of information relative to patients using the walk-in. Amount of information provided to patients was affected by the level of pharmacy busyness (RR 0.96, 95% CI: 0.95-0.99). Providing patient care at the drive-through counselling area may negatively influence quality of patient care. To improve quality of pharmacy drive-through services, standardization of drive-through services in pharmacies may be needed. © 2013 Royal Pharmaceutical Society.

Automated radio astronomy operations

NASA Technical Reports Server (NTRS)

Livermore, R. W.

1978-01-01

The improvements in using a computer to drive a DSN 64-meter antenna are described. The development is used to simplify operation, improve antenna safety, reduce antenna wear, present the abuse of antenna by misoperation, increase quantity and quality of data gathered, and give users a greater choice of automatic operations.

The six critical attributes of the next generation of quality management software systems.

PubMed

Clark, Kathleen

2011-07-01

Driven by both the need to meet regulatory requirements and a genuine desire to drive improved quality, quality management systems encompassing standard operating procedure, corrective and preventative actions and related processes have existed for many years, both in paper and electronic form. The impact of quality management systems on 'actual' quality, however, is often reported as far less than desired. A quality management software system that moves beyond formal forms-driven processes to include a true closed loop design, manage disparate processes across the enterprise, provide support for collaborative processes and deliver insight into the overall state of control has the potential to close the gap between simply accomplishing regulatory compliance and delivering measurable improvements in quality and efficiency.

Data Sharing to Drive the Improvement of Teacher Preparation Programs

ERIC Educational Resources Information Center

Bastian, Kevin C.; Fortner, C. Kevin; Chapman, Alisa; Fleener, M. Jayne; McIntyre, Ellen; Patriarca, Linda A.

2016-01-01

Background/Context: Teacher preparation programs (TPPs) face increasing pressure from the federal government, states, and accreditation agencies to improve the quality of their practices and graduates, yet they often do not possess enough data to make evidence-based reforms. Purpose/Objective: This manuscript has four objectives: (a) to present…

Kaizen and the Art of University Administration. AIR 1992 Annual Forum Paper.

ERIC Educational Resources Information Center

Muffo, John A.; Krallman, John D.

This paper examines how the concepts of strategic planning, assessment, and Total Quality Management fit together and relate to one another in the field of higher education. Central to the explanation of how these topics are related is the Japanese philosophy of Kaizen, a driving force behind the quality improvement movement in that country. The…

Improving performance on core processes of care.

PubMed

Austin, John Matthew; Pronovost, Peter J

2016-06-01

This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

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

PubMed

Stacy, Kathleen M

2015-01-01

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

Evaluating a nursing care delivery model using a quality improvement design.

PubMed

Nardone, P L; Markie, J W; Tolle, S

1995-10-01

The goal to develop and implement a new model of nursing care delivery grew out of administrative and shared governance initiatives to improve the quality of nursing care. This evaluative study used both quantitative and qualitative methods. Seven principles related to quality were identified and became the driving force behind the changes. Aspects of these changes in care delivery were piloted on a neurological unit and included implementation of collaborative rounds, a modular structure, role changes, and work redesign. Frequency distribution, questionnaire, focus group, and financial data indicated that there had been improvement in the delivery of care in addition to financial benefits. A considerable amount of the data provided evidence that supported continuing the changes.

Dynamical noise filter and conditional entropy analysis in chaos synchronization.

PubMed

Wang, Jiao; Lai, C-H

2006-06-01

It is shown that, in a chaotic synchronization system whose driving signal is exposed to channel noise, the estimation of the drive system states can be greatly improved by applying the dynamical noise filtering to the response system states. If the noise is bounded in a certain range, the estimation errors, i.e., the difference between the filtered responding states and the driving states, can be made arbitrarily small. This property can be used in designing an alternative digital communication scheme. An analysis based on the conditional entropy justifies the application of dynamical noise filtering in generating quality synchronization.

Switched capacitor charge pump used for low-distortion imaging in atomic force microscope.

PubMed

Zhang, Jie; Zhang, Lian Sheng; Feng, Zhi Hua

2015-01-01

The switched capacitor charge pump (SCCP) is an effective method of linearizing charges on piezoelectric actuators and therefore constitute a significant approach to nano-positioning. In this work, it was for the first time implemented in an atomic force microscope for low-distortion imaging. Experimental results showed that the image quality was improved evidently under the SCCP drive compared with that under traditional linear voltage drive. © Wiley Periodicals, Inc.

A study on the relationship between urban roads and car fuel consumption based on the ST-matching algorithm

NASA Astrophysics Data System (ADS)

Liu, Mingshan; Zhang, Wenbo; Zhou, Yuan; Xun, Yanqin; Wang, Rui

2017-07-01

Since the study of fuel consumptions is of great importance and the related data is accessible, many researches about factors affecting fuel consumptions have appeared.To sum up, the driving style of drivers, automobile emissions and the type of the routes are the mainly three factors.Classification is relatively single.In order to improve the classification accuracy' this text studies that there exist some special roads,when drivers drive through them,their fuel consumptions will be similar because of road qualities.To achieve this goal, the first step is to calculate fuel consumptions per 100km of all city roads.Recognizing and examining special roads based on the ST-Matching algorithm.Third is to analyze road qualities of special roads like the length of roads, the speed of driving, and compare them with other common roads.Then we choose 4 cases to analyze. We find that when driving through special roads, fuel consumptions would be similar because of road qualities.Besides, the average length of special roads is longer than common roads' and the mean velocity, the speed of getting and off special roads are faster than common roads'.The findings in this paper can filter out special road segments as noisy data in the study of relationship between driving styles and fuel consumptions,and it also has very high practical significance on recommending fuel-efficient paths.

Entrepreneurial organizations: the driving force for improving quality in the healthcare industry.

PubMed

Borkowski, Nancy; Gordon, Jean

2006-01-01

Using DiMaggio and Powell's concept of institutional isomorphism, the authors explain why healthcare lags behind other industries in innovating new production functions that address quality. Healthcare finns can "learn" to be entrepreneurial organizations within Stevenson's 'entrepreneurial versus administrative behavior' framework and Covin and Slevin's model of an entrepreneurial organization's required culture and behavioral support structure.

Moving the Needle on Program Quality: An Examination of the Organizational Characteristics That Drive Improvement in Expanded Learning Programs

ERIC Educational Resources Information Center

McCormick, Silvana

2017-01-01

Program evaluation can play a critical role in supporting high quality implementation of social programs to help them achieve their goal of social impact. Evaluation scholars have developed a wide range of strategies to help build programs' internal evaluation capacity in an effort to support meaningful use of evaluation. However, the evaluation…

Effects of Armodafinil on Simulated Driving and Self-Report Measures in Obstructive Sleep Apnea Patients prior to Treatment with Continuous Positive Airway Pressure

PubMed Central

Kay, Gary G.; Feldman, Neil

2013-01-01

Study Objectives: Obstructive sleep apnea (OSA) has been associated with an increased risk of motor vehicle crashes. This driving risk can be reduced (≥ 50%) by treatment with continuous positive airway pressure (CPAP). However residual excessive daytime sleepiness (EDS) can persist for some patients who regularly use CPAP. The current study was designed to assess the effect of armodafinil on simulated driving performance and subsequent CPAP treatment compliance in newly diagnosed OSA patients with EDS during a 2-week “waiting period” prior to initiation of CPAP. Methods: Sixty-nine newly diagnosed OSA patients, awaiting CPAP therapy, were randomized (1:1) to placebo or armodafinil (150 mg/day) treatment. Simulated driving tests and self-report measures were completed at baseline, after 2 weeks of drug treatment, and following 6 weeks of CPAP treatment. CPAP compliance was evaluated at the end of 6 weeks of CPAP. Results: Compared to placebo, armodafinil improved simulated driving safety performance in OSA patients awaiting CPAP therapy (p = 0.03). Improvement was seen in lane position deviation (p = 0.002) and number of lane excursions (p = 0.02). Improvement was also observed on measures of sleepiness using the Epworth Sleepiness Scale (ESS) and sleep related quality of life. Following 6 weeks of CPAP, there was also significant improvement observed on multiple measures of simulated driving performance. CPAP compliance did not differ between armodafinil-treated and placebo-treated patients (p = 0.80). Conclusions: Armodafinil was found to improve simulated driving performance in OSA patients with EDS prior to initiation of CPAP. Treatment with armodafinil showed no effect on subsequent CPAP compliance. Citation: Kay GG; Feldman N. Effects of armodafinil on simulated driving and self-report measures in obstructive sleep apnea patients prior to treatment with continuous positive airway pressure. J Clin Sleep Med 2013;9(5):445-454. PMID:23674935

Dynamic Simulation Research on Chain Drive Mechanism of Corn Seeder Based on ADAMS

NASA Astrophysics Data System (ADS)

Wang, Y. B.; Jia, H. P.

2017-12-01

In order to reduce the damage to the chain and improve the seeding quality of the seeding machine, the corn seeder has the characteristics of the seeding quality and some technical indexes in the work of the corn seeding machine. The dynamic analysis of the chain drive mechanism is carried out by using the dynamic virtual prototype. In this paper, the speed of the corn planter is 5km/h, and the speed of the simulated knuckle is 0.1~0.9s. The velocity is 0.12m/s, which is equal to the chain speed when the seeder is running normally. Of the dynamic simulation of the movement and the actual situation is basically consistent with the apparent speed of the drive wheel has changed the acceleration and additional dynamic load, the chain drive has a very serious damage, and the maximum load value of 47.28N, in order to reduce the damage to the chain, As far as possible so that the sowing machine in the work to maintain a reasonable uniform speed, to avoid a greater acceleration, the corn sowing machine drive the design of a certain reference.

Driving photomask supplier quality through automation

NASA Astrophysics Data System (ADS)

Russell, Drew; Espenscheid, Andrew

2007-10-01

In 2005, Freescale Semiconductor's newly centralized mask data prep organization (MSO) initiated a project to develop an automated global quality validation system for photomasks delivered to Freescale Semiconductor fabs. The system handles Certificate of Conformance (CofC) quality metric collection, validation, reporting and an alert system for all photomasks shipped to Freescale fabs from all qualified global suppliers. The completed system automatically collects 30+ quality metrics for each photomask shipped. Other quality metrics are generated from the collected data and quality metric conformance is automatically validated to specifications or control limits with failure alerts emailed to fab photomask and mask data prep engineering. A quality data warehouse stores the data for future analysis, which is performed quarterly. The improved access to data provided by the system has improved Freescale engineers' ability to spot trends and opportunities for improvement with our suppliers' processes. This paper will review each phase of the project, current system capabilities and quality system benefits for both our photomask suppliers and Freescale.

The Victorian Lung Cancer Registry pilot: improving the quality of lung cancer care through the use of a disease quality registry.

PubMed

Stirling, Rob G; Evans, S M; McLaughlin, P; Senthuren, M; Millar, J; Gooi, J; Irving, L; Mitchell, P; Haydon, A; Ruben, J; Conron, M; Leong, T; Watkins, N; McNeil, J J

2014-10-01

Lung cancer remains a major disease burden in Victoria (Australia) and requires a complex and multidisciplinary approach to ensure optimal care and outcomes. To date, no uniform mechanism is available to capture standardized population-based outcomes and thereby provide benchmarking. The establishment of such a data platform is, therefore, a primary requisite to enable description of process and outcome in lung cancer care and to drive improvement in the quality of care provided to individuals with lung cancer. A disease quality registry pilot has been established to capture prospective data on all adult patients with clinical or tissue diagnoses of small cell and non-small cell lung cancer. Steering and management committees provide clinical governance and supervise quality indicator selection. Quality indicators were selected following extensive literature review and evaluation of established clinical practice guidelines. A minimum dataset has been established and training and data capture by data collectors is facilitated using a web-based portal. Case ascertainment is established by regular institutional reporting of ICD-10 discharge coding. Recruitment is optimized by provision of opt-out consent. The collection of a standardized minimum data set optimizes capacity for harmonized population-based data capture. Data collection has commenced in a variety of settings reflecting metropolitan and rural, and public, and private health care institutions. The data set provides scope for the construction of a risk-adjusted model for outcomes. A data access policy and a mechanism for escalation policy for outcome outliers has been established. The Victorian Lung Cancer Registry provides a unique capacity to provide and confirm quality assessment in lung cancer and to drive improvement in quality of care across multidisciplinary stakeholders.

How Many Pixels Does It Take to Make a Good 4"×6" Print? Pixel Count Wars Revisited

NASA Astrophysics Data System (ADS)

Kriss, Michael A.

Digital still cameras emerged following the introduction of the Sony Mavica analog prototype camera in 1981. These early cameras produced poor image quality and did not challenge film cameras for overall quality. By 1995 digital still cameras in expensive SLR formats had 6 mega-pixels and produced high quality images (with significant image processing). In 2005 significant improvement in image quality was apparent and lower prices for digital still cameras (DSCs) started a rapid decline in film usage and film camera sells. By 2010 film usage was mostly limited to professionals and the motion picture industry. The rise of DSCs was marked by a “pixel war” where the driving feature of the cameras was the pixel count where even moderate cost, ˜120, DSCs would have 14 mega-pixels. The improvement of CMOS technology pushed this trend of lower prices and higher pixel counts. Only the single lens reflex cameras had large sensors and large pixels. The drive for smaller pixels hurt the quality aspects of the final image (sharpness, noise, speed, and exposure latitude). Only today are camera manufactures starting to reverse their course and producing DSCs with larger sensors and pixels. This paper will explore why larger pixels and sensors are key to the future of DSCs.

Making Quality Health Websites a National Public Health Priority: Toward Quality Standards.

PubMed

Devine, Theresa; Broderick, Jordan; Harris, Linda M; Wu, Huijuan; Hilfiker, Sandra Williams

2016-08-02

Most US adults have limited health literacy skills. They struggle to understand complex health information and services and to make informed health decisions. The Internet has quickly become one of the most popular places for people to search for information about their health, thereby making access to quality information on the Web a priority. However, there are no standardized criteria for evaluating Web-based health information. Every 10 years, the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion (ODPHP) develops a set of measurable objectives for improving the health of the nation over the coming decade, known as Healthy People. There are two objectives in Healthy People 2020 related to website quality. The first is objective Health Communication and Health Information Technology (HC/HIT) 8.1: increase the proportion of health-related websites that meet 3 or more evaluation criteria for disclosing information that can be used to assess information reliability. The second is objective HC/HIT-8.2: increase the proportion of health-related websites that follow established usability principles. The ODPHP conducted a nationwide assessment of the quality of Web-based health information using the Healthy People 2020 objectives. The ODPHP aimed to establish (1) a standardized approach to defining and measuring the quality of health websites; (2) benchmarks for measurement; (3) baseline data points to capture the current status of website quality; and (4) targets to drive improvement. The ODPHP developed the National Quality Health Website Survey instrument to assess the quality of health-related websites. The ODPHP used this survey to review 100 top-ranked health-related websites in order to set baseline data points for these two objectives. The ODPHP then set targets to drive improvement by 2020. This study reviewed 100 health-related websites. For objective HC/HIT-8.1, a total of 58 out of 100 (58.0%) websites met 3 or more out of 6 reliability criteria. For objective HC/HIT-8.2, a total of 42 out of 100 (42.0%) websites followed 10 or more out of 19 established usability principles. On the basis of these baseline data points, ODPHP set targets for the year 2020 that meet the minimal statistical significance-increasing objective HC/HIT-8.1 data point to 70.5% and objective HC/HIT-8.2 data point to 55.7%. This research is a critical first step in evaluating the quality of Web-based health information. The criteria proposed by ODPHP provide methods to assess website quality for professionals designing, developing, and managing health-related websites. The criteria, baseline data, and targets are valuable tools for driving quality improvement.

Making Quality Health Websites a National Public Health Priority: Toward Quality Standards

PubMed Central

2016-01-01

Background Most US adults have limited health literacy skills. They struggle to understand complex health information and services and to make informed health decisions. The Internet has quickly become one of the most popular places for people to search for information about their health, thereby making access to quality information on the Web a priority. However, there are no standardized criteria for evaluating Web-based health information. Every 10 years, the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion (ODPHP) develops a set of measurable objectives for improving the health of the nation over the coming decade, known as Healthy People. There are two objectives in Healthy People 2020 related to website quality. The first is objective Health Communication and Health Information Technology (HC/HIT) 8.1: increase the proportion of health-related websites that meet 3 or more evaluation criteria for disclosing information that can be used to assess information reliability. The second is objective HC/HIT-8.2: increase the proportion of health-related websites that follow established usability principles. Objective The ODPHP conducted a nationwide assessment of the quality of Web-based health information using the Healthy People 2020 objectives. The ODPHP aimed to establish (1) a standardized approach to defining and measuring the quality of health websites; (2) benchmarks for measurement; (3) baseline data points to capture the current status of website quality; and (4) targets to drive improvement. Methods The ODPHP developed the National Quality Health Website Survey instrument to assess the quality of health-related websites. The ODPHP used this survey to review 100 top-ranked health-related websites in order to set baseline data points for these two objectives. The ODPHP then set targets to drive improvement by 2020. Results This study reviewed 100 health-related websites. For objective HC/HIT-8.1, a total of 58 out of 100 (58.0%) websites met 3 or more out of 6 reliability criteria. For objective HC/HIT-8.2, a total of 42 out of 100 (42.0%) websites followed 10 or more out of 19 established usability principles. On the basis of these baseline data points, ODPHP set targets for the year 2020 that meet the minimal statistical significance—increasing objective HC/HIT-8.1 data point to 70.5% and objective HC/HIT-8.2 data point to 55.7%. Conclusions This research is a critical first step in evaluating the quality of Web-based health information. The criteria proposed by ODPHP provide methods to assess website quality for professionals designing, developing, and managing health-related websites. The criteria, baseline data, and targets are valuable tools for driving quality improvement. PMID:27485512

The Art of Chairing: What Deming Taught the Japanese and the Japanese Taught Me.

ERIC Educational Resources Information Center

Rodd, Laurel Rasplica

2001-01-01

Reveals how a business model--based on the work of W. Edwards Deming--helped a foreign language department chair become a better leader. Outlines seven principles for department chairs: create constancy of purpose; change and improvement are ongoing; drive out fear; work with suppliers to continually improve the quality of incoming people,…

Using Data to Drive Success in Educator Prep: Massachusetts and Endicott College Collaborate for Continuous Improvement

ERIC Educational Resources Information Center

Data Quality Campaign, 2016

2016-01-01

For educator preparation programs (EPPs) to produce effective teachers, they must engage in a process of continuous improvement using timely, high-quality information about the performance of their respective graduates in the classroom as measured by student outcomes. While states have the capacity to provide this information through their…

Toyota's tips drive dramatic ED improvements.

PubMed

2002-11-01

The Toyota Motor Corp.'s key concepts of allowing workers to make changes, putting the customer first, and reducing waste can have a dramatic impact when implemented in emergency departments. Staff should be empowered to make changes to improve quality. A chain of events should be set in motion for each customer request. Identify and eliminate roadblocks that cause delays.

Is the 'driving test' a robust quality indicator of colonoscopy performance?

PubMed

Kelly, Nicholas M; Moorehead, John; Tham, Tony

2010-04-16

Colorectal cancer is a major cause of death in the western world and is currently the second commonest cause of death from malignant disease in the UK. Recently a "driving test" for colonoscopists wishing to take part in the National Health Service Bowel Cancer Screening Program has been introduced, with the aim of improving quality in colonoscopy. We describe the accreditation process and have reviewed the published evidence for its use. We compared this method of assessment to what occurs in other developed countries. To the authors' knowledge no other countries have similar methods of assessment of practicing colonoscopists, and instead use critical evaluation of key quality criteria. The UK appears to have one of the most rigorous accreditation processes, although this still has flaws. The published evidence suggests that the written part of the accreditation is not a good discriminating test and it needs to be improved or abandoned. Further work is needed on the best methods of assessing polypectomy skills. Rigorous systems need to be in place for the colonoscopist who fails the assessment.

Developing models of how cognitive improvements change functioning: Mediation, moderation and moderated mediation

PubMed Central

Wykes, Til; Reeder, Clare; Huddy, Vyv; Taylor, Rumina; Wood, Helen; Ghirasim, Natalia; Kontis, Dimitrios; Landau, Sabine

2012-01-01

Background Cognitive remediation (CRT) affects functioning but the extent and type of cognitive improvements necessary are unknown. Aim To develop and test models of how cognitive improvement transfers to work behaviour using the data from a current service. Method Participants (N49) with a support worker and a paid or voluntary job were offered CRT in a Phase 2 single group design with three assessments: baseline, post therapy and follow-up. Working memory, cognitive flexibility, planning and work outcomes were assessed. Results Three models were tested (mediation — cognitive improvements drive functioning improvement; moderation — post treatment cognitive level affects the impact of CRT on functioning; moderated mediation — cognition drives functioning improvements only after a certain level is achieved). There was evidence of mediation (planning improvement associated with improved work quality). There was no evidence that cognitive flexibility (total Wisconsin Card Sorting Test errors) and working memory (Wechsler Adult Intelligence Scale III digit span) mediated work functioning despite significant effects. There was some evidence of moderated mediation for planning improvement if participants had poorer memory and/or made fewer WCST errors. The total CRT effect on work quality was d = 0.55, but the indirect (planning-mediated CRT effect) was d = 0.082 Conclusion Planning improvements led to better work quality but only accounted for a small proportion of the total effect on work outcome. Other specific and non-specific effects of CRT and the work programme are likely to account for some of the remaining effect. This is the first time complex models have been tested and future Phase 3 studies need to further test mediation and moderated mediation models. PMID:22503640

Creating a New Learning Community: A Case Study of School Leaders' Perceptions of the Baldrige Criteria for Performance Excellence and Their Implementation in a Suburban School District

ERIC Educational Resources Information Center

Adams, Denean

2013-01-01

The Baldrige Criteria for Performance Excellence (Baldrige categories) are increasingly being used throughout the health, education, and business sectors to drive continuous improvement in quality organizations. In each industry, specific categories are available to assist in identifying quality practices deployed throughout an organization. The…

The new health-care quality: value, outcomes, and continuous improvement.

PubMed

O'Connor, S J; Lanning, J A

1991-01-01

No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

Importance of relationship quality in the success of data warehouse systems

NASA Astrophysics Data System (ADS)

Almabhouh, Alaaeddin; Saleh, Abdul; Ahmad, Azizah

2011-10-01

Increased organizational dependence on data warehouse (DW) systems drives management attention towards improving DW systems success. However, the successful implementation rate of DW systems is low and many firms did not achieve intended goals. A recent studies show that improves and evaluates DW success is one of the top concerns facing IT/DW executives. Existing information system (IS) research has studied DW success more from information quality and system quality. Researchers argue in this study that we should also take the relationship quality, which has significant research and practical implications in that it connects to IS success directly. As our first attempt, this study, referring to both IS and marketing literature, examines how communication, coordination, cooperation, commitment, and trust can be achieved to some degrees by high quality relationships between DW parties.

Stages of driving behavior change within the Transtheoretical Model (TM).

PubMed

Kowalski, Kristina; Jeznach, Anna; Tuokko, Holly Anna

2014-09-01

Many older adults voluntarily restrict their driving or stop driving of their own accord. Driving behavior change may occur in stages, as predicted by the Transtheoretical Model of Behavior Change (TM). This study explored the process of older driver behavior change within the TM framework using interviews/focus groups with drivers and former drivers aged 71-94 years. Within those groups of drivers, driving behavior was divided into two classes: those who changed their driving with age and those who did not. Those who changed their driving as they aged included people gradually imposing restrictions ("gradual restrictors") and those making plans in anticipation of stopping driving ("preparers"). Participants who did not change their driving included those who employed lifelong driving restrictions ("consistent") and those who made no changes ("non-changers"). Preliminary support for TM within the driving context was found; however, further exploration of driving behavior change within this framework is warranted. It is important to continue to investigate the factors that might influence driving behavior in older adults. By promoting self-regulation in individuals, it may be possible to help older adults continue to drive, thereby improving older adult's mobility and quality of life. Copyright © 2014 National Safety Council and Elsevier Ltd. All rights reserved.

Many Spokes, Same Hub: Facilitating Collaboration among Library and Early-Childhood Services to Improve Outcomes for Children

ERIC Educational Resources Information Center

Lucas, Freya

2013-01-01

On 1 January 2012, early-childhood and out-of-school-hours care services were mandated to begin working under a new framework, designed to deliver greater consistency in service provision across the sector. With the aim of raising quality and driving continuous improvement through consistency among services and service ratings, the National…

Quality or financing: what drives design of the health care system?

PubMed Central

McLoughlin, V; Leatherman, S

2003-01-01



 The scope and scale of problems in the quality of health service provision have been increasingly recognised in recent years. Policy and planning for financing are usually concerned with how funding is made available and allocated, rather than with what is being achieved, including the quality of health services delivered. A fundamental challenge is how to improve the delivery of health services to achieve improved patient outcomes and to optimize financial outcomes. To accomplish this it is essential that the debates on quality of care and financing are aligned. Approaches to improving the quality of care are drawn from Australia, the US, and the UK. Financing arrangments for care at a national level have a bearing on how payment incentives can be used to promote or impede quality. The level of overall expenditure is obviously important, as are the mechanisms for payment. Long term programs to build knowledge, standardise processes, provide credible performance data and foster accountability are required to ensure that further investments lead to improvement in care. PMID:12679511

Balanced scorecard as a framework for driving performance in managed care organizations.

PubMed

Sahney, V K

1998-01-01

Managed care organizations in a highly competitive environment constantly face the pressure of improving their financial performance. At the same time, customers of the organization expect the organization to deliver high-quality outcomes and improve customer service. Payers expect the organization to develop innovative new products to meet their needs. This article presents an approach called "Balanced Scorecard" for measurement, development of strategy, and performance improvement in a managed care organization.

Lessons from school: what nurse leaders can learn from education.

PubMed

Davies, Nigel

2015-07-01

The drive to improve quality in the education sector is similar to that in health care, and lessons from the schools system are relevant to nursing leadership. This article discusses these shared traits, and details how school improvement was achieved in London and how a model of learning-centred leadership helped to transform pupil attainment in schools that had been performing poorly. Parallels are drawn between the education inspection system undertaken by Ofsted and the hospital inspections undertaken by the Care Quality Commission, and between the practice discipline-based managerial roles of nurse directors and head teachers. The article suggests that a learning-centred approach to improving the quality of patient care is needed, with a focus on the education and continuing professional development of staff.

The Effectiveness of Driver Education and Information Programs in the State of Nevada

DOT National Transportation Integrated Search

2014-06-01

The objectives of this project were 1) to examine the quality of Nevadas driver education by evaluating the effectiveness of its programs and 2) to provide recommendations to improve driving education in Nevada based on the results from this study...

STOCHASTIC DESCRIPTION OF SUBGRID POLLUTANT VARIABILITY IN CMAQ

EPA Science Inventory

This paper describes a tool for investigating and describing fine scale spatial variability in model concentration fields with the goal of improving the use of air quality models for driving exposure modeling to assess human risk to hazardous air pollutants or air toxics. Region...

Harnessing the power of enhanced data for healthcare quality improvement: lessons from a Minnesota Hospital Association Pilot Project.

PubMed

Pine, Michael; Sonneborn, Mark; Schindler, Joe; Stanek, Michael; Maeda, Jared Lane; Hanlon, Carrie

2012-01-01

The imperative to achieve quality improvement and cost-containment goals is driving healthcare organizations to make better use of existing health information. One strategy, the construction of hybrid data sets combining clinical and administrative data, has strong potential to improve the cost-effectiveness of hospital quality reporting processes, improve the accuracy of quality measures and rankings, and strengthen data systems. Through a two-year contract with the Agency for Healthcare Research and Quality, the Minnesota Hospital Association launched a pilot project in 2007 to link hospital clinical information to administrative data. Despite some initial challenges, this project was successful. Results showed that the use of hybrid data allowed for more accurate comparisons of risk-adjusted mortality and risk-adjusted complications across Minnesota hospitals. These increases in accuracy represent an important step toward targeting quality improvement efforts in Minnesota and provide important lessons that are being leveraged through ongoing projects to construct additional enhanced data sets. We explore the implementation challenges experienced during the Minnesota Pilot Project and their implications for hospitals pursuing similar data-enhancement projects. We also highlight the key lessons learned from the pilot project's success.

Can branding by health care provider organizations drive the delivery of higher technical and service quality?

PubMed

Snihurowych, Roman R; Cornelius, Felix; Amelung, Volker Eric

2009-01-01

Despite the widespread use of branding in nearly all other major industries, most health care service delivery organizations have not fully embraced the practices and processes of branding. Facilitating the increased and appropriate use of branding among health care delivery organizations may improve service and technical quality for patients. This article introduces the concepts of branding, as well as making the case that the use of branding may improve the quality and financial performance of organizations. The concepts of branding are reviewed, with examples from the literature used to demonstrate their potential application within health care service delivery. The role of branding for individual organizations is framed by broader implications for health care markets. Branding strategies may have a number of positive effects on health care service delivery, including improved technical and service quality. This may be achieved through more transparent and efficient consumer choice, reduced costs related to improved patient retention, and improved communication and appropriateness of care. Patient satisfaction may be directly increased as a result of branding. More research into branding could result in significant quality improvements for individual organizations, while benefiting patients and the health system as a whole.

SLIPTA e-Tool improves laboratory audit process in Vietnam and Cambodia.

PubMed

Nguyen, Thuong T; McKinney, Barbara; Pierson, Antoine; Luong, Khue N; Hoang, Quynh T; Meharwal, Sandeep; Carvalho, Humberto M; Nguyen, Cuong Q; Nguyen, Kim T; Bond, Kyle B

2014-01-01

The Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist is used worldwide to drive quality improvement in laboratories in developing countries and to assess the effectiveness of interventions such as the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. However, the paper-based format of the checklist makes administration cumbersome and limits timely analysis and communication of results. In early 2012, the SLMTA team in Vietnam developed an electronic SLIPTA checklist tool. The e-Tool was pilot tested in Vietnam in mid-2012 and revised. It was used during SLMTA implementation in Vietnam and Cambodia in 2012 and 2013 and further revised based on auditors' feedback about usability. The SLIPTA e-Tool enabled rapid turn-around of audit results, reduced workload and language barriers and facilitated analysis of national results. Benefits of the e-Tool will be magnified with in-country scale-up of laboratory quality improvement efforts and potential expansion to other countries.

The MOOC and the Multitude

ERIC Educational Resources Information Center

Curinga, Matthew X.

2016-01-01

Massive open online courses (MOOCs) take university lectures and other educational materials and make them available for free as online "courses." Liberal and neoliberal MOOC supporters laud these courses for opening up education to the world while incorporating market dynamics to improve quality and drive down costs. Skeptics claim…

Better Particle Accelerators with SRF Technology

ScienceCinema

Padamsee, Hasan; Martinello, Martina; Ross, Marc; Peskin, Michael; Yamamoto, Akira

2018-01-16

The use of superconducting radio frequency (SRF) technology is a driving force in the development of particle accelerators. Scientists from around the globe are working together to develop the newest materials and techniques to improve the quality and efficiency of the SRF cavities that are essential for this technology.

Evaluation of transportation/air quality model improvements based on TOTEMS on-road driving style and tailpipe emissions data.

DOT National Transportation Integrated Search

2014-06-01

In June 2012, the Environmental Protection Agency (EPA) released the Operating Mode : Distribution Generator (OMDG) a tool for developing an operating mode distribution as an input : to the Motor Vehicle Emissions Simulator model (MOVES). The t...

Better Particle Accelerators with SRF Technology

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

Padamsee, Hasan; Martinello, Martina; Ross, Marc

2017-02-20

The use of superconducting radio frequency (SRF) technology is a driving force in the development of particle accelerators. Scientists from around the globe are working together to develop the newest materials and techniques to improve the quality and efficiency of the SRF cavities that are essential for this technology.

The value of public transportation for improving the quality of life for the rural elderly.

DOT National Transportation Integrated Search

2012-07-01

Transportation for the rural elderly is an increasing concern as baby boomers age and young people continue to exit rural communities. As the elderly are no longer able to drive themselves, they rely on alternate forms of transportation, including pu...

Quality management standards for facility services in the Italian health care sector.

PubMed

Cesarotti, Vittorio; Di Silvio, Bruna

2006-01-01

Health care, one of the most dynamic sectors in Italy, is studied with a particular focus on outsourcing non-core activities such as facility management (FM) services. The project's goals are to define national standards to balance and control facility service evolution, and to drive FM services towards organisational excellence. The authors, in cooperation with a pool of facility service providers and hospitals managers, studied cleaning services--one of the most critical areas. This article describes the research steps and findings following definition and publication of the Italian standard and its application to an international benchmarking process. The method chosen for developing the Italian standard was to merge technical, strategic and organisational aspects with the goal of standardising the contracting system, giving service providers the chance to improve efficiency and quality, while helping healthcare organisations gain from a better, more reliable and less expensive service. The Italian standard not only improved services but also provided adequate control systems for outsourcing organisations. In this win-win context, it is hoped to continually drive FM services towards organisational excellence. This study is specific to the Italian national healthcare system. However, the strategic dynamics described are common to many other contexts. A systematic method for improving hospital FM services is presented. The authors believe that lessons learned from their Italian case study can be used to better understand and drive similar services in other countries or in other FM service outsourcing sectors.

Steering teens safe: a randomized trial of a parent-based intervention to improve safe teen driving.

PubMed

Peek-Asa, Corinne; Cavanaugh, Joseph E; Yang, Jingzhen; Chande, Vidya; Young, Tracy; Ramirez, Marizen

2014-07-31

Crashes are the leading cause of death for teens, and parent-based interventions are a promising approach. We assess the effectiveness of Steering Teens Safe, a parent-focused program to increase safe teen driving. Steering Teens Safe aimed to improve parental communication with teens about safe driving using motivational interviewing techniques in conjunction with 19 safe driving lessons. A randomized controlled trial involved 145 parent-teen dyads (70 intervention and 75 control). Intervention parents received a 45-minute session to learn the program with four follow-up phone sessions, a DVD, and a workbook. Control parents received a standard brochure about safe driving. Scores were developed to measure teen-reported quantity and quality of parental communication about safe driving. The main outcome measure was a previously validated Risky Driving Score reported by teens. Because the Score was highly skewed, a generalized linear model based on a gamma distribution was used for analysis. Intervention teens ranked their parent's success in talking about driving safety higher than control teens (p = 0.035) and reported that their parents talked about more topics (non-significant difference). The Risky Driving Score was 21% lower in intervention compared to control teens (85% CI = 0.60, 1.00). Interaction between communication quantity and the intervention was examined. Intervention teens who reported more successful communication had a 42% lower Risky Driving Score (95% CI = 0.37, 0.94) than control parents with less successful communication. This program had a positive although not strong effect, and it may hold the most promise in partnership with other programs, such as Driver's Education or Graduated Driver's License policies. ClinicalTrials.gov NCT01014923. Registered Nov. 16, 2009.

Assessment of Service Desk Quality at an Academic Health Sciences Library.

PubMed

Blevins, Amy E; DeBerg, Jennifer; Kiscaden, Elizabeth

2016-01-01

Due to an identified need for formal assessment, a small team of librarians designed and administered a survey to gauge the quality of customer service at their academic health sciences library. Though results did not drive major changes to services, several important improvements were implemented and a process was established to serve as a foundation for future use. This article details the assessment process used and lessons learned during the project.

Rapid core measure improvement through a "business case for quality".

PubMed

Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

2014-01-01

Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p < .001), and SCIP (p = .015). This program demonstrated that presentation of the financial implications of quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance. © 2012 National Association for Healthcare Quality.

The group employed model as a foundation for health care delivery reform.

PubMed

Minott, Jenny; Helms, David; Luft, Harold; Guterman, Stuart; Weil, Henry

2010-04-01

With a focus on delivering low-cost, high-quality care, several organizations using the group employed model (GEM)-with physician groups whose primary and specialty care physicians are salaried or under contract-have been recognized for creating a culture of patient-centeredness and accountability, even in a toxic fee-for-service environment. The elements that leaders of such organizations identify as key to their success are physician leadership that promotes trust in the organization, integration that promotes teamwork and coordination, governance and strategy that drive results, transparency and health information technology that drive continual quality improvement, and a culture of accountability that focuses providers on patient needs and responsibility for effective care and efficient use of resources. These organizations provide important lessons for health care delivery system reform.

Transportation and Aging: An Updated Research Agenda to Advance Safe Mobility among Older Adults Transitioning From Driving to Non-driving.

PubMed

Dickerson, Anne E; Molnar, Lisa J; Bédard, Michel; Eby, David W; Berg-Weger, Marla; Choi, Moon; Grigg, Jenai; Horowitz, Amy; Meuser, Thomas; Myers, Anita; O'Connor, Melissa; Silverstein, Nina M

2017-07-29

Engagement in civic, social, and community life plays an important role in health, well-being, and quality of life, and requires individuals to be mobile in their environment. In this article, we review what is currently known about 2 areas relevant to safe mobility for older drivers and identify future research in these areas. Using a framework for transportation and safe mobility, 2 key areas were selected for review: the process of transitioning to non-driving and the maintenance of mobility after driving has ceased. This article serves as a companion to another article that used the same approach to explore safe mobility issues for older adults who are still driving. We found that although there has been progress in supporting transitioning process to non-driving and improving mobility options for older adults following driving cessation, many knowledge gaps still exist. We identified several research topics that would benefit from continued scientific inquiry. In addition, several themes emerged from the review, including the need for: multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education and training for older adults and the variety of stakeholders involved in older adult transportation; and the need for programs and interventions that are flexible and responsive to individual needs and situational differences. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Technologies of the Future.

ERIC Educational Resources Information Center

Lipson, Joseph I.; Fisher, Kathleen M.

1985-01-01

In the future, the requirements of industry will generate a wide range of hardware devices and software programs that will significantly alter and improve the quality of education. The driving forces behind the development of new technological devices include economics; emotional factors, e.g., the desire to develop aids for the handicapped;…

Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis.

PubMed

Ng, G K B; Leung, G K K; Johnston, J M; Cowling, B J

2013-10-01

The objectives of this review were to identify factors that influence implementation of hospital accreditation programmes and to assess the impact of the accreditation process on quality improvement in public hospitals. Two electronic databases, Medline (OvidSP) and PubMed, were systematically searched. "Public hospital", "hospital accreditation", and "quality improvement" were used as the search terms. A total of 348 citations were initially identified. After critical appraisal and study selection, 26 articles were included in the review. The data were extracted and analysed using a SWOT (strengths, weaknesses, opportunities, threats) analysis. Increased staff engagement and communication, multidisciplinary team building, positive changes in organisational culture, and enhanced leadership and staff awareness of continuous quality improvement were identified as strengths. Weaknesses included organisational resistance to change, increased staff workload, lack of awareness about continuous quality improvement, insufficient staff training and support for continuous quality improvement, lack of applicable accreditation standards for local use, and lack of performance outcome measures. Opportunities included identification of improvement areas, enhanced patient safety, additional funding, public recognition, and market advantage. Threats included opportunistic behaviours, funding cuts, lack of incentives for participation, and a regulatory approach to mandatory participation. By relating the findings to the operational issues of accreditation, this review discussed the implications for successful implementation and how accreditation may drive quality improvement. These findings have implications for various stakeholders (government, the public, patients and health care providers), when it comes to embarking on accreditation exercises.

Using wind plant data to increase reliability.

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

Peters, Valerie A.; Ogilvie, Alistair B.; McKenney, Bridget L.

2011-01-01

Operators interested in improving reliability should begin with a focus on the performance of the wind plant as a whole. To then understand the factors which drive individual turbine performance, which together comprise the plant performance, it is necessary to track a number of key indicators. Analysis of these key indicators can reveal the type, frequency, and cause of failures and will also identify their contributions to overall plant performance. The ideal approach to using data to drive good decisions includes first determining which critical decisions can be based on data. When those required decisions are understood, then the analysismore » required to inform those decisions can be identified, and finally the data to be collected in support of those analyses can be determined. Once equipped with high-quality data and analysis capabilities, the key steps to data-based decision making for reliability improvements are to isolate possible improvements, select the improvements with largest return on investment (ROI), implement the selected improvements, and finally to track their impact.« less

Ambient air quality trends and driving factor analysis in Beijing, 1983-2007.

PubMed

Zhang, Ju; Ouyang, Zhiyun; Miao, Hong; Wang, Xiaoke

2011-01-01

The rapid development in Beijing, the capital of China, has resulted in serious air pollution problems. Meanwhile great efforts have been made to improve the air quality, especially since 1998. The variation in air quality under the interaction of pollution and control in this mega city has attracted much attention. We analyzed the changes in ambient air quality in Beijing since the 1980's using the Daniel trend test based on data from long-term monitoring stations. The results showed that different pollutants displayed three trends: a decreasing trend, an increasing trend and a flat trend. SO2, dustfall, B[a]P, NO2 and PM10 fit decreasing trend pattern, while NOx showed an increasing trend, and CO, ozone pollution, total suspended particulate (TSP), as well as Pb fit the flat trend. The cause of the general air pollution in Beijing has changed from being predominantly related to coal burning to mixed traffic exhaust and coal burning related pollution. Seasonally, the pollution level is typically higher during the heating season from November to the following March. The interaction between pollution sources change and implementation of air pollution control measures was the main driving factor that caused the variation in air quality. Changes of industrial structure and improved energy efficiency, the use of clean energy and preferred use of clean coal, reduction in pollution sources, and implementation of advanced environmental standards have all contributed to the reduction in air pollution, particularly since 1998.

Data quality and processing for decision making: divergence between corporate strategy and manufacturing processes

NASA Astrophysics Data System (ADS)

McNeil, Ronald D.; Miele, Renato; Shaul, Dennis

2000-10-01

Information technology is driving improvements in manufacturing systems. Results are higher productivity and quality. However, corporate strategy is driven by a number of factors and includes data and pressure from multiple stakeholders, which includes employees, managers, executives, stockholders, boards, suppliers and customers. It is also driven by information about competitors and emerging technology. Much information is based on processing of data and the resulting biases of the processors. Thus, stakeholders can base inputs on faulty perceptions, which are not reality based. Prior to processing, data used may be inaccurate. Sources of data and information may include demographic reports, statistical analyses, intelligence reports (e.g., marketing data), technology and primary data collection. The reliability and validity of data as well as the management of sources and information is critical element to strategy formulation. The paper explores data collection, processing and analyses from secondary and primary sources, information generation and report presentation for strategy formulation and contrast this with data and information utilized to drive internal process such as manufacturing. The hypothesis is that internal process, such as manufacturing, are subordinate to corporate strategies. The impact of possible divergence in quality of decisions at the corporate level on IT driven, quality-manufacturing processes based on measurable outcomes is significant. Recommendations for IT improvements at the corporate strategy level are given.

Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity.

PubMed

Sudhinaraset, May; Afulani, Patience; Diamond-Smith, Nadia; Bhattacharyya, Sanghita; Donnay, France; Montagu, Dominic

2017-11-06

Background: Globally, substantial health inequities exist with regard to maternal, newborn and reproductive health. Lack of access to good quality care-across its many dimensions-is a key factor driving these inequities. Significant global efforts have been made towards improving the quality of care within facilities for maternal and reproductive health. However, one critically overlooked aspect of quality improvement activities is person-centered care. Main body: The objective of this paper is to review existing literature and theories related to person-centered reproductive health care to develop a framework for improving the quality of reproductive health, particularly in low and middle-income countries. This paper proposes the Person-Centered Care Framework for Reproductive Health Equity, which describes three levels of interdependent contexts for women's reproductive health: societal and community determinants of health equity, women's health-seeking behaviors, and the quality of care within the walls of the facility. It lays out eight domains of person-centered care for maternal and reproductive health. Conclusions: Person-centered care has been shown to improve outcomes; yet, there is no consensus on definitions and measures in the area of women's reproductive health care. The proposed Framework reviews essential aspects of person-centered reproductive health care.

Transgenic Farm Animals

NASA Astrophysics Data System (ADS)

Solomon, Morse B.; Eastridge, Janet S.; Paroczay, Ernest W.

Conventional science to improve muscle and meat parameters has involved breeding strategies, such as selection of dominant traits or selection of preferred traits by cross breeding, and the use of endogenous and exogenous hormones. Improvements in the quality of food products that enter the market have largely been the result of postharvest intervention strategies. Biotechnology is a more extreme scientific method that offers the potential to improve the quality, yield, and safety of food products by direct genetic manipulation. In the December 13, 2007 issue of the Southeast Farm Press, an article by Roy Roberson pointed out that biotechnology is driving most segments of U.S. farm growth. He indicated that nationwide, the agriculture industry is booming and much of that growth is the result of biotechnology advancements.

Visually Impaired Drivers Who Use Bioptic Telescopes: Self-Assessed Driving Skills and Agreement With On-Road Driving Evaluation

PubMed Central

Owsley, Cynthia; McGwin, Gerald; Elgin, Jennifer; Wood, Joanne M.

2014-01-01

Purpose. To compare self-assessed driving habits and skills of licensed drivers with central visual loss who use bioptic telescopes to those of age-matched normally sighted drivers, and to examine the association between bioptic drivers' impressions of the quality of their driving and ratings by a “backseat” evaluator. Methods. Participants were licensed bioptic drivers (n = 23) and age-matched normally sighted drivers (n = 23). A questionnaire was administered addressing driving difficulty, space, quality, exposure, and, for bioptic drivers, whether the telescope was helpful in on-road situations. Visual acuity and contrast sensitivity were assessed. Information on ocular diagnosis, telescope characteristics, and bioptic driving experience was collected from the medical record or in interview. On-road driving performance in regular traffic conditions was rated independently by two evaluators. Results. Like normally sighted drivers, bioptic drivers reported no or little difficulty in many driving situations (e.g., left turns, rush hour), but reported more difficulty under poor visibility conditions and in unfamiliar areas (P < 0.05). Driving exposure was reduced in bioptic drivers (driving 250 miles per week on average vs. 410 miles per week for normally sighted drivers, P = 0.02), but driving space was similar to that of normally sighted drivers (P = 0.29). All but one bioptic driver used the telescope in at least one driving task, and 56% used the telescope in three or more tasks. Bioptic drivers' judgments about the quality of their driving were very similar to backseat evaluators' ratings. Conclusions. Bioptic drivers show insight into the overall quality of their driving and areas in which they experience driving difficulty. They report using the bioptic telescope while driving, contrary to previous claims that it is primarily used to pass the vision screening test at licensure. PMID:24370830

Visually impaired drivers who use bioptic telescopes: self-assessed driving skills and agreement with on-road driving evaluation.

PubMed

Owsley, Cynthia; McGwin, Gerald; Elgin, Jennifer; Wood, Joanne M

2014-01-15

To compare self-assessed driving habits and skills of licensed drivers with central visual loss who use bioptic telescopes to those of age-matched normally sighted drivers, and to examine the association between bioptic drivers' impressions of the quality of their driving and ratings by a "backseat" evaluator. Participants were licensed bioptic drivers (n = 23) and age-matched normally sighted drivers (n = 23). A questionnaire was administered addressing driving difficulty, space, quality, exposure, and, for bioptic drivers, whether the telescope was helpful in on-road situations. Visual acuity and contrast sensitivity were assessed. Information on ocular diagnosis, telescope characteristics, and bioptic driving experience was collected from the medical record or in interview. On-road driving performance in regular traffic conditions was rated independently by two evaluators. Like normally sighted drivers, bioptic drivers reported no or little difficulty in many driving situations (e.g., left turns, rush hour), but reported more difficulty under poor visibility conditions and in unfamiliar areas (P < 0.05). Driving exposure was reduced in bioptic drivers (driving 250 miles per week on average vs. 410 miles per week for normally sighted drivers, P = 0.02), but driving space was similar to that of normally sighted drivers (P = 0.29). All but one bioptic driver used the telescope in at least one driving task, and 56% used the telescope in three or more tasks. Bioptic drivers' judgments about the quality of their driving were very similar to backseat evaluators' ratings. Bioptic drivers show insight into the overall quality of their driving and areas in which they experience driving difficulty. They report using the bioptic telescope while driving, contrary to previous claims that it is primarily used to pass the vision screening test at licensure.

Through Their Eyes: Lessons Learned Using Participatory Methods in Health Care Quality Improvement Projects

PubMed Central

Balbale, Salva N.; Locatelli, Sara M.; LaVela, Sherri L.

2016-01-01

In this methodological article, we examine participatory methods in-depth to demonstrate how these methods can be adopted for quality improvement (QI) projects in health care. We draw on existing literature and our QI initiatives in the Department of Veterans Affairs to discuss the application of photovoice and guided tours in QI efforts. We highlight lessons learned and several benefits of using participatory methods in this area. Using participatory methods, evaluators can engage patients, providers and other stakeholders as partners to enhance care. Participant involvement helps yield actionable data that can be translated into improved care practices. Use of these methods also helps generate key insights to inform improvements that truly resonate with stakeholders. Using participatory methods is a valuable strategy to harness participant engagement and drive improvements that address individual needs. In applying these innovative methodologies, evaluators can transcend traditional approaches to uniquely support evaluations and improvements in health care. PMID:26667882

Curbing variations in packaging process through Six Sigma way in a large-scale food-processing industry

NASA Astrophysics Data System (ADS)

Desai, Darshak A.; Kotadiya, Parth; Makwana, Nikheel; Patel, Sonalinkumar

2015-03-01

Indian industries need overall operational excellence for sustainable profitability and growth in the present age of global competitiveness. Among different quality and productivity improvement techniques, Six Sigma has emerged as one of the most effective breakthrough improvement strategies. Though Indian industries are exploring this improvement methodology to their advantage and reaping the benefits, not much has been presented and published regarding experience of Six Sigma in the food-processing industries. This paper is an effort to exemplify the application of Six Sigma quality improvement drive to one of the large-scale food-processing sectors in India. The paper discusses the phase wiz implementation of define, measure, analyze, improve, and control (DMAIC) on one of the chronic problems, variations in the weight of milk powder pouch. The paper wraps up with the improvements achieved and projected bottom-line gain to the unit by application of Six Sigma methodology.

Improvement of mechanical performance for vibratory microgyroscope based on sense mode closed-loop control

NASA Astrophysics Data System (ADS)

Xiao, Dingbang; Su, Jianbin; Chen, Zhihua; Hou, Zhanqiang; Wang, Xinghua; Wu, Xuezhong

2013-04-01

In order to improve its structural sensitivity, a vibratory microgyroscope is commonly sealed in high vacuum to increase the drive mode quality factor. The sense mode quality factor of the microgyroscope will also increase simultaneously after vacuum sealing, which will lead to a long decay time of free response and even self-oscillation of the sense mode. As a result, the mechanical performance of the microgyroscope will be seriously degraded. In order to solve this problem, a closed-loop control technique is presented to adjust and optimize the sense mode quality factor. A velocity feedback loop was designed to increase the electric damping of the sense mode vibration. A circuit was fabricated based on this technique, and experimental results indicate that the sense mode quality factor of the microgyroscope was adjusted from 8052 to 428. The decay time of the sense mode free response was shortened from 3 to 0.5 s, and the vibration-rejecting ability of the microgyroscope was improved obviously without sensitivity degradation.

Monte Carlo simulation of PET/MR scanner and assessment of motion correction strategies

NASA Astrophysics Data System (ADS)

Işın, A.; Uzun Ozsahin, D.; Dutta, J.; Haddani, S.; El-Fakhri, G.

2017-03-01

Positron Emission Tomography is widely used in three dimensional imaging of metabolic body function and in tumor detection. Important research efforts are made to improve this imaging modality and powerful simulators such as GATE are used to test and develop methods for this purpose. PET requires acquisition time in the order of few minutes. Therefore, because of the natural patient movements such as respiration, the image quality can be adversely affected which drives scientists to develop motion compensation methods to improve the image quality. The goal of this study is to evaluate various image reconstructions methods with GATE simulation of a PET acquisition of the torso area. Obtained results show the need to compensate natural respiratory movements in order to obtain an image with similar quality as the reference image. Improvements are still possible in the applied motion field's extraction algorithms. Finally a statistical analysis should confirm the obtained results.

Professional Learning Drives Common Core and Educator Evaluation, Knowledge Brief

ERIC Educational Resources Information Center

Killion, Joellen; Hirsh, Stephanie

2014-01-01

The ultimate key to successful integration and implementation of college- and career-ready standards and educator evaluation systems is the quality of the professional learning that educators engage in every day. Effective professional learning at the school level occurs among a team of teachers learning in a cycle of continuous improvement.…

Insights into the Role of Research and Development in Teaching Schools

ERIC Educational Resources Information Center

Walker, Matt

2017-01-01

Evidence-informed practice is now regarded as instrumental to school reform efforts both in England and elsewhere (Greany, 2015). This is especially important given the focus on school self-improvement coupled with a drive for high-quality teaching within a devolved, and increasingly autonomous, education system. Teaching schools are outstanding…

Trace gas fluxes from a northern mixed-grass prairie interseeded with alfalfa

USDA-ARS?s Scientific Manuscript database

The role of legumes in improving soil fertility, forage quantity and quality is well established, however what is less clear is the extent that the nitrogen fixed by legumes may drive increased trace gas emissions. A chronosequence study in native prairie that had been interseed with the legume alfa...

Building an efficient supply chain.

PubMed

Scalise, Dagmara

2005-08-01

Realizing at last that supply chain management can produce efficiencies and save costs, hospitals are beginning to adopt practices from other industries, such as the concept of extended supply chains, to improve product flow. They're also investing in enterprise planning resource software, radio frequency identification and other technologies, using quality data to drive standardization and streamlining processes.

Quality and Cost in Thoracic Surgery.

PubMed

Medbery, Rachel L; Force, Seth D

2017-08-01

The value of health care is defined as health outcomes (quality) achieved per dollars spent (cost). The current national health care landscape is focused on minimizing spending while optimizing patient outcomes. With the introduction of minimally invasive thoracic surgery, there has been concern about added cost relative to improved outcomes. Moreover, differences in postoperative hospital care further drive patient outcomes and health care costs. This article presents a comprehensive literature review on quality and cost in thoracic surgery and aims to investigate current challenges with regard to achieving the greatest value for our patients. Copyright © 2017 Elsevier Inc. All rights reserved.

SLIPTA e-Tool improves laboratory audit process in Vietnam and Cambodia

PubMed Central

Nguyen, Thuong T.; McKinney, Barbara; Pierson, Antoine; Luong, Khue N.; Hoang, Quynh T.; Meharwal, Sandeep; Carvalho, Humberto M.; Nguyen, Cuong Q.; Nguyen, Kim T.

2014-01-01

Background The Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist is used worldwide to drive quality improvement in laboratories in developing countries and to assess the effectiveness of interventions such as the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. However, the paper-based format of the checklist makes administration cumbersome and limits timely analysis and communication of results. Development of e-Tool In early 2012, the SLMTA team in Vietnam developed an electronic SLIPTA checklist tool. The e-Tool was pilot tested in Vietnam in mid-2012 and revised. It was used during SLMTA implementation in Vietnam and Cambodia in 2012 and 2013 and further revised based on auditors’ feedback about usability. Outcomes The SLIPTA e-Tool enabled rapid turn-around of audit results, reduced workload and language barriers and facilitated analysis of national results. Benefits of the e-Tool will be magnified with in-country scale-up of laboratory quality improvement efforts and potential expansion to other countries. PMID:29043190

Impacts of Thermal Atomic Layer-Deposited AlN Passivation Layer on GaN-on-Si High Electron Mobility Transistors.

PubMed

Zhao, Sheng-Xun; Liu, Xiao-Yong; Zhang, Lin-Qing; Huang, Hong-Fan; Shi, Jin-Shan; Wang, Peng-Fei

2016-12-01

Thermal atomic layer deposition (ALD)-grown AlN passivation layer is applied on AlGaN/GaN-on-Si HEMT, and the impacts on drive current and leakage current are investigated. The thermal ALD-grown 30-nm amorphous AlN results in a suppressed off-state leakage; however, its drive current is unchanged. It was also observed by nano-beam diffraction method that thermal ALD-amorphous AlN layer barely enhanced the polarization. On the other hand, the plasma-enhanced chemical vapor deposition (PECVD)-deposited SiN layer enhanced the polarization and resulted in an improved drive current. The capacitance-voltage (C-V) measurement also indicates that thermal ALD passivation results in a better interface quality compared with the SiN passivation.

Evaluation of food drying with air dehumidification system: a short review

NASA Astrophysics Data System (ADS)

Djaeni, M.; Utari, F. D.; Sasongko, S. B.; Kumoro, A. C.

2018-01-01

Energy efficient drying for food and agriculture products resulting high quality products has been an important issue. Currently, about 50% of total energy for postharvest treatment was used for drying. This paper presents the evaluation of new approach namely air dehumidification system with zeolite for food drying. Zeolite is a material having affinity to water in which reduced the moisture in air. With low moisture content and relative humidity, the air can improve driving force for drying even at low temperature. Thus, the energy efficiency can be potentially enhanced and the product quality can be well retained. For proving the hypothesis, the paddy and onion have been dried using dehumidified air. As performance indicators, the drying time, product quality, and heat efficiency were evaluated. Results indicated that the drying with zeolite improved the performances significantly. At operating temperature ranging 50 - 60°C, the efficiency of drying system can reach 75% with reasonable product quality.

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

PubMed

Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

2013-01-01

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

The public gets what the public wants: experiences of public reporting in long-term care in Europe.

PubMed

Rodrigues, Ricardo; Trigg, Lisa; Schmidt, Andrea E; Leichsenring, Kai

2014-05-01

Public reporting of quality in long-term care is advocated on the basis of allowing providers to improve their performance by benchmarking and supporting users to choose the best providers. Both mechanisms are intended to drive improvements in quality. However, there is relatively scarce comparative research on the experiences and impact of public reporting on quality in long-term care in Europe. Using information gathered from key informants by means of a structured questionnaire and country profiles, this paper discusses experiences with public reporting mechanisms in seven European countries and available information on their impact on quality in long-term care. Countries surveyed included a variety of public reporting schemes, ranging from pilot programmes to statutory mechanisms. Public reporting mechanisms more often focus on institutional care. Inspections carried out as part of a legal quality assurance framework are the main source of information gathering, supplemented by provider self-assessments in the context of internal quality management and user satisfaction surveys. Information on quality goes well beyond structural indicators to also include indicators on quality of life of users. Information is displayed using numerical scores (percentages), but also measures such as ratings (similar to school grades) and ticks and crosses. Only one country corrects for case-mix. The internet is the preferred medium of displaying information. There was little evidence to show whether public reporting has a significant impact on driving users' choices of provider. Studies reported low awareness of quality indicators among potential end users and information was not always displayed in a convenient format, e.g. through complicated numerical scores. There is scarce evidence of public reporting directly causing improved quality, although the relative youth and the pilot characteristics of some of the schemes covered here could also have contributed to downplay their impact. The establishment of public reporting mechanisms did however contribute to shaping the discussion on quality measurement in several of the countries surveyed. The findings presented in this paper highlight the need to consider some factors in the discussion of the impact of public reporting in long-term care, namely, the organisation of care markets, frequently characterised by limited competition; the circumstances under which user choice takes place, often made under conditions of duress; and the leadership conditions needed to bring about improvements in quality in different care settings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

NASA Technical Reports Server (NTRS)

Kmak, Frank J.

2000-01-01

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

Healthcare Transformation and Changing Roles for Nursing

PubMed Central

Salmond, Susan W.; Echevarria, Mercedes

2017-01-01

Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. Cost and quality concerns along with changing social and disease-type demographics created the greatest urgency for the need for change. Caring for and paying for medical treatments for patients suffering from chronic health conditions are a significant concern. The Affordable Care Act includes programs now led by the Centers for Medicare & Medicaid Services aiming to improve quality and control cost. Greater coordination of care—across providers and across settings—will improve quality care, improve outcomes, and reduce spending, especially attributed to unnecessary hospitalization, unnecessary emergency department utilization, repeated diagnostic testing, repeated medical histories, multiple prescriptions, and adverse drug interactions. As a nation, we have taken incremental steps toward achieving better quality and lower costs for decades. Nurses are positioned to contribute to and lead the transformative changes that are occurring in healthcare by being a fully contributing member of the interprofessional team as we shift from episodic, provider-based, fee-for-service care to team-based, patient-centered care across the continuum that provides seamless, affordable, and quality care. These shifts require a new or an enhanced set of knowledge, skills, and attitudes around wellness and population care with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement. PMID:28107295

Metamorphic III–V Solar Cells: Recent Progress and Potential

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

Garcia, Ivan; France, Ryan M.; Geisz, John F.

Inverted metamorphic multijunction solar cells have been demonstrated to be a pathway to achieve the highest photovoltaic (PV) conversion efficiencies. Attaining high-quality lattice-mismatched (metamorphic) semiconductor devices is challenging. However, recent improvements to compositionally graded buffer epitaxy and junction structures have led to the achievement of high-quality metamorphic solar cells exhibiting internal luminescence efficiencies over 90%. For this high material quality, photon recycling is significant, and therefore, the optical environment of the solar cell becomes important. In this paper, we first present recent progress and performance results for 1- and 0.7-eV GaInAs solar cells grown on GaAs substrates. Then, an electroopticalmore » model is used to assess the potential performance improvements in current metamorphic solar cells under different realizable design scenarios. The results show that the quality of 1-eV subcells is such that further improving its electronic quality does not produce significant Voc increases in the four-junction inverted metamorphic subcells, unless a back reflector is used to enhance photon recycling, which would significantly complicate the structure. Conversely, improving the electronic quality of the 0.7-eV subcell would lead to significant Voc boosts, driving the progress of four-junction inverted metamorphic solar cells.« less

Proceedings of the Seminar on the DoD Computer Security Initiative Program (3rd), National Bureau of Standards, Gaithersburg, Maryland, November 18-20, 1980.

DTIC Science & Technology

1980-01-01

TECHNIQUES IMPROVING RAPIDLY C-7 INDUSTRY THRUSTS IN 70s DRIVING FORCE : IMPROVE PRODUCT QUALITY * EASE MAINTENANCE, MODIFICATION IMPROVE PERFORMANCE...together a task force to make recommendations on what we should be doing about computer secur- ity. Other members of the task force came from both our...of the marketing task force mostly echoed and endorsed the user’s report. Both reports were issued in March of 1973. Notice that DoD 5200.28 had just

Science You Can Use Bulletin: Road scholars for the western states: Protecting natural areas by improving road management research

Treesearch

Brian Cooke; Charlie Luce; Tom Black; David Tarboton

2016-01-01

A poorly placed or unsuitably designed road can result in landslides, flooding, gullies, stream damage, and wildlife habitat destruction. Particularly in natural areas, benefits of roads, such as accessibility and convenience, must be weighed against potential water quality degradation, scenic and wildlife habitat destruction, and hazardous driving conditions...

It's a Long Way down: The Underlying Tensions in the Education Export Industry

ERIC Educational Resources Information Center

Marginson, Simon

2011-01-01

The stellar rise of the education export industry in Australian higher education, and the even more spectacular downturn now occurring, mask underlying tensions that have long dogged the industry and prevented it from improving quality or achieving long-term sustainability. The international education programme has been unbalanced by the drive for…

Assessment in Medical Education; What Are We Trying to Achieve?

ERIC Educational Resources Information Center

Ferris, Helena; O'Flynn, Dermot

2015-01-01

Within the arena of medical education, it is generally acknowledged that assessment drives learning. Assessment is one of the most significant influences on a student's experience of higher education and improving assessment has a huge impact on the quality of learning (Liu, N. and Carless, D, 2006). Ideally we want to enhance student's capacity…

Health Care Information Technology in Rural America: Electronic Medical Record Adoption Status in Meeting the National Agenda

ERIC Educational Resources Information Center

Bahensky, James A.; Jaana, Mirou; Ward, Marcia M.

2008-01-01

Continuing is a national political drive for investments in health care information technology (HIT) that will allow the transformation of health care for quality improvement and cost reduction. Despite several initiatives by the federal government to spur this development, HIT implementation has been limited, particularly in the rural market. The…

From Data Entry to Evidence-Based Decision-Making: How Data and Analysis Can Drive Improvements in Admissions Policies

ERIC Educational Resources Information Center

Hourigan, Clare

2011-01-01

Academic standards and performance outcomes are a major focus of the current Cycle 2 Australian Universities Quality Agency (AUQA) audits. AUQA has clearly stated that universities will need to provide "evidence of setting, maintaining, and reviewing institutional academic standards and outcomes" (2010, p. 27). To do this, universities…

Blended Learning: Instructional Design Strategies for Maximizing Impact

ERIC Educational Resources Information Center

Adams, Jean

2013-01-01

Although e-learning has improved in quality, reach and learning impact over the past decade, it can be argued that it has not yet lived up to its potential to transform workplace learning. In the drive to increase effectiveness, interest has grown in blended learning, an instructional strategy that combines the use of web-technologies with more…

Performance-Based Contracting in Residential Care and Treatment: Driving Policy and Practice Change through Public-Private Partnership in Illinois

ERIC Educational Resources Information Center

Kearney, Kathleen A.; McEwen, Erwin; Bloom-Ellis, Brice; Jordan, Neil

2010-01-01

The National Quality Improvement Center on the Privatization of Child Welfare Services selected Illinois as a demonstration site in 2007 to evaluate performance-based contracting in residential treatment services. This article discusses the first two years of project implementation including developing residential treatment performance indicators,…

The practical problem of improving quality in multicenter dialysis facilities.

PubMed

Balter, Paul

2003-01-01

Multifacility dialysis groups are frequently interested in improving overall quality and find that there are major differences between individual units. Upper management must consider what strategy is needed for the whole company and what strategy must be formulated by individual facilities. To make substantive changes, management must decide to adopt a new culture of true teamwork, drive out fear, and emphasize leadership and education both at the management level and in the individual unit. Both at the corporate and unit levels, leaders must be chosen who are able to recognize people who have the ability, the educational background, the enthusiasm, and the time to direct change. Empowering the individual units and individual employees to make changes and be enthusiastic about improvement is the key to success.

Quality and productivity drive innovation and improvement at United Technologies Aerospace Operations, Inc.

NASA Technical Reports Server (NTRS)

Jamar, L. G.

1986-01-01

Quality and innovation are the hallmarks of the national space program. In programs that preceded the Shuttle Program the emphasis was on meeting the risks and technical challenges of space with safety, quality, reliability, and success. At United Technologies Aerospace Operations, Inc. (UTAO), the battle has developed along four primary fronts. These fronts include programs to motivate and reward people, development and construction of optimized processes and facilities, implementation of specifically tailored management systems, and the application of appropriate measurement and control systems. Each of these initiatives is described. However, to put this quality and productivity program in perspective, UTAO and its role in the Shuttle Program are described first.

A roadmap for improving healthcare service quality.

PubMed

Kennedy, Denise M; Caselli, Richard J; Berry, Leonard L

2011-01-01

A data-driven, comprehensive model for improving service and creating long-term value was developed and implemented at Mayo Clinic Arizona (MCA). Healthcare organizations can use this model to prepare for value-based purchasing, a payment system in which quality and patient experience measures will influence reimbursement. Surviving and thriving in such a system will require a comprehensive approach to sustaining excellent service performance from physicians and allied health staff (e.g., nurses, technicians, nonclinical staff). The seven prongs in MCA's service quality improvement model are (1) multiple data sources to drive improvement, (2) accountability for service quality, (3) service consultation and improvement tools, (4) service values and behaviors, (5) education and training, (6) ongoing monitoring and control, and (7) recognition and reward. The model was fully implemented and tested in five departments in which patient perception of provider-specific service attributes and/or overall quality of care were below the 90th percentile for patient satisfaction in the vendor's database. Extent of the implementation was at the discretion of department leadership. Perception data rating various service attributes were collected from randomly selected patients and monitored over a 24-month period. The largest increases in patient perception of excellence over the pilot period were realized when all seven prongs of the model were implemented as a comprehensive improvement approach. The results of this pilot may help other healthcare organizations prepare for value-based purchasing.

Optimal control of the gear shifting process for shift smoothness in dual-clutch transmissions

NASA Astrophysics Data System (ADS)

Li, Guoqiang; Görges, Daniel

2018-03-01

The control of the transmission system in vehicles is significant for the driving comfort. In order to design a controller for smooth shifting and comfortable driving, a dynamic model of a dual-clutch transmission is presented in this paper. A finite-time linear quadratic regulator is proposed for the optimal control of the two friction clutches in the torque phase for the upshift process. An integral linear quadratic regulator is introduced to regulate the relative speed difference between the engine and the slipping clutch under the optimization of the input torque during the inertia phase. The control objective focuses on smoothing the upshift process so as to improve the driving comfort. Considering the available sensors in vehicles for feedback control, an observer design is presented to track the immeasurable variables. Simulation results show that the jerk can be reduced both in the torque phase and inertia phase, indicating good shift performance. Furthermore, compared with conventional controllers for the upshift process, the proposed control method can reduce shift jerk and improve shift quality.

Strategies to enhance price and quality competition in health care: lessons learned from tracking local markets.

PubMed

Lesser, Cara S; Ginsburg, Paul B

2006-06-01

Drawing on observations from tracking changes in local health care markets over the past ten years, this article critiques two Federal Trade Commission and Department of Justice recommendations to enhance price and quality competition. First, we take issue with the notion that consumers, acting independently, will drive greater competition in health care markets. Rather we suggest an important role remains for trusted agents who can analyze inherently complex price and quality information and negotiate on consumers' behalf. With aggregated information identifying providers who deliver cost-effective care, consumers would be better positioned to respond to financial incentives about where to seek care and thereby drive more meaningful competition among providers to reduce costs and improve quality. Second, we take issue with the FTC/DOJ recommendation to provide more direct subsidies to prevent distortions in competition. In the current political environment, it is not practical to provide direct subsidies for all of the unfunded care that exists in health care markets today; instead, some interference with competition may be necessary to protect cross subsidies. Barriers can be reduced, though, by revising pricing policies that have resulted in marked disparities in the relative profitability of different services.

Socio-professional handicap and accidental risk in patients with hypersomnias of central origin.

PubMed

Bayon, Virginie; Léger, Damien; Philip, Pierre

2009-12-01

Narcolepsy and idiopathic hypersomnia profoundly affect quality of life, education and work. Young patients are very handicapped by unexpected sleep episodes during lessons. Professionals frequently complain about sleepiness at work. Motor discomfort (i.e., cataplectic attacks) surprisingly is less handicapping in narcoleptics than sleepiness but only a few studies clearly assess the problem. Quality of life is also largely impaired in its physical and emotional dimensions. Sleepiness is the major factor explaining a decrease of quality of life and unexpectedly cataplectic attacks have little impact on patients. Another potential problem for these patients is the risk of accidents at work or when driving. Narcoleptic and hypersomniac patients have a higher risk of accidents than apneic or insomniac subjects. But, confounding factors such as duration of driving, number of cataplectic attacks or even objective level of alertness are not always entered in the analytic models mainly because of small samples of patients. Unlike in apneic patients, the effect of treatment on accidental risk has not been studied in narcoleptics or in hypersomniacs. Epidemiological data are needed to improve knowledge concerning these areas. Clinical trials assessing the impact of treatment on driving and work are also urgently needed. Finally, medical treatment does not seem to be completely efficient and physicians should pay more attention to the education, work, life and social environment of their patients.

Do we need a national incident reporting system for medical imaging?

PubMed

Itri, Jason N; Krishnaraj, Arun

2012-05-01

The essential role of an incident reporting system as a tool to improve safety and reliability has been described in high-risk industries such as aviation and nuclear power, with anesthesia being the first medical specialty to successfully integrate incident reporting into a comprehensive quality improvement strategy. Establishing an incident reporting system for medical imaging that effectively captures system errors and drives improvement in the delivery of imaging services is a key component of developing and evaluating national quality improvement initiatives in radiology. Such a national incident reporting system would be most effective if implemented as one piece of a comprehensive quality improvement strategy designed to enhance knowledge about safety, identify and learn from errors, raise standards and expectations for improvement, and create safer systems through implementation of safe practices. The potential benefits of a national incident reporting system for medical imaging include reduced morbidity and mortality, improved patient and referring physician satisfaction, reduced health care expenses and medical liability costs, and improved radiologist satisfaction. The purposes of this article are to highlight the positive impact of external reporting systems, discuss how similar advancements in quality and safety can be achieved with an incident reporting system for medical imaging in the United States, and describe current efforts within the imaging community toward achieving this goal. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Cost benefit of investment on quality in pharmaceutical manufacturing: WHO GMP pre- and post-certification of a Nigerian pharmaceutical manufacturer.

PubMed

Anyakora, Chimezie; Ekwunife, Obinna; Alozie, Faith; Esuga, Mopa; Ukwuru, Jonathan; Onya, Steve; Nwokike, Jude

2017-09-18

Pharmaceutical companies in Africa need to invest in both facilities and quality management systems to achieve good manufacturing practice (GMP) compliance. Compliance to international GMP standards is important to the attainment of World Health Organization (WHO) prequalification. However, most of the local pharmaceutical manufacturing companies may be deterred from investing in quality because of many reasons, ranging from financial constraints to technical capacity. This paper primarily evaluates benefits against the cost of investing in GMP, using a Nigerian pharmaceutical company, Chi Pharmaceuticals Limited, as a case study. This paper also discusses how to drive more local manufacturers to invest in quality to attain GMP compliance; and proffers practical recommendations for local manufacturers who would want to invest in quality to meet ethical and regulatory obligations. The cost benefit of improving the quality of Chi Pharmaceuticals Limited's facilities and system to attain WHO GMP certification for the production of zinc sulfate 20-mg dispersible tablets was calculated by dividing the annual benefits derived from quality improvement interventions by the annual costs of implementing quality improvement interventions, referred to as a benefit-cost ratio (BCR). Cost benefit of obtaining WHO GMP certification for the production of zinc sulfate 20-mg dispersible tablets was 5.3 (95% confidence interval of 5.0-5.5). Investment in quality improvement intervention is cost-beneficial for local manufacturing companies. Governments and regulators in African countries should support pharmaceutical companies striving to invest in quality. Collaboration of local manufacturing companies with global companies will further improve quality. Local pharmaceutical companies should be encouraged to key into development opportunities available for pharmaceutical companies in Africa.

National direct-drive program on OMEGA and the National Ignition Facility

NASA Astrophysics Data System (ADS)

Goncharov, V. N.; Regan, S. P.; Campbell, E. M.; Sangster, T. C.; Radha, P. B.; Myatt, J. F.; Froula, D. H.; Betti, R.; Boehly, T. R.; Delettrez, J. A.; Edgell, D. H.; Epstein, R.; Forrest, C. J.; Glebov, V. Yu; Harding, D. R.; Hu, S. X.; Igumenshchev, I. V.; Marshall, F. J.; McCrory, R. L.; Michel, D. T.; Seka, W.; Shvydky, A.; Stoeckl, C.; Theobald, W.; Gatu-Johnson, M.

2017-01-01

A major advantage of the laser direct-drive (DD) approach to ignition is the increased fraction of laser drive energy coupled to the hot spot and relaxed hot-spot requirements for the peak pressure and convergence ratios relative to the indirect-drive approach at equivalent laser energy. With the goal of a successful ignition demonstration using DD, the recently established national strategy has several elements and involves multiple national and international institutions. These elements include the experimental demonstration on OMEGA cryogenic implosions of hot-spot conditions relevant for ignition at MJ-scale energies available at the National Ignition Facility (NIF) and developing an understanding of laser-plasma interactions and laser coupling using DD experiments on the NIF. DD designs require reaching central stagnation pressures in excess of 100 Gbar. The current experiments on OMEGA have achieved inferred peak pressures of 56 Gbar (Regan et al 2016 Phys. Rev. Lett. 117 025001). Extensive analysis of the cryogenic target experiments and two- and three-dimensional simulations suggest that power balance, target offset, and target quality are the main limiting factors in target performance. In addition, cross-beam energy transfer (CBET) has been identified as the main mechanism reducing laser coupling. Reaching the goal of demonstrating hydrodynamic equivalence on OMEGA includes improving laser power balance, target position, and target quality at shot time. CBET must also be significantly reduced and several strategies have been identified to address this issue.

Effects of state managed care patient protection laws on physician satisfaction.

PubMed

Sloan, Frank A; Rattliff, John R; Hall, Mark A

2007-10-01

Physician dissatisfaction often drives public policy, and is associated with lower quality of care and disruption of treatment relationships. Physicians expressed strong dissatisfaction with managed care, leading to enactment of patient protection laws. By 2001, almost all states enacted laws to curb alleged abuses of managed care organizations. To date, no studies have examined whether such laws improved physician satisfaction. This article examines whether enactment of these laws improved physician satisfaction, using responses to the Physician Survey component of the Community Tracking Study (CTS), supplemented with data on state statutes/regulations. Career satisfaction increased for both primary care physicians (PCPs) and specialists following enactment of such laws; improvements were limited to early-adopting states. Enactment was associated with improvements in early-adopting states for specialists but not for PCPs on: ability to provide high quality care, clinical freedom, and ability to make clinical decisions in patients' interests without sacrificing physician income.

A Difficult Journey: Reflections on Driving and Driving Cessation From a Team of Clinical Researchers.

PubMed

Liddle, Jacki; Gustafsson, Louise; Mitchell, Geoffrey; Pachana, Nancy A

2017-02-01

Recognizing the clinical importance and safety and well-being implications for the population, a multidisciplinary team has been researching older drivers and driving cessation issues for more than 15 years. Using empirical approaches, the team has explored quality of life and participation outcomes related to driving and nondriving for older people and has developed interventions to improve outcomes after driving cessation. The team members represent occupational therapists, medical practitioners, and clinical and neuropsychologists. While building the evidence base for driving- and driving cessation-related clinical practice, the researchers have also had first-hand experiences of interruptions to their own or parents' driving; involvement of older family members in road crashes; and provision of support during family members' driving assessment and cessation. This has led to reflection on their understandings and re-evaluation and refocusing of their perspectives in driving cessation research. This work will share the narratives of the authors and note their developing perspectives and foci within research as well as their clinical practice. Personal reflections have indicated the far-reaching implications for older drivers and family members of involvement in road crashes: the potential for interruptions to driving as a time for support and future planning and the conflicting and difficult roles of family members within the driving cessation process. Overall the lived, personal experience of the authors has reinforced the complex nature of driving and changes to driving status for the driver and their support team and the need for further research and support. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Multi-Billion Dollar Drug-Sensitive Spending Opportunity.

PubMed

Easter, Jon C; Thorpe, Kenneth

2018-01-01

Chronic diseases increase utilization and avoidable drug-sensitive spending, but little is done to optimize medication use and drive value. Value-based approaches to health care financing should shift focus to drug-sensitive spending to balance patient access and quality improvement with cost containment. ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Instructional Strategies Drive Student Achievement: Methods to Improve Student Understanding of Topics in Earth Science

ERIC Educational Resources Information Center

Wilson, Carolyn H.; Weston, Matthew Stephen

2010-01-01

The purpose of this research is to share strategies and techniques used by highly qualified educators and experts in the field of education and instruction. Differentiated instruction is one of the most common terms used in education. It is also the key to teaching students with multiple or a wide range of disabilities. Quality classroom…

Are Young Children's Utterances Affected by Characteristics of Their Learning Environments? A Multiple Case Study

ERIC Educational Resources Information Center

Richardson, Tanya; Murray, Jane

2017-01-01

Within English early childhood education, there is emphasis on improving speech and language development as well as a drive for outdoor learning. This paper synthesises both aspects to consider whether or not links exist between the environment and the quality of young children's utterances as part of their speech and language development and if…

Improving the Distribution of Teachers in Low-performing High Schools. Policy Brief

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2008

2008-01-01

Teacher quality is the school factor which makes the greatest impact on student achievement and consistent exposure to effective teachers can overcome obstacles to learning and even close achievement gaps. These facts were the driving force behind the development of federal law, in the No Child Left Behind Act, mandating that states ensure that 1)…

Management strategies to effect change in intensive care units: lessons from the world of business. Part I. Targeting quality improvement initiatives.

PubMed

Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

2014-02-01

The business community has developed strategies to ensure the quality of the goods or services they produce and to improve the management of multidisciplinary work teams. With modification, many of these techniques can be imported into intensive care units (ICUs) to improve clinical operations and patient safety. In Part I of a three-part ATS Seminar series, we argue for adopting business management strategies in ICUs and set forth strategies for targeting selected quality improvement initiatives. These tools are relevant to health care today as focus is placed on limiting low-value care and measuring, reporting, and improving quality. In the ICU, the complexity of illness and the need to standardize processes make these tools even more appealing. Herein, we highlight four techniques to help prioritize initiatives. First, the "80/20 rule" mandates focus on the few (20%) interventions likely to drive the majority (80%) of improvement. Second, benchmarking--a process of comparison with peer units or institutions--is essential to identifying areas of strength and weakness. Third, root cause analyses, in which structured retrospective reviews of negative events are performed, can be used to identify and fix systems errors. Finally, failure mode and effects analysis--a process aimed at prospectively identifying potential sources of error--allows for systems fixes to be instituted in advance to prevent negative outcomes. These techniques originated in fields other than health care, yet adoption has and can help ICU managers prioritize issues for quality improvement.

The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients.

PubMed

Fuchshuber, Pascal R; Greif, William; Tidwell, Chantal R; Klemm, Michael S; Frydel, Cheryl; Wali, Abdul; Rosas, Efren; Clopp, Molly P

2012-01-01

The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and complications is prepared twice a year. This article summarizes briefly the history of NSQIP and how its report on surgical outcomes can be used for performance improvement within a hospital system. In particular, it describes how to drive performance improvement with NSQIP data using the example of postoperative respiratory complications--a major factor of postoperative mortality. In addition, this article explains the benefit of a collaborative of several participating NSQIP hospitals and describes how to develop a "playbook" on the basis of an outcome improvement project.

Through Their Eyes: Lessons Learned Using Participatory Methods in Health Care Quality Improvement Projects.

PubMed

Balbale, Salva N; Locatelli, Sara M; LaVela, Sherri L

2016-08-01

In this methodological article, we examine participatory methods in depth to demonstrate how these methods can be adopted for quality improvement (QI) projects in health care. We draw on existing literature and our QI initiatives in the Department of Veterans Affairs to discuss the application of photovoice and guided tours in QI efforts. We highlight lessons learned and several benefits of using participatory methods in this area. Using participatory methods, evaluators can engage patients, providers, and other stakeholders as partners to enhance care. Participant involvement helps yield actionable data that can be translated into improved care practices. Use of these methods also helps generate key insights to inform improvements that truly resonate with stakeholders. Using participatory methods is a valuable strategy to harness participant engagement and drive improvements that address individual needs. In applying these innovative methodologies, evaluators can transcend traditional approaches to uniquely support evaluations and improvements in health care. © The Author(s) 2015.

Revealing driving factors of China's PM2.5 pollution

NASA Astrophysics Data System (ADS)

Zheng, Y.; Zhao, H.; Zhang, Q.; Geng, G.; Tong, D.; Peng, L.; He, K.

2017-12-01

China's rapid economic development and intensive energy consumption are deteriorating the air quality significantly. Understanding the key driving factors behind China's growing emissions of air pollutants and the accompanying PM2.5 pollution is critical for the development of China's clean air policies and also provides insight into how other emerging economies may develop a clear sky future. Here we reveal the socioeconomic drivers of the variations of China's PM2.5 concentrations during 2002-2012 by using an interdisciplinary framework that integrates an emission inventory model, an index decomposition analysis model, and a regional air quality model. The decomposition results demostrate that the improvements in emission efficiency and energy efficiency failed to offset the increased emissions of both primary PM2.5 and gaseous PM2.5 precursors (including SO2 NOx, and volatile organic compounds) triggered by the surging economic growth during 2002-2012. During the same time, the effects of energy structure, production structure and population growth were relatively less significant to all pollutants, which indicates the potential of large emission abatements through energy structure and production structure adjustment. Sensitivity simulations by the air quality model based on the provincial decomposition results also show that the economic growth have outpaced efficiency improvements in the increments of PM2.5 concentrations during the study years. As China continues to develop rapidly, future policies should promote further improvements in efficiency and accelerate the adjustments toward clean energy and production structures, which are critical for reducing China's emissions and alleviating the severe PM2.5 pollution.

Quality-adjusted cost of care: a meaningful way to measure growth in innovation cost versus the value of health gains.

PubMed

Lakdawalla, Darius; Shafrin, Jason; Lucarelli, Claudio; Nicholson, Sean; Khan, Zeba M; Philipson, Tomas J

2015-04-01

Technology drives both health care spending and health improvement. Yet policy makers rarely see measures of cost growth that account for both effects. To fill this gap, we present the quality-adjusted cost of care, which illustrates cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We applied the quality-adjusted cost of care to two cases. For colorectal cancer, drug cost per patient increased by $34,493 between 1998 and 2005 as a result of new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in quality-adjusted cost of care. For multiple myeloma, new therapies increased treatment cost by $72,937 between 2004 and 2009, but offsetting health benefits lowered overall quality-adjusted cost of care by $67,863. However, patients with multiple myeloma on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but they provide starkly different answers to the question of whether society got what it paid for. Project HOPE—The People-to-People Health Foundation, Inc.

Consumer input into health care: Time for a new active and comprehensive model of consumer involvement.

PubMed

Hall, Alix E; Bryant, Jamie; Sanson-Fisher, Rob W; Fradgley, Elizabeth A; Proietto, Anthony M; Roos, Ian

2018-03-07

To ensure the provision of patient-centred health care, it is essential that consumers are actively involved in the process of determining and implementing health-care quality improvements. However, common strategies used to involve consumers in quality improvements, such as consumer membership on committees and collection of patient feedback via surveys, are ineffective and have a number of limitations, including: limited representativeness; tokenism; a lack of reliable and valid patient feedback data; infrequent assessment of patient feedback; delays in acquiring feedback; and how collected feedback is used to drive health-care improvements. We propose a new active model of consumer engagement that aims to overcome these limitations. This model involves the following: (i) the development of a new measure of consumer perceptions; (ii) low cost and frequent electronic data collection of patient views of quality improvements; (iii) efficient feedback to the health-care decision makers; and (iv) active involvement of consumers that fosters power to influence health system changes. © 2018 The Authors Health Expectations published by John Wiley & Sons Ltd.

A faster technique for rendering meshes in multiple display systems

NASA Astrophysics Data System (ADS)

Hand, Randall E.; Moorhead, Robert J., II

2003-05-01

Level of detail algorithms have widely been implemented in architectural VR walkthroughs and video games, but have not had widespread use in VR terrain visualization systems. This thesis explains a set of optimizations to allow most current level of detail algorithms run in the types of multiple display systems used in VR. It improves both the visual quality of the system through use of graphics hardware acceleration, and improves the framerate and running time through moifications to the computaitons that drive the algorithms. Using ROAM as a testbed, results show improvements between 10% and 100% on varying machines.

Driver rehabilitation: a systematic review of the types and effectiveness of interventions used by occupational therapists to improve on-road fitness-to-drive.

PubMed

Unsworth, Carolyn A; Baker, Anne

2014-10-01

Driver rehabilitation has the potential to improve on-road safety and is commonly recommended to clients. The aim of this systematic review was to identify what intervention approaches are used by occupational therapists as part of driver rehabilitation programmes, and to determine the effectiveness of these interventions. Six electronic databases (MEDLINE, CINAHL, PsycInfo, Embase, The Cochrane Library, and OTDBase) were searched. Two authors independently reviewed studies reporting all types of research designs and for all patient populations, provided the interventions could be administered by occupational therapists. The methodological quality of studies was assessed using the 'Downs and Black Instrument', and the level of evidence for each intervention approach was established using 'Centre for Evidence Based Medicine' criteria. Sixteen studies were included in the review. The most common type of intervention approach used was computer-based driving simulator training (n=8), followed by off-road skill-specific training (n=4), and off-road education programmes (n=3). Car adaptations/modifications were used in one of the included studies. There was significant variability between studies with regards to frequency, duration, and total number of intervention sessions, and the diagnoses of the participants. Of the four intervention approaches, there is evidence to support the effectiveness of off-road skill-specific training (with older clients), and computer-based driving simulator training (with both older clients and participants with acquired brain injury). Three types of intervention approaches are commonly reported, however, there is limited evidence to determine to effectiveness of these in improving fitness-to-drive. Further research is required, with clients from a range of diagnostic groups to establish evidence-based interventions and determine their effectiveness in improving these clients' on-road fitness-to-drive. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Ergonomics and quality management--humans in interaction with technology, work environment, and organization.

PubMed

Eklund, J A

1999-01-01

In many studies, ergonomics has been shown to influence human performance. The aim of this paper was to demonstrate important ergonomics influences on quality in industrial production, from the perspective of interactions between humans, technology, organization, and work environment. A second aim was to elaborate on the implications of these findings for the development of quality management strategies. This paper shows that ergonomics problems in terms of adverse work environmental conditions, inappropriate design of technology, and an unsuitable organization are important causes of quality deficiencies. Problem solving aimed at improving ergonomics, quality, and productivity simultaneously is likely to obtain support from most of the interest parties of the company, and may also enhance participation. Ergonomics has the potential of becoming a driving force for the development of new quality management strategies.

Collecting mortality data to drive real-time improvement in suicide prevention.

PubMed

Ahmedani, Brian K; Coffey, Justin; Coffey, C Edward

2013-11-01

To evaluate the use of government mortality records compared with internally collected data to drive quality improvement in suicide prevention programs using suicide mortality data from the Perfect Depression Care initiative. Perfect Depression Care (PDC) is a quality improvement suicide prevention initiative within the Behavioral Health Services (BHS) division of the Henry Ford Health System. Eligible subjects were all patients who received services from BHS, were members of the health maintenance organization, and had a medical group physician during the 11-year study period. Mortality data were collected internally and from government-collected death records, and were linked to treatment utilization data from the medical record. The mean suicide rate was 96.6 per 100,000 during the 2-year baseline period (1999- 2000) and declined to 19.1 per 100,000 during the initiative (2002-2009) using both sources of data combined. We observed a similar statistically significant (P <.001) reduction in the suicide death rate using both the internal and government data sources. There were no significant differences between the 2 sources of data in the mean suicide rates for the baseline and intervention periods (P >.05). The data sources did differ in the capture of unique suicide deaths. Internally collected data were an effective measure of suicide deaths in the PDC initiative. A combination of internal and government-collected records may be most effective for future suicide prevention programs.

Morbidity and Mortality Conference: Its Purpose Reclaimed and Grounded in Theory.

PubMed

Gregor, Alexander; Taylor, David

2016-01-01

The morbidity and mortality conference (MMC) remains a central activity within the departments of our academic healthcare institutions. It is deeply rooted in the premise that we can learn from our mistakes, thereby improving the care we provide. Recent advances in our understanding of medical error and quality improvement have challenged the value of traditional models of MMC. As a result the purpose of MMC has become clouded and ill-defined: Is it an educational conference that promotes mastery of clinical acumen, or is it a venue to drive quality improvement by addressing systems-based issues in delivering care? Or can it serve both purposes? Review of the history of MMC, the literature, and critical application of education theory demonstrates the source of the confusion and the challenges in viewing it through the exclusive lens of either education or quality improvement. Application of experiential learning theory helps resolve this discord showing how the conference facilitates the development of clinical mastery while informing quality improvement programs about important and relevant systems-based issues. Building on this, we present a model for MMC involving five essential elements: case-based involving an adverse patient event, anonymity for participants, expert guided critical analysis, reframing understanding of the case presentation and related systems-based factors, and projection to practice change. This model builds on previously described models, is grounded in the literature, and helps clarify its role from both the educational and the quality improvement perspectives.

A collaborative approach to improve the assessment of physical health in adult consumers with schizophrenia in Queensland mental health services.

PubMed

Plever, Sally; McCarthy, Irene; Anzolin, Melissa; Emmerson, Brett; Khatun, Mohsina

2016-02-01

The objective of this study was to apply a quality improvement collaborative to increase the number of physical health assessments conducted with consumers diagnosed with schizophrenia in adult community mental health services across Queensland. Sixteen adult mental health service organisations voluntarily took part in the statewide collaborative initiative to increase the number of physical health assessments completed on persons with a diagnosis of schizophrenia spectrum disorders managed through the community mental health service. Improvement in the physical health assessment clinical indicator was demonstrated across the state over a 3-year period with an increase in the number of physical health assessments recorded from 12% to 58%. Significant improvements were made over a 3-year period by all mental health services involved in the collaborative, supporting the application of a quality improvement methodology to drive change across mental health services. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Defensive medicine and outcomes for medical malpractice liability.

PubMed

Genovese, Umberto; Amato, Simona; Del Sordo, Sara; Mobilia, Francesca; Casali, Michelangelo B

2014-01-01

Defensive medicine is a significant force driving the high costs of healthcare systems and has a substantial influence on physicians' behavior because they primarily concern about malpractice liability and not patient's health protection. This attitude disagrees with deontological duties and could impair physicians' ability of judgment and clinical reasoning. Reducing defensive medicine also could mean improving the quality in healthcare systems and eliminating unnecessary costs.

What Discourses Relating to the Purpose of Early Childhood Are Shaping the Work of Early Childhood Practitioners in Three Different Contexts: UK, Bhutan and Fiji?

ERIC Educational Resources Information Center

Sims, Margaret; Alexander, Elise; Pedey, Karma; Tausere-Tiko, Lavinia

2018-01-01

We explore the way dominant political discourses are perceived to influence developing professionalisation of early childhood in three contexts. The UK is strongly influenced by the neoliberal agenda which positions managerialism, bureaucracy, accountability and control as necessary to drive quality improvement. Bhutan has been exposed to western…

The new wave of hospital consolidation.

PubMed

Goldstein, Lisa

2012-04-01

Reimbursement challenges, spiraling healthcare costs, and a slow economic recovery are driving the latest wave of hospital consolidation. Health insurance companies and provider systems are forming partnerships in the consolidation field with the goal of reducing healthcare costs and improving quality. The "cost" of the acquisition may include debt and other obligations of the acquired hospital, such as pension liabilities, along with a multiyear capital commitment.

Talent Pipeline Management in Education: Using Supply Chain Management to Close the Educator Equity Gap. Solutions. Issue No. 7

ERIC Educational Resources Information Center

Barfield, Kathleen

2015-01-01

21st century economy demands a broad range of new skills and deeper knowledge in science, technology, engineering, and mathematics to both sustain our existing society and be successful in the future. This imperative must drive our collective school improvement efforts to ensure that every graduate is college and career ready. Teacher quality has…

Some Improvements in H-PDLCs

NASA Technical Reports Server (NTRS)

Crawford, Gregory P.; Li, Liuliu

2005-01-01

Some improvements have been made in the formulation of holographically formed polymer-dispersed liquid crystals (H-PDLCs) and in the fabrication of devices made from these materials, with resulting improvements in performance. H-PDLCs are essentially volume Bragg gratings. Devices made from H-PDLCs function as electrically switchable reflective filters. Heretofore, it has been necessary to apply undesirably high drive voltages in order to switch H-PDLC devices. Many scientific papers on H-PDLCs and on the potential utility of H-PDLC devices for display and telecommunication applications have been published. However, until now, little has been published about improving quality control in synthesis of H-PDLCs and fabrication of H-PDLC devices to minimize (1) spatial nonuniformities within individual devices, (2) nonuniformities among nominally identical devices, and (3) variations in performance among nominally identical devices. The improvements reported here are results of a research effort directed partly toward solving these quality-control problems and partly toward reducing switching voltages. The quality-control improvements include incorporation of a number of process controls to create a relatively robust process, such that the H-PDLC devices fabricated in this process are more nearly uniform than were those fabricated in a prior laboratory-type process. The improved process includes ultrasonic mixing, ultrasonic cleaning, the use of a micro dispensing technique, and the use of a bubble press.

Could clinical audit improve the diagnosis of pulmonary tuberculosis in Cuba, Peru and Bolivia?

PubMed

Siddiqi, Kamran; Volz, Anna; Armas, L; Otero, L; Ugaz, R; Ochoa, E; Gotuzzo, E; Torrico, F; Newell, James N; Walley, J; Robinson, Mike; Dieltiens, G; Van der Stuyft, P

2008-04-01

To assess the effectiveness of clinical audit in improving the quality of diagnostic care provided to patients suspected of tuberculosis; and to understand the contextual factors which impede or facilitate its success. Twenty-six health centres in Cuba, Peru and Bolivia were recruited. Clinical audit was introduced to improve the diagnostic care for patients attending with suspected TB. Standards were based on the WHO and TB programme guidelines relating to the appropriate use of microscopy, culture and radiological investigations. At least two audit cycles were completed over 2 years. Improvement was determined by comparing the performance between two six-month periods pre- and post-intervention. Qualitative methods were used to ascertain facilitating and limiting contextual factors influencing change among healthcare professionals' clinical behaviour after the introduction of clinical audit. We found a significant improvement in 11 of 13 criteria in Cuba, in 2 of 6 criteria in Bolivia and in 2 of 5 criteria in Peru. Twelve out of 24 of the audit criteria in all three countries reached the agreed standards. Barriers to quality improvement included conflicting objectives for clinicians and TB programmes, poor coordination within the health system and patients' attitudes towards illness. Clinical audit may drive improvements in the quality of clinical care in resource-poor settings. It is likely to be more effective if integrated within and supported by the local TB programmes. We recommend developing and evaluating an integrated model of quality improvement including clinical audit.

New research assessing the effect of engine operating conditions on regulated emissions of a 4-stroke motorcycle by test bench measurements

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

Iodice, Paolo, E-mail: paolo.iodice@unina.it; Senatore, Adolfo

In the latest years the effect of powered two-wheelers on air polluting emissions is generally noteworthy all over the world, notwithstanding advances in internal combustion engines allowed to reduce considerably both fuel consumption and exhaust emissions of SI engines. Nowadays, in fact, these vehicles represent common means of quotidian moving, serving to meet daily urban transport necessities with a significant environmental impact on air quality. Besides, the emissive behavior of the two-wheelers measured under fixed legislative driving standards (and not on the local driving conditions) might not be sufficiently representative of real world motorcycle riding. The purpose of this investigationmore » is a deeper research on emissive levels of in-use motorcycles equipped with last generation SI engines under real world driving behavior. In order to analyze the effect of vehicle instantaneous speed and acceleration on emissive behavior, instantaneous emissions of CO, HC and NO{sub X} were measured in the exhaust of a four-stroke motorcycle, equipped with a three-way catalyst and belonging to the Euro-3 legislative category. Experimental tests were executed on a chassis dynamometer bench in the laboratories of the National Research Council (Italy), during the Type Approval test cycle, at constant speed and under real-world driving cycles. This analytical-experimental investigation was executed with a methodology that improves vehicles emission assessment in comparison with the modeling approaches that are based on fixed legislative driving standards. The statistical processing results so obtained are very useful also in order to improve the database of emission models commonly used for estimating emissions from road transport sector, then they can be used to evaluate the environmental impact of last generation medium-size motorcycles under real driving behaviors.« less

How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement.

PubMed

Akdemir, Nesibe; Lombarts, Kiki M J M H; Paternotte, Emma; Schreuder, Bas; Scheele, Fedde

2017-06-02

Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands. To determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system. Four themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors' responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement. The challenge for accreditors is to find the right balance between trusting and controlling medical professionals. Their choices will be reflected in the accreditation design. The four themes could enhance international comparisons and encourage better choices in the design of accreditation systems.

Aero-Thermal Calibration of the NASA Glenn Icing Research Tunnel (2004 and 2005 Tests)

NASA Technical Reports Server (NTRS)

Arrington, E. Allen; Pastor, Christine M.; Gonsalez, Jose C.; Curry, Monroe R., III

2010-01-01

A full aero-thermal calibration of the NASA Glenn Icing Research Tunnel was completed in 2004 following the replacement of the inlet guide vanes upstream of the tunnel drive system and improvement to the facility total temperature instrumentation. This calibration test provided data used to fully document the aero-thermal flow quality in the IRT test section and to construct calibration curves for the operation of the IRT. The 2004 test was also the first to use the 2-D RTD array, an improved total temperature calibration measurement platform.

A new approach for measuring the work and quality of histopathology reporting.

PubMed

Sharma, Vijay; Davey, Jonathan G N; Humphreys, Catherine; Johnston, Peter W

2013-07-01

Cancer datasets drive report quality, but require more work to inform compliant reports. The aim of this study was to correlate the number of words with measures of quality, to examine the impact of the drive for improved quality on the workload of histopathology reporting over time. We examined the first 10 reports of colon, breast, renal, lung and ovarian carcinoma, melanoma resection, nodal lymphoma appendicitis and seborrhoeic keratosis (SK) issued in 1991, 2001 and 2011. Correlations were analysed using Pearson's partial correlation coefficients. Word count increased significantly over time for most specimen types examined. Word count almost always correlated with units of information, indicating that the word count was a good measure of the amount of information contained within the reports; this correlation was preserved following correction for the effect of time. A good correlation with compliance with cancer datasets was also observed, but was weakened or lost following correction for the increase in word count and units of information that occurred between time points. These data indicate that word count could potentially be used as a measure of information content if its integrity and usefulness are continuously validated. Further prospective studies are required to assess and validate this approach. © 2013 John Wiley & Sons Ltd.

Spatial variation of air quality index and urban driving factors linkages: evidence from Chinese cities.

PubMed

Pu, Haixia; Luo, Kunli; Wang, Pin; Wang, Shaobin; Kang, Shun

2017-02-01

Daily air quality index (AQI) of 161 Chinese cities obtained from the Ministry of Environmental Protection of China in 2015 is conducted. In this study, to better explore spatial distribution and regional characteristic of AQI, global and local spatial autocorrelation is utilized. Pearson's correlation is introduced to determine the influence of single urban indicator on AQI value. Meanwhile, multiple linear stepwise regression is chosen to estimate quantitatively the most influential urban indicators on AQI. The spatial autocorrelation analysis indicates that the AQI value of Chinese 161 cities shows a spatial dependency. Higher AQI is mainly located in north and northwest regions, whereas low AQI is concentrated in the south and the Qinghai-Tibet regions. The low AQI and high AQI values in China both exhibit relative immobility through seasonal variation. The influence degree of three adverse urban driving factors on AQI value is ranked from high to low: coal consumption of manufacturing > building area > coal consumption of the power industry. It is worth noting that the risk of exposed population to poor quality is greater in the northern region than in other regions. The results of the study provide a reference for the formulation of urban policy and improvement of air quality in China.

Leveraging information technology to drive improvement in patient satisfaction.

PubMed

Nash, Mary; Pestrue, Justin; Geier, Peter; Sharp, Karen; Helder, Amy; McAlearney, Ann Scheck

2010-01-01

A healthcare organization's commitment to quality and the patient experience requires senior leader involvement in improvement strategies, and accountability for goals. Further, improvement strategies are most effective when driven by data, and in the world of patient satisfaction, evidence is growing that nurse leader rounding and discharge calls are strategic tactics that can improve patient satisfaction. This article describes how The Ohio State University Medical Center (OSUMC) leveraged health information technology (IT) to apply a data-driven strategy execution to improve the patient experience. Specifically, two IT-driven approaches were used: (1) business intelligence reporting tools were used to create a meaningful reporting system including dashboards, scorecards, and tracking reports and (2) an improvement plan was implemented that focused on two high-impact tactics and data to hardwire accountability. Targeted information from the IT systems enabled clinicians and administrators to execute these strategic tactics, and senior leaders to monitor achievement of strategic goals. As a result, OSUMC's inpatient satisfaction scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey improved from 56% nines and tens in 2006 to 71% in 2009. © 2010 National Association for Healthcare Quality.

Application of uncertainty and sensitivity analysis to the air quality SHERPA modelling tool

NASA Astrophysics Data System (ADS)

Pisoni, E.; Albrecht, D.; Mara, T. A.; Rosati, R.; Tarantola, S.; Thunis, P.

2018-06-01

Air quality has significantly improved in Europe over the past few decades. Nonetheless we still find high concentrations in measurements mainly in specific regions or cities. This dimensional shift, from EU-wide to hot-spot exceedances, calls for a novel approach to regional air quality management (to complement EU-wide existing policies). The SHERPA (Screening for High Emission Reduction Potentials on Air quality) modelling tool was developed in this context. It provides an additional tool to be used in support to regional/local decision makers responsible for the design of air quality plans. It is therefore important to evaluate the quality of the SHERPA model, and its behavior in the face of various kinds of uncertainty. Uncertainty and sensitivity analysis techniques can be used for this purpose. They both reveal the links between assumptions and forecasts, help in-model simplification and may highlight unexpected relationships between inputs and outputs. Thus, a policy steered SHERPA module - predicting air quality improvement linked to emission reduction scenarios - was evaluated by means of (1) uncertainty analysis (UA) to quantify uncertainty in the model output, and (2) by sensitivity analysis (SA) to identify the most influential input sources of this uncertainty. The results of this study provide relevant information about the key variables driving the SHERPA output uncertainty, and advise policy-makers and modellers where to place their efforts for an improved decision-making process.

A Quantitative Evaluation of Drive Pattern Selection for Optimizing EIT-Based Stretchable Sensors

PubMed Central

Nefti-Meziani, Samia; Carbonaro, Nicola

2017-01-01

Electrical Impedance Tomography (EIT) is a medical imaging technique that has been recently used to realize stretchable pressure sensors. In this method, voltage measurements are taken at electrodes placed at the boundary of the sensor and are used to reconstruct an image of the applied touch pressure points. The drawback with EIT-based sensors, however, is their low spatial resolution due to the ill-posed nature of the EIT reconstruction. In this paper, we show our performance evaluation of different EIT drive patterns, specifically strategies for electrode selection when performing current injection and voltage measurements. We compare voltage data with Signal-to-Noise Ratio (SNR) and Boundary Voltage Changes (BVC), and study image quality with Size Error (SE), Position Error (PE) and Ringing (RNG) parameters, in the case of one-point and two-point simultaneous contact locations. The study shows that, in order to improve the performance of EIT based sensors, the electrode selection strategies should dynamically change correspondingly to the location of the input stimuli. In fact, the selection of one drive pattern over another can improve the target size detection and position accuracy up to 4.7% and 18%, respectively. PMID:28858252

A Quantitative Evaluation of Drive Pattern Selection for Optimizing EIT-Based Stretchable Sensors.

PubMed

Russo, Stefania; Nefti-Meziani, Samia; Carbonaro, Nicola; Tognetti, Alessandro

2017-08-31

Electrical Impedance Tomography (EIT) is a medical imaging technique that has been recently used to realize stretchable pressure sensors. In this method, voltage measurements are taken at electrodes placed at the boundary of the sensor and are used to reconstruct an image of the applied touch pressure points. The drawback with EIT-based sensors, however, is their low spatial resolution due to the ill-posed nature of the EIT reconstruction. In this paper, we show our performance evaluation of different EIT drive patterns, specifically strategies for electrode selection when performing current injection and voltage measurements. We compare voltage data with Signal-to-Noise Ratio (SNR) and Boundary Voltage Changes (BVC), and study image quality with Size Error (SE), Position Error (PE) and Ringing (RNG) parameters, in the case of one-point and two-point simultaneous contact locations. The study shows that, in order to improve the performance of EIT based sensors, the electrode selection strategies should dynamically change correspondingly to the location of the input stimuli. In fact, the selection of one drive pattern over another can improve the target size detection and position accuracy up to 4.7% and 18%, respectively.

A Methodological Critique of the ProPublica Surgeon Scorecard

PubMed Central

Friedberg, Mark W.; Pronovost, Peter J.; Shahian, David M.; Safran, Dana Gelb; Bilimoria, Karl Y.; Elliott, Marc N.; Damberg, Cheryl L.; Dimick, Justin B.; Zaslavsky, Alan M.

2016-01-01

Abstract On July 14, 2015, ProPublica published its Surgeon Scorecard, which displays “Adjusted Complication Rates” for individual, named surgeons for eight surgical procedures performed in hospitals. Public reports of provider performance have the potential to improve the quality of health care that patients receive. A valid performance report can drive quality improvement and usefully inform patients' choices of providers. However, performance reports with poor validity and reliability are potentially damaging to all involved. This article critiques the methods underlying the Scorecard and identifies opportunities for improvement. Until these opportunities are addressed, the authors advise users of the Scorecard—most notably, patients who might be choosing their surgeons—not to consider the Scorecard a valid or reliable predictor of the health outcomes any individual surgeon is likely to provide. The authors hope that this methodological critique will contribute to the development of more-valid and more-reliable performance reports in the future. PMID:28083411

Commentary: A call to leadership: the role of the academic medical center in driving sustainable health system improvement through performance measurement.

PubMed

Nedza, Susan M

2009-12-01

As the government attempts to address the high cost of health care in the United States, the issues being confronted include variations in the quality of care administered and the inconsistent application of scientifically proven treatments. To improve quality, methods of measurement and reporting with rewards or, eventually, penalties based on performance, must be developed. To date, well-intentioned national policy initiatives, such as value-based purchasing, have focused primarily on the measurement of discrete events and on attempts to construct incentives. While important, the current approach alone cannot improve quality, ensure equitability, decrease variability, and optimize value. Additional thought-leadership is required, both theoretical and applied. Academic medical centers' (AMCs') scholarly and practical participation is needed. Although quality cannot be sustainably improved without measurement, the existing measures alone do not ensure quality. There is not enough evidence to support strong measure development and, further, not enough insight regarding whether the existing measures have their intended effect of enhancing health care delivery that results in quality outcomes for patients. Perhaps the only way that the United States health care system will achieve a standard of quality care is through the strong embrace, effective engagement, intellectual insights, educational contributions, and practical applications in AMCs. Quality will never be achieved through public policies or national initiatives alone but instead through the commitment of the academic community to forward the science of performance measurement and to ensure that measurement leads to better health outcomes for our nation.

Driving and Age-Related Macular Degeneration

ERIC Educational Resources Information Center

Owsley, Cynthia; McGwin, Gerald, Jr.

2008-01-01

This article reviews the research literature on driving and age-related macular degeneration, which is motivated by the link between driving and the quality of life of older adults and their increased collision rate. It addresses the risk of crashes, driving performance, driving difficulty, self-regulation, and interventions to enhance, safety,…

Flow Quality Studies of the NASA Glenn Research Center Icing Research Tunnel Circuit (1995 Tests)

NASA Technical Reports Server (NTRS)

Arrington, E. Allen; Kee-Bowling, Bonnie A.; Gonsalez, Jose C.

2000-01-01

The purpose of conducting the flow-field surveys described in this report was to more fully document the flow quality in several areas of the tunnel circuit in the NASA Glenn Research Center Icing Research Tunnel. The results from these surveys provide insight into areas of the tunnel that were known to exhibit poor flow quality characteristics and provide data that will be useful to the design of flow quality improvements and a new heat exchanger for the facility. An instrumented traversing mechanism was used to survey the flow field at several large cross sections of the tunnel loop over the entire speed range of the facility. Flow-field data were collected at five stations in the tunnel loop, including downstream of the fan drive motor housing, upstream and downstream of the heat exchanger, and upstream and downstream of the spraybars located in the settling chamber upstream of the test section. The data collected during these surveys greatly expanded the data base describing the flow quality in each of these areas. The new data matched closely the flow quality trends recorded from earlier tests. Data collected downstream of the heat exchanger and in the settling chamber showed how the configuration of the folded heat exchanger affected the pressure, velocity, and flow angle distributions in these areas. Smoke flow visualization was also used to qualitatively study the flow field in an area downstream of the drive fan and in the settling chamber/contraction section.

Modelling and Simulation of Single-Phase Series Active Compensator for Power Quality Improvement

NASA Astrophysics Data System (ADS)

Verma, Arun Kumar; Mathuria, Kirti; Singh, Bhim; Bhuvaneshwari, G.

2017-10-01

A single-phase active series compensator is proposed in this work to reduce harmonic currents at the ac mains and to regulate the dc link voltage of a diode bridge rectifier (DBR) that acts as the front end converter for a voltage source inverter feeding an ac motor. This ac motor drive is used in any of the domestic, commercial or industrial appliances. Under fluctuating ac mains voltages, the dc link voltage of the DBR depicts wide variations and hence the ac motor is used at reduced rating as compared to its name-plate rating. The active series compensator proposed here provides dual functions of improving the power quality at the ac mains and regulating the dc link voltage thus averting the need for derating of the ac motor.

A systematic review of factors affecting driving and public transportation among youth and young adults with acquired brain injury.

PubMed

Lindsay, Sally; Stoica, Andrei

2017-01-01

Although many people with an acquired brain injury (ABI) encounter difficulties with executive functioning and memory which could negatively affect driving, few people are assessed for fitness to drive after injury. The purpose of this systematic review was to synthesize the literature on factors affecting driving and public transportation among youth and young adults with ABI, post injury. Seven databases were systematically searched for articles from 1980 to 2016. Studies were screened independently by two researchers who performed the data extraction. Study quality was appraised using the Standard Quality Assessment Criteria (Kmet) for evaluating primary research from a variety of fields. Of the 6577 studies identified in the search, 25 met the inclusion criteria, which involved 1527 participants with ABI (mean age = 25.1) across eight countries. Six studies focused on driving assessment and fitness to drive, ten on driving performance or risk of accidents and nine studies explored issues related to accessing or navigating public transportation. Quality assessment of the included studies ranged from 0.60 to 0.95. Our findings highlight several gaps in clinical practice and research along with a critical need for enhanced fitness to drive assessments and transportation-related training for young people with ABI.

Experimental evaluation of hybrid vehicle fuel economy and pollutant emissions over real-world simulation driving cycles

NASA Astrophysics Data System (ADS)

Fontaras, Georgios; Pistikopoulos, Panayotis; Samaras, Zissis

2008-06-01

The reduction of transport-generated CO2 emissions is currently a problem of global interest. Hybrid electric vehicles (HEVs) are considered as one promising technological solution for limiting transport-generated greenhouse gas emissions. Currently, the number of HEVs in the market remains limited, but this picture will change in the years to come as HEVs are expected to pave the way for cleaner technologies in transport. In this paper, results are presented regarding fuel economy and pollutant emissions measurements of two hybrid electric production vehicles. The measurements were conducted on a Prius II and a Honda Civic IMA using both the European legislated driving cycle (New European Driving Cycle, NEDC) and real-world simulation driving cycles (Artemis). In addition to the emissions measurements, other vehicle-operating parameters were studied in an effort to better quantify the maximum CO2 reduction potential. Data from real-world operation of a Prius II vehicle were also used in the evaluation. Results indicate that in most cases both vehicles present improved energy efficiency and pollutant emissions compared to conventional cars. The fuel economy benefit of the two HEVs peaked under urban driving conditions where reductions of 60% and 40% were observed, respectively. Over higher speeds the difference in fuel economy was lower, reaching that of conventional diesel at 95 km h-1. The effect of ambient temperature on fuel consumption was also quantified. It is concluded that urban operation benefits the most of hybrid technology, leading to important fuel savings and urban air quality improvement.

Family members' experiences of driving disruption after acquired brain injury.

PubMed

Liang, Phyllis; Fleming, Jennifer; Gustafsson, Louise; Griffin, Janelle; Liddle, Jacki

2017-01-01

1) To explore family members' lived experiences of driving disruption at early and later stages of the recovery continuum following acquired brain injury (ABI). 2) To describe health-related quality of life of family members of individuals with ABI who are experiencing driving disruption. Mixed methods phenomenological research approach. Semi-structured interviews and health-related quality of life questionnaires were conducted with 15 family members of individuals with ABI (early group: 1-12 months post-injury, n = 6; later group: >1 year post-injury, n = 9). Two main themes were identified: Different for everyone: how driving disruption affects families, and Making it harder: context of driving disruption. The challenges of driving disruption were reported more frequently and with a more intense focus by family members who were caring for their relative for more than 1 year post-injury. This group also reported higher caregiver strain and poorer health-related quality of life. Reduced satisfaction with life, poor mental health and affected family functioning were reported by both groups. Driving disruption impacts on family members and has long-lasting consequences. It is important for clinicians to work with family members to manage these challenges even years after ABI and consider individual contextual factors.

The power of cross-functional teams in driving total quality

NASA Astrophysics Data System (ADS)

McClung, Tim M.; McMaster, Tom J.

Garrett Canada, a Division of Allied-Signal Aerospace Canada, has been a member of the Canadian aerospace industry for 40 years. Although Garrett Canada has always been a profitable division with a solid market share, the changing and turbulent business environment and globalization of the aerospace industry has created new demands and challenges. The marketplace is demanding faster introduction of new products, as well as shorter leadtimes for repairs and spares. It was recognized that reducing cycle times for new products and for ongoing production would not only satisfy our customers, it would also enhance our business performance through reduced inventories, lower past due, and more responsiveness to change. It was evident that drastic function changes were required if we were to maintain our position as a premier aerospace supplier. The challenge was to convert a stable, somewhat slow-paced work environment with strong functional boundaries into a boundaryless world class team functioning in a total quality environment and focused on customer satisfaction. Complete and uncompromised customer satisfaction has become our driving force, with Total Quality being our engine to continuously improve our processes and increase our speed. The way in which this transition has been brought about is the subject of this presentation.

The power of cross-functional teams in driving total quality

NASA Technical Reports Server (NTRS)

Mcclung, Tim M.; Mcmaster, Tom J.

1992-01-01

Garrett Canada, a Division of Allied-Signal Aerospace Canada, has been a member of the Canadian aerospace industry for 40 years. Although Garrett Canada has always been a profitable division with a solid market share, the changing and turbulent business environment and globalization of the aerospace industry has created new demands and challenges. The marketplace is demanding faster introduction of new products, as well as shorter leadtimes for repairs and spares. It was recognized that reducing cycle times for new products and for ongoing production would not only satisfy our customers, it would also enhance our business performance through reduced inventories, lower past due, and more responsiveness to change. It was evident that drastic function changes were required if we were to maintain our position as a premier aerospace supplier. The challenge was to convert a stable, somewhat slow-paced work environment with strong functional boundaries into a boundaryless world class team functioning in a total quality environment and focused on customer satisfaction. Complete and uncompromised customer satisfaction has become our driving force, with Total Quality being our engine to continuously improve our processes and increase our speed. The way in which this transition has been brought about is the subject of this presentation.

Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria.

PubMed

Luckett, Tim; Bhattarai, Priyanka; Phillips, Jane; Agar, Meera; Currow, David; Krastev, Yordanka; Davidson, Patricia M

2015-11-01

A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Frameworkfor Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment--the Dying with Dignity Victoria Advance Healthcare Directive. More research is needed to understand how online resources can optimally elicit and record consumers' individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement.

Using Statistical Process Control to Drive Improvement in Neonatal Care: A Practical Introduction to Control Charts.

PubMed

Gupta, Munish; Kaplan, Heather C

2017-09-01

Quality improvement (QI) is based on measuring performance over time, and variation in data measured over time must be understood to guide change and make optimal improvements. Common cause variation is natural variation owing to factors inherent to any process; special cause variation is unnatural variation owing to external factors. Statistical process control methods, and particularly control charts, are robust tools for understanding data over time and identifying common and special cause variation. This review provides a practical introduction to the use of control charts in health care QI, with a focus on neonatology. Copyright © 2017 Elsevier Inc. All rights reserved.

Demonstrating PQS Effectiveness and Driving Continual Improvement: Evidence-Based Risk Reduction.

PubMed

Ramnarine, Emma; O'Donnell, Kevin

2018-04-18

Product knowledge grows and evolves during the life of a product. In order to maintain a state of control and deliver product with consistent quality throughout its commercial life, continuous improvement and product lifecycle management become essential. The practical link between product and process knowledge, risk-based control strategies, and continual improvement and innovation can be made stronger through evidence-based risk reduction. Regulatory relief and flexibility in post approval change management and overall product lifecycle management will only be possible with effective application of science and risk-based concepts and demonstrated effectiveness of the PQS in assuring a state of control. Copyright © 2018, Parenteral Drug Association.

Enhancing Soundtracks From Old Movies

NASA Technical Reports Server (NTRS)

Frazer, Robert E.

1992-01-01

Proposed system enhances soundtracks of old movies. Signal on optical soundtrack of film digitized and processed to reduce noise and improve quality; timing signals added, and signal recorded on compact disk. Digital comparator and voltage-controlled oscillator synchronizes speed of film-drive motor and compact disk motor. Frame-coded detector reads binary frame-identifying marks on film. Digital comparator generates error signal if marks on film do not match those on compact disk.

Evaluating and Enhancing Driving Ability Among Teens with Autism Spectrum Disorder (ASD)

DTIC Science & Technology

2014-10-01

able to engage in the driving training, and none have experienced simulation adaptation syndrome. 15. SUBJECT TERMS Autism, Driving Safety , Driving...routine driving training (RT) required by the DMV, VRDS training + RT (VRDS-T) would lead to greater improvement in driving safety and less driving...improved driving safety above and beyond RT. We hypothesized that computer-generated feedback would be more palatable than human-generated feedback to

Got (the Right) Milk? How a Blended Quality Improvement Approach Catalyzed Change.

PubMed

Luton, Alexandra; Bondurant, Patricia G; Campbell, Amy; Conkin, Claudia; Hernandez, Jae; Hurst, Nancy

2015-10-01

The expression, storage, preparation, fortification, and feeding of breast milk are common ongoing activities in many neonatal intensive care units (NICUs) today. Errors in breast milk administration are a serious issue that should be prevented to preserve the health and well-being of NICU babies and their families. This paper describes how a program to improve processes surrounding infant feeding was developed, implemented, and evaluated. The project team used a blended quality improvement approach that included the Model for Improvement, Lean and Six Sigma methodologies, and principles of High Reliability Organizations to identify and drive short-term, medium-term, and long-term improvement strategies. Through its blended quality improvement approach, the team strengthened the entire dispensation system for both human milk and formula and outlined a clear vision and plan for further improvements as well. The NICU reduced feeding errors by 83%. Be systematic in the quality improvement approach, and apply proven methods to improving processes surrounding infant feeding. Involve expert project managers with nonclinical perspective to guide work in a systematic way and provide unbiased feedback. Create multidisciplinary, cross-departmental teams that include a vast array of stakeholders in NICU feeding processes to ensure comprehensive examination of current state, identification of potential risks, and "outside the box" potential solutions. As in the realm of pharmacy, the processes involved in preparing feedings for critically ill infants should be carried out via predictable, reliable means including robust automated verification that integrates seamlessly into existing processes. The use of systems employed in pharmacy for medication preparation should be considered in the human milk and formula preparation setting.

Assessing Care of Vulnerable Elders – Alzheimer's Disease: A Pilot Study of a Practice Redesign Intervention to Improve the Quality of Dementia Care

PubMed Central

Reuben, David B.; Roth, Carol P.; Frank, Janet C.; Hirsch, Susan H.; Katz, Diane; McCreath, Heather; Younger, Jon; Murawski, Marta; Edgerly, Elizabeth; Maher, Joanne; Maslow, Katie; Wenger, Neil S.

2013-01-01

Objectives To determine whether a practice redesign intervention coupled with referral to local Alzheimer's Association chapters can improve the quality of dementia care. Design Pre-post intervention Setting Two community-based physician practices Participants Five physicians in each practice and their patients age 75 and older with dementia Intervention Adaptation of the Assessing Care of Vulnerable Elders (ACOVE)-2 intervention (screening, efficient collection of clinical data, medical record prompts, patient education/empowerment materials, and physician decision support/education). In addition, physicians faxed referral forms to local Alzheimer's Association chapters who assessed patients, provided counseling and education, and faxed information back to the physicians. Measurements Audits of pre- (5 per physician) and post- (10 per physician) intervention medical records using ACOVE-3 quality indicators for dementia to measure the quality of care provided. Results Based on 47 pre- and 90 post-intervention audits, the percentage of quality indicators satisfied rose from 38% to 46% with significant differences on quality indicators measuring the assessment of functional status (20% versus 51%), discussion of risk/benefits of antipsychotics (32% versus 100%), and counseling caregivers (2% versus 30%). Referral of patients to Alzheimer's Association chapters increased from 0 to 17%. Referred patients had higher quality scores (65% versus 41%) and better counseling about driving (50% versus 14%), caregiver counseling (100% versus 15%) and surrogate decision-maker specification (75% versus 44%). However, some quality indicators related to cognitive assessment and examination did not improve. Conclusions This pilot study suggests that a practice-based intervention can increase referral to AA chapters and improve quality of dementia care. PMID:20374405

SAGES quality initiative: an introduction.

PubMed

Lidor, Anne; Telem, Dana; Bower, Curtis; Sinha, Prashant; Orlando, Rocco; Romanelli, John

2017-08-01

The Medicare program has transitioned to paying healthcare providers based on the quality of care delivered, not on the quantity. In May 2015, SAGES held its first ever Quality Summit. The goal of this meeting was to provide us with the information necessary to put together a strategic plan for our Society over the next 3-5 years, and to participate actively on a national level to help develop valid measures of quality of surgery. The transition to value-based medicine requires that providers are now measured and reimbursed based on the quality of services they provide rather than the quantity of patients in their care. As of 2014, quality measures must cover 3 of the 6 available National Quality domains. Physician quality reporting system measures are created via a vigorous process which is initiated by the proposal of the quality measure and subsequent validation. Commercial, non-profit, and governmental agencies have now been engaged in the measurement of hospital performance through structural measures, process measures, and increasingly with outcomes measures. This more recent focus on outcomes measures have been linked to hospital payments through the Value-Based Purchasing program. Outcomes measures of quality drive CMS' new program, MACRA, using two formats: Merit-based incentive programs and alternative payment models. But, the quality of information now available is highly variable and difficult for the average consumer to use. Quality metrics serve to guide efforts to improve performance and for consumer education. Professional organizations such as SAGES play a central role in defining the agenda for improving quality, outcomes, and safety. The mission of SAGES is to improve the quality of patient care through education, research, innovation, and leadership, principally in gastrointestinal and endoscopic surgery.

Systematic review of factors affecting driving and motor vehicle transportation among people with autism spectrum disorder.

PubMed

Lindsay, Sally

2017-05-01

This systematic review is to critically appraise the literature on factors affecting driving and motor vehicle transportation experiences of people with autism spectrum disorders (ASD) and to provide insight into future directions for research. Systematic searches of eight databases identified 22 studies meeting our inclusion criteria. These studies were analysed in terms of the characteristics of the participants, methodology, results of the study and quality of the evidence. Among the 22 studies, 2919 participants (364 individuals with ASD; 2555 parents of youth with ASD; mean age of person with ASD = 17.3) were represented, across six countries. Studies (n = 13) focused on factors affecting driving, including challenges in obtaining a licence, driving confidence, driving behaviours and strategies to improve driving skills. In regards to factors related to public and/or school transportation, nine studies explored rates of transportation use, access, cost and safety. Our findings highlight several gaps in the research and an urgent need for further transportation-related training and supports for people with ASD. Implications for rehabilitation Many people with ASD encounter challenges in obtaining a driver's licence, driving confidence and driving performance compared to those without ASD. Several strategies can be useful when teaching people with ASD to drive including direct communication, encouraging coping mechanisms, breaking down tasks and providing regular and consistent driving lessons. Clinicians and educators should advocate for further transportation-related training and supports for people with ASD. More research is needed from the perspective of people with ASD to understand their experiences and the particular challenges that they encounter in obtaining a licence and navigating public transportation.

NOx emissions from Euro IV busses with SCR systems associated with urban, suburban and freeway driving patterns.

PubMed

Fu, Mingliang; Ge, Yunshan; Wang, Xin; Tan, Jianwei; Yu, Linxiao; Liang, Bin

2013-05-01

NOx and particulate matter (PM) emissions from heavy-duty diesel vehicles (HDVs) have become the most important sources of pollutants affecting urban air quality in China. In recent years, a series of emission control strategies and diesel engine polices have been introduced that require advanced emission control technology. China and Europe mostly have used Selective Catalytic Reduction (SCR) with urea to meet the Euro IV diesel engine emission standard. In this study, two Euro IV busses with SCR were tested by using potable emission measurement system (PEMS) to assess NOx emissions associated with urban, suburban and freeway driving patterns. The results indicated that with the SCR system, the urea injection time for the entire driving period increased with higher vehicle speed. For freeway driving, the urea injection time covered 71%-83% of the driving period; the NOx emission factors from freeway driving were lower than those associated with urban and suburban driving. Unfortunately, the NOx emission factors were 2.6-2.8-, 2.3-2.7- and 2.2-2.3-fold higher than the Euro IV standard limits for urban, suburban and freeway driving, respectively; NOx emission factors (in g/km and g/(kW·h)) from the original vehicles (without SCR) were higher than their corresponding vehicles with SCR for suburban and freeway driving. Compared with the IVE model results, the measured NOx emission factors were 1.60-1.16-, 1.77-1.27-, 2.49-2.44-fold higher than the NOx predicted by the IVE model for urban and suburban driving, respectively. Thus, an adjustment of emission factors is needed to improve the estimation of Euro IV vehicle emissions in China. Copyright © 2013 Elsevier B.V. All rights reserved.

Nonlinear oscillation and interfacial stability of an encapsulated microbubble under dual-frequency ultrasound

NASA Astrophysics Data System (ADS)

Calvisi, Michael; Liu, Yunqiao; Wang, Qianxi

2016-11-01

Encapsulated microbubbles (EMBs) are widely used in medical ultrasound imaging as contrast-enhanced agents. However, the potential damaging effects of violent, collapsing EMBs to cells and tissues in clinical practice have remained a concern. Dual-frequency ultrasound is a promising technique for improving the efficacy and safety of sonography. The EMB system modeled consists of the external liquid, membrane, and internal gases. The microbubble dynamics are simulated using a simple nonlinear interactive theory, considering the compressibility of the internal gas, viscosity of the liquid flow, and elasticity of the membrane. The radial oscillation and interfacial stability of an EMB under single and dual-frequency excitations are compared. The simulation results show that the dual-frequency technique produces larger backscatter pressure at higher harmonics of the primary driving frequency. This enriched acoustic spectrum can enhance blood-tissue contrast and improve sonographic image quality. The results further show that the acoustic pressure threshold associated with the onset of shape instability is greater for dual-frequency driving. This suggests that the dual-frequency technique stabilizes the EMB, thereby improving the efficacy and safety of contrast-enhanced agents.

Managing Quality and Productivity in Aerospace and Defense

DTIC Science & Technology

1989-11-01

subject of The VPC at Virginia Tech. The Maryland excellence. We hope they will be of value to Center for Productivity and Quality of Worklife your...Budget drives the plan • Plan drives the budget I nvolves only top management * Participation at all levels * Finance and operations imbalanced * Balance ...to create a better tend to cause us to drive the equation left-to- balance . The Planning Process discussed in right, focusing on the levels of

Capacitor regenerative braking system of electric wheelchair for senior citizen based on variable frequency chopper control.

PubMed

Takahashi, Yoshiaki; Seki, Hirokazu

2009-01-01

This paper proposes a novel regenerative braking control system of electric wheelchairs for senior citizen. "Electric powered wheelchair", which generates the driving force by electric motors according to the human operation, is expected to be widely used as a mobility support system for elderly people. This study focuses on the braking control to realize the safety and smooth stopping motion using the regenerative braking control technique based on fuzzy algorithm. The ride quality improvement and energy recycling can be expected by the proposed control system with stopping distance estimation and variable frequency control on the step-up/down chopper type of capacitor regenerative circuit. Some driving experiments confirm the effectiveness of the proposed control system.

Impact of ablator thickness and laser drive duration on a platform for supersonic, shockwave-driven hydrodynamic instability experiments

DOE PAGES

Wan, W. C.; Malamud, Guy; Shimony, A.; ...

2016-12-07

Here, we discuss changes to a target design that improved the quality and consistency of data obtained through a novel experimental platform that enables the study of hydrodynamic instabilities in a compressible regime. The experiment uses a laser to drive steady, supersonic shockwave over well-characterized initial perturbations. Early experiments were adversely affected by inadequate experimental timescales and, potentially, an unintended secondary shockwave. These issues were addressed by extending the 4 x 10 13 W/cm 2 laser pulse from 19 ns to 28 ns, and increasing the ablator thickness from 185 µm to 500 µm. We present data demonstrating the performancemore » of the platform.« less

Impact of ablator thickness and laser drive duration on a platform for supersonic, shockwave-driven hydrodynamic instability experiments

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

Wan, W. C.; Malamud, Guy; Shimony, A.

Here, we discuss changes to a target design that improved the quality and consistency of data obtained through a novel experimental platform that enables the study of hydrodynamic instabilities in a compressible regime. The experiment uses a laser to drive steady, supersonic shockwave over well-characterized initial perturbations. Early experiments were adversely affected by inadequate experimental timescales and, potentially, an unintended secondary shockwave. These issues were addressed by extending the 4 x 10 13 W/cm 2 laser pulse from 19 ns to 28 ns, and increasing the ablator thickness from 185 µm to 500 µm. We present data demonstrating the performancemore » of the platform.« less

Monitoring intensive care unit performance—impact of a novel individualised performance scorecard in critical care medicine: a mixed-methods study protocol

PubMed Central

Neilipovitz, David; Sarti, Aimee J; Rosenberg, Erin; Ishaq, Rabia; Thornton, Mary; Kim, John

2018-01-01

Introduction Patients admitted to a critical care medicine (CCM) environment, including an intensive care unit (ICU), are susceptible to harm and significant resource utilisation. Therefore, a strategy to optimise provider performance is required. Performance scorecards are used by institutions for the purposes of driving quality improvement. There is no widely accepted or standardised scorecard that has been used for overall CCM performance. We aim to improve quality of care, patient safety and patient/family experience in CCM practice through the utilisation of a standardised, repeatable and multidimensional performance scorecard, designed to provide a continuous review of ICU physician and nurse practice, as well as departmental metrics. Methods and analysis This will be a mixed-methods, controlled before and after study to assess the impact of a CCM-specific quality scorecard. Scorecard metrics were developed through expert consensus and existing literature. The study will include 19 attending CCM physicians and approximately 300 CCM nurses. Patient data for scorecard compilation are collected daily from bedside flow sheets. Preintervention baseline data will be collected for 6 months for each participant. After this, each participant will receive their scorecard measures. Following a 3-month washout period, postintervention data will be collected for 6 months. The primary outcome will be change in performance metrics following the provision of scorecard feedback to subjects. A cost analysis will also be performed, with the purpose of comparing total ICU costs prior to implementation of the scorecard with total ICU costs following implementation of the scorecard. The qualitative portion will include interviews with participants following the intervention phase. Interviews will be analysed in order to identify recurrent themes and subthemes, for the purposes of driving scorecard improvement. Ethics and dissemination This protocol has been approved by the local research ethics board. Publication of results is anticipated in 2019. If this intervention is found to improve patient- and unit-directed outcomes, with evidence of cost-effectiveness, it would support the utilisation of such a scorecard as a quality standard in CCM. PMID:29358441

Design Alternatives to Improve Access Time Performance of Disk Drives Under DOS and UNIX

NASA Astrophysics Data System (ADS)

Hospodor, Andy

For the past 25 years, improvements in CPU performance have overshadowed improvements in the access time performance of disk drives. CPU performance has been slanted towards greater instruction execution rates, measured in millions of instructions per second (MIPS). However, the slant for performance of disk storage has been towards capacity and corresponding increased storage densities. The IBM PC, introduced in 1982, processed only a fraction of a MIP. Follow-on CPUs, such as the 80486 and 80586, sported 5-10 MIPS by 1992. Single user PCs and workstations, with one CPU and one disk drive, became the dominant application, as implied by their production volumes. However, disk drives did not enjoy a corresponding improvement in access time performance, although the potential still exists. The time to access a disk drive improves (decreases) in two ways: by altering the mechanical properties of the drive or by adding cache to the drive. This paper explores the improvement to access time performance of disk drives using cache, prefetch, faster rotation rates, and faster seek acceleration.

Design of an immersive simulator for assisted power wheelchair driving.

PubMed

Devigne, Louise; Babel, Marie; Nouviale, Florian; Narayanan, Vishnu K; Pasteau, Francois; Gallien, Philippe

2017-07-01

Driving a power wheelchair is a difficult and complex visual-cognitive task. As a result, some people with visual and/or cognitive disabilities cannot access the benefits of a power wheelchair because their impairments prevent them from driving safely. In order to improve their access to mobility, we have previously designed a semi-autonomous assistive wheelchair system which progressively corrects the trajectory as the user manually drives the wheelchair and smoothly avoids obstacles. Developing and testing such systems for wheelchair driving assistance requires a significant amount of material resources and clinician time. With Virtual Reality technology, prototypes can be developed and tested in a risk-free and highly flexible Virtual Environment before equipping and testing a physical prototype. Additionally, users can "virtually" test and train more easily during the development process. In this paper, we introduce a power wheelchair driving simulator allowing the user to navigate with a standard wheelchair in an immersive 3D Virtual Environment. The simulation framework is designed to be flexible so that we can use different control inputs. In order to validate the framework, we first performed tests on the simulator with able-bodied participants during which the user's Quality of Experience (QoE) was assessed through a set of questionnaires. Results show that the simulator is a promising tool for future works as it generates a good sense of presence and requires rather low cognitive effort from users.

Secondary stroke prevention services in Canada: a cross-sectional survey and geospatial analysis of resources, capacity and geographic access

PubMed Central

Jewett, Lauren; Harroud, Adil; Hill, Michael D.; Côté, Robert; Wein, Theodore; Smith, Eric E.; Gubitz, Gord; Demchuk, Andrew M.; Sahlas, Demetrios J.; Gladstone, David J.; Lindsay, M. Patrice

2018-01-01

Background: Rapid assessment and management of transient ischemic attacks and nondisabling strokes by specialized stroke prevention services reduces the risk of recurrent stroke and improves outcomes. In Canada, with its vast geography and with 16.8% of the population living in rural areas, access to these services is challenging, and considerable variation in access to care exists. The purpose of this multiphase study was to identify sites across Canada providing stroke prevention services, evaluate resource capacity and determine geographic access for Canadians. Methods: We developed a Stroke Prevention Services Resource Inventory that contained 22 questions on the organization and delivery of stroke prevention services and quality monitoring. The inventory ran from November 2015 to January 2016 and was administered online. We conducted a geospatial analysis to estimate access by drive times. Considerations were made for hours of operation and access within and across provincial borders. Results: A total of 123 stroke prevention sites were identified, of which 119 (96.7%) completed the inventory. Most (95) are designated stroke prevention or rapid assessment clinics. Of the 119 sites, 68 operate full time, and 39 operate less than 2.5 days per week. A total of 87.3% of the Canadian population has access to a stroke prevention service within a 1-hour drive; however, only 69.2% has access to a service that operates 5-7 days a week. Allowing provincial border crossing improves access (< 6-h drive) for those who are beyond a 6-hour drive within their home province (3.4%). Interpretation: Most Canadians have reasonable geographic access to stroke prevention services. Allowing patients to cross borders improves the existing access for many, particularly some remote communities along the Ontario-Quebec and British Columbia-Alberta borders. PMID:29472251

Global quality imaging: emerging issues.

PubMed

Lau, Lawrence S; Pérez, Maria R; Applegate, Kimberly E; Rehani, Madan M; Ringertz, Hans G; George, Robert

2011-07-01

Quality imaging may be described as "a timely access to and delivery of integrated and appropriate procedures, in a safe and responsive practice, and a prompt delivery of an accurately interpreted report by capable personnel in an efficient, effective, and sustainable manner." For this article, radiation safety is considered as one of the key quality elements. The stakeholders are the drivers of quality imaging. These include those that directly provide or use imaging procedures and others indirectly supporting the system. Imaging is indispensable in health care, and its use has greatly expanded worldwide. Globalization, consumer sophistication, communication and technological advances, corporatization, rationalization, service outsourcing, teleradiology, workflow modularization, and commoditization are reshaping practice. This article defines the emerging issues; an earlier article in the May 2011 issue described possible improvement actions. The issues that could threaten the quality use of imaging for all countries include workforce shortage; increased utilization, population radiation exposure, and cost; practice changes; and efficiency drive and budget constraints. In response to these issues, a range of quality improvement measures, strategies, and actions are used to maximize the benefits and minimize the risks. The 3 measures are procedure justification, optimization of image quality and radiation protection, and error prevention. The development and successful implementation of such improvement actions require leadership, collaboration, and the active participation of all stakeholders to achieve the best outcomes that we all advocate. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.

PERSPECTIVES: Accountability for Mental Health: The Australian Experience.

PubMed

Rosenberg, Sebastian; Salvador-Carulla, Luis

2017-03-01

Australia was one of the first countries to develop a national policy for mental health. A persistent characteristic of all these policies has been their reference to the importance of accountability. What does this mean exactly and have we achieved it? Can Australia tell if anybody is getting better? To review accountability for mental health in Australia and question whether two decades of Australian rhetoric around accountability for mental health has been fulfilled. This paper first considers the concept of accountability and its application to mental health. We then draw on existing literature, reports, and empirical data from national and state governments to illustrate historical and current approaches to accountability for mental health. We provide a content analysis of the most current set of national indicators. The paper also briefly considers some relevant international processes to compare Australia's progress in establishing accountability for mental health. Australia's federated system of government permits competing approaches to accountability, with multiple and overlapping data sets. A clear national approach to accountability for mental health has failed to emerge. Existing data focuses on administrative and health service indicators, failing to reflect broader social factors which reveal quality of life. In spite of twenty years of investment and effort Australia has been described as outcome blind, unable to demonstrate the merit of USD 8bn spent on mental health annually. While it may be prolific, existing administrative data provide little outcomes information against which Australia can genuinely assess the health and welfare of people with a mental illness. International efforts are evolving slowly. Even in high income countries such as Australia, resources for mental health services are constrained. Countries cannot afford to continue to invest in services or programs that fail to demonstrate good outcomes for people with a mental illness or are not value for money. New approaches are needed which ensure that chosen accountability indicators reflect national health and social priorities. Such priorities must be meaningful to a range of stakeholders and the community about the state of mental health. They must drive an agenda of continuous improvement relevant to those most affected by mental disorders. These approaches should be operable in emerging international contexts. Australia must further develop its approach to health accountability in relation to mental health. A limited set of new preferred national mental health indicators should be agreed. These should be tested, both domestically and internationally, for their capacity to inform and drive quality improvement processes in mental health. Existing systems of accountability are not fit for purpose, incapable of firing necessary quality improvement processes. Supported by adequate resources, realistic targets and a culture of openness, new accountability could drive real quality improvement processes for mental health, facilitate jurisdictional comparisons in Australia, and contribute to new efforts to benchmark mental health internationally.

Evaluating and Enhancing Driving Ability Among Teens with Autism Spectrum Disorder (ASD)

DTIC Science & Technology

2014-10-01

impact. 15. SUBJECT TERMS Autism, Driving Safety , Driving Simulation, Automated Feedback, Eye Tracking 16. SECURITY CLASSIFICATION OF: 17...driving training (RT) required by the DMV, VRDS training + RT (VRDS-T) would lead to greater improvement in driving safety and less driving anxiety, 2...the Idea Development award we learned that VRDS-T can significantly improve the driving safety of novice drivers with ASD, and this is not enhanced by

Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care

PubMed Central

Mor, Vincent; Zinn, Jacqueline; Angelelli, Joseph; Teno, Joan M; Miller, Susan C

2004-01-01

Nursing home care is currently a two-tiered system. The lower tier consists of facilities housing mainly Medicaid residents and, as a result, has very limited resources. The nearly 15 percent of U.S. nonhospital-based nursing homes that serve predominantly Medicaid residents have fewer nurses, lower occupancy rates, and more health-related deficiencies. They are more likely to be terminated from the Medicaid/Medicare program, are disproportionately located in the poorest counties, and are more likely to serve African-American residents than are other facilities. The public reporting of quality indicators, intended to improve quality through market mechanisms, may result in driving poor homes out of business and will disproportionately affect nonwhite residents living in poor communities. This article recommends a proactive policy stance to mitigate these consequences of quality competition. PMID:15225329

Possible environmental effects of increased coal use in California

NASA Technical Reports Server (NTRS)

Carey, D. L.

1978-01-01

If coal is to be utilized in California it must be made compatible with the state's drive toward restoring environmental quality. The impacts resulting from coal's mining and transportation, or from water consumption, water quality degradation and electric transmission line routing can probably be adequately mitigated through strong and early planning efforts, the use of improved control and process technologies, and sincere utility commitment. The socioeconomic impacts may prove somewhat more difficult to satisfactorily mitigate. Of greatest concern is adequate control of generated air pollutants and disposal of solid and liquid wastes since acceptable technologies or handling techniques have yet to be conclusively demonstrated.

Leveraging the real value of laboratory medicine with the value proposition.

PubMed

Price, Christopher P; John, Andrew St; Christenson, Robert; Scharnhorst, Volker; Oellerich, Michael; Jones, Patricia; Morris, Howard A

2016-11-01

Improving quality and patient safety, containing costs and delivering value-for-money are the key drivers of change in the delivery of healthcare and have stimulated a shift from an activity-based service to a service based on patient-outcomes. The delivery of an outcomes-based healthcare agenda requires that the real value of laboratory medicine to all stakeholders be understood, effectively defined and communicated. The value proposition of any product or service is the link between the provider and the needs of the customer describing the utility of the product or service in terms of benefit to the customer. The framework of a value proposition for laboratory medicine provides the core business case that drives key activities in the evolution and maintenance of high quality healthcare from research through to adoption and quality improvement in an established service. The framework of a value proposition for laboratory medicine is described. The content is endorsed by IFCC and WASPaLM. Copyright © 2016 Elsevier B.V. All rights reserved.

Three-phase multilevel solar inverter for motor drive system

NASA Astrophysics Data System (ADS)

Bhasagare, Mayuresh P.

This thesis deals with three phase inverters and the different control strategies that can be associated with an inverter being used together. The first part of this thesis discusses the present research in the fields of PV panels, motor drive systems and three phase inverters along with their control. This control includes various strategies like MPPT, Volts-Hertz and modulation index compensation. Incorporating these techniques together is the goal of this thesis. A new topology for operating an open end motor drive system has also been discusses, where a boost converter and a flyback converter have been used in cascade to run a three phase motor. The main advantage of this is increasing the number of levels and improving the quality of the output voltage, not to mention a few other benefits of having the proposed circuit. A new algorithm has also been designed for starting and stopping the motor, which controls the current drawn from the power source during starting.

Symmetric operation of the resonant exchange qubit

NASA Astrophysics Data System (ADS)

Malinowski, Filip K.; Martins, Frederico; Nissen, Peter D.; Fallahi, Saeed; Gardner, Geoffrey C.; Manfra, Michael J.; Marcus, Charles M.; Kuemmeth, Ferdinand

2017-07-01

We operate a resonant exchange qubit in a highly symmetric triple-dot configuration using IQ-modulated rf pulses. We find that the qubit splitting is an order of magnitude less sensitive to all relevant control voltages, compared to the conventional operating point, but we observe no significant improvement in the quality of Rabi oscillations. For weak driving this is consistent with Overhauser field fluctuations modulating the qubit splitting. For strong driving we infer that effective voltage noise modulates the coupling strength between rf drive and the qubit, thereby quickening Rabi decay. Application of CPMG dynamical decoupling sequences consisting of up to 32 π pulses significantly prolongs qubit coherence, leading to marginally longer dephasing times in the symmetric configuration. This is consistent with dynamical decoupling from low frequency noise, but quantitatively cannot be explained by effective gate voltage noise and Overhauser field fluctuations alone. Our results inform recent strategies for the utilization of symmetric configurations in the operation of triple-dot qubits.

Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care.

PubMed

Kline, Ronald M; Bazell, Carol; Smith, Erin; Schumacher, Heidi; Rajkumar, Rahul; Conway, Patrick H

2015-03-01

Cancer is a medically complex and expensive disease with costs projected to rise further as new treatment options increase and the United States population ages. Studies showing significant regional variation in oncology quality and costs and model tests demonstrating cost savings without adverse outcomes suggest there are opportunities to create a system of oncology care in the US that delivers higher quality care at lower cost. The Centers for Medicare and Medicaid Services (CMS) have designed an episode-based payment model centered around 6 month periods of chemotherapy treatment. Monthly per-patient care management payments will be made to practices to support practice transformation, including additional patient services and specific infrastructure enhancements. Quarterly reporting of quality metrics will drive continuous quality improvement and the adoption of best practices among participants. Practices achieving cost savings will also be eligible for performance-based payments. Savings are expected through improved care coordination and appropriately aligned payment incentives, resulting in decreased avoidable emergency department visits and hospitalizations and more efficient and evidence-based use of imaging, laboratory tests, and therapeutic agents, as well as improved end of life care. New therapies and better supportive care have significantly improved cancer survival in recent decades. This has come at a high cost, with cancer therapy consuming $124 billion in 2010. CMS has designed an episode-based model of oncology care that incorporates elements from several successful model tests. By providing care management and performance based payments in conjunction with quality metrics and a rapid learning environment, it is hoped that this model will demonstrate how oncology care in the US can transform into a high value, high quality system. Copyright © 2015 by American Society of Clinical Oncology.

The role of hospital managers in quality and patient safety: a systematic review

PubMed Central

Parand, Anam; Dopson, Sue; Renz, Anna; Vincent, Charles

2014-01-01

Objectives To review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care. Design A systematic review of the literature. Methods A search was carried out on the databases MEDLINE, PSYCHINFO, EMBASE, HMIC. The search strategy covered three facets: management, quality of care and the hospital setting comprising medical subject headings and key terms. Reviewers screened 15 447 titles/abstracts and 423 full texts were checked against inclusion criteria. Data extraction and quality assessment were performed on 19 included articles. Results The majority of studies were set in the USA and investigated Board/senior level management. The most common research designs were interviews and surveys on the perceptions of managerial quality and safety practices. Managerial activities comprised strategy, culture and data-centred activities, such as driving improvement culture and promotion of quality, strategy/goal setting and providing feedback. Significant positive associations with quality included compensation attached to quality, using quality improvement measures and having a Board quality committee. However, there is an inconsistency and inadequate employment of these conditions and actions across the sample hospitals. Conclusions There is some evidence that managers’ time spent and work can influence quality and safety clinical outcomes, processes and performance. However, there is a dearth of empirical studies, further weakened by a lack of objective outcome measures and little examination of actual actions undertaken. We present a model to summarise the conditions and activities that affect quality performance. PMID:25192876

Oregon's experiment in health care delivery and payment reform: coordinated care organizations replacing managed care.

PubMed

Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M

2015-02-01

To control Medicaid costs, improve quality, and drive community engagement, the Oregon Health Authority introduced a new system of coordinated care organizations (CCOs). While CCOs resemble traditional Medicaid managed care, they have differences that have been deliberately designed to improve care coordination, increase accountability, and incorporate greater community governance. Reforms include global budgets integrating medical, behavioral, and oral health care and public health functions; risk-adjusted payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings. Copyright © 2015 by Duke University Press.

A Bidirectional High-Power-Quality Grid Interface With a Novel Bidirectional Noninverted Buck Boost Converter for PHEVs

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

Onar, Omer C

2012-01-01

Plug-in hybrid electric vehicles (PHEVs) will play a vital role in future sustainable transportation systems due to their potential in terms of energy security, decreased environmental impact, improved fuel economy, and better performance. Moreover, new regulations have been established to improve the collective gas mileage, cut greenhouse gas emissions, and reduce dependence on foreign oil. This paper primarily focuses on two major thrust areas of PHEVs. First, it introduces a grid-friendly bidirectional alternating current/direct current ac/dc dc/ac rectifier/inverter for facilitating vehicle-to-grid (V2G) integration of PHEVs. Second, it presents an integrated bidirectional noninverted buck boost converter that interfaces the energy storagemore » device of the PHEV to the dc link in both grid-connected and driving modes. The proposed bidirectional converter has minimal grid-level disruptions in terms of power factor and total harmonic distortion, with less switching noise. The integrated bidirectional dc/dc converter assists the grid interface converter to track the charge/discharge power of the PHEV battery. In addition, while driving, the dc/dc converter provides a regulated dc link voltage to the motor drive and captures the braking energy during regenerative braking.« less

Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden.

PubMed

Eldh, Ann Catrine; Fredriksson, Mio; Vengberg, Sofie; Halford, Christina; Wallin, Lars; Dahlström, Tobias; Winblad, Ulrika

2015-11-25

With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.

Statistical process control: separating signal from noise in emergency department operations.

PubMed

Pimentel, Laura; Barrueto, Fermin

2015-05-01

Statistical process control (SPC) is a visually appealing and statistically rigorous methodology very suitable to the analysis of emergency department (ED) operations. We demonstrate that the control chart is the primary tool of SPC; it is constructed by plotting data measuring the key quality indicators of operational processes in rationally ordered subgroups such as units of time. Control limits are calculated using formulas reflecting the variation in the data points from one another and from the mean. SPC allows managers to determine whether operational processes are controlled and predictable. We review why the moving range chart is most appropriate for use in the complex ED milieu, how to apply SPC to ED operations, and how to determine when performance improvement is needed. SPC is an excellent tool for operational analysis and quality improvement for these reasons: 1) control charts make large data sets intuitively coherent by integrating statistical and visual descriptions; 2) SPC provides analysis of process stability and capability rather than simple comparison with a benchmark; 3) SPC allows distinction between special cause variation (signal), indicating an unstable process requiring action, and common cause variation (noise), reflecting a stable process; and 4) SPC keeps the focus of quality improvement on process rather than individual performance. Because data have no meaning apart from their context, and every process generates information that can be used to improve it, we contend that SPC should be seriously considered for driving quality improvement in emergency medicine. Copyright © 2015 Elsevier Inc. All rights reserved.

Evolution and Initial Experience of a Statewide Care Transitions Quality Improvement Collaborative: Preventing Avoidable Readmissions Together.

PubMed

Axon, R Neal; Cole, Laura; Moonan, Aunyika; Foster, Richard; Cawley, Patrick; Long, Laura; Turley, Christine B

2016-02-01

Increasing scrutiny of hospital readmission rates has spurred a wide variety of quality improvement initiatives. The Preventing Avoidable Readmissions Together (PART) initiative is a statewide quality improvement learning collaborative organized by stakeholder organizations in South Carolina. This descriptive report focused on initial interventions with hospitals. Eligible participants included all acute care hospitals plus home health organizations, nursing facilities, hospices, and other health care organizations. Measures were degree of statewide participation, curricular engagement, adoption of evidence-based improvement strategies, and readmission rate changes. Fifty-nine of 64 (92%) acute care hospitals and 9 of 10 (90%) hospital systems participated in collaborative events. Curricular engagement included: webinars and coaching calls (49/59, 83%), statewide in-person meetings (35/59, 59%), regional in-person meetings (44/59, 75%), and individualized consultations (46/59, 78%). Among 34 (58%) participating hospitals completing a survey at the completion of Year 1, respondents indicated complete implementation of multidisciplinary rounding (58%), post-discharge telephone calls (58%), and teach-back (32%), and implementation in process of high-quality transition records (52%), improved discharge summaries (45%), and timely follow-up appointments (39%). A higher proportion of hospitals had significant decreases (≥10% relative change) in all-cause readmission rates for acute myocardial infarction (55.6% vs. 30.4%, P=0.01), heart failure (54.2% vs. 31.7%, P=0.09), and chronic obstructive pulmonary disease (41.7% vs. 33.3%, P=0.83) between 2011-2013 compared to earlier (2009-2011) trends. Focus on reducing readmissions is driving numerous, sometimes competing, quality improvement initiatives. PART successfully engaged the majority of acute care facilities in one state to harmonize and accelerate adoption of evidence-based care transitions strategies.

Driving with advanced vehicle technology: A qualitative investigation of older drivers' perceptions and motivations for use.

PubMed

Gish, Jessica; Vrkljan, Brenda; Grenier, Amanda; Van Miltenburg, Benita

2017-09-01

For older drivers, in-vehicle technology offers much potential to improve safety and increase longevity of retaining both licensure and community mobility. However, little is known about how older drivers perceive Advanced Vehicle Technologies (AVTs) based on everyday driving experience. Interviews with 35 older drivers (20 men; 15 women) aged 60-85 who owned a vehicle with at least two AVTs (e.g., back-up camera, lane departure warning) were conducted to explore the meanings that older drivers assigned to AVTs and motivations for use, including whether age-related functional changes were part of their automobile purchase decision. Findings indicate that age-related changes are not a primary reason for why older adults seek out AVTs, but they still perceived and experienced AVTs to counteract age-related changes in driving performance based upon changes they felt occurring within the body. Older drivers also described AVTs as generating a sense of comfort behind-the-wheel. Comfort with this technology was equated with convenience, ease of use, and increased feelings of safety. Discussion emphasizes how assessments of the quality of driving performance and value of technology occur in relation to an aging body. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

PubMed

Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

2014-07-01

Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

Can Youth with Autism Spectrum Disorder Use Virtual Reality Driving Simulation Training to Evaluate and Improve Driving Performance? An Exploratory Study.

PubMed

Cox, Daniel J; Brown, Timothy; Ross, Veerle; Moncrief, Matthew; Schmitt, Rose; Gaffney, Gary; Reeve, Ron

2017-08-01

Investigate how novice drivers with autism spectrum disorder (ASD) differ from experienced drivers and whether virtual reality driving simulation training (VRDST) improves ASD driving performance. 51 novice ASD drivers (mean age 17.96 years, 78% male) were randomized to routine training (RT) or one of three types of VRDST (8-12 sessions). All participants followed DMV behind-the-wheel training guidelines for earning a driver's license. Participants were assessed pre- and post-training for driving-specific executive function (EF) abilities and tactical driving skills. ASD drivers showed worse baseline EF and driving skills than experienced drivers. At post-assessment, VRDST significantly improved driving and EF performance over RT. This study demonstrated feasibility and potential efficacy of VRDST for novice ASD drivers.

The future of 2D metrology for display manufacturing

NASA Astrophysics Data System (ADS)

Sandstrom, Tor; Wahlsten, Mikael; Park, Youngjin

2016-10-01

The race to 800 PPI and higher in mobile devices and the transition to OLED displays are driving a dramatic development of mask quality: resolution, CDU, registration, and complexity. 2D metrology for large area masks is necessary and must follow the roadmap. Driving forces in the market place point to continued development of even more dense displays. State-of-the-art metrology has proven itself capable of overlay below 40 nm and registration below 65 nm for G6 masks. Future developments include incoming and recurrent measurements of pellicalized masks at the panel maker's factory site. Standardization of coordinate systems across supplier networks is feasible. This will enable better yield and production economy for both mask and panel maker. Better distortion correction methods will give better registration on the panels and relax the flatness requirements of the mask blanks. If panels are measured together with masks and the results are used to characterize the aligners, further quality and yield improvements are possible. Possible future developments include in-cell metrology and integration with other instruments in the same platform.

The evolution of Rare Pride: using evaluation to drive adaptive management in a biodiversity conservation organization.

PubMed

Jenks, Brett; Vaughan, Peter W; Butler, Paul J

2010-05-01

Rare Pride is a social marketing program that stimulates human behavior change in order to promote biodiversity conservation in critically threatened regions in developing countries. A series of formal evaluation studies, networking strategies, and evaluative inquiries have driven a 20-year process of adaptive management that has resulted in extensive programmatic changes within Pride. This paper describes the types of evaluation that Rare used to drive adaptive management and the changes it caused in Pride's theory-of-change and programmatic structure. We argue that (a) qualitative data gathered from partners and staff through structured interviews is most effective at identifying problems with current programs and procedures, (b) networking with other organizations is the most effective strategy for learning of new management strategies, and (c) quantitative data gathered through surveys is effective at measuring program impact and quality. Adaptive management has allowed Rare to increase its Pride program from implementing about two campaigns per year in 2001 to more than 40 per year in 2009 while improving program quality and maintaining program impact. Copyright 2009 Elsevier Ltd. All rights reserved.

Constant Switching Frequency DTC for Matrix Converter Fed Speed Sensorless Induction Motor Drive

NASA Astrophysics Data System (ADS)

Mir, Tabish Nazir; Singh, Bhim; Bhat, Abdul Hamid

2018-05-01

The paper presents a constant switching frequency scheme for speed sensorless Direct Torque Control (DTC) of Matrix Converter fed Induction Motor Drive. The use of matrix converter facilitates improved power quality on input as well as motor side, along with Input Power Factor control, besides eliminating the need for heavy passive elements. Moreover, DTC through Space Vector Modulation helps in achieving a fast control over the torque and flux of the motor, with added benefit of constant switching frequency. A constant switching frequency aids in maintaining desired power quality of AC mains current even at low motor speeds, and simplifies input filter design of the matrix converter, as compared to conventional hysteresis based DTC. Further, stator voltage estimation from sensed input voltage, and subsequent stator (and rotor) flux estimation is done. For speed sensorless operation, a Model Reference Adaptive System is used, which emulates the speed dependent rotor flux equations of the induction motor. The error between conventionally estimated rotor flux (reference model) and the rotor flux estimated through the adaptive observer is processed through PI controller to generate the rotor speed estimate.

Double-Mode Miniature Cantilever-Type Ultrasonic Motor Using Lead-Free Array-Type Multilayer Piezoelectric Ceramics

NASA Astrophysics Data System (ADS)

Doshida, Yutaka; Kishimoto, Sumiaki; Irieda, Taisei; Tamura, Hideki; Tomikawa, Yoshiro; Hirose, Seiji

2008-05-01

We studied the following to improve the characteristics of the lead-free ultrasonic micromotor. A double-mode miniature cantilever-type ultrasonic motor was fabricated using array-type multilayer piezoelectric ceramics (A-MLPC) of (Sr,Ca)2NaNb5O15 (SCNN) such as lead-free piezoelectric materials, and the electrical driving properties were investigated. The A-MLPC integrated multilayer piezoelectric ceramics (MLPC) arrayed in a 2 ×2 matrix. By using A-MLPC, double-mode bending vibration of the stator vibrator can be realized easily, and the quality factor of the vibrator increased. Furthermore, with the improvement of the piezoelectric properties of the SCNN, the electromechanical coupling coefficient of the vibrator increased. As a result, we succeeded in improving the driving properties of the motor. In particular, the driving voltage of SCNN motor decreased to 1/10 of the previous study, and this motor is similar to Pb(Zr,Ti)O3-Pb(Ni,Nb)O3-Pb(Zn,Nb)O3 (PZT) one in terms of properties by applying 3 times higher voltage than that required for the PZT one. The SCNN motor started to rotate at 0.3 Vp-p and showed such characteristics as revolution speed of 730 rpm, torque of 0.7 µN m, and efficiency of 3.5% at 1.6 Vp-p. It appeared that the SCNN motor was able to rotate by a lithium-ion cell used in the mobile equipment without an amplifier circuit.

Post-fire Water Quality Response and Associated Physical Drivers

NASA Astrophysics Data System (ADS)

Rust, A.; Saxe, S.; Hogue, T. S.; McCray, J. E.; Rhoades, C.

2017-12-01

The frequency and severity of forest fires is increasing across the western US. Wildfires are known to impact water quality in receiving waters; many of which are important sources of water supply. Studies on individual forest fires have shown an increase in total suspended solids, nutrient and metal concentrations and loading in receiving streams. The current research looks at a large number of fires across a broad region (Western United States) to identify typical water quality changes after fire and the physical characteristics that drive those responses. This presentation will overview recent development of an extensive database on post-fire water quality. Across 172 fires, we found that water quality changed significantly in one out of three fires up to five years after the event compared to pre-burn conditions. For basins with higher frequency data, it was evident that water quality changes were significant in the first three years following fire. In both the initial years following fire and five years after fire, concentrations and loading rates of dissolved nutrients such as nitrite, nitrate and orthophosphate and particulate forms of nutrients, total organic nitrogen, total nitrogen, total phosphate, and total phosphorus increase thirty percent of the time. Concentrations of some major dissolved ions and metals decrease, with increased post-fire flows, while total particulate concentrations increased; the flux of both dissolved and particulate forms increase in thirty percent of the fires over five years. Water quality change is not uniform across the studied watersheds. A second goal of this study is to identify physical characteristics of a watershed that drive water quality response. Specifically, we investigate the physical, geochemical, and climatological characteristics of watersheds that control the type, direction, and magnitude of water quality change. Initial results reveal vegetation recovery is a key driver in post-fire water quality response. Ultimately, improved understanding of post-fire response and related drivers will advance potential mitigation and treatment strategies as well as aid in the parametrization of post-fire models of water quality.

Local action on outdoor air pollution to improve public health.

PubMed

Vardoulakis, Sotiris; Kettle, Rachel; Cosford, Paul; Lincoln, Paul; Holgate, Stephen; Grigg, Jonathan; Kelly, Frank; Pencheon, David

2018-06-01

The National Institute for Health and Care Excellence, jointly with Public Health England, have developed a guideline on outdoor air pollution and its links to health. The guideline makes recommendations on local interventions that can help improve air quality and prevent a range of adverse health outcomes associated with road-traffic-related air pollution. The guideline was based on a rigorous assessment of the scientific evidence by an independent advisory committee, with input from public health professionals and other professional groups. The process included systematics reviews of the literature, expert testimonies and stakeholder consultation. The guideline includes recommendations for local planning, clean air zones, measures to reduce emissions from public sector transport services, smooth driving and speed reduction, active travel, and awareness raising. The guideline recommends taking a number of actions in combination, because multiple interventions, each producing a small benefit, are likely to act cumulatively to produce significant change. These actions are likely to bring multiple public health benefits, in addition to air quality improvements.

Refinement of the ICRF

NASA Technical Reports Server (NTRS)

Ma, Chopo

2004-01-01

Since the ICRF was generated in 1995, VLBI modeling and estimation, data quality: source position stability analysis, and supporting observational programs have improved markedly. There are developing and potential applications in the areas of space navigation Earth orientation monitoring and optical astrometry from space that would benefit from a refined ICRF with enhanced accuracy, stability and spatial distribution. The convergence of analysis, focused observations, and astrometric needs should drive the production of a new realization in the next few years.

Spatial control of photoemitted electron beams using a microlens-array transverse-shaping technique

DOE PAGES

Halavanau, A.; Qiang, G.; Ha, G.; ...

2017-10-26

A transversely inhomogeneous laser distribution on the photocathode surface generally produces electron beams with degraded beam quality. In this paper, we explore the use of microlens arrays to dramatically improve the transverse uniformity of an ultraviolet drive-laser pulse used in a photoinjector. Here, we also demonstrate a capability of microlens arrays to generate transversely modulated electron beams and present an application of such a feature to diagnose the properties of a magnetized beam.

Mental Healthcare Delivery in London-Middlesex Ontario - The Next Frontier.

PubMed

Velji, Karima; Links, Paul

2016-01-01

The next frontier for mental healthcare delivery will be focused on three facets of innovation, namely structure, process and outcome. The structure innovation will seek to develop new models of care delivery between the two hospitals and with the community. The process innovation will focus on embedding strategies to adopt a recovery and rehabilitation approach to care delivery. Lastly, the outcome innovation will use system wide quality improvement methods to drive breakthrough performance in mental healthcare.

Effect of chronic nonmalignant pain on highway driving performance.

PubMed

Veldhuijzen, D S; van Wijck, A J M; Wille, F; Verster, J C; Kenemans, J L; Kalkman, C J; Olivier, B; Volkerts, E R

2006-05-01

Most pain patients are treated in an outpatient setting and are engaged in daily activities including driving. Since several studies showed that cognitive functioning may be impaired in chronic nonmalignant pain, the question arises whether or not chronic nonmalignant pain affects driving performance. Therefore, the objective of the present study was to determine the effects of chronic nonmalignant pain on actual highway driving performance during normal traffic. Fourteen patients with chronic nonmalignant pain and 14 healthy controls, matched on age, educational level, and driving experience, participated in the study. Participants performed a standardized on-the-road driving test during normal traffic, on a primary highway. The primary parameter of the driving test is the Standard Deviation of Lateral Position (SDLP). In addition, driving-related skills (tracking, divided attention, and memory) were examined in the laboratory. Subjective assessments, such as pain intensity, and subjective driving quality, were rated on visual analogue scales. The results demonstrated that a subset of chronic nonmalignant pain patients had SDLPs that were higher than the matched healthy controls, indicating worse highway driving performance. Overall, there was a statistically significant difference in highway driving performance between the groups. Further, chronic nonmalignant pain patients rated their subjective driving quality to be normal, although their ratings were significantly lower than those of the healthy controls. No significant effects were found on the laboratory tests.

Flow quality studies of the NASA Lewis Research Center Icing Research Tunnel

NASA Technical Reports Server (NTRS)

Arrington, E. Allen; Pickett, Mark T.; Sheldon, David W.

1994-01-01

A series of studies have been conducted to determine the flow quality in the NASA Lewis Icing Research Tunnel. The primary purpose of these studies was to document airflow characteristics, including flow angularity, in the test section and tunnel loop. A vertically mounted rake was used to survey total and static pressure and two components of flow angle at three axial stations within the test section (test section inlet, test plane, and test section exit; 15 survey stations total). This information will be used to develop methods of improving the aerodynamic and icing characteristics within the test section. The data from surveys made in the tunnel loop were used to determine areas where overall tunnel flow quality and efficiency can be improved. A separate report documents similar flow quality surveys conducted in the diffuser section of the Icing Research Tunnel. The flow quality studies were conducted at several locations around the tunnel loop. Pressure, velocity, and flow angularity measurements were made by using both fixed and translating probes. Although surveys were made throughout the tunnel loop, emphasis was placed on the test section and tunnel areas directly upstream of the test section (settling chamber, bellmouth, and cooler). Flow visualization, by video recording smoke and tuft patterns, was also used during these studies. A great deal of flow visualization work was conducted in the area of the drive fan. Information gathered there will be used to improve the flow quality upstream and downstream of the fan.

Older Americans' patterns of driving and using other transportation

DOT National Transportation Integrated Search

2000-09-01

This article examines rural-urban patterns and trends in driving, older people's use of other modes of transportation, and the quality of life consequences of driving versus using other transportation. It is expected that between 1995 and 2025, the U...

The combination of two training approaches to improve older adults' driving safety.

PubMed

Bédard, Michel; Porter, Michelle M; Marshall, Shawn; Isherwood, Ivy; Riendeau, Julie; Weaver, Bruce; Tuokko, Holly; Molnar, Frank; Miller-Polgar, Jan

2008-03-01

An increasing number of older adults rely on the automobile for transportation. Educational approaches based on the specific needs of older drivers may help to optimize safe driving. We examined if the combination of an in-class education program with on-road education would lead to improvements in older drivers' knowledge of safe driving practices and on-road driving evaluations. We used a multisite, randomized controlled trial approach. Participants in the intervention group received the in-class and on-road education; those in the control group waited and were offered the education afterwards. We measured knowledge of safe driving practices before and after the in-class component of the program and on-road driving skills before and after the whole program. Participants' knowledge improved from 61% of correct answers before the in-class education component to 81% after (p < .001). The on-road evaluation results suggested improvements on some aspects of safe driving (e.g., moving in roadway, p < .05) but not on others. The results of this study demonstrate that education programs focused on the needs of older drivers may help improve their knowledge of safe driving practices and actual driving performance. Further research is required to determine if these changes will affect other variables such as driver confidence and crash rates.

Systematic review of the quality and generalizability of studies on the effects of opioids on driving and cognitive/psychomotor performance.

PubMed

Mailis-Gagnon, Angela; Lakha, Shehnaz Fatima; Furlan, Andrea; Nicholson, Keith; Yegneswaran, Balaji; Sabatowski, Rainer

2012-07-01

The effect of opioids on driving performance has been much debated. Driving is a complex task requiring integration of psychomotor, cognitive, motor and decision-making skills, visual-spatial abilities, divided attention, and behavioral and emotional control. The objective of this systematic review was to assess the quality of studies and to revisit the concept that patients on stable opioids are safe to drive as it applies to everyday practice. We searched MEDLINE, EMBASE, PSYCinfo, CENTRAL, TRANSPORT, CINAHL, reference lists of retrieved articles and narrative reviews, for studies on chronic cancer and noncancer pain patients on opioids, tested by driving, driving simulator, or cognitive/psychomotor tests. Methodological quality was assessed with Methodological Index for Nonrandomized Studies, cognitive/psychomotor tests were appraised regarding their sensitivity and validation, and whether confounding variables potentially affecting the study conclusions were recorded. The results were analyzed both quantitatively and qualitatively. We included 35 studies (2044 patients, 1994 controls), 9% of the studies were of poor, 54% of fair, and 37% of high quality; 3 quarters of the studies used high sensitivity cognitive tests. Amount and dose of opioids varied largely in many studies. Mean number of possible but unreported confounders was 2.2 (range, 0 to 4), relating to failure of the studies to mention co-prescriptions with psychotropic effects, pain severity, sleep disorder or daytime somnolence, and/or significant depressive or anxiety-related problems. The commonly held concept that "chronic pain patients on stable opioids are safe to drive" cannot be generalized to all such patients in everyday practice, but may be applicable only to a subset who meet certain criteria.

Nonlinear oscillation and interfacial stability of an encapsulated microbubble under dual-frequency ultrasound

NASA Astrophysics Data System (ADS)

Liu, Yunqiao; Calvisi, Michael L.; Wang, Qianxi

2017-04-01

Encapsulated microbubbles (EMBs) are widely used in medical ultrasound imaging as contrast-enhanced agents. However, the potential damaging effects of violent collapsing EMBs to cells and tissues in clinical settings have remained a concern. Dual-frequency ultrasound is a promising technique for improving the efficacy and safety of sonography. The system modeled consists of the external liquid, membrane and internal gases of an EMB. The microbubble dynamics are simulated using a simple nonlinear interactive theory, considering the compressibility of the internal gas, viscosity of the liquid flow and viscoelasticity of the membrane. The radial oscillation and interfacial stability of an EMB under single- and dual-frequency excitations are compared. The simulation results show that the dual-frequency technique produces larger backscatter pressure at higher harmonics of the primary driving frequency—this enriched acoustic spectrum can enhance blood-tissue contrast and improve the quality of sonographic images. The results further show that the acoustic pressure threshold associated with the onset of shape instability is greater for dual-frequency driving. This suggests that the dual-frequency technique stabilizes the encapsulated bubble, thereby improving the efficacy and safety of contrast-enhanced agents.

Economic and social structure for an ageing population.

PubMed Central

Fogel, R W

1997-01-01

The driving force behind the improvement in the quality of life, the rising standard of living, improving health, and increasing longevity, is a process called 'technophysio evolution', which began about 300 years ago, accelerated during the twentieth century, and is still in progress. Increased spending on health care and on pensions is an appropriate concomitant of technophysio evolution, and should be welcomed. Only wasteful medical services should be restricted. The resources available now and in the future can provide increasingly long and healthy lives of relative luxury for all. However, methods of financing health care and retirement need to be modernized. In the future, luxury will be defined increasingly in terms of spiritual rather than material resources. The test of well-being in the future for both young and old will be measured increasingly in terms of the quality of health and the opportunity for self-realization. PMID:9460076

Validity of chase car data used in developing emissions cycles

DOT National Transportation Integrated Search

2000-09-01

Air quality policies, driving cycles and profiles of average driving behavior have been constructed to characterize the driving behavior of the overall fleet in an effort to ensure vehicle compliance. Chase car data and speed-time profiles of in-use ...

Comparison of Quality Engineering Practices in Malaysian and Indonesian Automotive Related Companies

NASA Astrophysics Data System (ADS)

Putri, Nilda Tri; Sha'ri Mohd, Yusof; Irianto, Dradjad

2016-02-01

The main motivating factor driving this research is to find differences between the automotive related companies in Malaysia and Indonesia with regard to quality engineering (QE) implementation. A comparative study between Malaysia and Indonesia provides the opportunity to gain perspective and thorough understanding of the similarities and differences on the critical factors for successful QE practices in the context of both these countries. Face to face interviews are used to compare the QE practices in two automotive companies in Malaysia and Indonesia, respectively. The findings of study showed that both countries have clear quality objectives to achieving zero defects in processes and products and total customer satisfaction. Top and middle management in both countries were found to be directly involved in quality improvement on the shop floor to provide On-The-Job training and actively encourage team members to perform quality problem solving through the formation of quality control circles (QCC) particularly in Indonesia automotive industry. In Malaysia automotive industry, the implementation was not fully effective, but they have started to cultivate those values in the daily execution. Based on the case study results and analysis, the researcher has provided suggestions for both countries as an improvement plan for successful QE implementation. These recommendations will allow management to implement appropriate strategies for better QE implementation which hopefully can improve company's performance and ultimately the making the automotive industry in both countries to reach world class quality. It is strongly believed that the findings of this study can help Malaysia and Indonesia automotive industries in their efforts to become more effective and competitive.

Seizure attacks while driving: quality of life in persons with epilepsy.

PubMed

Tiamkao, Somsak; Sawanyawisuth, Kittisak; Towanabut, Somchai; Visudhipun, Pongsak

2009-07-01

To study the effect on quality of life (QOL) of a seizure attack while driving in persons with epilepsy (PWE). From four provincial and eight university hospitals in Thailand, we enrolled epileptic patients who drove a car or motorcycle or used to drive. The SF-36 questionnaire was used to evaluate QOL. The mean SF-36 score for all dimensions was calculated and compared with patients who either had or did not have a seizure attack while driving and in those who either had or had not been involved in a traffic accident while driving. We had 245 adult PWE who drove a car or motorcycle or used to drive. Of these, 69 cases (28%) had a seizure attack whilst driving. Over half (36/69; 57%) had had seizure-related accidents, most of which were mild but about 20% needed hospitalization. PWE having a seizure attack while driving had a significantly lower QOL in four of the eight categories compared with patients who had not. PWE who had a seizure-related accident had a significantly lower mean value in the vitality category than those who did not. Seizure attacks while driving diminished QOL in PWE even though they only suffered minor injuries. Driving as a QOL issue should be discussed with patients. A good public transportation system would ease the need to drive.

Examining the process of driving cessation in later life.

PubMed

Musselwhite, Charles B A; Shergold, Ian

2013-06-01

Driving cessation for many older people is associated with a poorer quality of life and can lead to health problems such as depression. This paper aims to reveal the process of giving-up driving, examining in particular triggers for giving-up driving, how information on alternative modes of transport is sought and how new transport and travel behaviour is integrated into older people's lives. It examines the challenges faced and how these are overcome and what impact the process has on self-reported quality of life, as articulated by the participants themselves. To this end, twenty-one individuals from three locations in the United Kingdom (UK) were followed over a period of 10 months, through five waves of data collection. Each participant took part in three interviews, a focus group and completed a diary of travel behaviour. Findings suggest that although a similar pattern was found between the trigger and life post-car, not all older people go through the stages of giving-up driving in the same way. Instead, a range of responses are seen, from contemplation of gradually reducing driving, through to stopping abruptly, with the route taken having consequences for the eventual outcome for any individual. Triggers for contemplating driving cessation could be varied and often involved health and social factors. Importantly, people who engaged in pre-planning reported a relatively higher quality of life beyond the car, whilst for those who were more reactive and engaged in little or no pre-planning a poorer quality of life resulted. In addition (and in conjunction with planning), other factors, such as flexibility in travel destinations, the role of family and friends, and wider support networks are also seen as important. With such evidence of the importance of pre-planning it is suggested that more could be done to support giving-up driving and encouraging contemplation at a younger age to mitigate the negative effects experienced by some.

INVESTIGATION OF THE INDOOR AIR QUALITY OF THE NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES AT 3800 BARRETT DRIVE, RALEIGH, NC

EPA Science Inventory

A limited-scale indoor air quality investigation was conducted over a 4 day period at the North Carolina Department of Environment, Health, and Natural Resources' offices located at 3800 Barrett Drive, Raleigh, NC. Integrated 9 hour particle, aldehyde, and volatile organic compou...

Regional Quality Assurance Activity in Higher Education in Southeast Asia: Its Characteristics and Driving Forces

ERIC Educational Resources Information Center

Umemiya, Naoki

2008-01-01

This article analyses the characteristics and driving forces of regional quality assurance activity in Southeast Asia, which has been actively promoted in recent years by the ASEAN University Network, an organisation for higher education under the auspices of the Association of Southeast Asian Nations (ASEAN). There are now more collaborative…

76 FR 2947 - Notice of Final Federal Agency Actions on Proposed Highway in California

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-18

...) from State Route 52 (SR-52) to La Jolla Village Drive. Two high occupancy vehicle (HOV) lanes (one in each direction) from La Jolla Village Drive to just north of Mira Mesa Boulevard (Blvd). The project.... Pending Federal actions include: 401 Water Quality Certification from the Regional Water Quality Control...

Improving Motor and Drive System Performance – A Sourcebook for Industry

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

None

This sourcebook outlines opportunities to improve motor and drive systems performance. The sourcebook is divided into four main sections: (1) Motor and Drive System Basics: Summarizes important terms, relationships, and system design considerations relating to motor and drive systems. (2) Performance Opportunity Road Map: Details the key components of well-functioning motor and drive systems and opportunities for energy performance opportunities. (3) Motor System Economics: Offers recommendations on how to propose improvement projects based on corporate priorities, efficiency gains, and financial payback periods. (4) Where to Find Help: Provides a directory of organizations associated with motors and drives, as well asmore » resources for additional information, tools, software, videos, and training opportunities.« less

Reproducible Growth of High-Quality Cubic-SiC Layers

NASA Technical Reports Server (NTRS)

Neudeck, Philip G.; Powell, J. Anthony

2004-01-01

Semiconductor electronic devices and circuits based on silicon carbide (SiC) are being developed for use in high-temperature, high-power, and/or high-radiation conditions under which devices made from conventional semiconductors cannot adequately perform. The ability of SiC-based devices to function under such extreme conditions is expected to enable significant improvements in a variety of applications and systems. These include greatly improved high-voltage switching for saving energy in public electric power distribution and electric motor drives; more powerful microwave electronic circuits for radar and communications; and sensors and controls for cleaner-burning, more fuel-efficient jet aircraft and automobile engines.

Strategic implementation and accountability: the case of the long-term care alliance.

PubMed

Seaman, Al; Elias, Maria; O'Neill, Bill; Yatabe, Karen

2010-01-01

A group of chief executives of long-term care homes formed an alliance in order to tap the resources residing within their management teams. Adopting a strategic implementation project based on a framework of accountability, the executives were able to better understand the uncertainties of the environment and potentially structure their strategic implementation to best use scarce resources. The framework of accountability allowed the homes to recognize the need for a strong business approach to long-term care. Communication improved throughout the organizations while systems and resources showed improved utilization. Quality became the driving force for all actions taken to move the organizations toward achieving their visions.

Identifying the principal driving factors of water ecosystem dependence and the corresponding indicator species in a pilot City, China

NASA Astrophysics Data System (ADS)

Zhao, C. S.; Shao, N. F.; Yang, S. T.; Xiang, H.; Lou, H. Z.; Sun, Y.; Yang, Z. Y.; Zhang, Y.; Yu, X. Y.; Zhang, C. B.; Yu, Q.

2018-01-01

The world's aquatic ecosystems yield numerous vital services, which are essential to human existence but have deteriorated seriously in recent years. By studying the mechanisms of interaction between ecosystems and habitat processes, the constraining factors can be identified, and this knowledge can be used to improve the success rate of ecological restoration initiatives. At present, there is insufficient data on the link between hydrological, water quality factors and the changes in the structure of aquatic communities to allow any meaningful study of driving factors of aquatic ecosystems. In this study, the typical monitoring stations were selected by fuzzy clustering analysis based on the spatial and temporal distribution characteristics of water ecology in Jinan City, the first pilot city for the construction of civilized aquatic ecosystems in China. The dominant species identification model was used to identify the dominant species of the aquatic community. The driving effect of hydrological and water quality factors on dominant species was analyzed by Canonical Correspondence Analysis. Then, the principal factors of aquatic ecosystem dependence were selected. The results showed that there were 10 typical monitoring stations out of 59 monitoring sites, which were representative of aquatic ecosystems, 9 dominant fish species, and 20 dominant invertebrate species. The selection of factors for aquatic ecosystem dependence in Jinan were highly influenced by its regional conditions. Chemical environmental parameters influence the temporal and spatial variation of invertebrate much more than that of fish in Jinan City. However, the methodologies coupling typical monitoring stations selection, dominant species determination and driving factors identification were certified to be a cost-effective way, which can provide in-deep theoretical and technical directions for the restoration of aquatic ecosystems elsewhere.

[Driving forces of carbon emission from energy consumption in China old industrial cities: a case study of Shenyang City, Northeast China].

PubMed

Ren, Wan-Xia; Geng, Yong; Xue, Bing

2012-10-01

To quantitatively analyze the effects of anthropogenic factors on regional environmental quality is a hot topic in the field of sustainable development research. Taking the typical old industrial city Shenyang in Northeast China as a case, and by using the IPCC method for calculating carbon emission from energy consumption, this paper estimated the carbon emission from energy consumption in the city in 1978-2009, and a time series analysis on the anthropogenic factors driving this carbon emission was made by the STIRPAT model based upon Kaya equation and ridge regression. In 1978-2009, the carbon emission in the city had a slow increase first, slow decrease then, and a rapid increase thereafter. The total carbon emission in 2009 was 4.6 times of that in 1978. Population growth was the main factor driving the growth of the emission, and there existed an equal-proportional variation between the population growth and the carbon emission growth. Urbanization was another main driving factor followed by population growth, and the per capita GDP was positively correlated with the carbon emission. Kuznets curve did not exist for the relationship between economic development and carbon emission in Shenyang. Energy source intensity reduction (representing technology improvement) was the main factor driving the reduction of the total carbon emission.

[Temporal variation of water quality and driving factors in Yanghe watershed of Zhangjiakou].

PubMed

Pang, Bo; Wang, Tie-Yu; Lü, Yong-Long; Du, Li-Yu; Luo, Wei

2013-01-01

Yanghe is an important water source for Guanting Reservoir, which once supplied the Beijing city with drinking water, industrial process water and water-use in landscape. Based on the data of water quality monitored by Yanghe watershed monitoring stations from 1992 to 2009, 11 pollutants were selected for analysis. The trends of changes in water quality were figured out, and the major pollutants and driving factors were measured by the integrated standard index and grey correlation analytical methods. The results showed that there were two stages of water quality change in Yanghe watershed of Zhangjiakou. Firstly, the water was polluted seriously but recovered rapidly from 1992 to 1996. Secondly, although light pollution occurred in the watershed from 1997 to 2009, the pollution factors were still above the limits. The main pollution factors are ammonia nitrogen, petroleum, permanganate index, BOD5, Cr6+ and Cd. The main driving factor of water quality is the change of land use type, and the agricultural land showed less impact on water quality than the industrial land.

Effect of simulator training on driving after stroke: a randomized controlled trial.

PubMed

Akinwuntan, A E; De Weerdt, W; Feys, H; Pauwels, J; Baten, G; Arno, P; Kiekens, C

2005-09-27

Neurologically impaired persons seem to benefit from driving-training programs, but there is no convincing evidence to support this notion. The authors therefore investigated the effect of simulator-based training on driving after stroke. Eighty-three first-ever subacute stroke patients entered a 5-week 15-hour training program in which they were randomly allocated to either an experimental (simulator-based training) or control (driving-related cognitive tasks) group. Performance in off-road evaluations and an on-road test were used to assess the driving ability of subjects pre- and post-training. Outcome of an official predriving assessment administered 6 to 9 months poststroke was also considered. Both groups significantly improved in a visual and many neuropsychological evaluations and in the on-road test after training. There were no significant differences between both groups in improvements from pre- to post-training except in the "road sign recognition test" in which the experimental subjects improved more. Significant improvements in the three-class decision ("fit to drive," "temporarily unfit to drive," and "unfit to drive") were found in favor of the experimental group post-training. Academic qualification and overall disability together determined subjects that benefited most from the simulator-based driving training. Significantly more experimental subjects (73%) than control subjects (42%) passed the follow-up official predriving assessment and were legally allowed to resume driving. Simulator-based driving training improved driving ability, especially for well educated and less disabled stroke patients. However, the findings of the study may have been modified as a result of the large number of dropouts and the possibility of some neurologic recovery unrelated to training.

Putting women at the center: a review of Indian policy to address person-centered care in maternal and newborn health, family planning and abortion.

PubMed

Srivastava, Aradhana; Singh, Devaki; Montagu, Dominic; Bhattacharyya, Sanghita

2017-07-14

Person-centered care is a critical component of quality care, essential to enable treatment adherence, and maximize health outcomes. Improving the quality of health services is a key strategy to achieve the new global target of zero preventable maternal deaths by 2030. Recognizing this, the Government of India has in the last decade initiated a number of strategies to address quality of care in health and family welfare services. We conducted a policy review of quality improvement strategies in India from 2005 to 15, covering three critical areas- maternal and newborn health, family planning, and abortion (MNHFP + A). Based on Walt and Gilson's policy triangle framework, we analyzed the extent to which policies incorporated person-centered care, while identifying unaddressed issues. Data was sourced from Government of India websites, scientific and grey literature databases. Twenty-two national policy documents, comprising two policy statements and 20 implementation guidelines of specific schemes were included in the review. Quality improvement strategies span infrastructure, commodities, human resources, competencies, and accountability that are driving quality assurance in MNHFP + A services. However, several implementation challenges have affected compliance with person-centered care, thereby affecting utilization and outcomes. Focus on person-centered care in Indian MNHFP + A policy has increased in recent years. Nevertheless, some aspects must still be strengthened, such as positive interpersonal behavior, information sharing and promptness of care. Implementation can be improved through better provider training, patient feedback and monitoring mechanisms. Moreover, unless persisting structural challenges are addressed implementation of person-centered care in facilities will not be effective.

Determining your organization's 'risk capability'.

PubMed

Hannah, Bill; Hancock, Melinda

2014-05-01

An assessment of a provider's level of risk capability should focus on three key elements: Business intelligence, including sophisticated analytical models that can offer insight into the expected cost and quality of care for a given population. Clinical enterprise maturity, marked by the ability to improve health outcomes and to manage utilization and costs to drive change. Revenue transformation, emphasizing the need for a revenue cycle platform that allows for risk acceptance and management and that provides incentives for performance against defined objectives.

Flow Quality Measurements in the NASA Ames Upgraded 11-by 11-Foot Transonic Wind Tunnel

NASA Technical Reports Server (NTRS)

Amaya, Max A.; Murthy, Sreedhara V.; George, M. W. (Technical Monitor)

2000-01-01

Among the many upgrades designed and implemented in the NASA Ames 11-by 11-Foot Transonic Wind Tunnel over the past few years, several directly affect flow quality in the test section: a turbulence reduction system with a honeycomb and two screens, a flow smoothing system in the back leg diffusers, an improved drive motor control system, and a full replacement set of composite blades for the compressor. Prior to the shut-down of the tunnel for construction activities, an 8-foot span rake populated with flow instrumentation was traversed in the test section to fully document the flow quality and establish a baseline against which the upgrades could be characterized. A similar set of measurements was performed during the recent integrated system test trials, but the scope was somewhat limited in accordance with the primary objective of such tests, namely to return the tunnel to a fully operational status. These measurements clearly revealed substantial improvements in flow angularity and significant reductions in turbulence level for both full-span and semi-span testing configurations, thus making the flow quality of the tunnel one of the best among existing transonic facilities.

"Meaningful use" of EHR in dental school clinics: how to benefit from the U.S. HITECH Act's financial and quality improvement incentives.

PubMed

Kalenderian, Elsbeth; Walji, Muhammad; Ramoni, Rachel B

2013-04-01

Through the 2009 HITECH (Health Information Technology for Economic and Clinical Health) Act, the U.S. government committed $27 billion to incentivize the adoption and "meaningful use" of certified electronic health records (EHRs) by providers, including dentists. Given their patient profiles, dental school clinics are in a position to benefit from this time-delimited commitment to support the adoption and use of certified EHR technology under the Medicaid-based incentive. The benefits are not merely financial: rather, the meaningful use objectives and clinical quality measures can drive quality improvement initiatives within dental practices and help develop a community of medical and dental professionals focused on quality. This article describes how dentists can qualify as eligible providers and the set of activities that must be undertaken and attested to in order to obtain this incentive. Two case studies describe the approaches that can be used to meet the Medicaid threshold necessary to be eligible for the incentive. Dentists can and have successfully applied for meaningful use incentive payments. Given the diverse set of patients who are treated at dental schools, these dental practices are among those most likely to benefit from the incentive programs.

The effect of antiresorptives on bone quality.

PubMed

Recker, Robert R; Armas, Laura

2011-08-01

Currently, antiresorptive therapy in the treatment and prevention of osteoporosis includes bisphosphonates, estrogen replacement, selective estrogen receptor modulators (raloxifene), and denosumab (a human antibody that inactivates RANKL). The original paradigm driving the development of antiresorptive therapy was that inhibition of bone resorption would allow bone formation to continue and correct the defect. However, it is now clear increases in bone density account for little of the antifracture effect of these treatments. We examined the antifracture benefit of antiresorptives deriving from bone quality changes. We searched the archive of nearly 30,000 articles accumulated over more than 40 years in our research center library using a software program (Refman™). Approximately 250 publications were identified in locating the 69 cited here. The findings document antiresorptive agents are not primarily anabolic. All cause a modest increase in bone density due to a reduction in the bone remodeling space; however, the majority of their efficacy is due to suppression of the primary cause of osteoporosis, ie, excessive bone remodeling not driven by mechanical need. All of them improve some element(s) of bone quality. Antiresorptive therapy reduces risk of fracture by improving bone quality through halting removal of bone tissue and the resultant destruction of microarchitecture of bone and, perhaps to some extent, by improving the intrinsic material properties of bone tissue. Information presented here may help clinicians to improve selection of patients for antiresorptive therapy by avoiding them in cases clearly not due to excessive bone remodeling.

[Impact of driving restrictions disclosure on quality of life of patients with a glial tumor: A prospective study].

PubMed

Bergot, Lydie; Cuchard, Solenn; Mazeaud, Sylvie; Magro, Elsa; Seizeur, Romuald

2016-03-01

Disclosure of driving restrictions on patients with glial tumors is a complex and difficult task. The difficulty of such task lies in the moral and ethical conflicts it generates for the patient on one hand and caregivers on the other. These aforementioned conflicts impinge upon the patient's quality of life which is one of the important aspects of neuro-oncologic care. In a prospective survey of 31 patients diagnosed with glial tumors, we studied how the patient perceived the disclosure of driving restrictions specifically the amount of retained information, and the level of distress. It seems that patients fail to assess the juridical implications of driving restrictions. The impact on quality of life as well as psychological and social aspects of these restrictions must not be taken lightly especially in young patients with low-grade glioma who has a long life expectancy. Therefore, we believe that planning a specific psychological and social accompaniment of the patient in relation to driving restrictions is an undeniable necessity. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

[The operation of the health program SICALIDAD: the role of managers in primary care and hospitals].

PubMed

Granados-Cosme, José Arturo; Tetelboin-Henrion, Carolina; Torres-Cruz, César; Pineda-Pérez, Dayana; Villa-Contreras, Blanca Margarita

2011-01-01

To characterize the role of quality managers in health care units and health districts, identifying the constraints they experience in their performance. An interview guide and a questionnaire were carried out and were applied to quality managers in nine states as well as in Mexico City´s Health Services, in a Reference Federal Hospital and in a National Institute of Health. These instruments were analyzed using SPSS and Atlas.ti software. The activities done by the managers depend on the organizational level of services, which can be a care unit or the health jurisdiction. For each of these, we identified different order constraints that affect the performance of the role of management in the strategies to improve the quality of the services for population without social insurance, which together make up the government program called Integrated Quality Health System. Jurisdictional managers are the link between care units and state authorities in the management of information, while the medical units' managers drive operational strategies to improve the quality. Although the health program is implemented with the personal and infrastructure of the health system, it requires a greater institutionalization and strengthening of its structure and integration, as well as greater human and material resources.

Baptist Memorial Hospital for Women: quality lifelines for a lifetime.

PubMed

Beard, Cindy; Lilly, Kristen; Poynter, Joni; Thetford, Carol; Thompson, Rosalee; Vaughn, Anita

2006-10-01

At Baptist Women's, a not-for-profit, 140-bed free-standing hospital, the Institute of Medicine's six quality dimensions are embedded into the quality blueprint and strategic plan. Quality initiatives and dashboards are shared through an established shared drive, which is accessible for all employees, to track performance on identified dashboards. IMPROVING MAMMOGRAPHY CYCLE TIME AT THE WOMEN'S HEALTH CENTER: Cycle time (arrival to departure) for mammography was identified as the top improvement priority. Increasing the percentage of patients who had preregistered reduced admission time, and process changes were made to move the patient through the center more efficiently. For example, patients with orders for additional films were flagged to ensure that these exams were completed before a new patient's exam. The ultrasound schedule was blocked during peak times to ensure that add-on exams could be performed in a timely manner. The cycle time was reduced for screening mammography (from 2 hours in 2003 to 30 minutes in April 2006) and diagnostic screenings, including review of films and reports with radiologist at departure, decreased from > 3 hours in 2003 to 2.5 hours in April 2006. Expectations of teamwork, proactive problem resolution, communication on all levels, and customer service are the cornerstone of Baptist Women's culture of quality.

Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder.

PubMed

Cox, Daniel J; Merkel, R Lawrence; Moore, Melissa; Thorndike, Frances; Muller, Carrie; Kovatchev, Boris

2006-09-01

Automobile accidents are the leading cause of death among adolescents, and collisions are 2 to 4 times more likely to occur among adolescents with attention-deficit/hyperactivity disorder. Studies have demonstrated that stimulants improve driving performance. This study compared 2 long-acting stimulant medications during daytime and evening driving evaluations. Adolescent drivers with attention-deficit/hyperactivity disorder were compared on a driving simulator after taking 72 mg of OROS methylphenidate, 30 mg of mixed amphetamine salts extended release, or placebo in a randomized, double-blind, placebo-controlled, crossover study design. During laboratory testing, adolescents drove a driving simulator at 5:00 pm, 8:00 pm, and 11:00 pm. Driving performance was rated by adolescents and investigators. The study included 35 adolescent drivers with attention-deficit/hyperactivity disorder (19 boys/16 girls). The mean age was 17.8 years. The overall Impaired Driving Score demonstrated that OROS methylphenidate led to better driving performance compared with placebo and mixed amphetamine salts extended release, whereas mixed amphetamine salts extended release demonstrated no statistical improvement over placebo. Specifically, relative to placebo, OROS methylphenidate resulted in less time driving off the road, fewer instances of speeding, less erratic speed control, more time executing left turns, and less inappropriate use of brakes. OROS methylphenidate and mixed amphetamine salts extended release worked equally well for male and female adolescents and equally as well with teenagers who have combined and inattentive subtypes of attention-deficit/hyperactivity disorder. This study validates the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder. In the study, OROS methylphenidate promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release.

The Influence of the Transportation Environment on Driving Reduction and Cessation.

PubMed

Vivoda, Jonathon M; Heeringa, Steven G; Schulz, Amy J; Grengs, Joe; Connell, Cathleen M

2017-10-01

Driving is by far the most common mode of transportation in the United States, but driving ability is known to decline as people experience age-related functional declines. Some older adults respond to such declines by self-limiting their driving to situations with a low perceived risk of crashing, and many people eventually stop driving completely. Previous research has largely focused on individual and interpersonal predictors of driving reduction and cessation (DRC). The purpose of this study was to assess the influence of the transportation environment on DRC. Data were combined from the Health and Retirement Study, the Urban Mobility Scorecard, and StreetMap North America (GIS data). Longitudinal survival analysis techniques were used to analyze seven waves of data spanning a 12-year period. As roadway density and congestion increased in the environment, the odds of DRC also increased, even after controlling for individual and interpersonal predictors. Other predictors of DRC included demographics, relationship status, health, and household size. The current study identified an association between the transportation environment and DRC. Future research is needed to determine whether a causal link can be established. If so, modifications to the physical environment (e.g., creating livable communities with goods and services in close proximity) could reduce driving distances in order to improve older drivers' ability to remain engaged in life. In addition, older individuals who wish to age in place should consider how their local transportation environment may affect their quality of life. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Quality improvement in medical education: current state and future directions.

PubMed

Wong, Brian M; Levinson, Wendy; Shojania, Kaveh G

2012-01-01

During the last decade, there has been a drive to improve the quality of patient care and prevent the occurrence of avoidable errors. This review describes current efforts to teach or engage trainees in patient safety and quality improvement (QI), summarises progress to date, as well as successes and challenges, and lists our recommendations for the next steps that will shape the future of patient safety and QI in medical education. Trainees encounter patient safety and QI through three main groups of activity. First are formal curricula that teach concepts or methods intended to facilitate trainees' participation in QI activities. These curricula increase learner knowledge and may improve clinical processes, but demonstrate limited capacity to modify learner behaviours. Second are educational activities that impart specific skills related to safety or quality which are considered to represent core doctor competencies (e.g. effective patient handover). These are frequently taught effectively, but without emphasis on the general safety or quality principles that inform the relevant skills. Third are real-life QI initiatives that involve trainees as active or passive participants. These innovative approaches expose trainees to safety and quality by integrating QI activities into trainees' day-to-day work. However, this integration can be challenging and can sometimes result in tension with broader educational goals. To prepare the next generation of doctors to make meaningful contributions to the quality mission, we propose the following call to action. Firstly, a major effort to build faculty capacity, especially among teachers of QI, should be instigated. Secondly, accreditation standards and assessment methods, both during training and at end-of-training certification examinations, should explicitly target these competencies. Finally, and perhaps most importantly, we must refocus our attention at all levels of training and instil fundamental, collaborative, open-minded behaviours so that future clinicians are primed to promote a culture of safer, higher-quality care. © Blackwell Publishing Ltd 2012.

Guidelines for research on drugged driving

PubMed Central

Walsh, J. Michael; Verstraete, Alain G.; Huestis, Marilyn A.; Mørland, Jørg

2009-01-01

Aim A major problem in assessing the true public health impact of drug-use on driving and overall traffic safety is that the variables being measured across studies vary significantly. In studies reported in a growing global literature, basic parameters assessed, analytical techniques and drugs tested are simply not comparable due to lack of standardization in the field. These shortcomings severely limit the value of this research to add knowledge to the field. A set of standards to harmonize research findings is sorely needed. This project was initiated by several international organizations to develop guidelines for research on drugged driving. Methods A September 2006 meeting of international experts discussed the harmonization of protocols for future research on drugged driving. The principal objective of the meeting was to develop a consensus report setting guidelines, standards, core data variables and other controls that would form the basis for future international research. A modified Delphi method was utilized to develop draft guidelines. Subsequently, these draft guidelines were posted on the internet for global review, and comments received were integrated into the final document. Results The Guidelines Document is divided into three major sections, each focusing upon different aspects of drugged driving research (e.g. roadside surveys, prevalence studies, hospital studies, fatality and crash investigations, etc.) within the critical issue areas of ‘behavior’, ‘epidemiology’ and ‘toxicology’. The behavioral section contains 32 specific recommendations; (2) epidemiology 40 recommendations; and (3) toxicology 64 recommendations. Conclusions It is anticipated that these guidelines will improve significantly the overall quality of drugged driving research and facilitate future cross-study comparisons nationally and globally. PMID:18855814

Programmable Positioner For Spot Welding

NASA Technical Reports Server (NTRS)

Roden, William A.

1989-01-01

Welding station mechanized by installing preset indexing system and gear drive. Mechanism includes a low-cost, versatile, single-axis motion control and motor drive to provide fully-automatic weld sequencing and spot-to-spot spacing. Welding station relieves operator of some difficult, tedious tasks and increases both productivity and quality of welds. Results in welds of higher quality and greater accuracy, fewer weld defects, and faster welding operation.

Glaucoma and quality of life: fall and driving risk.

PubMed

Montana, Cynthia L; Bhorade, Anjali M

2018-03-01

Numerous population-based studies suggest that glaucoma is an independent risk factor for falling and motor vehicle collisions, particularly for older adults. These adverse events lead to increased healthcare expenditures and decreased quality of life. Current research priorities, therefore, include identifying factors that predispose glaucoma patients to falling and unsafe driving, and developing screening strategies and targeted rehabilitation. The purpose of this article is to review recent studies that address these priorities. Studies continue to support that glaucoma patients, particularly those with advanced disease, have an increased risk of falling or unsafe driving. Risk factors, however, remain variable and include severity and location of visual field defects, contrast sensitivity, and performance on divided attention tasks. Such variability is likely because of the multifactorial nature of ambulating and driving and compensatory strategies used by patients. Falls and unsafe driving remain a serious public health issue for older adults with glaucoma. Ambulation and driving are complex tasks and there is no consensus yet, regarding the best methods for risk stratification and targeted interventions to increase safety. Therefore, comprehensive and individualized assessments are recommended to most effectively evaluate a patient's risk for falling or unsafe driving.

From Board to Bedside: How the Application of Financial Structures to Safety and Quality Can Drive Accountability in a Large Health Care System.

PubMed

Austin, J Matthew; Demski, Renee; Callender, Tiffany; Lee, K H Ken; Hoffman, Ann; Allen, Lisa; Radke, Deborah A; Kim, Yungjin; Werthman, Ronald J; Peterson, Ronald R; Pronovost, Peter J

2017-04-01

As the health care system in the United States places greater emphasis on the public reporting of quality and safety data and its use to determine payment, provider organizations must implement structures that ensure discipline and rigor regarding these data. An academic health system, as part of a performance management system, applied four key components of a financial reporting structure to support the goal of top-to-bottom accountability for improving quality and safety. The four components implemented by Johns Hopkins Medicine were governance, accountability, reporting of consolidated quality performance statements, and auditing. Governance is provided by the health system's Patient Safety and Quality Board Committee, which reviews goals and strategy for patient safety and quality, reviews quarterly performance for each entity, and holds organizational leaders accountable for performance. An accountability plan includes escalating levels of review corresponding to the number of months an entity misses the defined performance target for a measure. A consolidated quality statement helps inform the Patient Safety and Quality Board Committee and leadership on key quality and safety issues. An audit evaluates the efficiency and effectiveness of processes for data collection, validation, and storage, as to ensure the accuracy and completeness of quality measure reporting. If hospitals and health systems truly want to prioritize improvements in safety and quality, they will need to create a performance management system that ensures data validity and supports performance accountability. Without valid data, it is difficult to know whether a performance gap is due to data quality or clinical quality. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Evaluation of a Dry EEG System for Application of Passive Brain-Computer Interfaces in Autonomous Driving

PubMed Central

Zander, Thorsten O.; Andreessen, Lena M.; Berg, Angela; Bleuel, Maurice; Pawlitzki, Juliane; Zawallich, Lars; Krol, Laurens R.; Gramann, Klaus

2017-01-01

We tested the applicability and signal quality of a 16 channel dry electroencephalography (EEG) system in a laboratory environment and in a car under controlled, realistic conditions. The aim of our investigation was an estimation how well a passive Brain-Computer Interface (pBCI) can work in an autonomous driving scenario. The evaluation considered speed and accuracy of self-applicability by an untrained person, quality of recorded EEG data, shifts of electrode positions on the head after driving-related movements, usability, and complexity of the system as such and wearing comfort over time. An experiment was conducted inside and outside of a stationary vehicle with running engine, air-conditioning, and muted radio. Signal quality was sufficient for standard EEG analysis in the time and frequency domain as well as for the use in pBCIs. While the influence of vehicle-induced interferences to data quality was insignificant, driving-related movements led to strong shifts in electrode positions. In general, the EEG system used allowed for a fast self-applicability of cap and electrodes. The assessed usability of the system was still acceptable while the wearing comfort decreased strongly over time due to friction and pressure to the head. From these results we conclude that the evaluated system should provide the essential requirements for an application in an autonomous driving context. Nevertheless, further refinement is suggested to reduce shifts of the system due to body movements and increase the headset's usability and wearing comfort. PMID:28293184

Evaluation of a Dry EEG System for Application of Passive Brain-Computer Interfaces in Autonomous Driving.

PubMed

Zander, Thorsten O; Andreessen, Lena M; Berg, Angela; Bleuel, Maurice; Pawlitzki, Juliane; Zawallich, Lars; Krol, Laurens R; Gramann, Klaus

2017-01-01

We tested the applicability and signal quality of a 16 channel dry electroencephalography (EEG) system in a laboratory environment and in a car under controlled, realistic conditions. The aim of our investigation was an estimation how well a passive Brain-Computer Interface (pBCI) can work in an autonomous driving scenario. The evaluation considered speed and accuracy of self-applicability by an untrained person, quality of recorded EEG data, shifts of electrode positions on the head after driving-related movements, usability, and complexity of the system as such and wearing comfort over time. An experiment was conducted inside and outside of a stationary vehicle with running engine, air-conditioning, and muted radio. Signal quality was sufficient for standard EEG analysis in the time and frequency domain as well as for the use in pBCIs. While the influence of vehicle-induced interferences to data quality was insignificant, driving-related movements led to strong shifts in electrode positions. In general, the EEG system used allowed for a fast self-applicability of cap and electrodes. The assessed usability of the system was still acceptable while the wearing comfort decreased strongly over time due to friction and pressure to the head. From these results we conclude that the evaluated system should provide the essential requirements for an application in an autonomous driving context. Nevertheless, further refinement is suggested to reduce shifts of the system due to body movements and increase the headset's usability and wearing comfort.

Implementation of quality management systems and progress towards accreditation of National Tuberculosis Reference Laboratories in Africa

PubMed Central

de Dieu Iragena, Jean; Kao, Kekeletso; Erni, Donatelle; Mekonen, Teferi

2017-01-01

Background Laboratory services are essential at all stages of the tuberculosis care cascade, from diagnosis and drug resistance testing to monitoring response to treatment. Enabling access to quality services is a challenge in low-resource settings. Implementation of a strong quality management system (QMS) and laboratory accreditation are key to improving patient care. Objectives The study objective was to determine the status of QMS implementation and progress towards accreditation of National Tuberculosis Reference Laboratories (NTRLs) in the African Region. Method An online questionnaire was administered to NTRL managers in 47 World Health Organization Regional Office for Africa member states in the region, between February and April 2015, regarding the knowledge of QMS tools and progress toward implementation to inform strategies for tuberculosis diagnostic services strengthening in the region. Results A total of 21 laboratories (43.0%) had received SLMTA/TB-SLMTA training, of which 10 had also used the Global Laboratory Initiative accreditation tool. However, only 36.7% of NTRLs had received a laboratory audit, a first step in quality improvement. Most NTRLs participated in acid-fast bacilli microscopy external quality assurance (95.8%), although external quality assurance for other techniques was lower (60.4% for first-line drug susceptibility testing, 25.0% for second-line drug susceptibility testing, and 22.9% for molecular testing). Barriers to accreditation included lack of training and accreditation programmes. Only 28.6% of NTRLs had developed strategic plans and budgets which included accreditation. Conclusion Good foundations are in place on the continent from which to scale up accreditation efforts. Laboratory audits should be conducted as a first step in developing quality improvement action plans. Political commitment and strong leadership are needed to drive accreditation efforts; advocacy will require clear evidence of patient impact and cost-benefit. PMID:28879161

Can Youth with Autism Spectrum Disorder Use Virtual Reality Driving Simulation Training to Evaluate and Improve Driving Performance? An Exploratory Study

ERIC Educational Resources Information Center

Cox, Daniel J.; Brown, Timothy; Ross, Veerle; Moncrief, Matthew; Schmitt, Rose; Gaffney, Gary; Reeve, Ron

2017-01-01

Investigate how novice drivers with autism spectrum disorder (ASD) differ from experienced drivers and whether virtual reality driving simulation training (VRDST) improves ASD driving performance. 51 novice ASD drivers (mean age 17.96 years, 78% male) were randomized to routine training (RT) or one of three types of VRDST (8-12 sessions). All…

Key Performance Indicators in Radiology: You Can't Manage What You Can't Measure.

PubMed

Harvey, H Benjamin; Hassanzadeh, Elmira; Aran, Shima; Rosenthal, Daniel I; Thrall, James H; Abujudeh, Hani H

2016-01-01

Quality assurance (QA) is a fundamental component of every successful radiology operation. A radiology QA program must be able to efficiently and effectively monitor and respond to quality problems. However, as radiology QA has expanded into the depths of radiology operations, the task of defining and measuring quality has become more difficult. Key performance indicators (KPIs) are highly valuable data points and measurement tools that can be used to monitor and evaluate the quality of services provided by a radiology operation. As such, KPIs empower a radiology QA program to bridge normative understandings of health care quality with on-the-ground quality management. This review introduces the importance of KPIs in health care QA, a framework for structuring KPIs, a method to identify and tailor KPIs, and strategies to analyze and communicate KPI data that would drive process improvement. Adopting a KPI-driven QA program is both good for patient care and allows a radiology operation to demonstrate measurable value to other health care stakeholders. Copyright © 2015 Mosby, Inc. All rights reserved.

Road characteristics and driver fatigue: a simulator study.

PubMed

Oron-Gilad, Tal; Ronen, Adi

2007-09-01

Two experiments examined the influence of road characteristics on driver fatigue in a prolonged simulator drive. In experiment one, ten military truck drivers drove a mixed route, with straight, winding, and straight highway segments. In experiment two, 16 additional drivers drove either a straight, a winding, or a mixed route. Fatigue symptoms were assessed using performance, subjective, and psychophysiological measures (HRV). We hypothesized that drivers adopt different fatigue-coping strategies relative to the demands of the drive. Thus, on straight roads drivers are more likely to loosen their driving demands by either increasing their driving speed and/or not maintaining the lane position, as the road is tolerant to both strategies, whereas on winding roads, drivers are more likely to increase their speed but not their lane positioning. Our results confirm that decremental changes in driving performance varied among road types. In the straight road components, we found decrements in the quality of lane maintaining (experiment one) and steering quality (experiments one and two) and longitudinal speed (experiment two). In the winding road, we found that drivers increased their driving speed over time (experiments one and two).

Effects of alprazolam on driving ability, memory functioning and psychomotor performance: a randomized, placebo-controlled study.

PubMed

Verster, Joris C; Volkerts, Edmund R; Verbaten, Marinus N

2002-08-01

Alprazolam is prescribed for the treatment of anxiety and panic disorder. Most users are presumably involved in daily activities such as driving. However, the effects of alprazolam on driving ability have never been investigated. This study was conducted to determine the effects of alprazolam (1 mg) on driving ability, memory and psychomotor performance. Twenty healthy volunteers participated in a randomized, double-blind, placebo-controlled crossover study. One hour after oral administration, subjects performed a standardized driving test on a primary highway during normal traffic. They were instructed to drive with a constant speed (90 km/h) while maintaining a steady lateral position within the right traffic lane. Primary performance measures were the Standard Deviation of Lateral Position (SDLP) and the Standard Deviation of Speed (SDS). After the driving test, subjective driving quality, mental effort, and mental activation during driving were assessed. A laboratory test battery was performed 2.5 h after treatment administration, comprising the Sternberg Memory Scanning Test, a Continuous Tracking Test, and a Divided Attention Test. Relative to placebo, alprazolam caused serious driving impairment, as expressed by a significantly increased SDLP (F(1,19) = 97.3, p <.0001) and SDS (F(1,19) = 30.4, p <.0001). This was confirmed by subjective assessments showing significantly impaired driving quality (F(1,19) = 16.4, p <.001), decreased alertness (F(1,19) = 43.4, p <.0001), decreased mental activation (F(1,19) = 5.7, p <.03) and increased mental effort during driving (F(1,19) = 26.4, p <.0001). Furthermore, alprazolam significantly impaired performance on the laboratory tests. In conclusion, alprazolam users must be warned not to drive an automobile or operate potentially dangerous machinery.

Implementation of a Surgeon-Level Comparative Quality Performance Review to Improve Positive Surgical Margin Rates during Radical Prostatectomy.

PubMed

Matulewicz, Richard S; Tosoian, Jeffrey J; Stimson, C J; Ross, Ashley E; Chappidi, Meera; Lotan, Tamara L; Humphreys, Elizabeth; Partin, Alan W; Schaeffer, Edward M

2017-05-01

Success in the era of value-based payment will depend on the capacity of health systems to improve quality while controlling costs. Comparative quality performance review can be used to drive improvements in surgical outcomes and thereby reduce costs. We sought to determine the efficacy of a comparative quality performance review to improve a surgeon-level measure of surgical oncologic quality, that is the positive surgical margin rate at the time of radical prostatectomy. Eight surgeons who performed consecutive radical prostatectomies at a single high volume institution between January 1, 2015 and December 31, 2015 were included in analysis. Individual surgeons were provided with confidential report cards every 6 months detailing their case mix, case volume and pT2 radical prostatectomy positive surgical margin rate relative to 1) their own self-matched data, 2) the de-identified data of their colleagues and 3) institutional aggregate data during the study period. Positive surgical margin rates were compared before and after intervention. Hierarchal logistic regression analysis was used to examine the association of study period on the odds of positive surgical margins, adjusted for prostate specific antigen level and National Comprehensive Cancer Network® risk group. Overall, 1,822 (1,392 before and 430 after intervention) radical prostatectomies were performed that met study inclusion criteria. The aggregate departmental unadjusted positive surgical margin rates were 10.6% and 7.4% in the pre-intervention and post-intervention groups, respectively. After adjusting for higher risk cancer in the post-intervention group, there was a significant protective association of post-intervention status on positive margins (OR 0.64, 95% CI 0.43-0.97, p = 0.03). All 5 surgeons with positive surgical margin rates higher than the aggregate department rate in the pre-intervention period showed improvement after intervention. Comparative quality performance review can be implemented at the surgeon level and can promote improvement in an objective measure of surgical oncology quality. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Assessing video games to improve driving skills: a literature review and observational study.

PubMed

Sue, Damian; Ray, Pradeep; Talaei-Khoei, Amir; Jonnagaddala, Jitendra; Vichitvanichphong, Suchada

2014-08-07

For individuals, especially older adults, playing video games is a promising tool for improving their driving skills. The ease of use, wide availability, and interactivity of gaming consoles make them an attractive simulation tool. The objective of this study was to look at the feasibility and effects of installing video game consoles in the homes of individuals looking to improve their driving skills. A systematic literature review was conducted to assess the effect of playing video games on improving driving skills. An observatory study was performed to evaluate the feasibility of using an Xbox 360 Kinect console for improving driving skills. Twenty-nine articles, which discuss the implementation of video games in improving driving skills were found in literature. On our study, it was found the Xbox 360 with Kinect is capable of improving physical and mental activities. Xbox Video games were introduced to engage players in physical, visual and cognitive activities including endurance, postural sway, reaction time, eyesight, eye movement, attention and concentration, difficulties with orientation, and semantic fluency. However, manual dexterity, visuo-spatial perception and binocular vision could not be addressed by these games. It was observed that Xbox Kinect (by incorporating Kinect sensor facilities) combines physical, visual and cognitive engagement of players. These results were consistent with those from the literature review. From the research that has been carried out, we can conclude that video game consoles are a viable solution for improving user's physical and mental state. In future we propose to carry a thorough evaluation of the effects of video games on driving skills in elderly people.

Light scattering techniques for the characterization of optical components

NASA Astrophysics Data System (ADS)

Hauptvogel, M.; Schröder, S.; Herffurth, T.; Trost, M.; von Finck, A.; Duparré, A.; Weigel, T.

2017-11-01

The rapid developments in optical technologies generate increasingly higher and sometimes completely new demands on the quality of materials, surfaces, components, and systems. Examples for such driving applications are the steadily shrinking feature sizes in semiconductor lithography, nanostructured functional surfaces for consumer optics, and advanced optical systems for astronomy and space applications. The reduction of surface defects as well as the minimization of roughness and other scatter-relevant irregularities are essential factors in all these areas of application. Quality-monitoring for analysing and improving those properties must ensure that even minimal defects and roughness values can be detected reliably. Light scattering methods have a high potential for a non-contact, rapid, efficient, and sensitive determination of roughness, surface structures, and defects.

Quantifying the contribution of individual vehicles to NO2 pollution in an urban area

NASA Astrophysics Data System (ADS)

Pöhler, Denis; Kanatschnig, Florian; Horbanski, Martin; Friedrich, Axel; Lampel, Johannes; Platt, Ulrich

2015-04-01

Nitrogen Dioxide (NOx) emissions by road vehicles are the mayor contributor for poor air quality in urban areas. High NOx concentrations, and especially NO2, are typically the most problematic pollutant in mega and other cities. However emissions vary significantly depending on the type of vehicle and its engine, the age and condition of the vehicle, driving properties and many more. Even if data of the manufacturer exists how much NOx different vehicle types emit, reliable data under real driving conditions are rare and often missing. Especially data showing the degree to which different cars contribute to observed NOx levels are missing. Significant reduction of NOx concentrations can be achieved by identifying the strong emitting vehicles and excluding / replacing these. As this is only a small amount of vehicles (typically less than 10% of the vehicles make 90% of the emissions), such a small investment can significantly improve air quality. In order to perform measurements of NOx we applied a high speed NO2 CE-DOAS (Cavity-Enhanced DOAS) instrument in a car which was modified for this application. It measured directly the NO2 concentration behind followed vehicles while driving, with a time resolution of 2 s and an accuracy of ~1ppb. Even if such observations depend on many parameters like mixing-in of ambient air, distance, solar radiation, ozone concentration, background concentration etc., it delivers valuable data under real driving conditions. The instrument was applied in the city of Mainz, Germany to investigate within 7 days (March / April 2014) the NOx emission of 728 vehicles and to quantify the main emitters. Therefore the measured NO2 concentration in comparison to the background concentrations was quantified. Observed vehicles were separated in 4 categories: cars, busses, trucks, and motorcycles. We observed NO2 levels from a few ppb (within the background variation) up to 7000ppb NO2 above the background level. Strong variations within the same vehicle category could be observed. NO2 levels above 500ppb are found only for 2,2% of all measured vehicles and these are mainly busses (especially older models) but also few cars and motorcycles. On average NO2 concentrations behind the vehicles were 222ppb above background level. This could be reduced by 45% by just excluding the strongest emitters (2,2% of all vehicles). Our study clearly shows which vehicles exhibit the strongest NO2 emissions under real driving conditions and which vehicles contribute most to urban NOx pollution. It demonstrates how such measurements at high temporal resolution on a mobile platform can give recommendations to policy makers to significantly improve air quality in mega and other cities at moderate cost. In the future our system will be expanded with a NO and O3 measurement system to quantify all relevant species.

IS MANUAL THERAPY A RATIONAL APPROACH TO IMPROVING HEALTH-RELATED QUALITY OF LIFE IN PEOPLE WITH ARTHRITIS?

PubMed Central

Cameron, Melainie

2002-01-01

Background: People with arthritic disease are advised to participate in gentle exercise on a regular basis, and pursue long-term medication regimes. Alternative therapies are also used by people with arthritis, and may sometimes be recommended by rheumatologists and other medical personnel. Alternative therapies may be divided into two types: active therapies, in which the patient takes a driving role, and passive therapies, in which the therapy cannot proceed unless driven by a therapist. Objective: To review the effectiveness of manual therapy in improving the health-related quality of life (HRQOL) of people with two common arthritis conditions: Osteoarthritis and rheumatoid arthritis. Discussion: Massage, and other passive (practitioner-driven) manual therapies, have been anecdotally reported to improve health-related quality of life (HRQOL) in people with arthritis. Many manual therapists consult with patients who have arthritic diseases, receive referrals from rheumatologists, and consider the arthritic diseases to be within their field of practise. Although there is empirical evidence that manual therapy with some types of arthritis is beneficial, the level of effectiveness however is under-researched. Medical authorities are reluctant to endorse manual therapies for arthritis due to a lack of scientific evidence demonstrating efficacy, safety, and cost effectiveness. PMID:17987169

Experimental techniques for the calibration of lidar depolarization channels in EARLINET

NASA Astrophysics Data System (ADS)

Belegante, Livio; Bravo-Aranda, Juan Antonio; Freudenthaler, Volker; Nicolae, Doina; Nemuc, Anca; Ene, Dragos; Alados-Arboledas, Lucas; Amodeo, Aldo; Pappalardo, Gelsomina; D'Amico, Giuseppe; Amato, Francesco; Engelmann, Ronny; Baars, Holger; Wandinger, Ulla; Papayannis, Alexandros; Kokkalis, Panos; Pereira, Sérgio N.

2018-02-01

Particle depolarization ratio retrieved from lidar measurements are commonly used for aerosol-typing studies, microphysical inversion, or mass concentration retrievals. The particle depolarization ratio is one of the primary parameters that can differentiate several major aerosol components but only if the measurements are accurate enough. The accuracy related to the retrieval of particle depolarization ratios is the driving factor for assessing and improving the uncertainties of the depolarization products. This paper presents different depolarization calibration procedures used to improve the quality of the depolarization data. The results illustrate a significant improvement of the depolarization lidar products for all the selected lidar stations that have implemented depolarization calibration procedures. The calibrated volume and particle depolarization profiles at 532 nm show values that fall within a range that is generally accepted in the literature.

Outcomes measurement in hospitals: can the system change the organization?

PubMed

Linder, J C

1992-01-01

The U.S. health care industry is in crisis--a crisis of accountability. Many believe that improved information, especially outcomes information, is at least part of the solution. If this assessment is accurate, outcomes measurement could offer a powerful opportunity to help mold our dysfunctional health care machinery into an effective infrastructure. This article explores whether implementing an outcomes measurement system in a hospital compels this kind of change. It examines the experiences of 31 hospitals that implemented a market-leading outcomes measurement system. Despite its potential, MedisGroups did not compel important improvements in hospitals' quality of care or their internal practices. Hospitals found it particularly difficult to maintain momentum throughout implementation and to structure the system as a supporting tool, rather than a driving influence, in their pursuit of operating improvements.

In-simulator training of driving abilities in a person with a traumatic brain injury.

PubMed

Gamache, Pierre-Luc; Lavallière, Martin; Tremblay, Mathieu; Simoneau, Martin; Teasdale, Normand

2011-01-01

This study reports the case of a 23-year-old woman (MC) who sustained a severe traumatic brain injury in 2004. After her accident, her driving license was revoked. Despite recovering normal neuropsychological functions in the following years, MC was unable to renew her license, failing four on-road evaluations assessing her fitness to drive. In hope of an eventual license renewal, MC went through an in-simulator training programme in the laboratory in 2009. The training programme aimed at improving features of MC's driving behaviour that were identified as being problematic in prior on-road evaluations. To do so, proper driving behaviour was reinforced via driving-specific feedback provided during the training sessions. After 25 sessions in the simulator (over a period of 4 months), MC significantly improved various components of her driving. Notably, compared to early sessions, later ones were associated with a reduced cognitive load, less jerky speed profiles when stopping at intersections and better vehicle control and positioning. A 1-year retention test showed most of these improvements were consistent. The learning principles underlying well conducted simulator-based education programmes have a strong scientific basis. A simulator training programme like this one represents a promising avenue for driving rehabilitation. It allows individuals without a driving license to practice and improve their skills in a safe and realistic environment.

An interventional approach for patient and nurse safety: a fatigue countermeasures feasibility study.

PubMed

Scott, Linda D; Hofmeister, Nancee; Rogness, Neal; Rogers, Ann E

2010-01-01

Studies indicate that extended shifts worked by hospital staff nurses are associated with higher risk of errors. Long work hours coupled with insufficient sleep and fatigue are even riskier. Although other industries have developed programs to reduce fatigue-related errors and injury, fatigue countermeasures program for nurses (FCMPN) are lacking. The objective of this study was to evaluate the feasibility of an FCMPN for improving sleep duration and quality while reducing daytime sleepiness and patient care errors. Selected sleep variables, errors and drowsy driving, were evaluated among hospital staff nurses (n = 47) before and after FCMPN implementation. A one-group pretest-posttest repeated-measures approach was used. Participants provided data 2 weeks before the FCMPN, 4 weeks after receiving the intervention, and again at 3 months after intervention. Most of the nurses experienced poor sleep quality, severe daytime sleepiness, and decreased alertness at work and while operating a motor vehicle. After the FCMPN, significant improvements were noted in sleep duration, sleep quality, alertness, and error prevention. Although significant improvements were not found in daytime sleepiness scores, severity of daytime sleepiness appeared to decrease. Despite improvements in fatigue management, nurses reported feelings of guilt when engaging in FCMPN activities, especially strategic naps and relieved breaks. Initial findings support the feasibility of using an FCMPN for mitigating fatigue, improving sleep, and reducing errors among hospital staff nurses. In future investigations, the acceptability, efficacy, and effectiveness of FCMPNs can be examined.

Can social media be used as a hospital quality improvement tool?

PubMed

Lagu, Tara; Goff, Sarah L; Craft, Ben; Calcasola, Stephanie; Benjamin, Evan M; Priya, Aruna; Lindenauer, Peter K

2016-01-01

Many hospitals wish to improve their patients' experience of care. To learn whether social media could be used as a tool to engage patients and to identify opportunities for hospital quality improvement (QI), we solicited patients' narrative feedback on the Baystate Medical Center Facebook page during a 3-week period in 2014. Two investigators used directed qualitative content analysis to code comments and descriptive statistics to assess the frequency of selected codes and themes. We identified common themes, including: (1) comments about staff (17/37 respondents, 45.9%); (2) comments about specific departments (22/37, 59.5%); (3) comments on technical aspects of care, including perceived errors and inattention to pain control (9/37, 24.3%); and (4) comments describing the hospital physical plant, parking, and amenities (9/37, 24.3%). A small number (n = 3) of patients repeatedly responded, accounting for 30% (45/148) of narratives. Although patient feedback on social media could help to drive hospital QI efforts, any potential benefits must be weighed against the reputational risks, the lack of representativeness among respondents, and the volume of responses needed to identify areas of improvement. © 2015 Society of Hospital Medicine.

Design and evaluation of a seat orientation controller during uneven terrain driving.

PubMed

Candiotti, Jorge; Wang, Hongwu; Chung, Cheng-Shiu; Kamaraj, Deepan C; Grindle, Garrett G; Shino, Motoki; Cooper, Rory A

2016-03-01

Electric powered wheelchairs (EPWs) are essential devices for people with disabilities as aids for mobility and quality of life improvement. However, the design of currently available common EPWs is still limited and makes it challenging for the users to drive in both indoor and outdoor environments such as uneven surfaces, steep hills, or cross slopes, making EPWs susceptible to loss of stability and at risk for falls. An alternative wheel-legged robotic wheelchair, "MEBot", was designed to improve the safety and mobility of EPW users in both indoor and outdoor environments. MEBot is able to elevate its six wheels using pneumatic actuators, as well to detect changes in the seat angle using a gyroscope and accelerometer. This capability enables MEBot to provide sensing for a dynamic self-leveling seat application that can maintain the center of mass within the boundaries of the wheelchair, thereby, improving EPW safety. To verify the effectiveness of the application, MEBot was tested on a motion platform with six degrees of freedom to simulate different slopes that could be experienced by the EPW in outdoor environments. The results demonstrate the robustness of the application to maintain the wheelchair seat in a horizontal reference against changes in the ground angle. Published by Elsevier Ltd.

Design and control of one precise tracking simulation bed for Chinese 20/30 meter optic/infrared telescope

NASA Astrophysics Data System (ADS)

Ren, Changzhi; Li, Xiaoyan; Song, Xiaoli; Niu, Yong; Li, Aihua; Zhang, Zhenchao

2012-09-01

Direct drive technology is the key to solute future 30-m and larger telescope motion system to guarantee a very high tracking accuracy, in spite of unbalanced and sudden loads such as wind gusts and in spite of a structure that, because of its size, can not be infinitely stiff. However, this requires the design and realization of unusually large torque motor that the torque slew rate must be extremely steep too. A conventional torque motor design appears inadequate. This paper explores one redundant unit permanent magnet synchronous motor and its simulation bed for 30-m class telescope. Because its drive system is one high integrated electromechanical system, one complexly electromechanical design method is adopted to improve the efficiency, reliability and quality of the system during the design and manufacture circle. This paper discusses the design and control of the precise tracking simulation bed in detail.

Effects of Different Types of Cognitive Training on Cognitive Function, Brain Structure, and Driving Safety in Senior Daily Drivers: A Pilot Study.

PubMed

Nozawa, Takayuki; Taki, Yasuyuki; Kanno, Akitake; Akimoto, Yoritaka; Ihara, Mizuki; Yokoyama, Ryoichi; Kotozaki, Yuka; Nouchi, Rui; Sekiguchi, Atsushi; Takeuchi, Hikaru; Miyauchi, Carlos Makoto; Ogawa, Takeshi; Goto, Takakuni; Sunda, Takashi; Shimizu, Toshiyuki; Tozuka, Eiji; Hirose, Satoru; Nanbu, Tatsuyoshi; Kawashima, Ryuta

2015-01-01

Increasing proportion of the elderly in the driving population raises the importance of assuring their safety. We explored the effects of three different types of cognitive training on the cognitive function, brain structure, and driving safety of the elderly. Thirty-seven healthy elderly daily drivers were randomly assigned to one of three training groups: Group V trained in a vehicle with a newly developed onboard cognitive training program, Group P trained with a similar program but on a personal computer, and Group C trained to solve a crossword puzzle. Before and after the 8-week training period, they underwent neuropsychological tests, structural brain magnetic resonance imaging, and driving safety tests. For cognitive function, only Group V showed significant improvements in processing speed and working memory. For driving safety, Group V showed significant improvements both in the driving aptitude test and in the on-road evaluations. Group P showed no significant improvements in either test, and Group C showed significant improvements in the driving aptitude but not in the on-road evaluations. The results support the effectiveness of the onboard training program in enhancing the elderly's abilities to drive safely and the potential advantages of a multimodal training approach.

Effects of Different Types of Cognitive Training on Cognitive Function, Brain Structure, and Driving Safety in Senior Daily Drivers: A Pilot Study

PubMed Central

Taki, Yasuyuki; Kanno, Akitake; Akimoto, Yoritaka; Ihara, Mizuki; Yokoyama, Ryoichi; Kotozaki, Yuka; Sekiguchi, Atsushi; Takeuchi, Hikaru; Miyauchi, Carlos Makoto; Ogawa, Takeshi; Goto, Takakuni; Sunda, Takashi; Shimizu, Toshiyuki; Tozuka, Eiji; Hirose, Satoru; Nanbu, Tatsuyoshi; Kawashima, Ryuta

2015-01-01

Background. Increasing proportion of the elderly in the driving population raises the importance of assuring their safety. We explored the effects of three different types of cognitive training on the cognitive function, brain structure, and driving safety of the elderly. Methods. Thirty-seven healthy elderly daily drivers were randomly assigned to one of three training groups: Group V trained in a vehicle with a newly developed onboard cognitive training program, Group P trained with a similar program but on a personal computer, and Group C trained to solve a crossword puzzle. Before and after the 8-week training period, they underwent neuropsychological tests, structural brain magnetic resonance imaging, and driving safety tests. Results. For cognitive function, only Group V showed significant improvements in processing speed and working memory. For driving safety, Group V showed significant improvements both in the driving aptitude test and in the on-road evaluations. Group P showed no significant improvements in either test, and Group C showed significant improvements in the driving aptitude but not in the on-road evaluations. Conclusion. The results support the effectiveness of the onboard training program in enhancing the elderly's abilities to drive safely and the potential advantages of a multimodal training approach. PMID:26161000

A manual for addressing ineffectiveness within a Corrective Action System and driving on-time dispositions

NASA Astrophysics Data System (ADS)

Mallari, Lawrence Anthony Castro

This project proposes a manual specifically for remedying an ineffective Corrective Action Request System for Company ABC by providing dispositions within the company's quality procedure. A Corrective Action Request System is a corrective action tool that provides a means for employees to engage in the process improvement, problem elimination cycle. At Company ABC, Corrective Action Recommendations (CARs) are not provided with timely dispositions; CARs are being ignored due to a lack of training and awareness of Company ABC's personnel and quality procedures. In this project, Company ABC's quality management software database is scrutinized to identify the number of delinquent, non-dispositioned CARs in 2014. These CARs are correlated with the number of nonconformances generated for the same issue while the CAR is still open. Using secondary data, the primary investigator finds that nonconformances are being remediated at the operational level. However, at the administrative level, CARS are being ignored and forgotten.

Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.

PubMed

Steele, Joseph R; Schomer, Don F

2009-07-01

Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

Impact of social factors on the quality of life of patients with refractory epilepsy.

PubMed

Viteva, E

2013-06-01

To assess the impact of social factors on the quality of life of Bulgarian patients with refractory epilepsy. We have studied 70 patients with refractory epilepsy (RE) and 70 patients with pharmacosensitive epilepsy. All of them were between 18 and 65 years of age, without cognitive decline, progressive somatic or neurological disease or recent seizures. All participants were inquired about their education,employment, marital status, and driving. Only the patients with RE completed QOLIE-89. Twenty-five (35.71%) of the participants with RE were not married; 16 (22.86%) of them had an elementary education, 44 (62.86%) - a secondary education, and 10 (14.29%) - a university education.Nineteen (27.4%) participants were employed, 41 (58.57%) were recognized disabled, 10 (14.29%)were unemployed. Two (2.86%) of the patients with RE were drivers. We found out that the marital status did not change the quality of life. The university education correlated with a higher assessment of the “overall health” subscale (50%). The limited or lacking employment had a negative impact on the assessment of the following subscales: “pain”, “health discouragement”, “sexual relations”, “emotional well-being”, “memory”, “work/driving/social function”, “overall health”, “overall quality of life” and the overall score of QOLIE-89. The possibility of driving correlated with more worries about adverse events from antiepileptic drugs. The limited or lacking employment has a negative impact on most aspects of the quality of life, while education and driving influence single aspects of the quality of life.

The role of soil communities in improving ecosystem services in organic farming

NASA Astrophysics Data System (ADS)

Zandbergen, Jelmer; Koorneef, Guusje; Veen, Cees; Schrama, Jan; van der Putten, Wim

2017-04-01

Worldwide soil fertility decreases and it is generally believed that organic matter (OM) addition to agricultural soils can improve soil properties leading to beneficial ecosystem services. However, it remains unknown under which conditions and how fast biotic, physical and chemical soil properties respond to varying quality and quantity of OM inputs. Therefore, the aims of this research project are (1) to unravel biotic, physical and chemical responses of soils to varying quantity and quality of OM addition; and (2) to understand how we can accelerate the response of soils in order to improve beneficial soil ecosystem services faster. The first step in our research project is to determine how small-scale spatio-temporal patterns in soil biotic, physical and chemical properties relate to crop production and quality. To do this we combine field measurements on soil properties with remote and proximate sensing measures on crop development and yield in a long-term farming systems experiment in the Netherlands (Vredepeel). We hypothesize that spatio-temporal variation in crop development and yield are strongly related to spatio-temporal variation in soil parameters. In the second step of our project we will use this information to identify biological interactions underlying improving soil functions in response to OM addition over time. We will specifically focus on the role of soil communities in driving nutrient cycling, disease suppression and the formation of soil structure, all crucial elements of key soil services in agricultural soils. The knowledge that will be generated in our project can be used to detect specific organic matter qualities that support the underlying ecological processes to accelerate the transition towards improved soil functioning thereby governing enhanced crop yields.

Seven Q-Tracks monitors of laboratory quality drive general performance improvement: experience from the College of American Pathologists Q-Tracks program 1999-2011.

PubMed

Meier, Frederick A; Souers, Rhona J; Howanitz, Peter J; Tworek, Joseph A; Perrotta, Peter L; Nakhleh, Raouf E; Karcher, Donald S; Bashleben, Christine; Darcy, Teresa P; Schifman, Ron B; Jones, Bruce A

2015-06-01

Many production systems employ standardized statistical monitors that measure defect rates and cycle times, as indices of performance quality. Clinical laboratory testing, a system that produces test results, is amenable to such monitoring. To demonstrate patterns in clinical laboratory testing defect rates and cycle time using 7 College of American Pathologists Q-Tracks program monitors. Subscribers measured monthly rates of outpatient order-entry errors, identification band defects, and specimen rejections; median troponin order-to-report cycle times and rates of STAT test receipt-to-report turnaround time outliers; and critical values reporting event defects, and corrected reports. From these submissions Q-Tracks program staff produced quarterly and annual reports. These charted each subscriber's performance relative to other participating laboratories and aggregate and subgroup performance over time, dividing participants into best and median performers and performers with the most room to improve. Each monitor's patterns of change present percentile distributions of subscribers' performance in relation to monitoring durations and numbers of participating subscribers. Changes over time in defect frequencies and the cycle duration quantify effects on performance of monitor participation. All monitors showed significant decreases in defect rates as the 7 monitors ran variously for 6, 6, 7, 11, 12, 13, and 13 years. The most striking decreases occurred among performers who initially had the most room to improve and among subscribers who participated the longest. All 7 monitors registered significant improvement. Participation effects improved between 0.85% and 5.1% per quarter of participation. Using statistical quality measures, collecting data monthly, and receiving reports quarterly and yearly, subscribers to a comparative monitoring program documented significant decreases in defect rates and shortening of a cycle time for 6 to 13 years in all 7 ongoing clinical laboratory quality monitors.

Shared decision-making.

PubMed

Godolphin, William

2009-01-01

Shared decision-making has been called the crux of patient-centred care and identified as a key part of change for improved quality and safety in healthcare. However, it rarely happens, is hard to do and is not taught - for many reasons. Talking with patients about options is not embedded in the attitudes or communication skills training of most healthcare professionals. Information tools such as patient decision aids, personal health records and the Internet will help to shift this state, as will policy that drives patient and public involvement in healthcare delivery and training.

Novel Driving Control of Power Assisted Wheelchair Based on Minimum Jerk Trajectory

NASA Astrophysics Data System (ADS)

Seki, Hirokazu; Sugimoto, Takeaki; Tadakuma, Susumu

This paper describes a novel trajectory control scheme for power assisted wheelchair. Human input torque patterns are always intermittent in power assisted wheelchairs, therefore, the suitable trajectories must be generated also after the human decreases his/her input torque. This paper tries to solve this significant problem based on minimum jerk model minimizing the changing rate of acceleration. The proposed control system based on minimum jerk trajectory is expected to improve the ride quality, stability and safety. Some experiments show the effectiveness of the proposed method.

Assessing Video Games to Improve Driving Skills: A Literature Review and Observational Study

PubMed Central

Sue, Damian; Vichitvanichphong, Suchada

2014-01-01

Background For individuals, especially older adults, playing video games is a promising tool for improving their driving skills. The ease of use, wide availability, and interactivity of gaming consoles make them an attractive simulation tool. Objective The objective of this study was to look at the feasibility and effects of installing video game consoles in the homes of individuals looking to improve their driving skills. Methods A systematic literature review was conducted to assess the effect of playing video games on improving driving skills. An observatory study was performed to evaluate the feasibility of using an Xbox 360 Kinect console for improving driving skills. Results Twenty–nine articles, which discuss the implementation of video games in improving driving skills were found in literature. On our study, it was found the Xbox 360 with Kinect is capable of improving physical and mental activities. Xbox Video games were introduced to engage players in physical, visual and cognitive activities including endurance, postural sway, reaction time, eyesight, eye movement, attention and concentration, difficulties with orientation, and semantic fluency. However, manual dexterity, visuo-spatial perception and binocular vision could not be addressed by these games. It was observed that Xbox Kinect (by incorporating Kinect sensor facilities) combines physical, visual and cognitive engagement of players. These results were consistent with those from the literature review. Conclusions From the research that has been carried out, we can conclude that video game consoles are a viable solution for improving user’s physical and mental state. In future we propose to carry a thorough evaluation of the effects of video games on driving skills in elderly people. PMID:25654355

Systems Engineering Methodology for Fuel Efficiency and its Application to the TARDEC Fuel Efficient Demonstrator (FED) Program

DTIC Science & Technology

2010-08-19

highlight the benefits of regenerative braking . Parameters within the drive cycle may include vehicle speed, elevation/grade changes, road surface...assist to downsize the engine due to infinite maximum speed requirements • Drive cycle less suited to regenerative braking improvement compared to...will be cycle dependent. A high speed drive cycle may for example drive a focus on aerodynamic improvements, while high frequency of braking will

Peer review of human studies run amok: a break in the fiduciary relation between scientists and the public.

PubMed

Feldstein Ewing, Sarah W; Saitz, Richard

2015-02-01

Peer review aims to ensure the quality and credibility of research reporting. Conducted by volunteer scientists who receive no guidance or direction, peer review widely varies from fast and facilitative, to unclear and obstructive. Poor quality is an issue because most science research is publicly funded, whereby scientists must make an effort to quickly disseminate their findings back to the public. An unfortunately not uncommon barrier in this process is ineffective peer review. Most scientists agree that when done well, editors and reviewers drive and maintain the high standards of science. At the same time, ineffective peer review can cause great delay with no introduced improvement in final product. These delays and requests interfere with the path of communication between scientist and public, at a great cost to editors, reviewers, authors and those who stand to benefit from application of the results of the studies. We offer a series of concrete recommendations to improve this process.

Considerations In The Design And Specifications Of An Automatic Inspection System

NASA Astrophysics Data System (ADS)

Lee, David T.

1980-05-01

Considerable activities have been centered around the automation of manufacturing quality control and inspection functions. Several reasons can be cited for this development. The continuous pressure of direct and indirect labor cost increase is only one of the obvious motivations. With the drive for electronics miniaturization come more and more complex processes where control parameters are critical and the yield is highly susceptible to inadequate process monitor and inspection. With multi-step, multi-layer process for substrate fabrication, process defects that are not detected and corrected at certain critical points may render the entire subassembly useless. As a process becomes more complex, the time required to test the product increases significantly in the total build cycle. The urgency to reduce test time brings more pressure to improve in-process control and inspection. The advances and improvements of components, assemblies and systems such as micro-processors, micro-computers, programmable controllers, and other intelligent devices, have made the automation of quality control much more cost effective and justifiable.

[Internal and external quality controls for Elisa techniques of aspergillosis serodiagnosis: proposals of the group "sérodiagnostic fongique" of the Société française de mycologie médicale].

PubMed

Persat, F; Lachaud, L; Rabérin, H; Poggi, B; Roques, C; Gangneux, J P

2013-03-01

In the end of May 2012, a meeting of the group "sérodiagnostic fongique" of the "Société française de mycologie médicale" had concerned quality controls to use, in particular, in the follow-up of Elisa techniques. A preliminary investigation showed that the internal quality controls (CIQ), according to the terms defined by the accreditation, were not systematically used. In June, was published the new guide of the COFRAC SH-GTA-06 on quality controls, this text being applicable on July 1st, 2012. It incited the working group to formulate proposals on the choice of the CIQ for antigen and antibody Elisa in the aspergillosis serodiagnosis. Informations on the external evaluations of the quality (EEQ) have also been given to better define for what we can expect from it. All these controls will allow every laboratory to better master the used techniques and their conditions of realization. A strengthened dialogue between the users and the manufacturers should incite these last actors to improve the supplied kits. It will drive later to an improvement of the reliability of the results obtained by these techniques and their interest in the aspergillosis diagnosis. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Accountability for quality of care: Monitoring all aspects of quality across a framework adapted for action.

PubMed

Hulton, Louise; Matthews, Zoë; Bandali, Sarah; Izge, Abubakar; Daroda, Ramatu; Stones, William

2016-01-01

Quality of care is essential to maternal and newborn survival. The multidimensional nature of quality of care means that frameworks are useful for capturing it. The present paper proposes an adaptation to a widely used quality of care framework for maternity services. The framework subdivides quality into two inter-related dimensions-provision and experience of care-but suggests adaptations to reflect changes in the concept of quality over the past 15years. The application of the updated framework is presented in a case study, which uses it to measure and inform quality improvements in northern Nigeria across the reproductive, maternal, newborn, and child health continuum of care. Data from 231 sampled basic and comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) facilities in six northern Nigerian states showed that only 35%-47% of facilities met minimum quality standards in infrastructure. Standards for human resources performed better with 49%-73% reaching minimum standards. A framework like this could form the basis for a certification scheme. Certification offers a practical and concrete opportunity to drive quality standards up and reward good performance. It also offers a mechanism to strengthen accountability. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Determination of power and moment on shaft of special asynchronous electric drives

NASA Astrophysics Data System (ADS)

Karandey, V. Yu; Popov, B. K.; Popova, O. B.; Afanasyev, V. L.

2018-03-01

In the article, questions and tasks of determination of power and the moment on a shaft of special asynchronous electric drives are considered. Use of special asynchronous electric drives in mechanical engineering and other industries is relevant. The considered types of electric drives possess the improved mass-dimensional indicators in comparison with singleengine systems. Also these types of electric drives have constructive advantages; the improved characteristics allow one to realize the technological process. But creation and design of new electric drives demands adjustment of existing or development of new methods and approaches of calculation of parameters. Determination of power and the moment on a shaft of special asynchronous electric drives is the main objective during design of electric drives. This task has been solved based on a method of electromechanical transformation of energy.

Fatigue in Younger and Older Drivers: Effectiveness of an Alertness-Maintaining Task.

PubMed

Song, Woojin; Woon, Fu L; Doong, Alice; Persad, Carol; Tijerina, Louis; Pandit, Pooja; Cline, Carol; Giordani, Bruno

2017-09-01

The aim of this study was to examine the effects of an alertness-maintaining task (AMT) in older, fatigued drivers. Fatigue during driving increases crash risk, and previous research suggests that alertness and driving in younger adults may be improved using a secondary AMT during boring, fatigue-eliciting drives. However, the potential impact of an AMT on driving has not been investigated in older drivers whose ability to complete dual tasks has been shown to decline and therefore may be negatively affected with an AMT in driving. Younger ( n = 29) and older drivers ( n = 39) participated in a 50-minute simulated drive designed to induce fatigue, followed by four 10-minute sessions alternating between driving with and without an AMT. Younger drivers were significantly more affected by fatigue on driving performance than were older drivers but benefitted significantly from the AMT. Older drivers did not demonstrate increased driver errors with fatigue, and driving did not deteriorate significantly during participation in the AMT condition, although their speed was significantly more variable with the AMT. Consistent with earlier research, an AMT applied during fatiguing driving is effective in improving alertness and reducing driving errors in younger drivers. Importantly, older drivers were relatively unaffected by fatigue, and use of an AMT did not detrimentally affect their driving performance. These results support the potential use of an AMT as a new automotive technology to improve fatigue and promote driver safety, though the benefits of such technology may differ between different age groups.

Mitigating Structural Defects in Droop-Minimizing InGaN/GaN Quantum Well Heterostructures

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

Zhao, Zhibo; Chesin, Jordan; Singh, Akshay

2016-12-01

Modern commercial InGaN/GaN blue LEDs continue to suffer from efficiency droop, a reduction in efficiency with increasing drive current. External quantum efficiency (EQE) typically peaks at low drive currents (< 10 A cm 2) and drops monotonically at higher current densities, falling to <85% of the peak EQE at a drive current of 100 A cm 2. Mitigating droop-related losses will yield tremendous gains in both luminous efficacy (lumens/W) and cost (lumens/$). Such improvements are critical for continued large-scale market penetration of LED technologies, particularly in high-power and high flux per unit area applications. However, device structures that reduce droopmore » typically require higher indium content and are accompanied by a corresponding degradation in material quality which negates the droop improvement via enhanced Shockley-Read-Hall (SRH) recombination. In this work, we use advanced characterization techniques to identify and classify structural defects in InGaN/GaN quantum well (QW) heterostructures that share features with low-droop designs. Using aberration-corrected scanning transmission electron microscopy (C s-STEM), we find the presence of severe well width fluctuations (WWFs) in a number of low droop device architectures. However, the presence of WWFs does not correlate strongly with external quantum efficiency nor defect densities measured via deep level optical spectroscopy (DLOS). Hence, performance losses in the heterostructures of interest are likely dominated by nanoscale point or interfacial defects rather than large-scale extended defects.« less

Design of motion adjusting system for space camera based on ultrasonic motor

NASA Astrophysics Data System (ADS)

Xu, Kai; Jin, Guang; Gu, Song; Yan, Yong; Sun, Zhiyuan

2011-08-01

Drift angle is a transverse intersection angle of vector of image motion of the space camera. Adjusting the angle could reduce the influence on image quality. Ultrasonic motor (USM) is a new type of actuator using ultrasonic wave stimulated by piezoelectric ceramics. They have many advantages in comparison with conventional electromagnetic motors. In this paper, some improvement was designed for control system of drift adjusting mechanism. Based on ultrasonic motor T-60 was designed the drift adjusting system, which is composed of the drift adjusting mechanical frame, the ultrasonic motor, the driver of Ultrasonic Motor, the photoelectric encoder and the drift adjusting controller. The TMS320F28335 DSP was adopted as the calculation and control processor, photoelectric encoder was used as sensor of position closed loop system and the voltage driving circuit designed as generator of ultrasonic wave. It was built the mathematic model of drive circuit of the ultrasonic motor T-60 using matlab modules. In order to verify the validity of the drift adjusting system, was introduced the source of the disturbance, and made simulation analysis. It designed the control systems of motor drive for drift adjusting system with the improved PID control. The drift angle adjusting system has such advantages as the small space, simple configuration, high position control precision, fine repeatability, self locking property and low powers. It showed that the system could accomplish the mission of drift angle adjusting excellent.

What drives quality improvement in chronic kidney disease (CKD) in primary care: process evaluation of the Quality Improvement in Chronic Kidney Disease (QICKD) trial.

PubMed

Nihat, Akin; de Lusignan, Simon; Thomas, Nicola; Tahir, Mohammad Aumran; Gallagher, Hugh

2016-04-06

This study is a process evaluation of the Quality Improvement in Chronic Kidney Disease (QICKD) study, comparing audit-based education (ABE) and sending clinical guidelines and prompts (G&P) with usual practice, in improving systolic blood pressure control in primary care. This evaluation aimed to explore how far clinical staff in participating practices were aware of the intervention, and why change in practice might have taken place. 4 primary care practices in England: 2 received ABE, and 2 G&P. We purposively selected 1 northern/southern/city and rural practice from each study arm (from a larger pool of 132 practices as part of the QICKD trial). The 4 study practices were purposively sampled, and focus groups conducted with staff from each. All staff members were invited to attend. Focus groups in each of 4 practices, at the mid-study point and at the end. 4 additional trial practices not originally selected for in-depth process evaluation took part in end of trial focus groups, to a total of 12 focus groups. These were recorded, transcribed and analysed using the framework approach. 5 themes emerged: (1) involvement in the study made participants more positive about the CKD register; (2) clinicians did not always explain to patients that they had CKD; (3) while practitioners improved their monitoring of CKD, many were sceptical that it improved care and were more motivated by pay-for-performance measures; (4) the impact of study interventions on practice was generally positive, particularly the interaction with specialists, included in ABE; (5) the study stimulated ideas for future clinical practice. Improving quality in CKD is complex. Lack of awareness of clinical guidelines and scepticism about their validity are barriers to change. While pay-for-performance incentives are the main driver for change, quality improvement interventions can have a complementary influence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The effect of an information and communication technology (ICT) on older adults' quality of life: study protocol for a randomized control trial.

PubMed

Gustafson, David H; McTavish, Fiona; Gustafson, David H; Mahoney, Jane E; Johnson, Roberta A; Lee, John D; Quanbeck, Andrew; Atwood, Amy K; Isham, Andrew; Veeramani, Raj; Clemson, Lindy; Shah, Dhavan

2015-04-25

This study investigates the use of an information and communication technology (Elder Tree) designed for older adults and their informal caregivers to improve older adult quality of life and address challenges older adults face in maintaining their independence (for example, loneliness and isolation, falling, managing medications, driving and transportation). This study, an unblinded randomized controlled trial, will evaluate the effectiveness and cost of Elder Tree. Older adults who are at risk for losing their independence - along with their informal caregivers, if they name them - are randomized to two groups. The intervention group has access to their usual sources of information and communication as well as to Elder Tree for 18 months while the control group uses only their usual sources of information and communication. The primary outcome of the study is older adult quality of life. Secondary outcomes are cost per Quality-Adjusted Life Year and the impact of the technology on independence, loneliness, falls, medication management, driving and transportation, and caregiver appraisal and mastery. We will also examine the mediating effect of self-determination theory. We will evaluate the effectiveness of Elder Tree by comparing intervention- and control-group participants at baseline and months 6, 12, and 18. We will use mixed-effect models to evaluate the primary and secondary outcomes, where pretest score functions as a covariate, treatment condition is a between-subjects factor, and the multivariate outcome reflects scores for a given assessment at the three time points. Separate analyses will be conducted for each outcome. Cost per Quality-Adjusted Life Year will be compared between the intervention and control groups. Additional analyses will examine the mediating effect of self-determination theory on each outcome. Elder Tree is a multifaceted intervention, making it a challenge to assess which services or combinations of services account for outcomes in which subsets of older adults. If Elder Tree can improve quality of life and reduce healthcare costs among older adults, it could suggest a promising way to ease the burden that advancing age can place on older adults, their families, and the healthcare system. ClinicalTrials.gov NCT02128789 . Registered on 26 March 2014.

Linking Environmental Sustainability, Health, and Safety Data in Health Care: A Research Roadmap.

PubMed

Kaplan, Susan B; Forst, Linda

2017-08-01

Limited but growing evidence demonstrates that environmental sustainability in the health-care sector can improve worker and patient health and safety. Yet these connections are not appreciated or understood by decision makers in health-care organizations or oversight agencies. Several studies demonstrate improvements in quality of care, staff satisfaction, and work productivity related to environmental improvements in the health-care sector. A pilot study conducted by the authors found that already-collected data could be used to evaluate impacts of environmental sustainability initiatives on worker and patient health and safety, yet few hospitals do so. Future research should include a policy analysis of laws that could drive efforts to integrate these areas, elucidation of organizational models that promote sharing of environmental and health and safety data, and development of tools and methods to enable systematic linkage and evaluation of these data to expand the evidence base and improve the hospital environment.

Work motivation among healthcare professionals.

PubMed

Kjellström, Sofia; Avby, Gunilla; Areskoug-Josefsson, Kristina; Andersson Gäre, Boel; Andersson Bäck, Monica

2017-06-19

Purpose The purpose of this paper is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives. Design/methodology/approach Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. In total, 43 interviews were completed with different medical professions and qualitative deductive content analysis was conducted. Findings Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers' positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematic quality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. Practical implications Leaders need to consistently translate and integrate reforms with the professionals' drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work. Social implications The design of the reforms and leadership are essential preconditions for work motivation. Originality/value The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.

Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model.

PubMed

De Leeuw, R A; Westerman, Michiel; Nelson, E; Ket, J C F; Scheele, F

2016-07-08

E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings.

Understanding adolescent development: implications for driving safety.

PubMed

Keating, Daniel P

2007-01-01

The implementation of Graduated Driver Licensing (GDL) programs has significantly improved the crash and fatality rates of novice teen drivers, but these rates remain unacceptably high. A review of adolescent development research was undertaken to identify potential areas of improvement. Research support for GDL was found to be strong, particularly regarding early acquisition of expertise in driving safety (beyond driving skill), and to limitations that reduce opportunities for distraction. GDL regimes are highly variable, and no US jurisdictions have implemented optimal regimes. Expanding and improving GDL to enhance acquisition of expertise and self-regulation are indicated for implementation and for applied research. Driver training that effectively incorporates safety goals along with driving skill is another target. The insurance industry will benefit from further GDL enhancements. Benefits may accrue to improved driver training, improved simulation devices during training, and automated safety feedback instrumentation.

Prediction of driving capacity after traumatic brain injury: a systematic review.

PubMed

Ortoleva, Claudia; Brugger, Camille; Van der Linden, Martial; Walder, Bernhard

2012-01-01

To review the current evidence on predictors for the ability to return to driving after traumatic brain injury. Systematic searches were conducted in MEDLINE, PsycINFO, EMBASE, and CINAHL up to March 1, 2010. Studies were rigorously rated for their methodological content and quality and standardized data were extracted from eligible studies. We screened 2341 articles, of which 7 satisfied our inclusion criteria. Five studies were of limited quality because of undefined, unrepresentative samples and/or absence of blinding. Studies mentioned 38 candidate predictors and tested 37. The candidate predictors most frequently mentioned were "selective attention" and "divided attention" in 4/7 studies, and "executive functions" and "processing speed," both in 3/7 studies. No association with driving was observed for 19 candidate predictors. Eighteen candidate predictors from 3 domains were associated with driving capacity: patient and trauma characteristics, neuropsychological assessments, and general assessments; 10 candidate predictors were tested in only one study and 8 in more than one study. The results of associations were contradictory for all but one: time between trauma and driving evaluation. There is no sound basis at present for predicting driving capacity after traumatic brain injury because most studies have methodological limitations.

Lead/acid batteries in systems to improve power quality

NASA Astrophysics Data System (ADS)

Taylor, P.; Butler, P.; Nerbun, W.

Increasing dependence on computer technology is driving needs for extremely high-quality power to prevent loss of information, material, and workers' time that represent billions of dollars annually. This cost has motivated commercial and Federal research and development of energy storage systems that detect and respond to power-quality failures in milliseconds. Electrochemical batteries are among the storage media under investigation for these systems. Battery energy storage systems that employ either flooded lead/acid or valve-regulated lead/acid battery technologies are becoming commercially available to capture a share of this emerging market. Cooperative research and development between the US Department of Energy and private industry have led to installations of lead/acid-based battery energy storage systems to improve power quality at utility and industrial sites and commercial development of fully integrated, modular battery energy storage system products for power quality. One such system by AC Battery Corporation, called the PQ2000, is installed at a test site at Pacific Gas and Electric Company (San Ramon, CA, USA) and at a customer site at Oglethorpe Power Corporation (Tucker, GA, USA). The PQ2000 employs off-the-shelf power electronics in an integrated methodology to control the factors that affect the performance and service life of production-model, low-maintenance, flooded lead/acid batteries. This system, and other members of this first generation of lead/acid-based energy storage systems, will need to compete vigorously for a share of an expanding, yet very aggressive, power quality market.

Development of a driving method suitable for ultrahigh-speed shooting in a 2M-fps 300k-pixel single-chip color camera

NASA Astrophysics Data System (ADS)

Yonai, J.; Arai, T.; Hayashida, T.; Ohtake, H.; Namiki, J.; Yoshida, T.; Etoh, T. Goji

2012-03-01

We have developed an ultrahigh-speed CCD camera that can capture instantaneous phenomena not visible to the human eye and impossible to capture with a regular video camera. The ultrahigh-speed CCD was specially constructed so that the CCD memory between the photodiode and the vertical transfer path of each pixel can store 144 frames each. For every one-frame shot, the electric charges generated from the photodiodes are transferred in one step to the memory of all the parallel pixels, making ultrahigh-speed shooting possible. Earlier, we experimentally manufactured a 1M-fps ultrahigh-speed camera and tested it for broadcasting applications. Through those tests, we learned that there are cases that require shooting speeds (frame rate) of more than 1M fps; hence we aimed to develop a new ultrahigh-speed camera that will enable much faster shooting speeds than what is currently possible. Since shooting at speeds of more than 200,000 fps results in decreased image quality and abrupt heating of the image sensor and drive circuit board, faster speeds cannot be achieved merely by increasing the drive frequency. We therefore had to improve the image sensor wiring layout and the driving method to develop a new 2M-fps, 300k-pixel ultrahigh-speed single-chip color camera for broadcasting purposes.

Challenges ahead: social and institutional factors influencing sustainable urban stormwater management in Australia.

PubMed

Brown, R R; Farrelly, M A

2009-01-01

In a time of climate uncertainty and drought in Australia, improved urban stormwater quality management practices are required not only for protecting waterway health, but also as a fit-for-purpose supply source. To conceive of urban stormwater as an environmental threat as well as a water supply source requires a substantial shift in our traditional linear supply and wastewater structures towards more hybrid and complex infrastructure systems. To understand what drives and limits treatment technology adoption for stormwater management, over 800 urban water professionals in three Australian capital cities completed an online questionnaire survey in November 2006. Using the conceptual framework of receptivity assessment, the results revealed the professional community to be highly associated with the importance of improving stormwater quality for receiving waterway health, yet they do not consider that politicians share this perspective by placing a substantially lower level of importance on stormwater quality management. Significant acquisition barriers within each city, including institutional arrangements, costs, responsibilities, and regulations and approvals processes were all identified as constraining more sustainable practices. Capacity building programs, fostering greater socio-political capital and developing key demonstration projects with training events are recommended as useful policy interventions for addressing current institutional impediments.

Daily Management System of the Henry Ford Production System: QTIPS to Focus Continuous Improvements at the Level of the Work.

PubMed

Zarbo, Richard J; Varney, Ruan C; Copeland, Jacqueline R; D'Angelo, Rita; Sharma, Gaurav

2015-07-01

To support our Lean culture of continuous improvement, we implemented a daily management system designed so critical metrics of operational success were the focus of local teams to drive improvements. We innovated a standardized visual daily management board composed of metric categories of Quality, Time, Inventory, Productivity, and Safety (QTIPS); frequency trending; root cause analysis; corrective/preventive actions; and resulting process improvements. In 1 year (June 2013 to July 2014), eight laboratory sections at Henry Ford Hospital employed 64 unique daily metrics. Most assessed long-term (>6 months), monitored process stability, while short-term metrics (1-6 months) were retired after successful targeted problem resolution. Daily monitoring resulted in 42 process improvements. Daily management is the key business accountability subsystem that enabled our culture of continuous improvement to function more efficiently at the managerial level in a visible manner by reviewing and acting based on data and root cause analysis. Copyright© by the American Society for Clinical Pathology.

Combination spindle-drive system for high precision machining

DOEpatents

Gerth, Howard L.

1977-07-26

A combination spindle-drive is provided for fabrication of optical quality surface finishes. Both the spindle-and-drive utilize the spindle bearings for support, thereby removing the conventional drive-means bearings as a source of vibration. An airbearing spindle is modified to carry at the drive end a highly conductive cup-shaped rotor which is aligned with a stationary stator to produce torque in the cup-shaped rotor through the reaction of eddy currents induced in the rotor. This arrangement eliminates magnetic attraction forces and all force is in the form of torque on the cup-shaped rotor.

Just-in-time: maximizing its success potential.

PubMed

Johnston, S K

1990-08-01

The effective implementation and use of JIT manufacturing practices depends largely on the education, training, and commitment of all levels of management to a fundamental quality-first policy. Management must transfer and demonstrate that commitment to every level and extension of the manufacturing endeavor. As a company establishes and reaches toward that goal, the move to JIT manufacturing practices becomes rational and justifiable. Failing to establish and commit to a quality directive greatly diminishes the potential benefits of JIT. If all levels of manufacturing participate in the JIT planning, implementing, and maintenance procedure, the realization of positive change and improvement drives the process. Total participation makes the task of JIT implementation not only possible, but practical. Enhanced mutual respect for all concerned is a likely consequence, advancing the productive environment.

Partnering for Vaccine Emerging Markets--Berlin, June 10-11, 2013: balancing vaccine quality, capacity, and cost-of-goods in emerging markets.

PubMed

Onraedt, Annelies

2013-09-01

Phacilitates 1st Partnering event for Vaccine Emerging Markets brought together approximately 100 attendees from developed and developing world vaccine manufacturers, leading non-profit organizations and industry suppliers. The goal was to discuss the vaccine needs in the developing world and how these needs can be met by leveraging collaboration and partnership models, by improving access to existing, new and next generation vaccines, by using novel technologies to drive competitive advantage and economics of vaccine manufacturing and by investing in localized capacity, including capacity for pandemic vaccines. The present article summarizes insights out of 30 oral contributions on how quality and capacity requirements can be balanced with cost by using novel manufacturing technologies and operating models.

Acoustic Performance of Drive Rig Mufflers for Model Scale Engine Testing

NASA Technical Reports Server (NTRS)

Stephens, David, B.

2013-01-01

Aircraft engine component testing at the NASA Glenn Research Center (GRC) includes acoustic testing of scale model fans and propellers in the 9- by15-Foot Low Speed Wind Tunnel (LSWT). This testing utilizes air driven turbines to deliver power to the article being studied. These air turbines exhaust directly downstream of the model in the wind tunnel test section and have been found to produce significant unwanted noise that reduces the quality of the acoustic measurements of the engine model being tested. This report describes an acoustic test of a muffler designed to mitigate the extraneous turbine noise. The muffler was found to provide acoustic attenuation of at least 8 dB between 700 Hz and 20 kHz which significantly improves the quality of acoustic measurements in the facility.

Forming of AHSS using Servo-Presses

NASA Astrophysics Data System (ADS)

Groseclose, Adam Richard

Stamping of Advanced High Strength Steel (AHSS) alloys poses several challenges due to the material's higher strength and low formability compared to conventional steels and other problems such as (a) inconsistency of incoming material properties, (b) ductile fracture during forming, (c) higher contact pressure and temperature rise during forming, (d) higher die wear leading to reduced tool life, (e) higher forming load/press capacity, and (f) large springback leading to dimensional inaccuracy in the formed part. [Palaniswamy et. al., 2007]. The use of AHSS has been increasing steadily in automotive stamping. New AHSS alloys (TRIP, TWIP) may replace some of the Hot Stamping applications. Stamping of AHSS alloys, especially higher strength materials, 780 MPa and higher, present new challenges in obtaining good part definition (corner and fillet radii), formability (fracture and resulting scrap) and in reducing springback. Servo-drive presses, having the capability to have infinitely variable and adjustable ram speed and dwell at BDC, offer a potential improvement in quality, part definition, and springback reduction especially when the infinitely adjustable slide motion is used in combination with a CNC hydraulic cushion. Thus, it is desirable to establish a scientific/engineering basis for improving the stamping conditions in forming AHSS using a servo-drive press.

Delta L: An Apparatus for Measuring Macromolecule Crystal Growth Rates in Microgravity

NASA Technical Reports Server (NTRS)

Judge, Russell A.; Whitaker, Ann F. (Technical Monitor)

2001-01-01

Strongly diffracting high quality macromolecule crystals of suitable volume are keenly sought for X-ray diffraction analysis so that high-resolution molecular structure data can be obtained. Such data is of tremendous value to medical research, agriculture and commercial biotechnology. In previous studies by many investigators microgravity has been reported in some instances to improve biological macromolecule X-ray crystal quality while little or no improvement was observed in other cases. A better understanding of processes effecting crystal quality improvement in microgravity will therefore be of great benefit in optimizing crystallization success in microgravity. In ground based research with the protein lysozyme we have previously shown that a population of crystals grown under the same solution conditions, exhibit a variation in X-ray diffraction properties (Judge et al., 1999). We have also observed that under the same solution conditions, individual crystals will grow at slightly different growth rates. This phenomenon is called growth rate dispersion. For small molecule materials growth rate dispersion has been directly related to crystal quality (Cunningham et al., 1991; Ristic et al., 1991). We therefore postulate that microgravity may act to improve crystal quality by reducing growth rate dispersion. If this is the case then as different, Materials exhibit different degrees of growth rate dispersion on the ground then growth rate dispersion could be used to screen which materials may benefit the most from microgravity crystallization. In order to assess this theory the Delta L hardware is being developed so that macromolecule crystal growth rates can be measured in microgravity. Crystal growth rate is defined as the change or delta in crystal size (defined as a characteristic length, L) over time; hence the name of the hardware. Delta L will consist of an optics, a fluids, and a data acquisition sub-assemblies. The optics assembly will consist of a video microscope camera mounted on three axis computer controlled translation stages. The fluids assembly consists of macromolecule and precipitant reservoirs, a temperature controlled growth cell and waste container, The data acquisition is achieved by using a frame-gabber, with images being stored on a hard drive. In operation, macromolecule and precipitant solution will be injected into the temperature controlled growth cell. As macromolecule crystals grow, the video microscope camera controlled by the translation stages, will be used to locate and record images of individual crystals, returning to the same crystals at specific time intervals. The images will be stored on the hard drive and used to calculate the crystal growth rate. To prevent vibrations interfering in the crystal growth rate measurements (Snell et al., 1997) Delta L will be used in connection with the Glovebox Integrated Microgravity Isolation Technology (g-LIMIT) inside the Microgravity Science Glovebox (MSG), onboard the International Space Station (ISS).

Physician executives straddle the digital divide.

PubMed

Coile, R C

2001-01-01

e-Health is here to stay and experts predict that the Internet will become the hub of health care. Rapid advancements in biotechnology and medical research, increasingly curious patients who surf the Internet for medical information, and pressures from managed care companies to contain costs and speed treatments are the central components driving e-health. Despite physician reluctance to embrace the e-revolution, many hospitals and medical groups are employing the Internet and information technology to improve their customer interface, as well as to reduce business costs. This article offers seven e-strategies for health care performance improvement: (1) Supply chain management; (2) e-transactions; (3) care management; (4) improving quality; (5) boosting revenues; (6) outsourcing; and (7) provider networks (Intranets). By helping to incorporate these key e-solutions, physician executives can position their organizations for success in the new millennium.

An arch-shaped intraoral tongue drive system with built-in tongue-computer interfacing SoC.

PubMed

Park, Hangue; Ghovanloo, Maysam

2014-11-14

We present a new arch-shaped intraoral Tongue Drive System (iTDS) designed to occupy the buccal shelf in the user's mouth. The new arch-shaped iTDS, which will be referred to as the iTDS-2, incorporates a system-on-a-chip (SoC) that amplifies and digitizes the raw magnetic sensor data and sends it wirelessly to an external TDS universal interface (TDS-UI) via an inductive coil or a planar inverted-F antenna. A built-in transmitter (Tx) employs a dual-band radio that operates at either 27 MHz or 432 MHz band, according to the wireless link quality. A built-in super-regenerative receiver (SR-Rx) monitors the wireless link quality and switches the band if the link quality is below a predetermined threshold. An accompanying ultra-low power FPGA generates data packets for the Tx and handles digital control functions. The custom-designed TDS-UI receives raw magnetic sensor data from the iTDS-2, recognizes the intended user commands by the sensor signal processing (SSP) algorithm running in a smartphone, and delivers the classified commands to the target devices, such as a personal computer or a powered wheelchair. We evaluated the iTDS-2 prototype using center-out and maze navigation tasks on two human subjects, which proved its functionality. The subjects' performance with the iTDS-2 was improved by 22% over its predecessor, reported in our earlier publication.

Coater/developer based techniques to improve high-resolution EUV patterning defectivity

NASA Astrophysics Data System (ADS)

Hontake, Koichi; Huli, Lior; Lemley, Corey; Hetzer, Dave; Liu, Eric; Ko, Akiteru; Kawakami, Shinichiro; Shimoaoki, Takeshi; Hashimoto, Yusaku; Tanaka, Koichiro; Petrillo, Karen; Meli, Luciana; De Silva, Anuja; Xu, Yongan; Felix, Nelson; Johnson, Richard; Murray, Cody; Hubbard, Alex

2017-10-01

Extreme ultraviolet lithography (EUVL) technology is one of the leading candidates under consideration for enabling the next generation of devices, for 7nm node and beyond. As the focus shifts to driving down the 'effective' k1 factor and enabling the full scaling entitlement of EUV patterning, new techniques and methods must be developed to reduce the overall defectivity, mitigate pattern collapse, and eliminate film-related defects. In addition, CD uniformity and LWR/LER must be improved in terms of patterning performance. Tokyo Electron Limited (TEL™) and IBM Corporation are continuously developing manufacturing quality processes for EUV. In this paper, we review the ongoing progress in coater/developer based processes (coating, developing, baking) that are required to enable EUV patterning.

Transitioning to a High-Value Health Care Model: Academic Accountability.

PubMed

Johnson, Pamela T; Alvin, Matthew D; Ziegelstein, Roy C

2018-06-01

Health care spending in the United States has increased to unprecedented levels, and these costs have broken medical providers' promise to do no harm. Medical debt is the leading contributor to U.S. personal bankruptcy, more than 50% of household foreclosures are secondary to medical debt and illness, and patients are choosing to avoid necessary care because of its cost. Evidence that the health care delivery model is contributing to patient hardship is a call to action for the profession to transition to a high-value model, one that delivers the highest health care quality and safety at the lowest personal and financial cost to patients. As such, value improvement work is being done at academic medical centers across the country. To promote measurable improvements in practice on a national scale, academic institutions need to align efforts and create a new model for collaboration, one that transcends cross-institutional competition, specialty divisions, and geographical constraints. Academic institutions are particularly accountable because of the importance of research and education in driving this transition. Investigations that elucidate effective implementation methodologies and evaluate safety outcomes data can facilitate transformation. Engaging trainees in quality improvement initiatives will instill high-value care into their practice. This article charges academic institutions to go beyond dissemination of best practice guidelines and demonstrate accountability for high-value quality improvement implementation. By effectively transitioning to a high-value health care system, medical providers will convincingly demonstrate that patients are their most important priority.

Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy.

PubMed

Lacey, Susan R; Goodyear-Bruch, Caryl; Olney, Adrienne; Hanson, Dave; Altman, Marian S; Varn-Davis, Natasha S; Brinker, Debbie; Lavandero, Ramón; Cox, Karen S

2017-08-01

Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes. The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes. ©2017 American Association of Critical-Care Nurses.

iDriving (Intelligent Driving)

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

Malikopoulos, Andreas

2012-09-17

iDriving identifies the driving style factors that have a major impact on fuel economy. An optimization framework is used with the aim of optimizing a driving style with respect to these driving factors. A set of polynomial metamodels is constructed to reflect the responses produced in fuel economy by changing the driving factors. The optimization framework is used to develop a real-time feedback system, including visual instructions, to enable drivers to alter their driving styles in responses to actual driving conditions to improve fuel efficiency.

Mortality and pulmonary mechanics in relation to respiratory system and transpulmonary driving pressures in ARDS.

PubMed

Baedorf Kassis, Elias; Loring, Stephen H; Talmor, Daniel

2016-08-01

The driving pressure of the respiratory system has been shown to strongly correlate with mortality in a recent large retrospective ARDSnet study. Respiratory system driving pressure [plateau pressure-positive end-expiratory pressure (PEEP)] does not account for variable chest wall compliance. Esophageal manometry can be utilized to determine transpulmonary driving pressure. We have examined the relationships between respiratory system and transpulmonary driving pressure, pulmonary mechanics and 28-day mortality. Fifty-six patients from a previous study were analyzed to compare PEEP titration to maintain positive transpulmonary end-expiratory pressure to a control protocol. Respiratory system and transpulmonary driving pressures and pulmonary mechanics were examined at baseline, 5 min and 24 h. Analysis of variance and linear regression were used to compare 28 day survivors versus non-survivors and the intervention group versus the control group, respectively. At baseline and 5 min there was no difference in respiratory system or transpulmonary driving pressure. By 24 h, survivors had lower respiratory system and transpulmonary driving pressures. Similarly, by 24 h the intervention group had lower transpulmonary driving pressure. This decrease was explained by improved elastance and increased PEEP. The results suggest that utilizing PEEP titration to target positive transpulmonary pressure via esophageal manometry causes both improved elastance and driving pressures. Treatment strategies leading to decreased respiratory system and transpulmonary driving pressure at 24 h may be associated with improved 28 day mortality. Studies to clarify the role of respiratory system and transpulmonary driving pressures as a prognosticator and bedside ventilator target are warranted.

Quality control management and communication between radiologists and technologists.

PubMed

Nagy, Paul G; Pierce, Benjamin; Otto, Misty; Safdar, Nabile M

2008-06-01

The greatest barrier to quality control (QC) in the digital imaging environment is the lack of communication and documentation between those who interpret images and those who acquire them. Paper-based QC methods are insufficient in a digital image management system. Problem work flow must be incorporated into reengineering efforts when migrating to a digital practice. The authors implemented a Web-based QC feedback tool to document and facilitate the communication of issues identified by radiologists. The goal was to promote a responsive and constructive tool that contributes to a culture of quality. The hypothesis was that by making it easier for radiologists to submit quality issues, the number of QC issues submitted would increase. The authors integrated their Web-based quality tracking system with a clinical picture archiving and communication system so that radiologists could report quality issues without disrupting clinical work flow. Graphical dashboarding techniques aid supervisors in using this database to identify the root causes of different types of issues. Over the initial 12-month rollout period, starting in the general section, the authors recorded 20 times more QC issues submitted by radiologists, accompanied by a rise in technologists' responsiveness to QC issues. For technologists with high numbers of QC issues, the incorporation of data from this tracking system proved useful in performance appraisals and in driving individual improvement. This tool is an example of the types of information technology innovations that can be leveraged to support QC in the digital imaging environment. Initial data suggest that the result is not only an improvement in quality but higher levels of satisfaction for both radiologists and technologists.

Development and Implementation of an Innovative Burn Nursing Handbook for Quality Improvement

PubMed Central

Olszewski, Anna; Yanes, Amber; Stafford, Jessica; Greenhalgh, David G.; Palmieri, Tina L.; Sen, Soman; Tran, Nam

2015-01-01

Objective Evidence-based burn nursing literature is extremely limited and often non-existent. As a result, there is a lack of standardization in burn nursing care. Our objective is to evaluate burn nursing knowledge at an academic medical center and implement innovative educational tools to enhance staff competency and improve the quality of care. Methods A collaboration of practicing clinical nurses developed a 24-question knowledge assessment survey (“pre-survey”) to evaluate fundamental burn nursing knowledge (fluid management, burn pathophysiology, burn-related procedures, wound care, infection control). Pre-education knowledge surveys were administered to 59 burn nurses electronically. A writing team of new and experienced nurses was established and developed a 51-page handbook focusing on areas of need identified in the survey. This book was disseminated to staff as required reading. Post-educational surveys were sent to the same nurses who completed the initial survey. Results Forty-six nurses (46/59, 78.0%) completed the survey with a mean (SD) of 55.9 (11.0)% of questions being answered correctly. Post-surveys sent to the same 46 nurses who completed the pre-survey had a response rate of 78.3% (36/46). We observed a significant increase in correctly answered questions (mean [SD]: 69.6 (8.7)%, P<0.001) in the post-survey intervention. Conclusion The handbook improved education and significantly improved overall fundamental burn knowledge of practicing nursing staff. Use of electronic surveys to drive development of targeted educational interventions provides evidence-based tools for establishing burn nursing standards and developing quality improvement metrics. PMID:26284646

Ocular disease and driving.

PubMed

Wood, Joanne M; Black, Alex A

2016-09-01

As the driving population ages, the number of drivers with visual impairment resulting from ocular disease will increase given the age-related prevalence of ocular disease. The increase in visual impairment in the driving population has a number of implications for driving outcomes. This review summarises current research regarding the impact of common ocular diseases on driving ability and safety, with particular focus on cataract, glaucoma, age-related macular degeneration, hemianopia and diabetic retinopathy. The evidence considered includes self-reported driving outcomes, driving performance (on-road and simulator-based) and various motor vehicle crash indices. Collectively, this review demonstrates that driving ability and safety are negatively affected by ocular disease; however, further research is needed in this area. Older drivers with ocular disease need to be aware of the negative consequences of their ocular condition and in the case where treatment options are available, encouraged to seek these earlier for optimum driving safety and quality of life benefits. © 2016 Optometry Australia.

Real-time compression of raw computed tomography data: technology, architecture, and benefits

NASA Astrophysics Data System (ADS)

Wegener, Albert; Chandra, Naveen; Ling, Yi; Senzig, Robert; Herfkens, Robert

2009-02-01

Compression of computed tomography (CT) projection samples reduces slip ring and disk drive costs. A lowcomplexity, CT-optimized compression algorithm called Prism CTTM achieves at least 1.59:1 and up to 2.75:1 lossless compression on twenty-six CT projection data sets. We compare the lossless compression performance of Prism CT to alternative lossless coders, including Lempel-Ziv, Golomb-Rice, and Huffman coders using representative CT data sets. Prism CT provides the best mean lossless compression ratio of 1.95:1 on the representative data set. Prism CT compression can be integrated into existing slip rings using a single FPGA. Prism CT decompression operates at 100 Msamp/sec using one core of a dual-core Xeon CPU. We describe a methodology to evaluate the effects of lossy compression on image quality to achieve even higher compression ratios. We conclude that lossless compression of raw CT signals provides significant cost savings and performance improvements for slip rings and disk drive subsystems in all CT machines. Lossy compression should be considered in future CT data acquisition subsystems because it provides even more system benefits above lossless compression while achieving transparent diagnostic image quality. This result is demonstrated on a limited dataset using appropriately selected compression ratios and an experienced radiologist.

A Lever Coupling Mechanism in Dual-Mass Micro-Gyroscopes for Improving the Shock Resistance along the Driving Direction.

PubMed

Gao, Yang; Li, Hongsheng; Huang, Libin; Sun, Hui

2017-04-30

This paper presents the design and application of a lever coupling mechanism to improve the shock resistance of a dual-mass silicon micro-gyroscope with drive mode coupled along the driving direction without sacrificing the mechanical sensitivity. Firstly, the mechanical sensitivity and the shock response of the micro-gyroscope are theoretically analyzed. In the mechanical design, a novel lever coupling mechanism is proposed to change the modal order and to improve the frequency separation. The micro-gyroscope with the lever coupling mechanism optimizes the drive mode order, increasing the in-phase mode frequency to be much larger than the anti-phase one. Shock analysis results show that the micro-gyroscope structure with the designed lever coupling mechanism can notably reduce the magnitudes of the shock response and cut down the stress produced in the shock process compared with the traditional elastic coupled one. Simulations reveal that the shock resistance along the drive direction is greatly increased. Consequently, the lever coupling mechanism can change the gyroscope's modal order and improve the frequency separation by structurally offering a higher stiffness difference ratio. The shock resistance along the driving direction is tremendously enhanced without loss of the mechanical sensitivity.

Factors driving diabetes care improvement in a large medical group: ten years of progress.

PubMed

Sperl-Hillen, JoAnn M; O'Connor, Patrick J

2005-08-01

The purpose of this study was to document trends in diabetes quality of care and coinciding strategies for quality improvement over 10 years in a large medical group. Adults with diagnosed diabetes mellitus were identified each year from 1994 (N = 5610) to 2003 (N = 7650), and internal medical group data quantified improvement trends. Multivariate analysis was used to identify factors that did and did not contribute to improvement trends. Median glycosylated hemoglobin A1C (A1C) levels improved from 8.3% in 1994 to 6.9% in 2003 (P <.001). Mean low-density lipoprotein (LDL) cholesterol measurements improved from 132 mg/dL in 1995 to 97 mg/dL in 2003 (P <.001). Both A1C (P <.01) and LDL improvement (P <.0001) were driven by drug intensification, leadership commitment to diabetes improvement, greater continuity of primary care, participation in local and national diabetes care improvement initiatives, and allocation of multidisciplinary resources at the clinic level to improve diabetes care. Resources were spent on nurse and dietitian educators, active outreach to high-risk patients facilitated by registries, physician opinion leader activities including clinic-based training programs, and financial incentives to primary care clinics. Use of endocrinology referrals was stable throughout the period at about 10% of patients per year, and there were no disease management contracts to outside vendors over the study period. Electronic medical records did not favorably affect glycemic control or lipid control in this setting. This primary care-based system achieved A1C and LDL reductions sufficient to reduce macrovascular and microvascular risk by about 50% according to landmark studies; further risk reduction should be attainable through better blood pressure control. Strategies for diabetes improvement need to be customized to address documented gaps in quality of care, provider prescribing behaviors, and patient characteristics.

Small-Gauge Pars Plana Vitrectomy for the Management of Symptomatic Posterior Vitreous Detachment after Phacoemulsification and Multifocal Intraocular Lens Implantation: A Pilot Study from the Pan-American Collaborative Retina Study Group

PubMed Central

Navarro, Rodrigo M.; Machado, Leonardo M.; Maia, Ossires; Wu, Lihteh; Farah, Michel E.; Magalhaes, Octaviano; Arevalo, J. Fernando; Maia, Mauricio

2015-01-01

Purpose. To determine the efficacy of 23-gauge pars plana vitrectomy (PPV) for symptomatic posterior vitreous detachment (PVD) on visual acuity (VA) and quality after multifocal intraocular lenses (IOLs). Methods. In this prospective case series, patients who developed symptomatic PVD and were not satisfied with visual quality due to floaters and halos after multifocal IOL implantation underwent PPV. Examinations included LogMAR uncorrected visual acuity (UCVA), intraocular pressure, biomicroscopy, and indirect ophthalmoscopy at baseline and 1, 7, 30, and 180 days postoperatively. Ultrasonography and aberrometry were performed. The Visual Functioning Questionnaire 25 (VFQ-25) was administered preoperatively and at 30 days postoperatively. Both the postoperative UCVA and questionnaire results were compared to preoperative findings using the Wilcoxon test. Results. Sixteen eyes of 8 patients were included. VA significantly improved from 0.17 to 0.09 postoperatively (P = 0.017). All patients reported improvement of halos, glare, and floaters. VFQ-25 scores significantly improved in general vision (P = 0.023), near activities (P = 0.043), distance activities (P = 0.041), mental health (P = 0.011), role difficulties (P = 0.042), and driving (P = 0.016). Conclusion. PPV may increase UCVA and quality of vision in patients with bilateral multifocal IOLs and symptomatic PVD. Larger studies are advised. PMID:26504590

Integration of membrane distillation into traditional salt farming method: Process development and modelling

NASA Astrophysics Data System (ADS)

Hizam, S.; Bilad, M. R.; Putra, Z. A.

2017-10-01

Farmers still practice the traditional salt farming in many regions, particularly in Indonesia. This archaic method not only produces low yield and poor salt quality, it is also laborious. Furthermore, the farming locations typically have poor access to fresh water and are far away from electricity grid, which restrict upgrade to a more advanced technology for salt production. This paper proposes a new concept of salt harvesting method that improves the salt yield and at the same time facilitates recovery of fresh water from seawater. The new concept integrates solar powered membrane distillation (MD) and photovoltaic cells to drive the pumping. We performed basic solar still experiments to quantify the heat flux received by a pond. The data were used as insight for designing the proposed concept, particularly on operational strategy and the most effective way to integrate MD. After the conceptual design had been developed, we formulated mass and energy balance to estimate the performance of the proposed concept. Based on our data and design, it is expected that the system would improve the yield and quality of the salt production, maximizing fresh water harvesting, and eventually provides economical gain for salt farmers hence improving their quality of life. The key performance can only be measured via experiment using gain output ratio as performance indicator, which will be done in a future study.

Parenting and the Young Driver Problem

PubMed Central

Simons-Morton, Bruce G.; Ouimet, Marie Claude; Catalano, Richard F.

2008-01-01

Crash rates increase sharply at the age teenagers begin to drive and remain elevated relative to adult levels well into the twenties. Parents have important roles to play in managing the risk for teenage drivers before and after licensure. Parents can be involved in their teenagers’ driving, allowing them to test for permit and licensure, supervising practice driving, providing access to a vehicle, and setting and enforcing limits on driving privileges after licensure. However, the management practices of many parents may not be sufficient to provide safety effects. The literature indicates that the two most important decisions parents can make to reduce teenagers driving risk is to delay licensure and impose limits on high-risk driving conditions (such as driving at night and with teenage passengers) during the first year of licensure. Two intervention programs have been shown to increase parent limit setting as a means of reducing risky driving behaviors and improving driving performance among novice teenage drivers. This article describes the contexts of and opportunities for parent involvement in teenage driving and the efficacy of interventions to increase and improve parental management of young drivers. PMID:18702985

European Community Respiratory Health Survey calibration project of dosimeter driving pressures.

PubMed

Ward, R J; Ward, C; Johns, D P; Skoric, B; Abramson, M; Walters, E H

2002-02-01

Two potential sources of systematic variation in output from Mefar dosimeters, the system used in the European Community Respiratory Health Survey (ECRHS) study have been evaluated: individual nebulizer characteristics and dosimeter driving pressure. Output variation from 366 new nebulizers produced in two batches for the second ECRHS were evaluated, using a solute tracer method, at a fixed driving pressure. The relationship between dosimeter driving pressure was then characterized and between-centre variation in dosimeter driving pressure was evaluated in an Internet-based survey. A systematic difference between nebulizers manufactured in the two batches was identified. Batch one had a mean+/-SD output of 7.0+/-0.8 mg x s(-1) and batch two, 6.3+/-0.7 mg x s(-1) (p<0.005). There was a wide range of driving pressures generated by Mefar dosimeters as set, ranging between 70-245 kPa, with most outside the quoted manufacturer's specification of 180+/-5%. Nebulizer output was confirmed as linearly related to dosimeter driving pressure (coefficient of determination (R2)=0.99, output=0.0377 x driving pressure-0.4151). The range in driving pressures observed was estimated as consistent with a variation of about one doubling in the provocative dose causing a 20% fall in forced expiratory volume in one second. Systematic variation has been identified that constitutes potentially significant confounders for between-centre comparisons of airway responsiveness in the European Community Respiratory Health Survey, with the dosimeter driving pressure representing the most serious issue. This work confirms the need for appropriate quality control of both nebulizer output and dosimeter driving pressure, in laboratories undertaking field measurements of airway responsiveness. In particular, appropriate data on driving pressures need to be collected and factored into between-centre comparisons. Comprehensive collection of such data to optimize quality control is practicable and has been instigated by the organizing committee for the European Community Respiratory Health Survey II.

Replacing Concrete with Natural and Social Engineering: Learning the Lessons of Stakeholder Engagement from South West Water's Upland Catchment Management Programme

NASA Astrophysics Data System (ADS)

Smith, David; Grand-Clement, Emile; Brazier, Richard

2014-05-01

Replacing Concrete with Natural and Social Engineering: Learning the Lessons of Stakeholder Engagement from South West Water's Upland Catchment Management Programme Smith, D., Grand-Clement, E., Anderson, K., Luscombe, D., G, N., Bratis, Brazier, R.E Peatlands in the South West of the British Isles have been extensively drained for agricultural reclamation and peat cutting. The improvement in food production resulting from this management practice has never clearly been observed. Instead, we are now faced with several detrimental consequences on a whole suite of ecosystem services, such as the delivery of water, water quality, biodiversity and carbon storage. Alongside the direct environmental implications, poor water quality is increasing water treatment costs and will drive significant future investment. As a result, water companies now need to find appropriate solutions to varying water levels and decreasing water quality through catchment management. The Mires Project, the catchment management programme used by South West Water (SWW) is working with a wide range of stakeholders to restore the hydrological functioning of peatlands, and the ecosystem services they provide. This programme is driven by overarching legal requirements (i.e. the water framework directive, Natura 2000), future climate change predictions, corporate responsibility and commercial needs. Post-restoration scientific monitoring is at the heart of the project improving of our understanding of the eco-hydrological and chemical process driving changes in management practice. The challenges faced from the involvement of a wide range of stakeholders will be explored, focusing on the benefits from stakeholder involvement in catchment management and hydrological research, but also considering the difficulties to be overcome. SWW is working with private land-owners, government agencies, local and national park Authorities, community and single interest groups and research institutions to achieve its catchment management objectives. To achieve this it has replaced the traditional water company approach of hard engineering solutions with a mixture of softer natural and social engineering.

Development of a national audit tool for juvenile idiopathic arthritis: a BSPAR project funded by the Health Care Quality Improvement Partnership

PubMed Central

McErlane, Flora; Foster, Helen E; Armitt, Gillian; Bailey, Kathryn; Cobb, Joanna; Davidson, Joyce E; Douglas, Sharon; Fell, Andrew; Friswell, Mark; Pilkington, Clarissa; Strike, Helen; Smith, Nicola; Thomson, Wendy; Cleary, Gavin

2018-01-01

Abstract Objective Timely access to holistic multidisciplinary care is the core principle underpinning management of juvenile idiopathic arthritis (JIA). Data collected in national clinical audit programmes fundamentally aim to improve health outcomes of disease, ensuring clinical care is equitable, safe and patient-centred. The aim of this study was to develop a tool for national audit of JIA in the UK. Methods A staged and consultative methodology was used across a broad group of relevant stakeholders to develop a national audit tool, with reference to pre-existing standards of care for JIA. The tool comprises key service delivery quality measures assessed against two aspects of impact, namely disease-related outcome measures and patient/carer reported outcome and experience measures. Results Eleven service-related quality measures were identified, including those that map to current standards for commissioning of JIA clinical services in the UK. The three-variable Juvenile Arthritis Disease Activity Score and presence/absence of sacro-iliitis in patients with enthesitis-related arthritis were identified as the primary disease-related outcome measures, with presence/absence of uveitis a secondary outcome. Novel patient/carer reported outcomes and patient/carer reported experience measures were developed and face validity confirmed by relevant patient/carer groups. Conclusion A tool for national audit of JIA has been developed with the aim of benchmarking current clinical practice and setting future standards and targets for improvement. Staged implementation of this national audit tool should facilitate investigation of variability in levels of care and drive quality improvement. This will require engagement from patients and carers, clinical teams and commissioners of JIA services. PMID:29069424

Development of a national audit tool for juvenile idiopathic arthritis: a BSPAR project funded by the Health Care Quality Improvement Partnership.

PubMed

McErlane, Flora; Foster, Helen E; Armitt, Gillian; Bailey, Kathryn; Cobb, Joanna; Davidson, Joyce E; Douglas, Sharon; Fell, Andrew; Friswell, Mark; Pilkington, Clarissa; Strike, Helen; Smith, Nicola; Thomson, Wendy; Cleary, Gavin

2018-01-01

Timely access to holistic multidisciplinary care is the core principle underpinning management of juvenile idiopathic arthritis (JIA). Data collected in national clinical audit programmes fundamentally aim to improve health outcomes of disease, ensuring clinical care is equitable, safe and patient-centred. The aim of this study was to develop a tool for national audit of JIA in the UK. A staged and consultative methodology was used across a broad group of relevant stakeholders to develop a national audit tool, with reference to pre-existing standards of care for JIA. The tool comprises key service delivery quality measures assessed against two aspects of impact, namely disease-related outcome measures and patient/carer reported outcome and experience measures. Eleven service-related quality measures were identified, including those that map to current standards for commissioning of JIA clinical services in the UK. The three-variable Juvenile Arthritis Disease Activity Score and presence/absence of sacro-iliitis in patients with enthesitis-related arthritis were identified as the primary disease-related outcome measures, with presence/absence of uveitis a secondary outcome. Novel patient/carer reported outcomes and patient/carer reported experience measures were developed and face validity confirmed by relevant patient/carer groups. A tool for national audit of JIA has been developed with the aim of benchmarking current clinical practice and setting future standards and targets for improvement. Staged implementation of this national audit tool should facilitate investigation of variability in levels of care and drive quality improvement. This will require engagement from patients and carers, clinical teams and commissioners of JIA services. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Response to ProPublica's Rebuttal of Our Critique of the Surgeon Scorecard

PubMed Central

Friedberg, Mark W.; Bilimoria, Karl Y.; Pronovost, Peter J.; Shahian, David M.; Damberg, Cheryl L.; Zaslavsky, Alan M.

2016-01-01

Abstract In the summer of 2015, ProPublica published its Surgeon Scorecard, which displays “Adjusted Complication Rates” for individual, named surgeons for eight surgical procedures performed in hospitals. Public reports of provider performance have the potential to improve the quality of health care that patients receive. A valid performance report can drive quality improvement and usefully inform patients' choices of providers. However, performance reports with poor validity and reliability are potentially damaging to all involved. In September 2015, RAND released a critique of the Scorecard authored by a group of health policy researchers from RAND and other institutions, and on October 7, 2015 ProPublica published a rebuttal of our critique. In this follow-on Perspective, we revisit the main points in our initial critique, summarize ProPublica's rebuttal, explain why this rebuttal fails to address our methodological concerns, provide suggestions on how to validate and improve the Scorecard, and explain why we continue to advise potential users of the Scorecard, as it is currently constructed, not to consider it a valid or reliable predictor of the health outcomes any individual surgeon is likely to provide. PMID:28083432

Emergency department throughput, crowding, and financial outcomes for hospitals.

PubMed

Handel, Daniel A; Hilton, Joshua A; Ward, Michael J; Rabin, Elaine; Zwemer, Frank L; Pines, Jesse M

2010-08-01

Emergency department (ED) crowding has been identified as a major public health problem in the United States by the Institute of Medicine. ED crowding not only is associated with poorer patient outcomes, but it also contributes to lost demand for ED services when patients leave without being seen and hospitals must go on ambulance diversion. However, somewhat paradoxically, ED crowding may financially benefit hospitals. This is because ED crowding allows hospitals to maximize occupancy with well-insured, elective patients while patients wait in the ED. In this article, the authors propose a more holistic model of hospital flow and revenue that contradicts this notion and offer suggestions for improvements in ED and hospital management that may not only reduce crowding and improve quality, but also increase hospital revenues. Also proposed is that increased efficiency and quality in U.S. hospitals will require changes in systematic microeconomic and macroeconomic incentives that drive the delivery of health services in the United States. Finally, the authors address several questions to propose mutually beneficial solutions to ED crowding that include the realignment of hospital incentives, changing culture to promote flow, and several ED-based strategies to improve ED efficiency.

Marketing netcoatings for aquaculture.

PubMed

Martin, Robert J

2014-10-17

Unsustainable harvesting of natural fish stocks is driving an ever growing marine aquaculture industry. Part of the aquaculture support industry is net suppliers who provide producers with nets used in confining fish while they are grown to market size. Biofouling must be addressed in marine environments to ensure maximum product growth by maintaining water flow and waste removal through the nets. Biofouling is managed with copper and organic biocide based net coatings. The aquaculture industry provides a case study for business issues related to entry of improved fouling management technology into the marketplace. Several major hurdles hinder entry of improved novel technologies into the market. The first hurdle is due to the structure of business relationships. Net suppliers can actually cut their business profits dramatically by introducing improved technologies. A second major hurdle is financial costs of registration and demonstration of efficacy and quality product with a new technology. Costs of registration are prohibitive if only the net coatings market is involved. Demonstration of quality product requires collaboration and a team approach between formulators, net suppliers and farmers. An alternative solution is a vertically integrated business model in which the support business and product production business are part of the same company.

Marketing Netcoatings for Aquaculture

PubMed Central

Martin, Robert J.

2014-01-01

Unsustainable harvesting of natural fish stocks is driving an ever growing marine aquaculture industry. Part of the aquaculture support industry is net suppliers who provide producers with nets used in confining fish while they are grown to market size. Biofouling must be addressed in marine environments to ensure maximum product growth by maintaining water flow and waste removal through the nets. Biofouling is managed with copper and organic biocide based net coatings. The aquaculture industry provides a case study for business issues related to entry of improved fouling management technology into the marketplace. Several major hurdles hinder entry of improved novel technologies into the market. The first hurdle is due to the structure of business relationships. Net suppliers can actually cut their business profits dramatically by introducing improved technologies. A second major hurdle is financial costs of registration and demonstration of efficacy and quality product with a new technology. Costs of registration are prohibitive if only the net coatings market is involved. Demonstration of quality product requires collaboration and a team approach between formulators, net suppliers and farmers. An alternative solution is a vertically integrated business model in which the support business and product production business are part of the same company. PMID:25329615

The effects of sleep loss on young drivers' performance: A systematic review.

PubMed

Shekari Soleimanloo, Shamsi; White, Melanie J; Garcia-Hansen, Veronica; Smith, Simon S

2017-01-01

Young drivers (18-24 years) are over-represented in sleep-related crashes (comprising one in five fatal crashes in developed countries) primarily due to decreased sleep opportunity, lower tolerance for sleep loss, and ongoing maturation of brain areas associated with driving-related decision making. Impaired driving performance is the proximal reason for most car crashes. There is still a limited body of evidence examining the effects of sleep loss on young drivers' performance, with discrepancies in the methodologies used, and in the definition of outcomes. This study aimed to identify the direction and magnitude of the effects of sleep loss on young drivers' performance, and to appraise the quality of current evidence via a systematic review. Based on the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) approach, 16 eligible studies were selected for review, and their findings summarised. Next, critical elements of these studies were identified, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines augmented to rate those elements. Using those criteria, the quality of individual papers was calculated and the overall body of evidence for each driving outcome were assigned a quality ranking (from 'very low' to 'high-quality'). Two metrics, the standard deviation of lateral position and number of line crossings, were commonly reported outcomes (although in an overall 'low-quality' body of evidence), with significant impairments after sleep loss identified in 50% of studies. While speed-related outcomes and crash events (also with very low- quality evidence) both increased under chronic sleep loss, discrepant findings were reported under conditions of acute total sleep deprivation. It is crucial to obtain more reliable data about the effects of sleep loss on young drivers' performance by using higher quality experimental designs, adopting common protocols, and the use of consistent metrics and reporting of findings based on GRADE criteria and the PRISMA statement. Key words: Young drivers, sleep loss, driving performance, PRISMA, the GRADE, systematic review.

Driver distraction by smartphone use (WhatsApp) in different age groups.

PubMed

Ortiz, C; Ortiz-Peregrina, S; Castro, J J; Casares-López, M; Salas, C

2018-08-01

This paper investigates the effect that texting with WhatsApp, one of the most common applications for instant messaging, exerts on driving performance. Because distracted driving also affects older drivers, who can have seriously compromised vision, we also analysed the associations between visual-function parameters and driving performance. A total of 75 drivers, experienced in sending WhatsApp messages (≥10WhatsApp messages/week), participated in this study and were divided into four age categories. Visual-function tests included contrast sensitivity with and without glare, retinal straylight and objective assessment of optical quality. Simulated driving performance was assessed under a baseline driving condition (without distraction) as well as a texting condition (WhatsApp messages) while driving. The participants used their own mobile phone. Lastly, objective results of driving performance were compared with subjective self-report data from the Driver Behaviour Questionnaire (DBQ). The analysis indicated that functional changes occurring with age, such as a lower contrast sensitivity and greater retinal straylight, were correlated with a higher number of collisions, longer distances driven outside the lane, and greater standard deviation of lateral position (SDLP). The results showed a significant main effect of age for the driving-performance parameters. Also, compared to the baseline, texting WhatsApp messages while driving worsens driving performance for all age groups, most notably among older participants. Thus, the older drivers' SDLP was ∼14% higher than that for the baseline average of all the other drivers and rose to 29% under distraction, reflecting the impact of secondary tasks. The negative effect of the use of the smartphone during driving was also reflected in the number of collisions, with a greater risk of accidents in all the groups of drivers (by 8.3% for young adults, 25.0% for adults, 80.5% for middle-aged adults, and 134.5% for older drivers). Lastly, participants' subjective responses indicated that younger drivers (18-24 years) had a higher risk of deliberately violating safe driving practices (p < 0.05). The present study demonstrates that texting WhatsApp messages while driving significantly impairs the ability to drive safely, with older drivers being the group most adversely affected. It would be recommendable to include other nonstandard vision tests, which have shown associations with driving performance, in the examination for driver licensing. This would help raise the awareness of older drivers concerning their visual limitations, permitting them to adopt compensatory measures to improve their driving safety. Nevertheless, it is also necessary to raise awareness among the younger drivers of the risks involved in behaviour behind the wheel. Copyright © 2018 Elsevier Ltd. All rights reserved.

Development of a hospital-based program focused on improving healthcare value.

PubMed

Moriates, Christopher; Mourad, Michelle; Novelero, Maria; Wachter, Robert M

2014-10-01

Frontline physicians face increasing pressure to improve the quality of care they deliver while simultaneously decreasing healthcare costs. Although hospitals and physicians are beginning to implement initiatives targeting this new goal of healthcare value, few of them have a well-developed infrastructure to support this work. In March 2012, we launched a high-value care (HVC) program within the Division of Hospital Medicine at the University of California, San Francisco. The HVC program is co-led by a physician and the division's administrator, and includes other hospitalists, resident physicians, pharmacists, and administrators. The program aims to (1) use financial and clinical data to identify areas with clear evidence of waste in the hospital, (2) promote evidence-based interventions that improve both quality of care and value, and (3) pair interventions with evidence-based cost awareness education to drive culture change. We identified 6 ongoing projects during our first year. Preliminary data for our inaugural projects are encouraging. One initiative, which targeted decreasing nebulizer use on a high-acuity medical floor (often using metered-dose inhalers instead) led to a decrease in rates of more than 50%. The HVC program is proving to be a successful mechanism to promote improved healthcare value and clinician engagement. © 2014 Society of Hospital Medicine.

Achieving Hand Hygiene Success With a Partnership Between Graduate Medical Education, Hospital Leadership, and Physicians.

PubMed

Rosenbluth, Glenn; Garritson, Susan; Green, Adrienne L; Milev, Dimiter; Vidyarthi, Arpana R; Auerbach, Andrew D; Baron, Robert B

2016-11-01

Engaging physicians in hand hygiene programs is a challenge faced by many academic medical centers. Partnerships between education and academic leaders present opportunities for effective collaboration and improvement. The authors developed a robust hand hygiene quality improvement program, with attention to rapid-cycle improvements, including all levels of staff and health care providers. The program included a defined governance structure, clear data collection process, educational interventions, rapid-cycle improvements, and financial incentive for staff and physicians (including residents and fellows). Outcomes were measured on patients in all clinical areas. Run charts were used to document compliance in aggregate and by subgroups throughout the project duration. Institutional targets were achieved and then exceeded, with sustained hand hygiene compliance >90%. Physician compliance lagged behind aggregate compliance but ultimately was sustained at a level exceeding the target. Successfully achieving the institutional goal required collaboration among all stakeholders. Physician-specific data and physician champions were essential to drive improvement. © The Author(s) 2015.

Using music to change mood while driving.

PubMed

van der Zwaag, Marjolein D; Janssen, Joris H; Nass, Clifford; Westerink, Joyce H D M; Chowdhury, Shrestha; de Waard, Dick

2013-01-01

This study investigated whether gradual or abrupt music change towards more calming music is most effective in calming drivers during high-demand driving situations. Twenty-eight participants were subjected to two types of music change (gradual, abrupt) in a within-subject design. First, a relatively happy mood was induced with personally selected music during an eight-minute simulated high-demand drive. The drive then continued and the mood was changed either gradually or abruptly. Subjective results showed successful music mood induction irrespective of gradual or abrupt changes. The results further showed lower skin conductance (less arousal) and more facial corrugator muscle tension (more sadness) during the abrupt music change. Fewer accidents occurred during the abrupt music mood change. To conclude, the results support the abrupt way of changing music type to down-regulate one's mood: during high-demand driving, abrupt changes in music led to more physiological calmness and improved driving performance, and were thus safer and more effective. The current study shows that during high-demand drives, drivers are calmed more effectively using abrupt music changes compared to gradual music changes. This is illustrated by reductions in physiological arousal and improved driving behaviour. Hence, in-car music presentation can be used as a tool to improve driver's mood and behaviour.

Fifty years of driving safety research.

PubMed

Lee, John D

2008-06-01

This brief review covers the 50 years of driving-related research published in Human Factors, its contribution to driving safety, and emerging challenges. Many factors affect driving safety, making it difficult to assess the impact of specific factors such as driver age, cell phone distractions, or collision warnings. The author considers the research themes associated with the approximately 270 articles on driving published in Human Factors in the past 50 years. To a large extent, current and past research has explored similar themes and concepts. Many articles published in the first 25 years focused on issues such as driver impairment, individual differences, and perceptual limits. Articles published in the past 25 years address similar issues but also point toward vehicle technology that can exacerbate or mitigate the negative effect of these issues. Conceptual and computational models have played an important role in this research. Improved crash-worthiness has contributed to substantial improvements in driving safety over the past 50 years, but future improvements will depend on enhancing driver performance and perhaps, more important, improving driver behavior. Developing models to guide this research will become more challenging as new technology enters the vehicle and shifts the focus from driver performance to driver behavior. Over the past 50 years, Human Factors has accumulated a large base of driving-related research that remains relevant for many of today's design and policy concerns.

Service Quality in Higher Education Using an Enhanced SERVQUAL Approach

ERIC Educational Resources Information Center

Tan, Kay C.; Kek, Sei W.

2004-01-01

Customer service and quality are driving forces in the business community. As higher educational institutions tussle for competitive advantage and high service quality, the evaluation of educational service quality is essential to provide motivation for and to give feedback on the effectiveness of educational plans and implementation. This…

Gaps in the evidence on improving social care outcomes: findings from a meta-review of systematic reviews.

PubMed

Dickson, Kelly; Sutcliffe, Katy; Rees, Rebecca; Thomas, James

2017-07-01

Adult social care continues to be a central policy concern in the UK. The Adult Social Care Outcomes Framework (ASCOF) is a range of measures nationally available to drive forward improvement on outcomes and quality in local councils. While there is an emphasis on improving transparency, quality and outcomes, drawing on research evidence to achieve these aims is often difficult because the evidence is not easily identifiable, is disparate or of variable quality. We conducted a meta-review to analyse and summarise systematic review-level evidence on the impact of interventions on the four outcomes set out in the ASCOF: quality of life, delaying and reducing the need for services, satisfaction with services and safeguarding of vulnerable adults. This paper focuses on the availability of review-level evidence and the presence of significant gaps in this evidence base. A range of health and social care databases were searched, including MEDLINE, ASSIA and The Cochrane Library in January and February 2012. All systematic reviews evaluating the efficacy of social care interventions for improving ASCOF outcomes for older people, people with long-term conditions, mental health problems or physical and/or learning disabilities were eligible. Two reviewers independently screened systematic reviews for quality and relevance and extracted data; 43 systematic reviews were included, the majority of which examined the impact of interventions on quality of life (n = 34) and delaying and reducing the need for support (n = 25). Limited systematic review-level evidence was found regarding satisfaction with services and safeguarding. There were also significant gaps in relation to key social care interventions and population groups. Research priorities include addressing these gaps and the collation of data on interventions, outcomes and populations more closely related to social care. Overall, a more relevant, comprehensive and robust evidence base is required to support improvement of outcomes for recipients of adult social care. © 2015 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

Regulating the Flow of Change to Reduce Fontline Nurse Stress and Burnout.

PubMed

Koppel, Jenna; Virkstis, Katherine; Strumwasser, Sarah; Katz, Marie; Boston-Fleischhauer, Carol

2015-11-01

The nursing workforce is at the center of many changes associated with care delivery transformation. To achieve this transformation, frontline nursing staff must be engaged in their work, committed to their organization's mission, and capable of delivering high-quality care. To identify top opportunities for driving nursing engagement, researchers from The Advisory Board Company analyzed engagement survey responses from more than 343 000 employees at 575 healthcare organizations. In this article, the authors describe 3 strategies for addressing 1 of the greatest opportunities for improving nurse engagement: ensuring nurses feel their organization helps them reduce stress and burnout.

Schistosoma comparative genomics: integrating genome structure, parasite biology and anthelmintic discovery

PubMed Central

Swain, Martin T.; Larkin, Denis M.; Caffrey, Conor R.; Davies, Stephen J.; Loukas, Alex; Skelly, Patrick J.; Hoffmann, Karl F.

2011-01-01

Schistosoma genomes provide a comprehensive resource for identifying the molecular processes that shape parasite evolution and for discovering novel chemotherapeutic or immunoprophylactic targets. Here, we demonstrate how intra- and intergenus comparative genomics can be used to drive these investigations forward, illustrate the advantages and limitations of these approaches and review how post genomic technologies offer complementary strategies for genome characterisation. While sequencing and functional characterisation of other schistosome/platyhelminth genomes continues to expedite anthelmintic discovery, we contend that future priorities should equally focus on improving assembly quality, and chromosomal assignment, of existing schistosome/platyhelminth genomes. PMID:22024648

Parenting behaviors during risky driving by teens with attention-deficit/hyperactivity disorder.

PubMed

Schatz, Nicole K; Fabiano, Gregory A; Morris, Karen L; Shucard, Jennifer M; Leo, Brittany A; Bieniek, Courtney

2014-03-01

Parenting practices for teen drivers with ADHD were observed via a video monitor installed in vehicles. All teens had recently completed a driver education course and were in the driving permit stage of a graduated driver-licensing program. Parent behaviors were coded during drives when teens were driving safely and during drives when teens engaged in risky driving. The overall frequency of positive parenting strategies was low, regardless of whether teens drove safely or engaged in risky driving. Although the rate of negative feedback was also low, parents engaged in significantly more criticism and were rated by an observer to appear angrier when teens were driving in a risky manner. No other differences in parent behaviors associated with the quality of teen driving were observed. The inconsistencies between observed parenting behaviors and those parenting practices recommended as effective with teens with ADHD are discussed. The need for further research addressing effective strategies for teaching teens with ADHD to drive is highlighted. © 2013.

Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

PubMed Central

2011-01-01

Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. Methods Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. Results The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37). Conclusions Future research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups as well as the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality. PMID:21592322

Criteria for acceptance to preprofessional dietetics programs vs desired qualities of professionals: an analysis.

PubMed

Moore, K K

1995-01-01

The objectives of this analysis were to examine the literature and compare and contrast (a) qualities preferred in preprofessional dietetics students by directors of internships and approved preprofessional practice programs (AP4s), (b) characteristics needed to succeed in a scientific field, (c) traits emphasized by dietetics training programs compared with those most valued by employers, (d) skills needed by high-level managerial dietitians and those in business and communications, and (e) qualities dietitians have aspired to develop for increased competitiveness in the marketplace. Even though the revised Standards of Education have been in place since 1988, recent evaluation of criteria for internship and AP4 admission has shown traditional emphasis on academic performance and the importance of work experience. Success in scientific pursuits has been linked with more than innate intelligence; a drive for success and enthusiasm for learning are also involved. Internships foster mostly technical learning, so development of skills in human and conceptual areas are somewhat lacking. These skills, which have been identified as valuable to employers, need greater development or more consistent identification in the selection and training process. Perhaps serious consideration should be given to applicants for preprofessional programs who have shown leadership qualities through extracurricular activities or who have given themselves the opportunity to develop and improve these skills. Such students might hasten the metamorphosis of dietetics practitioners toward improved levels of compensation and professional fulfillment.

Service Quality in Higher Education--A Case Study of Universiti Brunei Darussalam

ERIC Educational Resources Information Center

Alani, Farooq; Yaqoub, Yasir; Hamdan, Mahani

2015-01-01

No one doubts the value and importance of quality education, and quality assurance is one major driving force to achieve this. Measuring the performance of service quality of education services of Universiti Brunei Darussalam (UBD), as part of the quality assessment, was assessed based on Parasuraman's five Servqual dimensions. The assessment was…

FY2014 Electric Drive Technologies Annual Progress Report

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

None

The Electric Drive Technologies research and development (R&D) subprogram within the DOE Vehicle Technologies Office (VTO) provides support and guidance for many cutting-edge automotive technologies under development. Research is focused on developing power electronics (PE), electric motor, and traction drive system (TDS) technologies that will reduce system cost and improve their efficiency in transforming battery energy to useful work. The R&D is also aimed at better understanding and improving how various components of tomorrow’s automobiles will function as a unified system to improve fuel efficiency.

FY2016 Electric Drive Technologies Annual Progress Report

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

None, None

The Electric Drive Technologies research and development (R&D) subprogram within the DOE Vehicle Technologies Office (VTO) provides support and guidance for many cutting-edge automotive technologies under development. Research is focused on developing power electronics (PE), electric motor, and traction drive system (TDS) technologies that will reduce system cost and improve their efficiency in transforming battery energy to useful work. The R&D is also aimed at better understanding and improving how various components of tomorrow’s automobiles will function as a unified system to improve fuel efficiency.

FY2015 Electric Drive Technologies Annual Progress Report

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

None, None

The Electric Drive Technologies research and development (R&D) subprogram within the DOE Vehicle Technologies Office (VTO) provides support and guidance for many cutting-edge automotive technologies under development. Research is focused on developing power electronics (PE), electric motor, and traction drive system (TDS) technologies that will reduce system cost and improve their efficiency in transforming battery energy to useful work. The R&D is also aimed at better understanding and improving how various components of tomorrow’s automobiles will function as a unified system to improve fuel efficiency.

A novel approach to leveraging electronic health record data to enhance pediatric surgical quality improvement bundle process compliance.

PubMed

Fisher, Jason C; Godfried, David H; Lighter-Fisher, Jennifer; Pratko, Joseph; Sheldon, Mary Ellen; Diago, Thelma; Kuenzler, Keith A; Tomita, Sandra S; Ginsburg, Howard B

2016-06-01

Quality improvement (QI) bundles have been widely adopted to reduce surgical site infections (SSI). Improvement science suggests when organizations achieve high-reliability to QI processes, outcomes dramatically improve. However, measuring QI process compliance is poorly supported by electronic health record (EHR) systems. We developed a custom EHR tool to facilitate capture of process data for SSI prevention with the aim of increasing bundle compliance and reducing adverse events. Ten SSI prevention bundle processes were linked to EHR data elements that were then aggregated into a snapshot display superimposed on weekly case-log reports. The data aggregation and user interface facilitated efficient review of all SSI bundle elements, providing an exact bundle compliance rate without random sampling or chart review. Nine months after implementation of our custom EHR tool, we observed centerline shifts in median SSI bundle compliance (46% to 72%). Additionally, as predicted by high reliability principles, we began to see a trend toward improvement in SSI rates (1.68 to 0.87 per 100 operations), but a discrete centerline shift was not detected. Simple informatics solutions can facilitate extraction of QI process data from the EHR without relying on adjunctive systems. Analyses of these data may drive reductions in adverse events. Pediatric surgical departments should consider leveraging the EHR to enhance bundle compliance as they implement QI strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

Parent Involvement in Novice Teen Driving: Rationale, Evidence of Effects, and Potential for Enhancing Graduated Driver Licensing Effectiveness

PubMed Central

Simons-Morton, Bruce

2007-01-01

Motor vehicle crash rates are highly elevated immediately after licensure and then decline gradually over a period of years. Young age, risk taking, and inexperience contribute to the problem, but inexperience is particularly important early on. Driving is like other complex, skilled behaviors in which subtle improvements in perception and judgment develop gradually over a period of years. After all, safe driving is more a matter of attention and perception than physical management of the vehicle. Inexperience is particularly linked to driving performance and safety outcomes under certain driving conditions, with driving at night and with teen passengers as the most important cases. Surprisingly, driving outcomes do not appear to be affected by the pre-license training or supervised practice driving. Given the limits of training, safety effects can best be achieved by countermeasures that delay licensure or limit driving novice teen driving under high risk driving conditions while novices gain experience and develop safety competence. The two complementary approaches of Graduated Driver Licensing policies and parent management have been shown to provide safety effects by limiting the driving conditions of novice teenagers. Impact on Research, Practice, Policy, and Industry: Advances in GDL and improvements in parent management practices have the potential to reduce crashes and save lives. PMID:17478190

[Simulating of carbon fluxes in bamboo forest ecosystem using BEPS model based on the LAI assimilated with Dual Ensemble Kalman Filter].

PubMed

Li, Xue Jian; Mao, Fang Jie; Du, Hua Qiang; Zhou, Guo Mo; Xu, Xiao Jun; Li, Ping Heng; Liu, Yu Li; Cui, Lu

2016-12-01

LAI is one of the most important observation data in the research of carbon cycle of forest ecosystem, and it is also an important parameter to drive process-based ecosystem model. The Moso bamboo forest (MBF) and Lei bamboo forest (LBF) were selected as the study targets. Firstly, the MODIS LAI time series data during 2014-2015 was assimilated with Dual Ensemble Kalman Filter method. Secondly, the high quality assimilated MBF LAI and LBF LAI were used as input dataset to drive BEPS model for simulating the gross primary productivity (GPP), net ecosystem exchange (NEE) and total ecosystem respiration (TER) of the two types of bamboo forest ecosystem, respectively. The modeled carbon fluxes were evaluated by the observed carbon fluxes data, and the effects of different quality LAI inputs on carbon cycle simulation were also studied. The LAI assimilated using Dual Ensemble Kalman Filter of MBF and LBF were significantly correlated with the observed LAI, with high R 2 of 0.81 and 0.91 respectively, and lower RMSE and absolute bias, which represented the great improvement of the accuracy of MODIS LAI products. With the driving of assimilated LAI, the modeled GPP, NEE, and TER were also highly correlated with the flux observation data, with the R 2 of 0.66, 0.47, and 0.64 for MBF, respectively, and 0.66, 0.45, and 0.73 for LBF, respectively. The accuracy of carbon fluxes modeled with assimilated LAI was higher than that acquired by the locally adjusted cubic-spline capping method, in which, the accuracy of mo-deled NEE for MBF and LBF increased by 11.2% and 11.8% at the most degrees, respectively.

Improving the quality of perinatal mental health: a health visitor-led protocol.

PubMed

Lewis, Anne; Ilot, Irene; Lekka, Chrysanthi; Oluboyede, Yemi

2011-02-01

The mental health of mothers is of significant concern to community practitioners. This paper reports on a case study exploring the success factors of a well established, health visitor-led protocol to identify and treat women with mild to moderate depression. Data were collected through interviews with a purposive sample of 12 community practitioners, a focus group of four health visitors and observation of a multidisciplinary steering group meeting. The protocol was described as an evidence-based tool and safety net that could be used flexibly to support clinical judgments and tailored to individual needs. Success factors included frontline clinician engagement and ownership, continuity of leadership to drive development and maintain momentum, comprehensive and on-going staff training, and strategic support for the protocol as a quality indicator at a time of organisational change. Quality and clinical leadership are continuing policy priorities. The protocol enabled frontline staff to lead a service innovation, providing a standardised multiprofessional approach to women's mental health needs through effective support, advice and treatment that can be measured and quality assured.

Safe driving for teens

MedlinePlus

... in order to improve the odds in their favor. Reckless driving is still a danger to teens -- ... dangerous as alcohol. Do not mix driving with marijuana, other illegal drugs or any prescribed medicine that ...

Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea

PubMed Central

Hack, M.; Davies, R.; Mullins, R.; Choi, S. J.; Ramdassingh-Dow, S.; Jenkinson, C.; Stradling, J.

2000-01-01

BACKGROUND—Obstructive sleep apnoea (OSA) impairs vigilance and may lead to an increased rate of driving accidents. In uncontrolled studies accident rates and simulated steering performance improve following treatment with nasal continuous positive airway pressure (NCPAP). This study seeks to confirm the improvement in steering performance in a randomised controlled trial using subtherapeutic NCPAP as a control treatment.
METHODS—Fifty nine men with OSA (Epworth Sleepiness Score (ESS) of ⩾10, and ⩾10/h dips in SaO2 of >4% due to OSA) received therapeutic or subtherapeutic NCPAP (≈1 cm H2O) for one month. Simulated steering performance over three 30-minute "drives" was quantified as: standard deviation (SD) of road position, deterioration in SD across the drive, length of drive before "crashing", and number of off-road events. The reaction times to peripheral target stimuli during the drive were also measured.
RESULTS—Subtherapeutic NCPAP did not improve overnight >4% SaO2 dips/h compared with baseline values, thus acting as a control. The SD of the steering position improved from 0.36 to 0.21 on therapeutic NCPAP, and from 0.35 to 0.30 on subtherapeutic NCPAP (p = 0.03). Deterioration in SD of the steering position improved from 0.18to 0.06 SD/h with therapeutic NCPAP and worsened from 0.18 to 0.24 with subtherapeutic NCPAP (p = 0.04). The reaction time to target stimuli was quicker after therapeutic than after subtherapeutic NCPAP (2.3 versus 2.7 seconds, p = 0.04).
CONCLUSIONS—Therapeutic NCPAP improves steering performance and reaction time to target stimuli in patients with OSA, lending further support to the hypothesis that OSA impairs driving, increases driving accident rates, and that these improve following treatment with NCPAP.

 PMID:10679542

Protecting Public Health: Plug-In Electric Vehicle Charging and the Healthcare Industry

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

Ryder, Carrie; Lommele, Stephen

In 2014, the U.S. transportation sector consumed more than 13 million barrels of petroleum a day, approximately 70% of all domestic petroleum consumption. Internal combustion engine vehicles are major sources of greenhouse gases (GHGs), smog-forming compounds, particulate matter, and other air pollutants. Widespread use of alternative fuels and advanced vehicles, including plug-in electric vehicles (PEVs), can reduce our national dependence on petroleum and decrease the emissions that impact our air quality and public health. Healthcare organizations are major employers and community leaders that are committed to public well-being and are often early adopters of employer best practices. A growing numbermore » of hospitals are offering PEV charging stations for employees to help promote driving electric vehicles, reduce their carbon footprint, and improve local air quality.« less

Perspectives on the Use of Clinical Pathways in Oncology Care.

PubMed

Chiang, Anne C; Ellis, Peter; Zon, Robin

2017-01-01

Pathways and guidelines are valuable tools to provide evidence-based care in oncology. Pathways may be more restrictive than guidelines because they attempt (where possible) to reduce cost, add efficiency, and remove unwarranted variability. Pathways offer an opportunity to measure, report, and improve quality of care; they can drive to evidence-based targeted therapy where appropriate; they can enhance efficiency through standardization; and, finally, they can be a vehicle to enhance participation in clinical trials. Pathway implementation requires understanding and commitment on the part of the physician and leadership as they may initially disrupt workflow, but ultimately have the ability to enhance patient care. ASCO criteria have been published for the development and implementation of high-quality oncology pathway programs. Future challenges for pathways include incorporation of molecular testing and appropriate targeted care in a real-time precision oncology approach.

The Geothermal Data Repository: Five Years of Open Geothermal Data, Benefits to the Community: Preprint

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

Weers, Jonathan D; Taverna, Nicole; Anderson, Arlene

In the five years since its inception, the Department of Energy's (DOE) Geothermal Data Repository (GDR) has grown from the simple idea of storing public data in a centralized location to a valuable tool at the center of the DOE open data movement where it is providing a tangible benefit to the geothermal scientific community. Throughout this time, the GDR project team has been working closely with the community to refine the data submission process, improve the quality of submitted data, and embrace modern proper data management strategies to maximize the value and utility of submitted data. This paper exploresmore » some of the motivations behind various improvements to the GDR over the last 5 years, changes in data submission trends, and the ways in which these improvements have helped to drive research, fuel innovation, and accelerate the adoption of geothermal technologies.« less

The Geothermal Data Repository: Five Years of Open Geothermal Data, Benefits to the Community

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

Weers, Jonathan D; Taverna, Nicole; Anderson, Arlene

In the five years since its inception, the Department of Energy's (DOE) Geothermal Data Repository (GDR) has grown from the simple idea of storing public data in a centralized location to a valuable tool at the center of the DOE open data movement where it is providing a tangible benefit to the geothermal scientific community. Throughout this time, the GDR project team has been working closely with the community to refine the data submission process, improve the quality of submitted data, and embrace modern proper data management strategies to maximize the value and utility of submitted data. This paper exploresmore » some of the motivations behind various improvements to the GDR over the last 5 years, changes in data submission trends, and the ways in which these improvements have helped to drive research, fuel innovation, and accelerate the adoption of geothermal technologies.« less

Simulations of a Molecular Cloud experiment using CRASH

NASA Astrophysics Data System (ADS)

Trantham, Matthew; Keiter, Paul; Vandervort, Robert; Drake, R. Paul; Shvarts, Dov

2017-10-01

Recent laboratory experiments explore molecular cloud radiation hydrodynamics. The experiment irradiates a gold foil with a laser producing x-rays to drive the implosion or explosion of a foam ball. The CRASH code, an Eulerian code with block-adaptive mesh refinement, multigroup diffusive radiation transport, and electron heat conduction developed at the University of Michigan to design and analyze high-energy-density experiments, is used to perform a parameter search in order to identify optically thick, optically thin and transition regimes suitable for these experiments. Specific design issues addressed by the simulations are the x-ray drive temperature, foam density, distance from the x-ray source to the ball, as well as other complicating issues such as the positioning of the stalk holding the foam ball. We present the results of this study and show ways the simulations helped improve the quality of the experiment. This work is funded by the LLNL under subcontract B614207 and NNSA-DS and SC-OFES Joint Program in High-Energy-Density Laboratory Plasmas, Grant Number DE-NA0002956.

Integer, Fractional, and Sideband Injection Locking of a Spintronic Feedback Nano-Oscillator to a Microwave Signal

NASA Astrophysics Data System (ADS)

Singh, Hanuman; Konishi, K.; Bhuktare, S.; Bose, A.; Miwa, S.; Fukushima, A.; Yakushiji, K.; Yuasa, S.; Kubota, H.; Suzuki, Y.; Tulapurkar, A. A.

2017-12-01

In this paper we demonstrate the injection locking of a recently demonstrated spintronic feedback nano-oscillator to microwave magnetic fields at integers (n =1 , 2, 3) as well as fractional multiples (f =1 /2 , 3 /2 , and 5 /2 ) of its auto-oscillation frequency. Feedback oscillators have delay as a new "degree of freedom" which is absent for spin-transfer torque-based oscillators, which gives rise to side peaks along with a main peak. We show that it is also possible to lock the oscillator on its sideband peaks, which opens an alternative avenue to phase-locked oscillators with large frequency differences. We observe that for low driving fields, sideband locking improves the quality factor of the main peak, whereas for higher driving fields the main peak is suppressed. Further, measurements at two field angles provide some insight into the role of the symmetry of oscillation orbit in determining the fractional locking.

Quality detection system and method of micro-accessory based on microscopic vision

NASA Astrophysics Data System (ADS)

Li, Dongjie; Wang, Shiwei; Fu, Yu

2017-10-01

Considering that the traditional manual detection of micro-accessory has some problems, such as heavy workload, low efficiency and large artificial error, a kind of quality inspection system of micro-accessory has been designed. Micro-vision technology has been used to inspect quality, which optimizes the structure of the detection system. The stepper motor is used to drive the rotating micro-platform to transfer quarantine device and the microscopic vision system is applied to get graphic information of micro-accessory. The methods of image processing and pattern matching, the variable scale Sobel differential edge detection algorithm and the improved Zernike moments sub-pixel edge detection algorithm are combined in the system in order to achieve a more detailed and accurate edge of the defect detection. The grade at the edge of the complex signal can be achieved accurately by extracting through the proposed system, and then it can distinguish the qualified products and unqualified products with high precision recognition.

Verification and Validation in a Rapid Software Development Process

NASA Technical Reports Server (NTRS)

Callahan, John R.; Easterbrook, Steve M.

1997-01-01

The high cost of software production is driving development organizations to adopt more automated design and analysis methods such as rapid prototyping, computer-aided software engineering (CASE) tools, and high-level code generators. Even developers of safety-critical software system have adopted many of these new methods while striving to achieve high levels Of quality and reliability. While these new methods may enhance productivity and quality in many cases, we examine some of the risks involved in the use of new methods in safety-critical contexts. We examine a case study involving the use of a CASE tool that automatically generates code from high-level system designs. We show that while high-level testing on the system structure is highly desirable, significant risks exist in the automatically generated code and in re-validating releases of the generated code after subsequent design changes. We identify these risks and suggest process improvements that retain the advantages of rapid, automated development methods within the quality and reliability contexts of safety-critical projects.

Operationality Improvement Control of Electric Power Assisted Wheelchair by Fuzzy Algorithm Considering Posture Angle

NASA Astrophysics Data System (ADS)

Murakami, Hiroki; Seki, Hirokazu; Minakata, Hideaki; Tadakuma, Susumu

This paper describes a novel operationality improvement control for electric power assisted wheelchairs. “Electric power assisted wheelchair” which assists the driving force by electric motors is expected to be widely used as a mobility support system for elderly people and disabled people, however, the performance of the straight and circular road driving must be further improved because the two wheels drive independently. This paper proposes a novel operationality improvement control by fuzzy algorithm to realize the stable driving on straight and circular roads. The suitable assisted torque of the right and left wheels is determined by fuzzy algorithm based on the posture angular velocity, the posture angle of the wheelchair, the human input torque proportion and the total human torque of the right and left wheels. Some experiments on the practical roads show the effectiveness of the proposed control system.

A Lever Coupling Mechanism in Dual-Mass Micro-Gyroscopes for Improving the Shock Resistance along the Driving Direction

PubMed Central

Gao, Yang; Li, Hongsheng; Huang, Libin; Sun, Hui

2017-01-01

This paper presents the design and application of a lever coupling mechanism to improve the shock resistance of a dual-mass silicon micro-gyroscope with drive mode coupled along the driving direction without sacrificing the mechanical sensitivity. Firstly, the mechanical sensitivity and the shock response of the micro-gyroscope are theoretically analyzed. In the mechanical design, a novel lever coupling mechanism is proposed to change the modal order and to improve the frequency separation. The micro-gyroscope with the lever coupling mechanism optimizes the drive mode order, increasing the in-phase mode frequency to be much larger than the anti-phase one. Shock analysis results show that the micro-gyroscope structure with the designed lever coupling mechanism can notably reduce the magnitudes of the shock response and cut down the stress produced in the shock process compared with the traditional elastic coupled one. Simulations reveal that the shock resistance along the drive direction is greatly increased. Consequently, the lever coupling mechanism can change the gyroscope’s modal order and improve the frequency separation by structurally offering a higher stiffness difference ratio. The shock resistance along the driving direction is tremendously enhanced without loss of the mechanical sensitivity. PMID:28468288

Ability to monitor driving under the influence of marijuana among non-fatal motor-vehicle crashes: An evaluation of the Colorado electronic accident reporting system.

PubMed

Peterson, Alexis B; Sauber-Schatz, Erin K; Mack, Karin A

2018-06-01

As more states legalize medical/recreational marijuana use, it is important to determine if state motor-vehicle surveillance systems can effectively monitor and track driving under the influence (DUI) of marijuana. This study assessed Colorado's Department of Revenue motor-vehicle crash data system, Electronic Accident Reporting System (EARS), to monitor non-fatal crashes involving driving under the influence (DUI) of marijuana. Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to assess EARS' usefulness, flexibility, timeliness, simplicity, acceptability, and data quality. We assessed system components, interviewed key stakeholders, and analyzed completeness of Colorado statewide 2014 motor-vehicle crash records. EARS contains timely and complete data, but does not effectively monitor non-fatal motor-vehicle crashes related to DUI of marijuana. Information on biological sample type collected from drivers and toxicology results were not recorded into EARS; however, EARS is a flexible system that can incorporate new data without increasing surveillance system burden. States, including Colorado, could consider standardization of drug testing and mandatory reporting policies for drivers involved in motor-vehicle crashes and proactively address the narrow window of time for sample collection to improve DUI of marijuana surveillance. Practical applications: The evaluation of state motor-vehicle crash systems' ability to capture crashes involving drug impaired driving (DUID) is a critical first step for identifying frequency and risk factors for crashes related to DUID. Published by Elsevier Ltd.

Advances in Dental Materials through Nanotechnology: Facts, Perspectives and Toxicological Aspects.

PubMed

Padovani, Gislaine C; Feitosa, Victor P; Sauro, Salvatore; Tay, Franklin R; Durán, Gabriela; Paula, Amauri J; Durán, Nelson

2015-11-01

Nanotechnology is currently driving the dental materials industry to substantial growth, thus reflecting on improvements in materials available for oral prevention and treatment. The present review discusses new developments in nanotechnology applied to dentistry, focusing on the use of nanomaterials for improving the quality of oral care, the perspectives of research in this arena, and discussions on safety concerns regarding the use of dental nanomaterials. Details are provided on the cutting-edge properties (morphological, antibacterial, mechanical, fluorescence, antitumoral, and remineralization and regeneration potential) of polymeric, metallic and inorganic nano-based materials, as well as their use as nanocluster fillers, in nanocomposites, mouthwashes, medicines, and biomimetic dental materials. Nanotoxicological aspects, clinical applications, and perspectives for these nanomaterials are also discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Just-in-time in the infrastructure.

PubMed

Guarriello, M L

1997-08-01

We know that just-in-time (JIT) manufacturing is a set of philosophies, not a set of techniques. These same philosophies are embraced by the total quality management (TQM) school. The most important element of this philosophy is that of continuous improvement--the acceptance of constantly changing objectives as a departure from reliance on standard requirements. This fundamental concept drives other philosophical aspects such as improving utilization of resources (employee involvement, reduction of waste) and long-term success (customer focus, vendor partnerships). Clearly, these philosophies are applicable to all organizations and functions. Perhaps some of these philosophies are manifest by certain JIT principles that we might consider when we design organizational routines and practices. Why not apply what has been proven in the factory to the seemingly bureaucratic behaviors in the office.

Wetland biogeochemistry and ecological risk assessment

NASA Astrophysics Data System (ADS)

Bai, Junhong; Huang, Laibin; Gao, Haifeng; Zhang, Guangliang

2017-02-01

Wetlands are an important ecotone between terrestrial and aquatic ecosystems and can provide great ecological service functions. Soils/sediments are one of the important components of wetland ecosystems, which support wetland plants and microorganisms and influence wetland productivity. Moreover, wetland soils/sediments serve as sources, sinks and transfers of carbon, nitrogen, phosphorus and chemical contaminants such as heavy metals. In natural wetland ecosystems, wetland soils/sediments play a great role in improving water quality as these chemical elements can be retained in wetland soils/sediments for a long time. Moreover, the biogeochemical processes of the abovementioned elements in wetland soils/sediments can drive wetland evolution and development, and their changes will considerably affect wetland ecosystem health. Therefore, a better understanding of wetland soil biogeochemistry will contribute to improving wetland ecological service functions.

Single Crystal Casting with Fluidized Carbon Bed Cooling: A Process Innovation for Quality Improvement and Cost Reduction

NASA Astrophysics Data System (ADS)

Hofmeister, M.; Franke, M. M.; Koerner, C.; Singer, R. F.

2017-12-01

Superalloy gas turbine blades are being produced by investment casting and directional solidification. A new process, Fluidized Carbon Bed Cooling (FCBC), has been developed and is now being optimized in a prototype casting unit with 10 kg pouring weight. In early test runs with still rather simple mold cluster geometries, a reduction of the primary dendrite arm spacing of around 40 pct compared to the standard radiation cooling process (HRS) could be demonstrated. The improvement is mainly attributed to higher temperature gradients driving solidification, made possible by a functioning Dynamic Baffle. Compared to earlier development efforts in the literature, contamination of the melt and damage to the equipment are avoided using carbon-based fluidized bed materials and the so-called "counter pressure concept."

Consolidated View on Space Software Engineering Problems - An Empirical Study

NASA Astrophysics Data System (ADS)

Silva, N.; Vieira, M.; Ricci, D.; Cotroneo, D.

2015-09-01

Independent software verification and validation (ISVV) has been a key process for engineering quality assessment for decades, and is considered in several international standards. The “European Space Agency (ESA) ISVV Guide” is used for the European Space market to drive the ISVV tasks and plans, and to select applicable tasks and techniques. Software artefacts have room for improvement due to the amount if issues found during ISVV tasks. This article presents the analysis of the results of a large set of ISVV issues originated from three different ESA missions-amounting to more than 1000 issues. The study presents the main types, triggers and impacts related to the ISVV issues found and sets the path for a global software engineering improvement based on the most common deficiencies identified for space projects.

Depression, diet and exercise.

PubMed

Jacka, Felice N; Berk, Michael

2013-09-16

Unhealthy lifestyle behaviour is driving an increase in the burden of chronic non-communicable diseases worldwide. Recent evidence suggests that poor diet and a lack of exercise contribute to the genesis and course of depression. While studies examining dietary improvement as a treatment strategy in depression are lacking, epidemiological evidence clearly points to diet quality being of importance to the risk of depression. Exercise has been shown to be an effective treatment strategy for depression, but this is not reflected in treatment guidelines, and increased physical activity is not routinely encouraged when managing depression in clinical practice. Recommendations regarding dietary improvement, increases in physical activity and smoking cessation should be routinely given to patients with depression. Specialised and detailed advice may not be necessary. Recommendations should focus on following national guidelines for healthy eating and physical activity.

Classification of driving workload affected by highway alignment conditions based on classification and regression tree algorithm.

PubMed

Hu, Jiangbi; Wang, Ronghua

2018-02-17

Guaranteeing a safe and comfortable driving workload can contribute to reducing traffic injuries. In order to provide safe and comfortable threshold values, this study attempted to classify driving workload from the aspects of human factors mainly affected by highway geometric conditions and to determine the thresholds of different workload classifications. This article stated a hypothesis that the values of driver workload change within a certain range. Driving workload scales were stated based on a comprehensive literature review. Through comparative analysis of different psychophysiological measures, heart rate variability (HRV) was chosen as the representative measure for quantifying driving workload by field experiments. Seventy-two participants (36 car drivers and 36 large truck drivers) and 6 highways with different geometric designs were selected to conduct field experiments. A wearable wireless dynamic multiparameter physiological detector (KF-2) was employed to detect physiological data that were simultaneously correlated to the speed changes recorded by a Global Positioning System (GPS) (testing time, driving speeds, running track, and distance). Through performing statistical analyses, including the distribution of HRV during the flat, straight segments and P-P plots of modified HRV, a driving workload calculation model was proposed. Integrating driving workload scales with values, the threshold of each scale of driving workload was determined by classification and regression tree (CART) algorithms. The driving workload calculation model was suitable for driving speeds in the range of 40 to 120 km/h. The experimental data of 72 participants revealed that driving workload had a significant effect on modified HRV, revealing a change in driving speed. When the driving speed was between 100 and 120 km/h, drivers showed an apparent increase in the corresponding modified HRV. The threshold value of the normal driving workload K was between -0.0011 and 0.056 for a car driver and between -0.00086 and 0.067 for a truck driver. Heart rate variability was a direct and effective index for measuring driving workload despite being affected by multiple highway alignment elements. The driving workload model and the thresholds of driving workload classifications can be used to evaluate the quality of highway geometric design. A higher quality of highway geometric design could keep driving workload within a safer and more comfortable range. This study provided insight into reducing traffic injuries from the perspective of disciplinary integration of highway engineering and human factor engineering.

mHealth: Mobile Technologies to Virtually Bring the Patient Into an Oncology Practice.

PubMed

Pennell, Nathan A; Dicker, Adam P; Tran, Christine; Jim, Heather S L; Schwartz, David L; Stepanski, Edward J

2017-01-01

Accompanied by the change in the traditional medical landscape, advances in wireless technology have led to the development of telehealth or mobile health (mHealth), which offers an unparalleled opportunity for health care providers to continually deliver high-quality care. This revolutionary shift makes the patient the consumer of health care and empowers patients to be the driving force of management of their own health through mobile devices and wearable technology. This article presents an overview of technology as it pertains to clinical practice considerations. Telemedicine is changing the way clinical care is delivered without regard for proximity to the patient, whereas nonclinical telehealth applications affect distance education for consumers or clinicians, meetings, research, continuing medical education, and health care management. Technology has the potential to reduce administrative burdens and improve both efficiency and quality of care delivery in the clinic. Finally, the potential for telehealth approaches as cost-effective ways to improve adherence to treatment is explored. As telehealth advances, health care providers must understand the fundamental framework for applying telehealth strategies to incorporate into successful clinical practice.

Multidisciplinary approach to converting power chair into motorized prone cart.

PubMed

Brose, Steven W; Wali, Eisha

2014-01-01

Pressure ulcers remain a major source of morbidity and mortality in veterans with neurologic impairment. Management of pressure ulcers typically involves pressure relief over skin regions containing wounds, but this can lead to loss of mobility and independence when the wounds are located in regions that receive pressure from sitting. An innovative, low-cost, multidisciplinary effort was undertaken to maximize quality of life in a veteran with a thoracic-4 level complete spinal cord injury and a stage 4 ischial wound. The person's power wheelchair was converted into a motorized prone cart, allowing navigation of the Department of Veterans Affairs spinal cord injury hospital ward and improved socialization while relieving pressure on the wound. Physical and occupational therapy assisted with the reconfiguration of the power chair and verified safe transfers into the chair and driving of the device. Psychology verified positive psychosocial benefit, while nursing and physician services verified an absence of unwanted pain or skin injury resulting from use of the device. Further investigation of ways to apply this technique is warranted to improve the quality of life of persons with pressure ulcers.

NewYork-Presbyterian Hospital: translating innovation into practice.

PubMed

Johnson, Trudy; Currie, Gail; Keill, Patricia; Corwin, Steven J; Pardes, Herbert; Cooper, Mary Reich

2005-10-01

NewYork-Presbyterian (NYP) Hospital, a 2,242-bed not-for-profit academic medical center, was formed by a merger of The New York Hospital and The Presbyterian Hospital in the City of New York. It is also the flagship for the NewYork-Presbyterian Healthcare System, with 37 acute care facilities and 18 others. The hospital embeds safety in the culture through strategic initiatives and enhances service and efficiency using Six Sigma and other techniques to drive adoption of improvements. Goals are selected in alignment with the annual strategic initiatives, which are chosen on the basis of satisfaction surveys, patient and family complaints, community advisory groups, and performance measures, among other sources. A new business intelligence system enables online, dynamic analysis of performance results, replacing static paper reports. Advanced features in the clinical information systems include computerized physician order entry; interactive clinical alerts for decision support; a real-time infection control tracking system; and a clinical data warehouse supporting data mining and analysis for quality improvement, decision making, and education. To achieve clinical, service, and operational excellence, NYP focuses on all Institute of Medicine quality aims.

On-board Measurement of HCN and NH3 Emissions from Vehicles During Real-World Driving

NASA Astrophysics Data System (ADS)

Moss, J. A.; Baum, M. M.

2013-12-01

Emission control systems in light-duty motor vehicles have played an important role in improving regional air quality by dramatically reducing the concentration of criteria pollutants (carbon monoxide, hydrocarbons, and nitrogen oxides) in exhaust emissions. Unintended side-reactions occurring on the surface of three-way catalysts can, however, lead to emission of non-criteria pollutants such as ammonia (NH3) and hydrogen cyanide (HCN). A pair of spectrometers based on tunable diode lasers (TDL) emitting in the near-infrared (1529 nm) and mid-infrared (2975 nm) have been developed for determination of HCN and acetylene (C2H2) emission rates from light-duty motor vehicles in real-time, while driving. Both spectrometers have been evaluated extensively using standard gas mixtures in the laboratory and exhaust from idling and moving vehicles. The TDL spectrometers were incorporated into an on-board instrument suite containing instrumentation for measurement of CO2, HCN, C2H2, NH3 and amines, and exhaust flow rate. On-board measurements were carried out on a fleet of ten vehicles driving a 30 minute circuit representative of real-world urban driving conditions. These measurements afforded emission factors for NH3 (194 × 147 mg km-1) and HCN (3.33 × 3.61 mg km-1), as well as the first report of methylamine emission factors, 0.70 × 0.61 mg km-1. Emissions of both amines were highly correlated (R2 = 0.95). The temporally-resolved TDL spectrometer measurements indicate that the highest HCN and C2H2 emissions occur during specific emission modes that are a function of driving conditions.

Does the Tempo of Music Impact Human Behavior Behind the Wheel?

PubMed

Navarro, Jordan; Osiurak, François; Reynaud, Emanuelle

2018-06-01

Assess the influence of background music tempo on driving performance. Music with a fast tempo is known to increase the level of arousal, whereas the reverse is observed for slow music. The relationship between driving performance and level of arousal was expected to take the form of an inverted U-curve. Three experiments were undertaken to manipulate the musical background during driving. In Experiment 1, the driver's preferred music track played at its original and modified (plus or minus 30%) tempo were used together with the simple ticking of a metronome. In Experiment 2, music tracks of different tempos were played during driving. In Experiment 3, music tracks were categorized as arousing or relaxing based on the associated perceived level of arousal. Listening to music tended to influence drivers' performances in a car-following task by improving coherence and gain adjustments relative to the followed vehicle but simultaneously shortened the intervehicular time. Although the tempo of the music per se did not directly affect driving behavior, arousing music tracks improved drivers' adjustments to the followed vehicle (Experiment 3). The tempo of the music listened to behind the wheel was not found to influence driving behaviors. However, arousing music improved drivers' responsiveness to changes in the speed of the followed vehicle. However, this benefit was canceled out by a reduction in the drivers' intervehicle safety margin. Listening to arousing music while driving cannot be considered to improve road safety, at least in a car-following task without attentional impairments.

Diversity of global rice markets and the science required for consumer-targeted rice breeding.

PubMed

Calingacion, Mariafe; Laborte, Alice; Nelson, Andrew; Resurreccion, Adoracion; Concepcion, Jeanaflor Crystal; Daygon, Venea Dara; Mumm, Roland; Reinke, Russell; Dipti, Sharifa; Bassinello, Priscila Zaczuk; Manful, John; Sophany, Sakhan; Lara, Karla Cordero; Bao, Jinsong; Xie, Lihong; Loaiza, Katerine; El-hissewy, Ahmad; Gayin, Joseph; Sharma, Neerja; Rajeswari, Sivakami; Manonmani, Swaminathan; Rani, N Shobha; Kota, Suneetha; Indrasari, Siti Dewi; Habibi, Fatemeh; Hosseini, Maryam; Tavasoli, Fatemeh; Suzuki, Keitaro; Umemoto, Takayuki; Boualaphanh, Chanthkone; Lee, Huei Hong; Hung, Yiu Pang; Ramli, Asfaliza; Aung, Pa Pa; Ahmad, Rauf; Wattoo, Javed Iqbal; Bandonill, Evelyn; Romero, Marissa; Brites, Carla Moita; Hafeel, Roshni; Lur, Huu-Sheng; Cheaupun, Kunya; Jongdee, Supanee; Blanco, Pedro; Bryant, Rolfe; Thi Lang, Nguyen; Hall, Robert D; Fitzgerald, Melissa

2014-01-01

With the ever-increasing global demand for high quality rice in both local production regions and with Western consumers, we have a strong desire to understand better the importance of the different traits that make up the quality of the rice grain and obtain a full picture of rice quality demographics. Rice is by no means a 'one size fits all' crop. Regional preferences are not only striking, they drive the market and hence are of major economic importance in any rice breeding / improvement strategy. In this analysis, we have engaged local experts across the world to perform a full assessment of all the major rice quality trait characteristics and importantly, to determine how these are combined in the most preferred varieties for each of their regions. Physical as well as biochemical characteristics have been monitored and this has resulted in the identification of no less than 18 quality trait combinations. This complexity immediately reveals the extent of the specificity of consumer preference. Nevertheless, further assessment of these combinations at the variety level reveals that several groups still comprise varieties which consumers can readily identify as being different. This emphasises the shortcomings in the current tools we have available to assess rice quality and raises the issue of how we might correct for this in the future. Only with additional tools and research will we be able to define directed strategies for rice breeding which are able to combine important agronomic features with the demands of local consumers for specific quality attributes and hence, design new, improved crop varieties which will be awarded success in the global market.

Diversity of Global Rice Markets and the Science Required for Consumer-Targeted Rice Breeding

PubMed Central

Calingacion, Mariafe; Laborte, Alice; Nelson, Andrew; Resurreccion, Adoracion; Concepcion, Jeanaflor Crystal; Daygon, Venea Dara; Mumm, Roland; Reinke, Russell; Dipti, Sharifa; Bassinello, Priscila Zaczuk; Manful, John; Sophany, Sakhan; Lara, Karla Cordero; Bao, Jinsong; Xie, Lihong; Loaiza, Katerine; El-hissewy, Ahmad; Gayin, Joseph; Sharma, Neerja; Rajeswari, Sivakami; Manonmani, Swaminathan; Rani, N. Shobha; Kota, Suneetha; Indrasari, Siti Dewi; Habibi, Fatemeh; Hosseini, Maryam; Tavasoli, Fatemeh; Suzuki, Keitaro; Umemoto, Takayuki; Boualaphanh, Chanthkone; Lee, Huei Hong; Hung, Yiu Pang; Ramli, Asfaliza; Aung, Pa Pa; Ahmad, Rauf; Wattoo, Javed Iqbal; Bandonill, Evelyn; Romero, Marissa; Brites, Carla Moita; Hafeel, Roshni; Lur, Huu-Sheng; Cheaupun, Kunya; Jongdee, Supanee; Blanco, Pedro; Bryant, Rolfe; Thi Lang, Nguyen; Hall, Robert D.; Fitzgerald, Melissa

2014-01-01

With the ever-increasing global demand for high quality rice in both local production regions and with Western consumers, we have a strong desire to understand better the importance of the different traits that make up the quality of the rice grain and obtain a full picture of rice quality demographics. Rice is by no means a ‘one size fits all’ crop. Regional preferences are not only striking, they drive the market and hence are of major economic importance in any rice breeding / improvement strategy. In this analysis, we have engaged local experts across the world to perform a full assessment of all the major rice quality trait characteristics and importantly, to determine how these are combined in the most preferred varieties for each of their regions. Physical as well as biochemical characteristics have been monitored and this has resulted in the identification of no less than 18 quality trait combinations. This complexity immediately reveals the extent of the specificity of consumer preference. Nevertheless, further assessment of these combinations at the variety level reveals that several groups still comprise varieties which consumers can readily identify as being different. This emphasises the shortcomings in the current tools we have available to assess rice quality and raises the issue of how we might correct for this in the future. Only with additional tools and research will we be able to define directed strategies for rice breeding which are able to combine important agronomic features with the demands of local consumers for specific quality attributes and hence, design new, improved crop varieties which will be awarded success in the global market. PMID:24454799

The ACTIVE conceptual framework as a structural equation model.

PubMed

Gross, Alden L; Payne, Brennan R; Casanova, Ramon; Davoudzadeh, Pega; Dzierzewski, Joseph M; Farias, Sarah; Giovannetti, Tania; Ip, Edward H; Marsiske, Michael; Rebok, George W; Schaie, K Warner; Thomas, Kelsey; Willis, Sherry; Jones, Richard N

2018-01-01

Background/Study Context: Conceptual frameworks are analytic models at a high level of abstraction. Their operationalization can inform randomized trial design and sample size considerations. The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) conceptual framework was empirically tested using structural equation modeling (N=2,802). ACTIVE was guided by a conceptual framework for cognitive training in which proximal cognitive abilities (memory, inductive reasoning, speed of processing) mediate treatment-related improvement in primary outcomes (everyday problem-solving, difficulty with activities of daily living, everyday speed, driving difficulty), which in turn lead to improved secondary outcomes (health-related quality of life, health service utilization, mobility). Measurement models for each proximal, primary, and secondary outcome were developed and tested using baseline data. Each construct was then combined in one model to evaluate fit (RMSEA, CFI, normalized residuals of each indicator). To expand the conceptual model and potentially inform future trials, evidence of modification of structural model parameters was evaluated by age, years of education, sex, race, and self-rated health status. Preconceived measurement models for memory, reasoning, speed of processing, everyday problem-solving, instrumental activities of daily living (IADL) difficulty, everyday speed, driving difficulty, and health-related quality of life each fit well to the data (all RMSEA < .05; all CFI > .95). Fit of the full model was excellent (RMSEA = .038; CFI = .924). In contrast with previous findings from ACTIVE regarding who benefits from training, interaction testing revealed associations between proximal abilities and primary outcomes are stronger on average by nonwhite race, worse health, older age, and less education (p < .005). Empirical data confirm the hypothesized ACTIVE conceptual model. Findings suggest that the types of people who show intervention effects on cognitive performance potentially may be different from those with the greatest chance of transfer to real-world activities.

The use of meta-analysis or research synthesis to combine driving simulation or naturalistic study results on driver distraction.

PubMed

Caird, Jeff K; Johnston, Katherine A; Willness, Chelsea R; Asbridge, Mark

2014-06-01

Three important and inter-related topics are addressed in this paper. First, the importance of meta-analysis and research synthesis methods to combine studies on traffic safety, in general, and on driver distraction, in particular, is briefly reviewed. Second, naturalistic, epidemiologic, and driving simulation studies on driver distraction are used to illustrate convergent and divergent results that have accumulated thus far in this domain of research. In particular, mobile phone conversation, passenger presence, and text messaging naturalistic studies use meta-analyses and research syntheses to illustrate important patterns of results that are in need of more in-depth study. Third, a number of driver distraction study limitations such as poorly defined dependent variables, lack of methodological detail, and omission of statistical information prevent the integration of many studies into meta-analyses. In addition, the overall quality of road safety studies suffers from these same limitations and suggestions for improvement are made to guide researchers and reviewers. Practical Applications. The use of research synthesis and meta-analysis provide comprehensive estimates of the impact of distractions on driving performance, which can be used to guide public policy and future research. Copyright © 2014 National Safety Council and Elsevier Ltd. All rights reserved.

Drive-level dependence of doubly rotated langasite resonators with different configurations.

PubMed

Zhang, Haifeng; Kosinski, John; Xie, Yuan; Turner, Joseph

2013-05-01

The miniaturization of crystal resonators and filters toward the micro electromechanical systems (MEMS) and nano-structured scales demands improvement of nonlinear piezoelectricity theory and a better understanding of the nonlinear behavior of new crystal materials. The nonlinearities affect the quality factor and acoustic behavior of MEMS and nano-structured resonators and filters. Among these nonlinear effects, drive-level dependence (DLD), which describes the instability of the resonator frequency resulting from voltage level and/or power density, is a potentially significant problem for miniaturized resonators. Langasite, a promising new piezoelectric material, is of current interest for a variety of applications because of its good temperature behavior, good piezoelectric coupling, low acoustic loss, and high Q-factor. It has been recently used to make high-temperature MEMS. In this paper, we report experimental measurements of the DLD of langasite resonators with different resonator configurations (plano-plano, single bevel, and double bevel). The results show that the resonator configuration affects the DLD of the langasite resonator. The DLD measurement results for langasite are compared with literature values for quartz, langaniste, and langatate, and with additional new measurements for a GaPO4 resonator of type R-30 (-11.1° rotated Y-cut). Uncertainty analysis for the measured drive-level sensitivity is performed as well.

Risk-adjusted hospital outcomes for children's surgery.

PubMed

Saito, Jacqueline M; Chen, Li Ern; Hall, Bruce L; Kraemer, Kari; Barnhart, Douglas C; Byrd, Claudia; Cohen, Mark E; Fei, Chunyuan; Heiss, Kurt F; Huffman, Kristopher; Ko, Clifford Y; Latus, Melissa; Meara, John G; Oldham, Keith T; Raval, Mehul V; Richards, Karen E; Shah, Rahul K; Sutton, Laura C; Vinocur, Charles D; Moss, R Lawrence

2013-09-01

BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program-Pediatric was initiated in 2008 to drive quality improvement in children's surgery. Low mortality and morbidity in previous analyses limited differentiation of hospital performance. Participating institutions included children's units within general hospitals and free-standing children's hospitals. Cases selected by Current Procedural Terminology codes encompassed procedures within pediatric general, otolaryngologic, orthopedic, urologic, plastic, neurologic, thoracic, and gynecologic surgery. Trained personnel abstracted demographic, surgical profile, preoperative, intraoperative, and postoperative variables. Incorporating procedure-specific risk, hierarchical models for 30-day mortality and morbidities were developed with significant predictors identified by stepwise logistic regression. Reliability was estimated to assess the balance of information versus error within models. In 2011, 46 281 patients from 43 hospitals were accrued; 1467 codes were aggregated into 226 groupings. Overall mortality was 0.3%, composite morbidity 5.8%, and surgical site infection (SSI) 1.8%. Hierarchical models revealed outlier hospitals with above or below expected performance for composite morbidity in the entire cohort, pediatric abdominal subgroup, and spine subgroup; SSI in the entire cohort and pediatric abdominal subgroup; and urinary tract infection in the entire cohort. Based on reliability estimates, mortality discriminates performance poorly due to very low event rate; however, reliable model construction for composite morbidity and SSI that differentiate institutions is feasible. The National Surgical Quality Improvement Program-Pediatric expansion has yielded risk-adjusted models to differentiate hospital performance in composite and specific morbidities. However, mortality has low utility as a children's surgery performance indicator. Programmatic improvements have resulted in actionable data.

Strategies to sustain a quality improvement initiative in neonatal resuscitation

PubMed Central

van Heerden, Carlien; Janse van Rensburg, Elsie S.

2016-01-01

Background Many neonatal deaths can be prevented globally through effective resuscitation. South Africa (SA) committed towards attaining the Millennium Development Goal 4 (MDG4) set by the World Health Organization (WHO). However, SA’s district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes associated with patient-related, administrative and health care provider factors contribute to neonatal mortality. A quality improvement initiative in neonatal resuscitation could contribute towards decreasing neonatal mortality, thereby contributing towards the attainment of the MDG4. Aim The aim of this study was, (1) to explore and describe the existing situation regarding neonatal resuscitation in a district hospital, (2) to develop strategies to sustain a neonatal resuscitation quality improvement initiative and (3) to decrease neonatal mortality. Changes that occurred and the sustainability of strategies were evaluated. Setting A maternity section of a district hospital in South Africa. Methods The National Health Service (NHS) Sustainability Model formed the theoretical framework for the study. The Problem Resolving Action Research model was applied and the study was conducted in three cycles. Purposive sampling was used for the quantitative and qualitative aspects of data collection. Data was analysed accordingly. Results The findings indicated that the strategies formulated and implemented to address factors related to neonatal resuscitation (training, equipment and stock, staff shortages, staff attitude, neonatal transport and protocols) had probable sustainability and contributed towards a reduction in neonatal mortality in the setting. Conclusion These strategies had the probability of sustainability and could potentially improve neonatal outcomes and reduce neonatal mortality to contribute toward South Africa’s’ drive to attain the MDG4. PMID:27380840

Mechanical-thermal noise in drive-mode of a silicon micro-gyroscope.

PubMed

Yang, Bo; Wang, Shourong; Li, Hongsheng; Zhou, Bailing

2009-01-01

A new closed-loop drive scheme which decouples the phase and the gain of the closed-loop driving system was designed in a Silicon Micro-Gyroscope (SMG). We deduce the system model of closed-loop driving and use stochastic averaging to obtain an approximate "slow" system that clarifies the effect of thermal noise. The effects of mechanical-thermal noise on the driving performance of the SMG, including the noise spectral density of the driving amplitude and frequency, are derived. By calculating and comparing the noise amplitude due to thermal noise both in the opened-loop driving and in the closed-loop driving, we find that the closed-loop driving does not reduce the RMS noise amplitude. We observe that the RMS noise frequency can be reduced by increasing the quality factor and the drive amplitude in the closed-loop driving system. The experiment and simulation validate the feasibility of closed-loop driving and confirm the validity of the averaged equation and its stablility criterion. The experiment and simulation results indicate the electrical noise of closed-loop driving circuitry is bigger than the mechanical-thermal noise and as the driving mass decreases, the mechanical-thermal noise may get bigger than the electrical noise of the closed-loop driving circuitry.

The Employer-Led Health Care Revolution.

PubMed

McDonald, Patricia A; Mecklenburg, Robert S; Martin, Lindsay A

2015-01-01

To tame its soaring health care costs, intel tried many popular approaches: "consumer-driven health care" offerings such as high-deductible/low-premium plans, on-site clinics and employee wellness programs. But by 2009 intel realized that those programs alone would not enable the company to solve the problem, because they didn't affect its root cause: the steadily rising cost of the care employees and their families were receiving. Intel projected that its health care expenditures would hit a whopping $1 billion by 2012. So the company decided to try a novel approach. As a large purchaser of health services and with expertise in quality improvement and supplier management, intel was uniquely positioned to drive transformation in its local health care market. The company decided that it would manage the quality and cost of its health care suppliers with the same rigor it applied to its equipment suppliers by monitoring quality and cost. It spearheaded a collaborative effort in Portland, Oregon, that included two health systems, a plan administrator, and a major government employer. So far the Portland collaborative has reduced treatment costs for certain medical conditions by 24% to 49%, improved patient satisfaction, and eliminated over 10,000 hours worth of waste in the two health systems' business processes.

Transformational change in health care systems: an organizational model.

PubMed

Lukas, Carol VanDeusen; Holmes, Sally K; Cohen, Alan B; Restuccia, Joseph; Cramer, Irene E; Shwartz, Michael; Charns, Martin P

2007-01-01

The Institute of Medicine's 2001 report Crossing the Quality Chasm argued for fundamental redesign of the U.S. health care system. Six years later, many health care organizations have embraced the report's goals, but few have succeeded in making the substantial transformations needed to achieve those aims. This article offers a model for moving organizations from short-term, isolated performance improvements to sustained, reliable, organization-wide, and evidence-based improvements in patient care. Longitudinal comparative case studies were conducted in 12 health care systems using a mixed-methods evaluation design based on semistructured interviews and document review. Participating health care systems included seven systems funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and five systems with long-standing commitments to improvement and high-quality care. Five interactive elements appear critical to successful transformation of patient care: (1) Impetus to transform; (2) Leadership commitment to quality; (3) Improvement initiatives that actively engage staff in meaningful problem solving; (4) Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization; and (5) Integration to bridge traditional intra-organizational boundaries among individual components. These elements drive change by affecting the components of the complex health care organization in which they operate: (1) Mission, vision, and strategies that set its direction and priorities; (2) Culture that reflects its informal values and norms; (3) Operational functions and processes that embody the work done in patient care; and (4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization. The conceptual model holds promise for guiding health care organizations in their efforts to pursue the Institute of Medicine aims of fundamental system redesign to achieve dramatically improved patient care.

Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement.

PubMed

Fiori, Kevin; Schechter, Jennifer; Dey, Monica; Braganza, Sandra; Rhatigan, Joseph; Houndenou, Spero; Gbeleou, Christophe; Palerbo, Emmanuel; Tchangani, Elfamozo; Lopez, Andrew; Bensen, Emily; Hirschhorn, Lisa R

2016-03-01

Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39-95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67-100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67-100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo.

Use of Failure Mode and Effects Analysis to Improve Emergency Department Handoff Processes.

PubMed

Sorrentino, Patricia

2016-01-01

The purpose of this article is to describe a quality improvement process using failure mode and effects analysis (FMEA) to evaluate systems handoff communication processes, improve emergency department (ED) throughput and reduce crowding through development of a standardized handoff, and, ultimately, improve patient safety. Risk of patient harm through ineffective communication during handoff transitions is a major reason for breakdown of systems. Complexities of ED processes put patient safety at risk. An increased incidence of submitted patient safety event reports for handoff communication failures between the ED and inpatient units solidified a decision to implement the use of FMEA to identify handoff failures to mitigate patient harm through redesign. The clinical nurse specialist implemented an FMEA. Handoff failure themes were created from deidentified retrospective reviews. Weekly meetings were held over a 3-month period to identify failure modes and determine cause and effect on the process. A functional block diagram process map tool was used to illustrate handoff processes. An FMEA grid was used to list failure modes and assign a risk priority number to quantify results. Multiple areas with actionable failures were identified. A majority of causes for high-priority failure modes were specific to communications. Findings demonstrate the complexity of transition and handoff processes. The FMEA served to identify and evaluate risk of handoff failures and provide a framework for process improvement. A focus on mentoring nurses to quality handoff processes so that it becomes habitual practice is crucial to safe patient transitions. Standardizing content and hardwiring within the system are best practice. The clinical nurse specialist is prepared to provide strong leadership to drive and implement system-wide quality projects.

Long-term quality of life improvement for chronic intractable back and leg pain patients using spinal cord stimulation: 12-month results from the SENZA-RCT.

PubMed

Amirdelfan, Kasra; Yu, Cong; Doust, Matthew W; Gliner, Bradford E; Morgan, Donna M; Kapural, Leonardo; Vallejo, Ricardo; Sitzman, B Todd; Yearwood, Thomas L; Bundschu, Richard; Yang, Thomas; Benyamin, Ramsin; Burgher, Abram H; Brooks, Elizabeth S; Powell, Ashley A; Subbaroyan, Jeyakumar

2018-06-01

Chronic axial low-back pain is a debilitating disorder that impacts all aspects of an afflicted individual's life. Effective, durable treatments have historically been elusive. Interventional therapies, such as spinal cord stimulation (SCS), have shown limited efficacy at best. Recently, a novel treatment, 10 kHz SCS, has demonstrated superior pain relief compared with traditional SCS in a randomized controlled trial (RCT). In this manuscript, we report on the long-term improvements in quality of life (QoL) outcomes for subjects enrolled in this study. A prospective, multicenter, randomized controlled trial (SENZA-RCT) was conducted. Patients with both chronic back and leg pain were enrolled and randomized (1:1) into 10 kHz SCS or traditional SCS treatment groups. A total of 171 subjects received a permanent SCS device implant. QoL and functionality measures were collected up to 12 months. The device remote control utilization, which is an indication of patient interaction with the device for adjustments, was collected at 24-month post-implantation. At 12 months, a higher proportion of 10 kHz SCS subjects had marked improvement of their disability (Oswestry Disability Index) to a "moderate" or "minimal" impact on their daily function versus the control group. The subjects also reported better improvement in the Global Assessment of Functioning, Clinician Global Impression of Change, Pittsburgh Sleep Quality Index, and short-form McGill Pain Questionnaire, compared to traditional SCS subjects. The 10 kHz SCS subjects also reported far higher rates of both driving and sleeping with their device turned on, as well as reduced reliance on their programmers to adjust therapy settings. In addition to superior pain relief, 10 kHz SCS provides long-term improvements in quality of life and functionality for subjects with chronic low-back and leg pain. ClinicalTrials.gov (NCT01609972).

Meaningful Peer Review in Radiology: A Review of Current Practices and Potential Future Directions.

PubMed

Moriarity, Andrew K; Hawkins, C Matthew; Geis, J Raymond; Dreyer, Keith J; Kamer, Aaron P; Khandheria, Paras; Morey, Jose; Whitfill, James; Wiggins, Richard H; Itri, Jason N

2016-12-01

The current practice of peer review within radiology is well developed and widely implemented compared with other medical specialties. However, there are many factors that limit current peer review practices from reducing diagnostic errors and improving patient care. The development of "meaningful peer review" requires a transition away from compliance toward quality improvement, whereby the information and insights gained facilitate education and drive systematic improvements that reduce the frequency and impact of diagnostic error. The next generation of peer review requires significant improvements in IT functionality and integration, enabling features such as anonymization, adjudication by multiple specialists, categorization and analysis of errors, tracking, feedback, and easy export into teaching files and other media that require strong partnerships with vendors. In this article, the authors assess various peer review practices, with focused discussion on current limitations and future needs for meaningful peer review in radiology. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The use of "vertical integration groups" to help define and update course/clerkship content.

PubMed

Nierenberg, D W

1998-10-01

Faculty at many medical schools are working hard to improve the quality of their curricula. While the world "curriculum" means different things to different people, curricular change often includes improving the structure of the teaching/learning environment (e.g., seminars or problem-based learning groups vs lectures), the content of courses and clerkships (the core set of knowledge, skills, and attitudes that should be learned), and the manner in which student learning of knowledge and skills is evaluated (the sense that evaluation can help "drive" the curriculum). The author describes how "vertical integration groups" have been used over four years at Dartmouth Medical School to improve and modernize the content of courses and clerkships. In this approach, students and faculty work together to address and improve content areas that normally are not associated with traditional, discipline-centered courses or clerkships. The author discusses the advantages of this approach, the challenges encountered during implementation, and examples of how the approach has been put into action.

Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health community

PubMed Central

Wright, J; Harrison, S; McGeorge, M; Patterson, C; Russell, I; Russell, D; Small, N; Taylor, M; Walsh, M; Warren, E; Young, J

2006-01-01

Problem Rapid referral and management of patients with transient ischaemic attacks is a key component in the national strategy for stroke prevention. However, patients with transient ischaemic attacks are poorly identified and undertreated. Design and setting Before and after evaluation of quality improvement programme with controlled comparison in three primary care trusts reflecting diverse populations and organisational structures in an urban district in the North of England. Key measures for improvement The proportion of patients receiving antiplatelet drugs and safe driving advice on referral to a speciality clinic, and the numbers of referrals, adjusted for age, to the specialist clinic before and after the improvement programme. Strategies for change Interviews with patient and professionals to identify gaps and barriers to good practice; development of evidence based guidelines for the management of patients with transient ischaemic attacks; interactive multidisciplinary workshops for each primary care trust with feedback of individual audit results of referral practice; outreach visits to teams who were unable to attend the workshops; referral templates and desktop summaries to provide reminders of the guidelines to clinicians; incorporation of standards into professional contracts. Effects of change A significant improvement occurred in identification and referral of patients with transient ischaemic attacks to specialist clinics, with a 41% increase in referrals from trained practices compared with control practices. There were also significant improvements in the early treatment and safety advice provided to patients before referral. Lessons learnt A strategic approach to effective quality improvement across a diverse health community is feasible and achievable. Careful planning with patient and professional involvement to develop a tailored and multifaceted quality improvement programme to implement evidence based practice can work in very different primary care settings. Key components of the effectiveness of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication, and use of established networks and opinion leaders. PMID:16456203

Spreading a medication administration intervention organizationwide in six hospitals.

PubMed

Kliger, Julie; Singer, Sara; Hoffman, Frank; O'Neil, Edward

2012-02-01

Six hospitals from the San Francisco Bay Area participated in a 12-month quality improvement project conducted by the Integrated Nurse Leadership Program (INLP). A quality improvement intervention that focused on improving medication administration accuracy was spread from two pilot units to all inpatient units in the hospitals. INLP developed a 12-month curriculum, presented in a combination of off-site training sessions and hospital-based training and consultant-led meetings, to teach clinicians the key skills needed to drive organizationwide change. Each hospital established a nurse-led project team, as well as unit teams to address six safety processes designed to improve medication administration accuracy: compare medication to the medication administration record; keep medication labeled throughout; check two patient identifications; explain drug to patient (if applicable); chart immediately after administration; and protect process from distractions and interruptions. From baseline until one year after project completion, the six hospitals improved their medication accuracy rates, on average, from 83.4% to 98.0% in the spread units. The spread units also improved safety processes overall from 83.1% to 97.2%. During the same time, the initial pilot units also continued to improve accuracy from 94.0% to 96.8% and safety processes overall from 95.3% to 97.2%. With thoughtful planning, engaging those doing the work early and focusing on the "human side of change" along with technical knowledge of improvement methodologies, organizations can spread initiatives enterprisewide. This program required significant training of frontline workers in problem-solving skills, leading change, team management, data tracking, and communication.

On-board generation of a highly volatile starting fuel to reduce automobile cold-start emissions.

PubMed

Ashford, Marcus D; Matthews, Ronald D

2006-09-15

The on-board distillation system (OBDS) was developed to extract, from gasoline, a high-volatility fuel for exclusive use during the starting and warm-up periods. The use of OBDS distillate fuel results in much improved mixture preparation, allowing combinations of air/fuel ratio and ignition timing that are not possible with gasoline, even with a fully warm engine. The volatility of the distillate is a function of the parent fuel volatility; however, the variability in distillate quality can be diminished via manipulation of the OBDS operating conditions. Thus, it is possible to develop aggressive starting calibrations that are relatively immune to variations in pump gasoline volatility. The key benefits provided bythe OBDS fuel relative to standard gasoline were found to be (1) improved mixture preparation allowing a 70% reduction of cranking fuel requirements, elimination of air-fuel mixture enrichment during the warm-up period, and significant extension of warm-up ignition timing retard; (2) a 57% decrease in catalyst light-off time, (3) emissions reductions over the FTP drive cycle of 81% for regulated hydrocarbons (NMOG); (4) emissions index (NMOG) approaching that of SULEV/PZEV vehicles; and (5) an apparent 1% increase in fuel economy over the FTP drive cycle.

Case management: key to access, quality, and financial success.

PubMed

Smith, Alison P

2003-01-01

Several strategic, organizational, and operational variables drive successful case management programs. Organizational goals and accountability for support by administrative and medical staff leaders set the stage for a comprehensive program. The integration of utilization review, discharge planning, and other functions into the role of the case manager improves productivity and continuity. Choosing a model for assigning patients, a variable unique to the institution, should be carefully considered. Regardless of the power of strategic goals or the creative selection of a model, daily practices that promote daily review and communication will reveal all of the opportunities for improved performance. Complications are avoided one patient at a time and patients deserve vigilance. Length of stay is shortened 1 day at a time and we can no longer afford to miss these opportunities. In the period of high census, an unnecessary day for one patient at the end of his/her stay may mean another patient being diverted to another hospital away from his/her physician and past medical records. Creating constructive physician partnerships and cooperative relationships with postacute care providers can bring a case management program to higher level of performance. While many organizations have employees called "case managers," fewer have a comprehensive approach that has the potential to drive so many important indicators of performance.

Solid-state transformer-based new traction drive system and control

NASA Astrophysics Data System (ADS)

Feng, Jianghua; Shang, Jing; Zhang, Zhixue; Liu, Huadong; Huang, Zihao

2017-11-01

A new type of traction drive system consisting of solid-state traction transformer (SSTT), inverter unit, auxiliary inverter, traction motor and other key components is built in order to suit the demand of developing the next-generation electric traction system which will be efficient and lightweight, with high power density. For the purpose of reducing system volume and weight and improving efficiency and grid-side power quality, an efficient SSTT optimized topology combining high-voltage cascaded rectifiers with high-power high-frequency LLC resonant converter is proposed. On this basis, an integrated control strategy built upon synchronous rotating reference frame is presented to achieve unified control over fundamental active, reactive and harmonic components. The carrier-interleaving phase shift modulation strategy is proposed to improve the harmonic performance of cascaded rectifiers. In view of the secondary pulsating existing in a single-phase system, the mathematical model of secondary power transfer is built, and the mechanism of pulsating voltage resulting in beat frequency of LLC resonant converter is revealed, so as to design optimum matching of system parameters. Simulation and experimental results have verified that the traction system and control scheme mentioned in this paper are reasonable and superior and that they meet the future application requirements for rail transit.

EVALUATION METHOD OF FUEL-EFFICIENT DRIVING IN DUMP TRUCK USING VEHICLE SPEED AND ENGINE ROTATIONAL SPEED

NASA Astrophysics Data System (ADS)

Hirata, Masafumi; Yamamoto, Tatsuo; Yasui, Toshiaki; Hayashi, Mayu; Takebe, Atsuji; Funahashi, Masashi

In the construction site, the light oil that the construction vehicle such as dump trucks uses accounts for 70 percent of the amount of the energy use. Therefore, the eco-driving education of the construction vehicle is effective in the fuel cost improvement and the CO2 reduction. The eco-driving education can be executed cheap and easily, and a high effect can be expected. However, it is necessary to evaluate the eco-driving situation of the construction vehicle exactly to maintain the educative effect for a long term. In this paper, the method for evaluating the effect of the fuel cost improvement was examined by using the vehicle speed and the engine rotational speed of the dump truck. In this method, "Ideal eco-driving model" that considers the difference between the vehicle model and the running condition (traffic jam etc.) is made. As a result, it is possible to evaluate the fuel consumption improvement effect of a dump truck by the same index.

Decoupling control of steering and driving system for in-wheel-motor-drive electric vehicle

NASA Astrophysics Data System (ADS)

Zhang, Han; Zhao, Wanzhong

2018-02-01

To improve the maneuverability and stability of in-wheel-motor-drive electric vehicle, a control strategy based on nonlinear decoupling control method is proposed in this paper, realizing the coordinated control of the steering and driving system. At first, the nonlinear models of the in-wheel-motor-drive electric vehicle and its sub-system are constructed. Then the inverse system decoupling theory is applied to decompose the nonlinear system into several independent subsystems, which makes it possible to realize the coordinated control of each subsystem. Next, the μ-Synthesis theory is applied to eliminate the influence of model uncertainty, improving the stability, robustness and tracking performance of in-wheel-motor-drive electric vehicle. Simulation and experiment results and numerical analyses, based on the electric vehicle actuated by in-wheel-motors, prove that the proposed control method is effective to accomplish the decoupling control of the steering and driving system in both simulation and real practice.

Amount of Sleep, Daytime Sleepiness, Hazardous Driving, and Quality of Life of Second Year Medical Students.

PubMed

Johnson, Kay M; Simon, Nancy; Wicks, Mark; Barr, Karen; O'Connor, Kim; Schaad, Doug

2017-10-01

The authors describe the sleep habits of second year medical students and look for associations between reported sleep duration and depression, burnout, overall quality of life, self-reported academic success, and falling asleep while driving. The authors conducted a cross-sectional descriptive study of two consecutive cohorts of second year medical students at a large public university in the USA. Participants completed an anonymous survey about their sleep habits, daytime sleepiness (Epworth sleepiness scale), burnout (Maslach burnout inventory), depression (PRIME MD), and perceived stress (perceived stress scale). Categorical and continuous variables were compared using chi square tests and t tests, respectively. Sixty-eight percent of the students responded. Many (34.3%) reported fewer than 7 h of sleep on typical weeknights, including 6.5% who typically sleep less than 6 h. Twenty-five students (8.4%) reported nodding off while driving during the current academic year. Low typical weeknight sleep (fewer than 6 h vs 6-6.9 h vs 7 or more hours) was associated with (1) higher Epworth sleepiness scale scores, (2) nodding off while driving, (3) symptoms of burnout or depression, (4) decreased satisfaction with quality of life, and (5) lower perceived academic success (all p values ≤0.01). Students reporting under 6 h of sleep were four times more likely to nod off while driving than those reporting 7 h or more. Educational, behavioral, and curricular interventions should be explored to help pre-clinical medical students obtain at least 7 h of sleep most on weeknights.

Quality of Services and Quality of Life from Service Providers' Perspectives: Analysis with Focus Groups

ERIC Educational Resources Information Center

Jenaro, C.; Vega, V.; Flores, N.; Cruz, M.

2013-01-01

Background: Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this…

Adjustment to loss of the driving role following traumatic brain injury: a qualitative exploration with key stakeholders.

PubMed

Liddle, Jacki; Fleming, Jennifer; McKenna, Kryss; Turpin, Merrill; Whitelaw, Penny; Allen, Shelley

2012-02-01

Community mobility is affected by an interruption to or cessation of driving following traumatic brain injury (TBI). This study aimed to examine loss of the driving role and to explore the outcomes associated with driving cessation from the perspectives of key people involved within the process: people with TBI, their family members and involved health professionals. A qualitative methodology was used, employing semi-structured interviews with 15 individuals with TBI who had experienced driving cessation, 10 family members and 10 health professionals working with this population. This article focuses on two themes, each with three subthemes. Being stuck: needs related to driving cessation had subthemes: (i) an emotional time, (ii) being normal and (iii) participation without driving. The second theme, A better way: suggestions to improve outcomes had subthemes: (i) information, (ii) support and trying it out and (iii) their family member's roles and needs. Driving cessation following TBI is associated with emotional, identity, transport and participation-related needs. An ongoing, individualised approach involving information, support and practical experiences may improve outcomes of driving cessation for people with TBI and their family members. © 2011 The Authors. Australian Occupational Therapy Journal © 2011 Occupational Therapy Australia.

Effects of efforts to optimise morbidity and mortality rounds to serve contemporary quality improvement and educational goals: a systematic review.

PubMed

Smaggus, Andrew; Mrkobrada, Marko; Marson, Alanna; Appleton, Andrew

2018-01-01

The quality and safety movement has reinvigorated interest in optimising morbidity and mortality (M&M) rounds. We performed a systematic review to identify effective means of updating M&M rounds to (1) identify and address quality and safety issues, and (2) address contemporary educational goals. Relevant databases (Medline, Embase, PubMed, Education Resource Information Centre, Cumulative Index to Nursing and Allied Health Literature, Healthstar, and Global Health) were searched to identify primary sources. Studies were included if they (1) investigated an intervention applied to M&M rounds, (2) reported outcomes relevant to the identification of quality and safety issues, or educational outcomes relevant to quality improvement (QI), patient safety or general medical education and (3) included a control group. Study quality was assessed using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. Given the heterogeneity of interventions and outcome measures, results were analysed thematically. The final analysis included 19 studies. We identified multiple effective strategies (updating objectives, standardising elements of rounds and attaching rounds to a formal quality committee) to optimise M&M rounds for a QI/safety purpose. These efforts were associated with successful integration of quality and safety content into rounds, and increased implementation of QI interventions. Consistent effects on educational outcomes were difficult to identify, likely due to the use of methodologies ill-fitted for educational research. These results are encouraging for those seeking to optimise the quality and safety mission of M&M rounds. However, the inability to identify consistent educational effects suggests the investigation of M&M rounds could benefit from additional methodologies (qualitative, mixed methods) in order to understand the complex mechanisms driving learning at M&M rounds. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Quality of Life of Post-Mastectomy Women Living in a Semi-Arid Region of Brazil.

PubMed

Araújo Neto, Emídio A; Alves, Beatriz C A; Gehrke, Flávia de S; Azzalis, Ligia A; Junqueira, Virginia C B; Sousa, Luiz Vinicius de A; Adami, Fernando; Fonseca, Fernando L A

2017-06-05

Health is the major reference regarding quality of life; when it comes to breast cancer in particular, the loss of a breast traumatically affects a woman's life, reflecting on her quality of life. Recognizing this problem, our aim was to investigate the quality of life of women who live in a semi-arid region of Brazil after breast cancer mastectomy. In this exploratory, transversal and observational study, a Brazilian variantof the shorter version of the original instrument from the World Health Organization Quality of Life (WHOQOL-BREF), applied in the study population, was analyzed and their socio-demographic profile was obtained. The sample was composed of 50 mastectomized women. The 50 included patients comprised women at a mean age of 54 years. Most of them had finished elementary school, and their average income was one Brazilian minimum monthly wage. Regarding the data related to quality of life, the highest score was found in the social relationships domain (4.29) followed by the psychological (4.09) and environmental (3.88) domains. The lowest score observed was for the physical domain (3.48). With these findings we can say that social and psychological parameters are driving factors of the quality of life in post-mastectomy women. Therefore, these results are useful to establish strategies to improve the quality of life of breast cancer mastectomy patients.

Product development cycle time reduction

NASA Astrophysics Data System (ADS)

Farran, Robin

1992-05-01

We are facing here today the key issues that face us in the competitive environment. North American companies are struggling to compete in the global marketplace. Gone are the days when presence ensured success. Then, sales and earnings were guaranteed. Today the competition is intense. Many manufacturing and service companies are no longer competitive. Traditionally, manufacturing companies have created the most wealth for the community and economy. Losing this ability to create wealth is tragic and unnecessary. A company can only be successful by focusing on customer satisfaction at competitive costs. Revenue growth and earnings growth require a continuous stream of products that anticipate the customers' needs, result from shorter and shorter innovation cycles, continually improve in quality, and are produced at improved costs on each cycle. The best opportunities for increased quality and decreased costs are with new products. Sure, work on quality and costs everyday. The biggest changes, however, will come through the new product development cycle. We must improve our development processes to provide leadership products which result in high levels of customer satisfaction. This is a prerequisite for business success. When presence in the marketplace was a virtual guarantee of success for a North American company, technology tended to drive the products, and the customers bought virtually everything that was produced. Functional excellence was stressed within companies ... and that was enough. Effective planning processes were not a prerequisite for success. Today success demands highly developed business research and planning processes, and functional excellence combined with organizational capabilities that ensure commercialization excellence.

Provider diversity in the English NHS: a study of recent developments in four local health economies.

PubMed

Allen, Pauline; Turner, Simon; Bartlett, Will; Perotin, Virginie; Matchaya, Greenwell; Zamora, Bernarda

2012-01-01

To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers. Case studies of four local health economies. Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and third sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Involvement of diverse providers in the NHS is limited. Commissioners' local strategies influence degrees of diversity. Barriers to entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS trusts to respond by making improvements. Information sharing diminishes as competition intensifies. There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

Assessment and prediction of land ecological environment quality change based on remote sensing-a case study of the Dongting lake area in China

NASA Astrophysics Data System (ADS)

Hu, Wenmin; Wang, Zhongcheng; Li, Chunhua; Zhao, Jin; Li, Yi

2018-02-01

Multi-source remote sensing data is rarely used for the comprehensive assessment of land ecologic environment quality. In this study, a digital environmental model was proposed with the inversion algorithm of land and environmental factors based on the multi-source remote sensing data, and a comprehensive index (Ecoindex) was applied to reconstruct and predict the land environment quality of the Dongting Lake Area to assess the effect of human activities on the environment. The main finding was that with the decrease of Grade I and Grade II quality had a decreasing tendency in the lake area, mostly in suburbs and wetlands. Atmospheric water vapour, land use intensity, surface temperature, vegetation coverage, and soil water content were the main driving factors. The cause of degradation was the interference of multi-factor combinations, which led to positive and negative environmental agglomeration effects. Positive agglomeration, such as increased rainfall and vegetation coverage and reduced land use intensity, could increase environmental quality, while negative agglomeration resulted in the opposite. Therefore, reasonable ecological restoration measures should be beneficial to limit the negative effects and decreasing tendency, improve the land ecological environment quality and provide references for macroscopic planning by the government.

Preventing distracted driving among college students: Addressing smartphone use.

PubMed

Hassani, Sahar; Kelly, Erin H; Smith, Jennifer; Thorpe, Sara; Sozzer, Fatima H; Atchley, Paul; Sullivan, Elroy; Larson, Dean; Vogel, Lawrence C

2017-02-01

Based on the National Highway Traffic Safety Association's (NHTSA) Report, fatalities due to distracted driving are on the rise and the highest proportion of fatalities by age group is the 20-29 year old category. To date little has been done to educate college students about the dangers of distracted driving and engage these students in promoting a safe driving culture. Intervening among college students has the potential for making real-time behavior change, can foster a lifetime of safe driving habits among these students, and can help contribute to a culture of safe driving that can be created and sustained through positive messages from peers. The goals of this study were to develop, implement and evaluate a distracted driving presentation for college students to change knowledge, attitude and behavior on distracted driving. A 30-min, multi-media presentation on distracted driving was presented to 19 colleges and universities, totaling 444 college students (mean age 23.7±7.0 years of age, 61% females, 39% males). Students completed three surveys: prior to the workshop (interview 1), immediately after the workshop (interview 2), and 3 months following the workshop (interview 3). We assessed changes between interview 1 and interview 2 and found 15 of the 15 attitude-knowledge based questions significantly improved after the course. In addition, we assessed changes from interviews 1 and 3, and found 11 of the 15 attitude-knowledge based questions maintained their significance. Responses to behavior related questions at three months were also compared to baseline, and significant improvements were found for 12 of the 14 questions. While this study was successful in improving the short-term attitude-knowledge and behaviors on distracted driving, work is needed to sustain (and evaluate) long-term effects. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of tailored on-road driving lessons on driving safety in older adults: A randomised controlled trial.

PubMed

Anstey, Kaarin J; Eramudugolla, Ranmalee; Kiely, Kim M; Price, Jasmine

2018-06-01

We evaluated the effectiveness of individually tailored driving lessons compared with a road rules refresher course for improving older driver safety. Two arm parallel randomised controlled trial, involving current drivers aged 65 and older (Mean age 72.0, 47.4% male) residing in Canberra, Australia. The intervention group (n = 28) received a two-hour class-based road rules refresher course, and two one-hour driving lessons tailored to improve poor driving skills and habits identified in a baseline on-road assessment. The control group (n = 29) received the road rules refresher course only. Tests of cognitive performance, and on-road driving were conducted at baseline and at 12-weeks. Main outcome measure was the Driver safety rating (DSR) on the on-road driving test. The number of Critical Errors made during the on-road was also recorded. 55 drivers completed the trial (intervention group: 27, control group: 28). Both groups showed reduction in dangerous/hazardous driver errors that required instructor intervention. From baseline to follow-up there was a greater reduction in the number of critical errors made by the intervention group relative to the control group (IRR = 0.53, SE = 0.1, p = .008). The intervention group improved on the DSR more than the control group (intervention mean change = 1.07 SD = 2.00, control group mean change = 0.32 SD = 1.61). The intervention group had 64% remediation of unsafe driving, where drivers who achieved a score of 'fail' at baseline, 'passed' at follow-up. The control group had 25% remediation. Tailored driving lessons reduced the critical driving errors made by older adults. Longer term follow-up and larger trials are required. Copyright © 2018 Elsevier Ltd. All rights reserved.

The impact of false warnings on partial and full lane departure warnings effectiveness and acceptance in car driving.

PubMed

Navarro, Jordan; Yousfi, Elsa; Deniel, Jonathan; Jallais, Christophe; Bueno, Mercedes; Fort, Alexandra

2016-12-01

In the past, lane departure warnings (LDWs) were demonstrated to improve driving behaviours during lane departures but little is known about the effects of unreliable warnings. This experiment focused on the influence of false warnings alone or in combination with missed warnings and warning onset on assistance effectiveness and acceptance. Two assistance unreliability levels (33 and 17%) and two warning onsets (partial and full lane departure) were manipulated in order to investigate interaction. Results showed that assistance, regardless unreliability levels and warning onsets, improved driving behaviours during lane departure episodes and outside of these episodes by favouring better lane-keeping performances. Full lane departure and highly unreliable warnings, however, reduced assistance efficiency. Drivers' assistance acceptance was better for the most reliable warnings and for the subsequent warnings. The data indicate that imperfect LDWs (false warnings or false and missed warnings) further improve driving behaviours compared to no assistance. Practitioner Summary: This study revealed that imperfect lane departure warnings are able to significantly improve driving performances and that warning onset is a key element for assistance effectiveness and acceptance. The conclusion may be of particular interest for lane departure warning designers.

Features of electric drive sucker rod pumps for oil production

NASA Astrophysics Data System (ADS)

Gizatullin, F. A.; Khakimyanov, M. I.; Khusainov, F. F.

2018-01-01

This article is about modes of operation of electric drives of downhole sucker rod pumps. Downhole oil production processes are very energy intensive. Oil fields contain many oil wells; many of them operate in inefficient modes with significant additional losses. Authors propose technical solutions to improve energy performance of a pump unit drives: counterweight balancing, reducing of electric motor power, replacing induction motors with permanent magnet motors, replacing balancer drives with chain drives, using of variable frequency drives.

Oscillatory nonohomic current drive for maintaining a plasma current

DOEpatents

Fisch, N.J.

1984-01-01

Apparatus and methods are described for maintaining a plasma current with an oscillatory nonohmic current drive. Each cycle of operation has a generation period in which current driving energy is applied to the plasma, and a relaxation period in which current driving energy is removed. Plasma parameters, such as plasma temperature or plasma average ionic charge state, are modified during the generation period so as to oscillate plasma resistivity in synchronism with the application of current driving energy. The invention improves overall current drive efficiencies.

Oscillatory nonhmic current drive for maintaining a plasma current

DOEpatents

Fisch, Nathaniel J.

1986-01-01

Apparatus and method of the invention maintain a plasma current with an oscillatory nonohmic current drive. Each cycle of operation has a generation period in which current driving energy is applied to the plasma, and a relaxation period in which current driving energy is removed. Plasma parameters, such as plasma temperature or plasma average ionic charge state, are modified during the generation period so as to oscillate plasma resistivity in synchronism with the application of current driving energy. The invention improves overall current drive efficiencies.

Analyzing Vehicle Fuel Saving Opportunities through Intelligent Driver Feedback

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

Gonder, J.; Earleywine, M.; Sparks, W.

2012-06-01

Driving style changes, e.g., improving driver efficiency and motivating driver behavior changes, could deliver significant petroleum savings. This project examines eliminating stop-and-go driving and unnecessary idling, and also adjusting acceleration rates and cruising speeds to ideal levels to quantify fuel savings. Such extreme adjustments can result in dramatic fuel savings of over 30%, but would in reality only be achievable through automated control of vehicles and traffic flow. In real-world driving, efficient driving behaviors could reduce fuel use by 20% on aggressively driven cycles and by 5-10% on more moderately driven trips. A literature survey was conducted of driver behaviormore » influences, and pertinent factors from on-road experiments with different driving styles were observed. This effort highlighted important driver influences such as surrounding vehicle behavior, anxiety over trying to get somewhere quickly, and the power/torque available from the vehicle. Existing feedback approaches often deliver efficiency information and instruction. Three recommendations for maximizing fuel savings from potential drive cycle improvement are: (1) leveraging applications with enhanced incentives, (2) using an approach that is easy and widely deployable to motivate drivers, and (3) utilizing connected vehicle and automation technologies to achieve large and widespread efficiency improvements.« less

Measuring Professionalism in Medicine and Nursing: Results of a European Survey

PubMed Central

Lombarts, Kiki M. J. M. H.; Plochg, Thomas; Thompson, Caroline A.; Arah, Onyebuchi A.

2014-01-01

Background Leveraging professionalism has been put forward as a strategy to drive improvement of patient care. We investigate professionalism as a factor influencing the uptake of quality improvement activities by physicians and nurses working in European hospitals. Objective To (i) investigate the reliability and validity of data yielded by using the self-developed professionalism measurement tool for physicians and nurses, (ii) describe their levels of professionalism displayed, and (iii) quantify the extent to which professional attitudes would predict professional behaviors. Methods and Materials We designed and deployed survey instruments amongst 5920 physicians and nurses working in European hospitals. This was conducted under the cross-sectional multilevel study “Deepening Our Understanding of Quality Improvement in Europe” (DUQuE). We used psychometric and generalized linear mixed modelling techniques to address the aforementioned objectives. Results In all, 2067 (response rate 69.8%) physicians and 2805 nurses (94.8%) representing 74 hospitals in 7 European countries participated. The professionalism instrument revealed five subscales of professional attitude and one scale for professional behaviour with moderate to high internal consistency and reliability. Physicians and nurses display equally high professional attitude sum scores (11.8 and 11.9 respectively out of 16) but seem to have different perceptions towards separate professionalism aspects. Lastly, professionals displaying higher levels of professional attitudes were more involved in quality improvement actions (physicians: b = 0.019, P<0.0001; nurses: b = 0.016, P<0.0001) and more inclined to report colleagues’ underperformance (physicians – odds ratio (OR) 1.12, 95% CI 1.01–1.24; nurses – OR 1.11, 95% CI 1.01–1.23) or medical errors (physicians – OR 1.14, 95% CI 1.01–1.23; nurses – OR 1.43, 95% CI 1.22–1.67). Involvement in QI actions was found to increase the odds of reporting incompetence or medical errors. Conclusion A tool that reliably and validly measures European physicians’ and nurses’ commitment to professionalism is now available. Collectively leveraging professionalism as a quality improvement strategy may be beneficial to patient care quality. PMID:24849320

Controlled Speed Accessory Drive demonstration program

NASA Technical Reports Server (NTRS)

Hoehn, F. W.

1981-01-01

A Controlled Speed Accessory Drive System was examined in an effort to improve the fuel economy of passenger cars. Concept feasibility and the performance of a typical system during actual road driving conditions were demonstrated. The CSAD system is described as a mechanical device which limits engine accessory speeds, thereby reducing parasitic horsepower losses and improving overall vehicle fuel economy. Fuel consumption data were compiled for fleets of GSA vehicles. Various motor pool locations were selected, each representing different climatic conditions. On the basis of a total accumulated fleet usage of nearly three million miles, an overall fuel economy improvement of 6 percent to 7 percent was demonstrated. Coincident chassis dynamometer tests were accomplished on selected vehicles to establish the effect of different accessory drive systems on exhaust emissions, and to evaluate the magnitude of the mileage benefits which could be derived.

Sleep habits and road traffic accident risk for Iranian occupational drivers.

PubMed

Ebrahimi, Mohammad Hossein; Sadeghi, Masoumeh; Dehghani, Mohsen; Niiat, Khosro Sadegh

2015-01-01

The aim of this study is to assess the sleep quality and sleep disorders (prevalence of obstructive sleep apnea and sleepiness) among occupational drivers in Iran and to determine which demographic factors and occupational habits are linked to road traffic accidents. In this analytic cross-sectional study 556 occupational road drivers from Shahroud city (in the northeast of Iran) participated, upon a prior verbal informed consent, during 2013-2014. The Pittsburgh Sleep Quality Index (PSQI) standard questionnaire that scored on 7 point scale, the 8-item Epworth Sleepiness Scale (ESS) questionnaire and the 8-question STOP-Bang questionnaire along with demographic information and occupational data were used. To explore the independent factors associated with odds of poor sleep quality and road accident, multiple logistic regression models were used. Prevalence of previous road accidents, sleepiness while driving, and obstructive sleep apnea scored ≥ 3 in the study, and drivers accounted for 23.8%, 29%, and 24.8%, respectively. The global mean score of sleep quality and excessive sleepiness score were 5.2 and 4.8, respectively. The main factors related to the odds of poor sleep quality were snoring (odds ratio (OR) = 2.34; 95% confidence interval (CI): 1.15-4.77), smoking (OR = 2.12; 95% CI: 1.15-3.97), and driving times in a day (OR = 1.12; 95% CI: 1.03-1.21). The Epworth Sleepiness Scale (OR = 1.13; 95% CI: 1.07-1.23) and suffering from apnea (OR = 4.89; 95% CI: 1.07-23.83) were the best predictors for odds (increased risk) of road accidents. A considerable proportion of Iranian drivers had records of road accidents; poor sleep quality, sleepiness while driving, and sleep disorder breathing (obstructive sleep apnea - OSA). Snoring, smoking, driving time in a day, excessive sleepiness, and presumably apnea increase the odds of poor sleep quality and road traffic accident for Iranian occupational drivers. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Why do drivers become safer over the first three months of driving? A longitudinal qualitative study.

PubMed

Day, Marianne R; Thompson, Andrew R; Poulter, Damian R; Stride, Christopher B; Rowe, Richard

2018-08-01

Drivers are at high crash risk when they begin independent driving, with liability decreasing steeply over the first three months. Their behavioural development, and other changes underlying improved safety are not well understood. We adopted an innovative longitudinal qualitative design, with thirteen newly qualified drivers completing a total of 36 semi-structured interviews, one, two and three months after acquiring a full UK driving license. The interviews probed high-risk factors for new drivers, as well as allowing space for generating novel road safety issues. Analysis adopted a dual deductive and inductive interpretative thematic approach, identifying three super-ordinate themes: (1) Improvements in car control skills and situation awareness; (2) A reduction in the thrill of taking risks when driving against a background of generally increasing driving speed; (3) Early concerns about their social status in the eyes of other road users during the early stages of driving, which may put pressure on them to drive faster than they felt comfortable with. The study provides important new leads towards understanding how novice driving becomes safer over the first few months of driving, including how well-studied concepts of driving skill and style may change during development of independent driving, and bringing the less rigorously studied concept of social status into focus. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Study of the impact of a telematics system on safe and fuel-efficient driving in trucks.

DOT National Transportation Integrated Search

2014-04-01

A telematics system has been successfully demonstrated to be useful for improving motor carrier efficiency. In this : particular field study, the research team demonstrated that telematics can be used to monitor and improve safe : driving behavior as...

Membrane-Based Absorption Refrigeration Systems: Nanoengineered Membrane-Based Absorption Cooling for Buildings Using Unconcentrated Solar & Waste Heat

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

None

BEETIT Project: UFL is improving a refrigeration system that uses low quality heat to provide the energy needed to drive cooling. This system, known as absorption refrigeration system (ARS), typically consists of large coils that transfer heat. Unfortunately, these large heat exchanger coils are responsible for bulkiness and high cost of ARS. UFL is using new materials as well as system design innovations to develop nanoengineered membranes to allow for enhanced heat exchange that reduces bulkiness. UFL’s design allows for compact, cheaper and more reliable use of ARS that use solar or waste heat.

Clean Energy Manufacturing Initiative Solid-State Lighting

ScienceCinema

Thomas, Sunil; Edmond, John; Krames, Michael; Rama

2018-05-30

The importance of U.S. manufacturing for clean energy technologies, such as solid-state lighting (SSL), is paramount to increasing competitiveness in a global marketplace. SSLs are poised to drive the lighting market, worldwide. In order to continue that competitiveness and support further innovation, the time to invest in U.S. manufacturing of clean energy technologies is now. Across the country, companies developing innovative clean energy technologies find competitive advantages to manufacturing in the U.S. The Department of Energy's Building Technology Office SSL Manufacturing Roadmap is just one example of how we support manufacturing through convening industry perspectives on opportunities to significantly reduce risk, improve quality, increase yields, and lower costs.

Rack 'em, pack 'em and stack 'em: challenges and opportunities in teaching large classes in higher education.

PubMed

Kumar, Saravana

2013-01-01

The higher education sector is undergoing tremendous change, driven by complex driving forces including financial, administrative, and organisational and stakeholder expectations. It is in this challenging environment, educators are required to maintain and improve the quality of teaching and learning outcomes while contending with increasing class sizes. Despite mixed evidence on the effectiveness of large classes on student outcomes, large classes continue to play an important part in higher education. While large classes pose numerous challenges, they also provide opportunities for innovative solutions. This paper provides an overview of these challenges and highlights opportunities for innovative solutions.

Impact of Methylphenidate Delivery Profiles on Driving Performance of Adolescents with Attention-Deficit/hyperactivity Disorder: A Pilot Study

ERIC Educational Resources Information Center

Cox, Daniel J.; Merkel, R. Lawrence; Penberthy, Jennifer Kim; Kovatchev, Boris; Hankin, Cheryl S.

2004-01-01

Objective: Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at high risk for driving accidents. One dose of methylphenidate (MPH) improves simulator driving performances of ADHD-diagnosed adolescents at 1.5 hours post-dose. However, little is known about the effects of different MPH delivery profiles on driving performance…

A regional programme to improve skin cancer management.

PubMed

McGeoch, Graham R; Sycamore, Mark J; Shand, Brett I; Simcock, Jeremy W

2015-12-01

In 2008, public specialist and general practice services in Canterbury were unable to manage demand for skin cancer treatment. Local clinicians decided the solution was to develop a see-and-treat skin excision clinic staffed by plastic surgeons and general practitioners (GPs), and the introduction of subsidised excisions in general practice. This paper describes the collaboration between clinicians, managers and funders and the results and quality management measures of these initiatives. There is an increasing incidence of skin cancer. GPs in Canterbury were unable to meet increasing demand for skin cancer treatment because some lacked confidence and competence in skin cancer management. There was no public funding for primary care management of skin cancer, driving patients to fully funded secondary care services. Secondary care services were at capacity, with no coordinated programme across primary and secondary care. The programme has resulted in a greater number of skin cancers being treated by the public health system, a reduction in waiting times for treatment, and fewer minor skin lesions being referred to secondary care. Quality measures have been achieved and are improving steadily. Development of the programme has improved working relationships between primary and secondary care clinicians. The strategy was to facilitate the working relationship between primary and secondary care and increase the capacity for skin lesion excisions in both sectors. Skin cancer management can be improved by a coordinated approach between primary and secondary care.

Development of the breastfeeding quality improvement in hospitals learning collaborative in New York state.

PubMed

Fitzpatrick, Eileen; Dennison, Barbara A; Welge, Sara Bonam; Hisgen, Stephanie; Boyce, Patricia Simino; Waniewski, Patricia A

2013-06-01

Exclusive breastfeeding is a public health priority. A strong body of evidence links maternity care practices, based on the Ten Steps to Successful Breastfeeding, to increased breastfeeding initiation, duration and exclusivity. Despite having written breastfeeding policies, New York (NY) hospitals vary widely in reported maternity care practices and in prevalence rates of breastfeeding, especially exclusive breastfeeding, during the birth hospitalization. To improve hospital maternity care practices, breastfeeding support, and the percentage of infants exclusively breastfeeding, the NY State Department of Health developed the Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative. The BQIH Learning Collaborative was the first to use the Institute for Health Care Improvement's Breakthrough Series methodology to specifically focus on increasing hospital breastfeeding support. The evidence-based maternity care practices from the Ten Steps to Successful Breastfeeding provided the basis for the Change Package and Data Measurement Plan. The present article describes the development of the BQIH Learning Collaborative. The engagement of breastfeeding experts, partners, and stakeholders in refining the Learning Collaborative design and content, in defining the strategies and interventions (Change Package) that drive hospital systems change, and in developing the Data Measurement Plan to assess progress in meeting the Learning Collaborative goals and hospital aims is illustrated. The BQIH Learning Collaborative is a model program that was implemented in a group of NY hospitals with plans to spread to additional hospitals in NY and across the country.

Quality of Cultural Heritage in EIA; twenty years of experience in Norway

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

Lindblom, Inge, E-mail: inge.lindblom@niku.no

2012-04-15

The aim of this paper is to clarify and discuss how quality, relevance, attitudes, beliefs and transfer value act as underlying driving forces in the development of the Cultural Heritage theme in EIAs. One purpose is to identify and discuss some conditions that can better environmental assessment in order to increase the significance of EIA in decision-making with regard to Cultural Heritage. The main tools used are different research methods designed for analyses of quality and quality changes, primarily based on the relevant opinions of 160 people occupied with Cultural Heritage in EIA in Norway. The study is based onmore » a review of 40 types of EIAs from 1991 to 2000, an online questionnaire to 319 (160 responded) individuals from 14 different backgrounds, and interviews with three institutions in Sweden and Denmark. The study confirms a steadily increasing quality on EIRs over time, parallel with an improvement of the way in which Cultural Heritage is treated in EIA. This is supported by both the interviews and the qualitative comments regarding the survey. Potential for improvements is shown to be a need for more detailed background material as well as more use of adequate methods. The survey shows the existence of a wide variety of negative views, attitudes and beliefs, but the consequences of this are difficult to evaluate. However, most certainly, negative attitudes and beliefs have not been powerful enough to be detrimental to the quality of Cultural Heritage component, as nothing in the study indicates that negative attitudes and myths are undermining the system of EIA. The study shows the importance of having on-going discussions on quality and quality change over time by people involved in EIA, and how this is a necessary condition for successful implementation and acceptance. Beliefs and negative attitudes can also be a catalyst for developing better practice and advancing new methodology. In addition, new EIA countries must be prepared for several years of development and improvements after implementation. This is important in order to gain acceptance from the bureaucracy, especially from the Cultural Heritage authorities and local population.« less

Feasibility and acceptability of esophageal-directed hypnotherapy for functional heartburn.

PubMed

Riehl, M E; Pandolfino, J E; Palsson, O S; Keefer, L

2016-07-01

Functional heartburn (FH) is a benign but burdensome condition characterized by painful, burning epigastric sensations in the absence of acid reflux or symptom-reflux correlation. Esophageal hypersensitivity and its psychological counterpart, esophageal hypervigilance (EHv) drive symptom experience. Hypnotherapy (HYP) is an established and preferred intervention for refractory symptoms in functional gastrointestinal disorders (FGIDs) and could be applied to FH. The objective of this study was to determine the feasibility, acceptability, and clinical utility of 7 weekly sessions of esophageal-directed HYP (EHYP) on heartburn symptoms, quality of life, and EHv. Similar to other work in FGIDs and regardless of hypnotizability, there were consistent and significant changes in heartburn symptoms, visceral anxiety, and quality of life and a trend for improvement in catastrophizing. We would recommend EHYP in FH patients who are either non-responsive to medications or who would prefer a lifestyle intervention. © 2015 International Society for Diseases of the Esophagus.

The feasibility and acceptability of esophageal-directed hypnotherapy for functional heartburn

PubMed Central

Riehl, M. E.; Pandolfino, J. E.; Palsson, O. S.; Keefer, L.

2015-01-01

SUMMARY Functional Heartburn (FH) is a benign but burdensome condition characterized by painful, burning epigastric sensations in the absence of acid reflux or symptom-reflux correlation. Esophageal hypersensitivity and its psychological counterpart, esophageal hypervigilance (EHv) drive symptom experience. Hypnotherapy (HYP) is an established and preferred intervention for refractory symptoms in functional gastrointestinal disorders (FGIDs) and could be applied to FH. The objective of this study was to determine the feasibility, acceptability and clinical utility of 7 weekly sessions of esophageal-directed hypnotherapy (EHYP) on heartburn symptoms, quality of life and EHv. Similar to other work in FGIDs and regardless of hypnotizability, there were consistent and significant changes in heartburn symptoms, visceral anxiety and quality of life and a trend for improvement in catastrophizing. We would recommend EHYP in FH patients who are either non-responsive to medications or who would prefer a lifestyle intervention. PMID:25824436

Cesarean Delivery Rates Vary 10-Fold Among US Hospitals; Reducing Variation May Address Quality, Cost Issues

PubMed Central

Kozhimannil, Katy Backes; Law, Michael R.; Virnig, Beth A.

2013-01-01

Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordination of maternity care, more data collection and measurement, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting. PMID:23459732

MRI Artifacts of a Metallic Stent Derived From a Human Aorta Specimen

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

Soto, M. E.; Flores, P.; Marrufo, O.

Magnetic resonance imaging has proved to be a useful technique to get images of the whole body. However, the presence of ferromagnetic material can cause susceptibility artifacts, which result from microscopic gradients that occur near the boundaries between areas displaying different magnetic susceptibility. These gradients cause dephasing of spins and frequency shifts in the surrounding tissues. Intravoxel dephasing and spatial mis-registration can degrade image quality. An aorta with a metallic stent was preserved in formaldehyde at 10% inside acrylic cylinders and used to obtain MR images. We tested pulsed spin echo and gradient echo sequences to improve image quality. Allmore » experiments were performed on a 7T/21 cm Varian system (Varian, Inc, Palo Alto, CA) equipped with Direct Drive technology and a 16-rung birdcage coil transceiver. The presence of metallic stents produces a lack of signal that might give falsely reassuring appearances within the vessel lumen.« less

Wavefront sensorless adaptive optics temporal focusing-based multiphoton microscopy

PubMed Central

Chang, Chia-Yuan; Cheng, Li-Chung; Su, Hung-Wei; Hu, Yvonne Yuling; Cho, Keng-Chi; Yen, Wei-Chung; Xu, Chris; Dong, Chen Yuan; Chen, Shean-Jen

2014-01-01

Temporal profile distortions reduce excitation efficiency and image quality in temporal focusing-based multiphoton microscopy. In order to compensate the distortions, a wavefront sensorless adaptive optics system (AOS) was integrated into the microscope. The feedback control signal of the AOS was acquired from local image intensity maximization via a hill-climbing algorithm. The control signal was then utilized to drive a deformable mirror in such a way as to eliminate the distortions. With the AOS correction, not only is the axial excitation symmetrically refocused, but the axial resolution with full two-photon excited fluorescence (TPEF) intensity is also maintained. Hence, the contrast of the TPEF image of a R6G-doped PMMA thin film is enhanced along with a 3.7-fold increase in intensity. Furthermore, the TPEF image quality of 1μm fluorescent beads sealed in agarose gel at different depths is improved. PMID:24940539

Quality of life technology: the state of personal transportation.

PubMed

van Roosmalen, Linda; Paquin, Gregory J; Steinfeld, Aaron M

2010-02-01

Motor vehicles are a technology that has been embedded in the built environment since the early 1900s. Personal transportation is important for the quality of life of individuals who have disabilities because it gives a feeling of freedom and enables individuals who have mobility impairments to participate in the community. This article describes the evaluation of individuals and their cognitive, sensory, and physical abilities that are important for (safe) driving. A case is made for independent mobility for individuals who have disabilities and elderly individuals by first giving an overview of the functional, cognitive, and sensory abilities that are critical for driving. Second, the types of vehicle modifications and state-of-the-art controls that are available and on the horizon are described and the way in which these technologies are selected to meet driver needs is explained. Requirements for driver safety systems for drivers who remain in their wheelchairs are then discussed. Finally, emerging and innovative driving enhancement systems, such as obstacle avoidance and navigation, are discussed, as are their benefits in helping drivers who have disabilities and elderly drivers to experience safe and independent driving.

Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health community.

PubMed

Wright, J; Harrison, S; McGeorge, M; Patterson, C; Russell, I; Russell, D; Small, N; Taylor, M; Walsh, M; Warren, E; Young, J

2006-02-01

Rapid referral and management of patients with transient ischaemic attacks is a key component in the national strategy for stroke prevention. However, patients with transient ischaemic attacks are poorly identified and undertreated. Before and after evaluation of quality improvement programme with controlled comparison in three primary care trusts reflecting diverse populations and organisational structures in an urban district in the North of England. The proportion of patients receiving antiplatelet drugs and safe driving advice on referral to a specialty clinic, and the numbers of referrals, adjusted for age, to the specialist clinic before and after the improvement programme. Interviews with patient and professionals to identify gaps and barriers to good practice; development of evidence based guidelines for the management of patients with transient ischaemic attacks; interactive multidisciplinary workshops for each primary care trust with feedback of individual audit results of referral practice; outreach visits to teams who were unable to attend the workshops; referral templates and desktop summaries to provide reminders of the guidelines to clinicians; incorporation of standards into professional contracts. A significant improvement occurred in identification and referral of patients with transient ischaemic attacks to specialist clinics, with a 41% increase in referrals from trained practices compared with control practices. There were also significant improvements in the early treatment and safety advice provided to patients before referral. A strategic approach to effective quality improvement across a diverse health community is feasible and achievable. Careful planning with patient and professional involvement to develop a tailored and multifaceted quality improvement programme to implement evidence based practice can work in very different primary care settings. Key components of the effectiveness of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication, and use of established networks and opinion leaders.

Clinicians’ and researchers’ perspectives on establishing and implementing core outcomes in haemodialysis: semistructured interview study

PubMed Central

Tong, Allison; Crowe, Sally; Gill, John S; Harris, Tess; Hemmelgarn, Brenda R; Manns, Braden; Pecoits-Filho, Roberto; Tugwell, Peter; van Biesen, Wim; Wang, Angela Yee Moon; Wheeler, David C; Winkelmayer, Wolfgang C; Gutman, Talia; Ju, Angela; O’Lone, Emma; Sautenet, Benedicte; Viecelli, Andrea; Craig, Jonathan C

2018-01-01

Objectives To describe the perspectives of clinicians and researchers on identifying, establishing and implementing core outcomes in haemodialysis and their expected impact. Design Face-to-face, semistructured interviews; thematic analysis. Stetting Twenty-seven centres across nine countries. Participants Fifty-eight nephrologists (42 (72%) who were also triallists). Results We identified six themes: reflecting direct patient relevance and impact (survival as the primary goal of dialysis, enabling well-being and functioning, severe consequences of comorbidities and complications, indicators of treatment success, universal relevance, stakeholder consensus); amenable and responsive to interventions (realistic and possible to intervene on, differentiating between treatments); reflective of economic burden on healthcare; feasibility of implementation (clarity and consistency in definition, easily measurable, requiring minimal resources, creating a cultural shift, aversion to intensifying bureaucracy, allowing justifiable exceptions); authoritative inducement and directive (endorsement for legitimacy, necessity of buy-in from dialysis providers, incentivising uptake); instituting patient-centredness (explicitly addressing patient-important outcomes, reciprocating trial participation, improving comparability of interventions for decision-making, driving quality improvement and compelling a focus on quality of life). Conclusions Nephrologists emphasised that core outcomes should be relevant to patients, amenable to change, feasible to implement and supported by stakeholder organisations. They expected core outcomes would improve patient-centred care and outcomes. PMID:29678992

Improving the quality of transition and transfer of care in young adults with congenital heart disease.

PubMed

Everitt, Ian K; Gerardin, Jennifer F; Rodriguez, Fred H; Book, Wendy M

2017-05-01

The transition and transfer from pediatric to adult care is becoming increasingly important as improvements in the diagnosis and management of congenital heart disease allow patients to live longer. Transition is a complex and continuous process that requires careful planning. Inadequate transition has adverse effects on patients, their families and healthcare delivery systems. Currently, significant gaps exist in patient care as adolescents transfer to adult care and there are little data to drive the informed management of transition and transfer of care in adolescent congenital heart disease patients. Appropriate congenital heart disease care has been shown to decrease mortality in the adult population. This paper reviews the transition and transfer of care processes and outlines current congenital heart disease specific guidelines in the United States and compares these recommendations to Canadian and European guidelines. It then reviews perceived and real barriers to successful transition and identifies predictors of success during transfer to adult congenital heart disease care. Lastly, it explores how disease-specific markers of outcomes and quality indicators are being utilized to guide transition and transfer of care in other chronic childhood illnesses, and identifies existing knowledge gaps and structural impediments to improving the management of transition and transfer among congenital heart disease patients. © 2017 Wiley Periodicals, Inc.

Multiple Sensitivity Testing for Regional Air Quality Model in summer 2014

NASA Astrophysics Data System (ADS)

Tang, Y.; Lee, P.; Pan, L.; Tong, D.; Kim, H. C.; Huang, M.; Wang, J.; McQueen, J.; Lu, C. H.; Artz, R. S.

2015-12-01

The NOAA Air Resources laboratory leads to improve the performance of the U.S. Air Quality Forecasting Capability (NAQFC). It is operational in NOAA National Centers for Environmental Prediction (NCEP) which focuses on predicting surface ozone and PM2.5. In order to improve its performance, we tested several approaches, including NOAA Environmental Modeling System Global Aerosol Component (NGAC) simulation derived ozone and aerosol lateral boundary conditions (LBC), bi-direction NH3 emission and HMS(Hazard Mapping System)-BlueSky emission with the latest U.S. EPA Community Multi-scale Air Quality model (CMAQ) version and the U.S EPA National Emission Inventory (NEI)-2011 anthropogenic emissions. The operational NAQFC uses static profiles for its lateral boundary condition (LBC), which does not impose severe issue for near-surface air quality prediction. However, its degraded performance for the upper layer (e.g. above 3km) is evident when comparing with aircraft measured ozone. NCEP's Global Forecast System (GFS) has tracer O3 prediction treated as 3-D prognostic variable (Moorthi and Iredell, 1998) after being initialized with Solar Backscatter Ultra Violet-2 (SBUV-2) satellite data. We applied that ozone LBC to the CMAQ's upper layers and yield more reasonable O3 prediction than that with static LBC comparing with the aircraft data in Discover-AQ Colorado campaign. NGAC's aerosol LBC also improved the PM2.5 prediction with more realistic background aerosols. The bi-direction NH3 emission used in CMAQ also help reduce the NH3 and nitrate under-prediction issue. During summer 2014, strong wildfires occurred in northwestern USA, and we used the US Forest Service's BlueSky fire emission with HMS fire counts to drive CMAQ and tested the difference of day-1 and day-2 fire emission estimation. Other related issues were also discussed.

Vegetable Grafting: The Implications of a Growing Agronomic Imperative for Vegetable Fruit Quality and Nutritive Value

PubMed Central

Kyriacou, Marios C.; Rouphael, Youssef; Colla, Giuseppe; Zrenner, Rita; Schwarz, Dietmar

2017-01-01

Grafting has become an imperative for intensive vegetable production since chlorofluorocarbon-based soil fumigants were banned from use on grounds of environmental protection. Compelled by this development, research into rootstock–scion interaction has broadened the potential applications of grafting in the vegetable industry beyond aspects of soil phytopathology. Grafting has been increasingly tapped for cultivation under adverse environs posing abiotic and biotic stresses to vegetable crops, thus enabling expansion of commercial production onto otherwise under-exploited land. Vigorous rootstocks have been employed not only in the open field but also under protected cultivation where increase in productivity improves distribution of infrastructural and energy costs. Applications of grafting have expanded mainly in two families: the Cucurbitaceae and the Solanaceae, both of which comprise major vegetable crops. As the main drives behind the expansion of vegetable grafting have been the resistance to soilborne pathogens, tolerance to abiotic stresses and increase in yields, rootstock selection and breeding have accordingly conformed to the prevailing demand for improving productivity, arguably at the expense of fruit quality. It is, however, compelling to assess the qualitative implications of this growing agronomic practice for human nutrition. Problems of impaired vegetable fruit quality have not infrequently been associated with the practice of grafting. Accordingly, the aim of the current review is to reassess how the practice of grafting and the prevalence of particular types of commercial rootstocks influence vegetable fruit quality and, partly, storability. Physical, sensorial and bioactive aspects of quality are examined with respect to grafting for watermelon, melon, cucumber, tomato, eggplant, and pepper. The physiological mechanisms at play which mediate rootstock effects on scion performance are discussed in interpreting the implications of grafting for the configuration of vegetable fruit physicochemical quality and nutritive value. PMID:28553298

Effects of armodafinil on simulated driving and alertness in shift work disorder.

PubMed

Drake, Christopher; Gumenyuk, Valentina; Roth, Thomas; Howard, Ryan

2014-12-01

Forty-one percent of shift workers report dozing while driving. This study tested whether armodafinil improves driving simulator performance in subjects with shift work disorder (SWD). A primary outcome was performance late in the shift when workers are typically driving home. Randomized, double-blind, crossover. During each 12-h test session (21:30-09:30), subjects were kept awake except for multiple sleep latency testing (MSLT: 01:30, 03:30, 05:30, and 07:30). Subjective sleepiness (Karolinska Sleepiness Scale, KSS), driving performance, and cognitive performance (digit symbol substitution test and creativity on the Remote Associates Test, RAT) were evaluated during the night shift and commute home times. Hospital-based sleep research laboratory. Twenty night workers (age: 42.7 ± 8.7 y, 17 F) with excessive sleepiness (≥ 10 on the Epworth Sleepiness Scale), meeting International Classification of Sleep Disorders, Second Edition (ICSD-2) criteria for SWD, and having no other medical conditions. Armodafinil (150 mg) or placebo at (23:45 h) on counterbalanced nights separated by 7-14 days. Primary endpoints were driving simulator performance (standard deviation of lateral position (SDLP) and off-road deviations) with four sessions starting 3.25 h after drug administration, objective sleepiness (MSLT; 1.75 to 7.75 h post-drug), and creativity (5 h post-drug). Significant effects of drug were observed for each driving measure (P < 0.05). Armodafinil significantly improved SDLP for simulator sessions at 05:30, 07:30, and 09:30, and off-road deviations at 7 h, 15 min and 9 h, 15 min post-drug (P < 0.05). Armodafinil also improved objective sleepiness from 3.7 ± 0.6 min to 9.7 ± 5.2 min (P < 0.001) and RAT score from 8.75 ± 4.9 to 11.25 ± 6.0 (P < 0.005). Armodafinil 150 mg early in the night shift improves driving simulator performance in SWD. Effects on sleepiness, cognition, and driving were found up to 9.5 h post-ingestion, during the critical time when many night workers are driving home. © 2014 Associated Professional Sleep Societies, LLC.

Statistical Patterns of Ionospheric Convection Derived From Mid-latitude, High-Latitude, and Polar SuperDARN HF Radar Observations

NASA Astrophysics Data System (ADS)

Thomas, E. G.; Shepherd, S. G.

2018-04-01

Over the last decade, the Super Dual Auroral Radar Network (SuperDARN) has undergone a dramatic expansion in the Northern Hemisphere with the addition of more than a dozen radars offering improved coverage at mid-latitudes (50°-60° magnetic latitude) and in the polar cap (80°-90° magnetic latitude). In this study, we derive a statistical model of ionospheric convection (TS18) using line-of-sight velocity measurements from the complete network of mid-latitude, high-latitude, and polar radars for the years 2010-2016. These climatological patterns are organized by solar wind, interplanetary magnetic field (IMF), and dipole tilt angle conditions. We find that for weak solar wind driving conditions the TS18 model patterns are largely similar to the average patterns obtained using high-latitude radar data only. For stronger solar wind driving the inclusion of mid-latitude radar data at the equatorward extent of the ionospheric convection can increase the measured cross-polar cap potential (ΦPC) by as much as 40%. We also derive an alternative model organized by the Kp index to better characterize the statistical convection under a range of magnetic activity conditions. These Kp patterns exhibit similar IMF By dependencies as the TS18 model results and demonstrate a linear increase in ΦPC with increasing Kp for a given IMF orientation. Overall, the mid-latitude radars provide a better specification of the flows within the nightside Harang reversal region for moderate to strong solar wind driving or geomagnetic activity, while the polar radars improve the quality of velocity measurements in the deep polar cap under all conditions.

Prevalence and correlates of poor sleep quality and daytime sleepiness in Belgian truck drivers.

PubMed

Braeckman, Lutgart; Verpraet, Rini; Van Risseghem, Marleen; Pevernagie, Dirk; De Bacquer, Dirk

2011-03-01

Sleepiness and sleep complaints are common among professional drivers. Sleepiness is a considerable problem not only because it affects the drivers' well-being, but also because of the consequences for performance and safety. Assessment of the (self-reported) prevalence and research into the risk factors are thus an important health issue and are also indispensable to prevent productivity loss and work-related accidents and injuries. Therefore, the aim of this study was to describe sleeping, driving, and health characteristics of Belgian truck drivers and to determine occupational and individual factors associated with poor sleep quality and daytime sleepiness. Cross-sectional data were collected using a self-administered questionnaire that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Berlin Questionnaire (BQ). The mean (SD) age of the 476 studied truck drivers was 42.7 (10.2) yrs and the mean (SD) body mass index was 27.3 (5.1) kg/m(2). Approximately 47% declared that they drove >50 h/wk and found their work schedule unrealistic. The mean (SD) PSQI score was 4.45 (2.7); poor quality of sleep (PSQI >5) was found in 27.2%. The mean (SD) ESS score was 6.79 (4.17); 18% had a score >10. The BQ indicated that 21.5% had a higher risk on obstructive sleep apnea. In multiple logistic regression analysis, low educational level (odds ratio [OR] 1.86), current smoking (OR 1.75), unrealistic work schedule (OR 1.75), and risk for obstructive sleep apnea (OR 2.97) were found to be independent correlates of daytime sleepiness. Poor sleep quality was significantly associated with poor self-perceived health (OR 1.95), unrealistic work schedule (OR 2.85), low job satisfaction (OR 1.91), and less driving experience (OR 1.73). These results show that poor sleep quality and daytime sleepiness were prevalent in Belgian truck drivers. Taking into account that several significant correlates with respect to these sleep problems were identified both at the individual and the occupational level, comprehensive countermeasures to improve working conditions and organization are needed, as well as health promotion interventions, to ensure the safety and well-being of truck drivers.

An evaluation of the impact of the Virginia driver improvement program on negligent driving : 24-month report [final report].

DOT National Transportation Integrated Search

1982-01-01

This study evaluated the impact of the four basic treatment combinations of the rehabilitation component of the Virginia driver improvement program. This was accomplished through a comparison of the driving records of experimental group subjects who ...

FUZZY-LOGIC-BASED CONTROLLERS FOR EFFICIENCY OPTIMIZATION OF INVERTER-FED INDUCTION MOTOR DRIVES

EPA Science Inventory

This paper describes a fuzzy-logic-based energy optimizing controller to improve the efficiency of induction motor/drives operating at various load (torque) and speed conditions. Improvement of induction motor efficiency is important not only from the considerations of energy sav...

Research and simulation on the rollover system of corn harvester

NASA Astrophysics Data System (ADS)

Li, Shizhuang; Cao, Shukun

2017-01-01

The structural characteristics of our country's corn harvester are narrow-track, high centroid and existence of eccentric distance, so rollover accident is easily to occur when driving in mountainous and hilly regions. In order to improve the design quality of corn harvester and enhance the security of operation, it is of great significance to research the rollover prevention system of the corn harvester. Hydro-pneumatic suspension has powerful function of adjusting the balance of automobile body and good shock absorption function. In this paper, hydro-pneumatic suspension is applied to the rollover prevention system of the corn harvester to improve the ability of anti-rollover. At last using ADAMS simulation technology to simulate the roll stability of traditional corn harvester and the corn harvester with hydro pneumatic suspension, then calculating the heeling angle in both cases.

The North Carolina State Health Plan for Teachers and State Employees: Strategies in Creating Financial Stability While Improving Member Health.

PubMed

Jones, Dee; Horner, Beth

2018-01-01

The North Carolina State Health Plan provides health care coverage to more than 700,000 members, including teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents. The State Health Plan is a division of the North Carolina Department of State Treasurer, self-insured, and exempt from the Employee Retirement Income Security Act as a government-sponsored plan. With health care costs rising at rates greater than funding, the Plan must take measures to stem cost growth while ensuring access to quality health care. The Plan anticipates focusing on strategic initiatives that drive results and cost savings while improving member health to protect the Plan's financial future. ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Effects of fuel-capsule shimming and drive asymmetry on inertial-confinement-fusion symmetry and yield

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

Séguin, F. H.; Li, C. K.; DeCiantis, J. L.

Three orthogonal proton emission imaging cameras were used to study the 3D effects of low-mode drive asymmetries and target asymmetries on nuclear burn symmetry and yield in direct-drive, inertial-confinement-fusion experiments. The fusion yield decreased quickly as the burn region became asymmetric due to either drive or capsule asymmetry. Measurements and analytic scaling are used to predict how intentionally asymmetric capsule shells could improve performance by compensating for drive asymmetry when it cannot be avoided (such as with indirect drive or with polar direct drive).

Effects of fuel-capsule shimming and drive asymmetry on inertial-confinement-fusion symmetry and yield

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

Seguin, F. H.; Li, C. K.; DeCiantis, J. L.

Three orthogonal proton emission imaging cameras were used to study the 3D effects of low-mode drive asymmetries and target asymmetries on nuclear burn symmetry and yield in direct-drive, inertial-confinement-fusion experiments. The fusion yield decreased quickly as the burn region became asymmetric due to either drive or capsule asymmetry. Furthermore, measurements and analytic scaling are used to predict how intentionally asymmetric capsule shells could improve performance by compensating for drive asymmetry when it cannot be avoided (such as with indirect drive or with polar direct drive).

Effects of fuel-capsule shimming and drive asymmetry on inertial-confinement-fusion symmetry and yield

DOE PAGES

Seguin, F. H.; Li, C. K.; DeCiantis, J. L.; ...

2016-03-22

Three orthogonal proton emission imaging cameras were used to study the 3D effects of low-mode drive asymmetries and target asymmetries on nuclear burn symmetry and yield in direct-drive, inertial-confinement-fusion experiments. The fusion yield decreased quickly as the burn region became asymmetric due to either drive or capsule asymmetry. Furthermore, measurements and analytic scaling are used to predict how intentionally asymmetric capsule shells could improve performance by compensating for drive asymmetry when it cannot be avoided (such as with indirect drive or with polar direct drive).

Improving the driver-automation interaction: an approach using automation uncertainty.

PubMed

Beller, Johannes; Heesen, Matthias; Vollrath, Mark

2013-12-01

The aim of this study was to evaluate whether communicating automation uncertainty improves the driver-automation interaction. A false system understanding of infallibility may provoke automation misuse and can lead to severe consequences in case of automation failure. The presentation of automation uncertainty may prevent this false system understanding and, as was shown by previous studies, may have numerous benefits. Few studies, however, have clearly shown the potential of communicating uncertainty information in driving. The current study fills this gap. We conducted a driving simulator experiment, varying the presented uncertainty information between participants (no uncertainty information vs. uncertainty information) and the automation reliability (high vs.low) within participants. Participants interacted with a highly automated driving system while engaging in secondary tasks and were required to cooperate with the automation to drive safely. Quantile regressions and multilevel modeling showed that the presentation of uncertainty information increases the time to collision in the case of automation failure. Furthermore, the data indicated improved situation awareness and better knowledge of fallibility for the experimental group. Consequently, the automation with the uncertainty symbol received higher trust ratings and increased acceptance. The presentation of automation uncertaintythrough a symbol improves overall driver-automation cooperation. Most automated systems in driving could benefit from displaying reliability information. This display might improve the acceptance of fallible systems and further enhances driver-automation cooperation.

Enhanced recovery clinical education programme improves quality of post-operative care.

PubMed

McDonald, Ruth

2015-01-01

Quality is the driving principle of Enhanced Recovery (ER). It improves the patient experience by getting patients better sooner and changes clinical practice to make care safer and more efficient. As a consequence of ER patients spend less time in hospital. A successful ER programme began to fail after organisational restructuring and staff changes. Patients did not meet their ER goals and length of stay (LOS) increased. An ER nurse was appointed to get the programme back on track. This involved a multidisciplinary approach to an ER clinical education programme. The programme aimed to develop knowledge of the physiology of post-operative recovery and the evidence underpinning the interventions required. This was considered crucial to secure longer term staff engagement while avoiding unthinking protocol driven compliance. Success of the education programme was measured by improved outcomes in patient LOS and readmission statistics. During the four months of the clinical education programme there were no significant changes in monthly LOS. At six months post implementation of the programme there was a reduction in LOS of 0.6 days compared to the previous six months. At 12 months there was a reduction in 1.1 days compared with previous 12 months. There was a mean reduction of 28 day readmissions for all elective gynaecology surgery of 1.1 patients per month in the 12 months post programme implementation compared to the 12 months before. Delivering a multidisciplinary participatory education programme improved overall understanding of ER, and achieved sustained improvement in ER for patient benefit.

Cleaner Technology in the Hard Disk Drive Manufacturing Industry: A Case Study

NASA Astrophysics Data System (ADS)

Moolla, Premchai; Chompu-inwai, Rungchat

2010-10-01

The objectives of this research are to improve raw material and energy consumption efficiency, as well as reduce defects and the use of chemicals in the arm coil assembly process of hard disk drive manufacturing in the case study company by applying the Cleaner Technology concepts. The four main sequential steps used in this research were: (1) pre-assessment, (2) assessment, (3) feasibility study, and (4) implementation. In the first step, raw data, such as process flows, raw material usage and defects data were collected. In the second step, the loss during production and causes of loss were analyzed. Opportunities to reduce raw material, chemical and energy wastage could then be recommended. The next step was to evaluate the feasibility and potential benefits of a particular Cleaner Technology opportunity. Finally, in the last step, after a thorough evaluation and implementation of the opportunities to apply Cleaner Technology, the results showed that arm coil defects could be reduced by improving the production process using the ECRS technique. ECRS stands for Eliminate, Combine, Rearrange and Simplify. This improvement reduced arm coil defect rates from 0.48% to 0.15%, thus saving approximately 139,638 Thai Baht per month. In addition, production stoppage decision made by workers was used to increase employee involvement in defect detection. Allowing workers to participate in such a decision was an effective way to reduce defect rate and could motivate workers to produce a better quality job. This resulted in arm coil defects reducing from 0.41% to 0.025%, with about 74,562 Thai Baht per month saving. Additionally, an increase in the efficiency of electricity consumption occurred, by increasing the speed of the infrared oven conveyor belt, improving average productivity from 533 pieces/hour to 560 pieces/hour, without adversely affecting product costs and quality, thus producing products of up to the value of 206,242 Thai Baht per month. Furthermore, the new two-layer curing equipment was designed, developed and used. The upper layer of the equipment was used for arm curing and the lower layer was used for arm coil curing. The result of using such equipment led to a saving of approximately 25,502 Thai Baht per month in electricity costs, without affecting product quality. The outcome of these Cleaner Technology applications was that total costs of approximately 239,702 Thai Baht per month were able to be saved.

Thrill and adventure seeking in risky driving at work: The moderating role of safety climate.

PubMed

Wishart, Darren; Somoray, Klaire; Evenhuis, Amanda

2017-12-01

Introduction Within many industrialized countries, the leading cause of worker fatalities and serious injuries can be attributed to road trauma. In non-occupational research, high levels of sensation seeking personality, and specifically thrill and adventure seeking, have been associated with risky driving behaviors. In work driving literature, high organizational safety climate has been associated with reduced risky driving in work drivers. However, the extent that factors such as safety climate and thrill seeking interact in regard to work driving safety remains unclear, and the current research examined this interaction. Methods A total of 1,011 work drivers from four organizations participated in the research. Surveys were distributed online and hardcopies were sent via mail. The survey included measures of thrill and adventure seeking, safety climate and work-related driving behaviors, as well as questions relating to participant demographics and information about their work driving. Results The results demonstrated that safety climate significantly moderated the effect of thrill and adventure seeking trait on driving errors, driving violations, and driving while fatigued. Conclusion These results suggest that the development of a strong safety climate has the potential to improve work driving safety outcomes by reducing the impact of particular personality traits such as thrill seeking within an organizational context. Practical application To improve work driving safety, organizations and management need to develop strategies to encourage and foster positive work driving safety climate, particularly within work settings that may attract thrill and adventure seeking employees. Copyright © 2017. Published by Elsevier Ltd.

Distracted Walking, Bicycling, and Driving: Systematic Review and Meta-Analysis of Mobile Technology and Youth Crash Risk.

PubMed

Stavrinos, Despina; Pope, Caitlin N; Shen, Jiabin; Schwebel, David C

2018-01-01

This article examined the impact of mobile technology on young pedestrians, bicyclists, and drivers. A systematic search yielded 41 articles meeting inclusion criteria: peer-reviewed, published before February 1, 2016, behavioral outcome related to pedestrian, bicycling, or driving in the presence of mobile technology use, youth sample. Eleven studies were meta-analyzed to evaluate increased risk for crash/near-crash while distracted. Risk of bias and quality of research were assessed. Across methodologies, developmental stages, and type of distracting task, mobile technology use impairs youth safety on the road. Quality of evidence was low (pedestrian) to moderate (driving). Findings are discussed from the perspective of cognitive and visual distractions. Policy and behavioral efforts should continue to reduce mobile technology use in transportation settings. © 2017 The Authors. Child Development © 2017 Society for Research in Child Development, Inc.

When can the cause of a population decline be determined?

PubMed

Hefley, Trevor J; Hooten, Mevin B; Drake, John M; Russell, Robin E; Walsh, Daniel P

2016-11-01

Inferring the factors responsible for declines in abundance is a prerequisite to preventing the extinction of wild populations. Many of the policies and programmes intended to prevent extinctions operate on the assumption that the factors driving the decline of a population can be determined. Exogenous factors that cause declines in abundance can be statistically confounded with endogenous factors such as density dependence. To demonstrate the potential for confounding, we used an experiment where replicated populations were driven to extinction by gradually manipulating habitat quality. In many of the replicated populations, habitat quality and density dependence were confounded, which obscured causal inference. Our results show that confounding is likely to occur when the exogenous factors that are driving the decline change gradually over time. Our study has direct implications for wild populations, because many factors that could drive a population to extinction change gradually through time. © 2016 John Wiley & Sons Ltd/CNRS.

When can the cause of a population decline be determined?

USGS Publications Warehouse

Hefley, Trevor J.; Hooten, Mevin B.; Drake, John M.; Russell, Robin E.; Walsh, Daniel P.

2016-01-01

Inferring the factors responsible for declines in abundance is a prerequisite to preventing the extinction of wild populations. Many of the policies and programmes intended to prevent extinctions operate on the assumption that the factors driving the decline of a population can be determined. Exogenous factors that cause declines in abundance can be statistically confounded with endogenous factors such as density dependence. To demonstrate the potential for confounding, we used an experiment where replicated populations were driven to extinction by gradually manipulating habitat quality. In many of the replicated populations, habitat quality and density dependence were confounded, which obscured causal inference. Our results show that confounding is likely to occur when the exogenous factors that are driving the decline change gradually over time. Our study has direct implications for wild populations, because many factors that could drive a population to extinction change gradually through time.

Valuing School Quality Using Boundary Discontinuities. CEE DP 132

ERIC Educational Resources Information Center

Gibbons, Stephen; Machin, Stephen; Silva, Olmo

2012-01-01

Existing research shows that house prices respond to local school quality as measured by average test scores. However, higher test scores could signal better quality teaching and academic value-added, or higher ability, sought-after intakes. In our research, we show decisively that value-added drives households' demand for good schooling. However,…

Sleep quality and motor vehicle crashes in adolescents.

PubMed

Pizza, Fabio; Contardi, Sara; Antognini, Alessandro Baldi; Zagoraiou, Maroussa; Borrotti, Matteo; Mostacci, Barbara; Mondini, Susanna; Cirignotta, Fabio

2010-02-15

Sleep-related complaints are common in adolescents, but their impact on the rate of motor vehicle crashes accidents is poorly known. We studied subjective sleep quality, driving habits, and self-reported car crashes in high-school adolescents. Self-administered questionnaires (with items exploring driving habits) were distributed to 339 students who had a driver's license and attended 1 of 7 high schools in Bologna, Italy. Statistical analysis were performed to describe lifestyle habits, sleep quality, sleepiness, and their relationship with the binary dependent variable (presence or absence of car crashes) to identify the factors significantly affecting the probability of car crashes in a multivariate binary logistic regression model. Nineteen percent of the sample reported bad sleep, 64% complained of daytime sleepiness, and 40% reported sleepiness while driving. Eighty students (24%), 76% of which were males, reported that they had already crashed at least once, and 15% considered sleepiness to have been the main cause of their crash. As compared with adolescents who had not had a crash, those who had at least 1 previous crash reported that they more frequently used to drive (79% vs 62%), drove at night (25% vs 9%), drove while sleepy (56% vs 35%), had bad sleep (29% vs 16%), and used stimulants such as caffeinated soft drinks (32% vs 19%), tobacco (54% vs 27%), and drugs (21% vs 7%). The logistic procedure established a significant predictive role of male sex (p < 0.0001; odds ratio = 3.3), tobacco use (p < 0.0001; odds ratio = 3.2), sleepiness while driving (p = 0.010; odds ratio = 2.1), and bad sleep (p = 0.047; odds ratio = 1.9) for the crash risk. Our results confirm the high prevalence of sleep-related complaints among adolescents and highlight their independent role on self-reported crash risk.

Parent involvement in novice teen driving: a review of the literature

PubMed Central

Simons‐Morton, B; Ouimet, M C

2006-01-01

Motor vehicle crashes remain elevated among novice teen drivers for at least several years after licensure. Licensing policies and driver education are the two primary countermeasures employed to decrease young driver crash risks. Graduated driver licensing policies have proved to be effective in reducing crash rates where evaluated. Driver education is an essential part of teaching teens the rules of the road and operating a vehicle, but requires few hours of professional driver training, relying mainly on parents to provide most of the supervised practice driving teens obtain before independent driving licensure. The few studies that have been conducted to increase parent supervised practice driving have not shown positive results. Moreover, it is unclear that increases in practice would improve independent driving safety. Recent research has shown that parent management of the early independent driving experience of novice teens improves safety outcomes, and other research has shown that it is possible to increase parent management practices. This paper provides a review of the literature on parent involvement in supervised practice and independent driving, and efforts to increase parental management. PMID:16788109

Parent involvement in novice teen driving: a review of the literature.

PubMed

Simons-Morton, B; Ouimet, M C

2006-06-01

Motor vehicle crashes remain elevated among novice teen drivers for at least several years after licensure. Licensing policies and driver education are the two primary countermeasures employed to decrease young driver crash risks. Graduated driver licensing policies have proved to be effective in reducing crash rates where evaluated. Driver education is an essential part of teaching teens the rules of the road and operating a vehicle, but requires few hours of professional driver training, relying mainly on parents to provide most of the supervised practice driving teens obtain before independent driving licensure. The few studies that have been conducted to increase parent supervised practice driving have not shown positive results. Moreover, it is unclear that increases in practice would improve independent driving safety. Recent research has shown that parent management of the early independent driving experience of novice teens improves safety outcomes, and other research has shown that it is possible to increase parent management practices. This paper provides a review of the literature on parent involvement in supervised practice and independent driving, and efforts to increase parental management.

Tele-Presence: Bringing the Operator Back in the Loop

DTIC Science & Technology

2006-06-01

1998). Improved Camera - Monitor system for driving YPR-765 under armour (Report TM-98-A024). Soesterberg, The Netherlands: TNO Human Factors Research...Institute. [25] Van Erp, J.B.F., Padmos, P. (1997). Improving outside view when driving YPR-765 under armour (TM-97-A026). Soesterberg, The

Driver training interests of a Spanish sample of young drivers and its relationship with their self-assessment skills concerning risky driving behavior.

PubMed

Molina, J Gabriel; Sanmartín, Jaime; Keskinen, Esko

2013-03-01

Poor driving self-assessment skills (e.g., over-confidence) have been pointed out as an important explanatory factor behind young drivers' accident involvement. This paper explores (1) what young drivers miss in their training as drivers in order to analyze whether an assessment of one's own driving skills plays an important role in their desire to improve as drivers, and (2) how these training interests are related to an estimate of their self-assessment skills concerning risky driving behavior. For this purpose, a study was conducted using a survey with a blocked sampling design of novice drivers. The survey solicited respondents' self-report about (1) the contents of training courses that they feel would improve their driving, (2) their risky driving behavior, and (3) their likelihood of being involved in a risky driving situation. From the initial sample invited to participate, of nearly 1300 people, we finally obtained complete data from 321 young Spanish drivers. Two main results were apparent from our data analysis: (1) the novice drivers were mainly interested in improving their ability to recognize their strengths and weaknesses as drivers (i.e., self-assessment skills); (2) a significant relationship was found between novice drivers' interests and their current self-assessment skills concerning risky driving behavior. Specifically, there was greater general interest expressed in post-license training by the under-confident self-assessors than the over-confident ones. These results provide a relevant input which should be taken into account when designing driver training programs for novice drivers. Moreover, the relationship between their training interests and their risky driving self-assessment skills introduces an additional factor to be considered in the implementation of these training programs. Copyright © 2012 Elsevier Ltd. All rights reserved.

Advances in traction drive technology

NASA Technical Reports Server (NTRS)

Loewenthal, S. H.; Anderson, N. E.; Rohn, D. A.

1983-01-01

Traction drives are traced from early uses as main transmissions in automobiles at the turn of the century to modern, high-powered traction drives capable of transmitting hundreds of horsepower. Recent advances in technology are described which enable today's traction drive to be a serious candidate for off-highway vehicles and helicopter applications. Improvements in materials, traction fluids, design techniques, power loss and life prediction methods will be highlighted. Performance characteristics of the Nasvytis fixed-ratio drive are given. Promising future drive applications, such as helicopter main transmissions and servo-control positioning mechanisms are also addressed.

Stable adaptive PI control for permanent magnet synchronous motor drive based on improved JITL technique.

PubMed

Zheng, Shiqi; Tang, Xiaoqi; Song, Bao; Lu, Shaowu; Ye, Bosheng

2013-07-01

In this paper, a stable adaptive PI control strategy based on the improved just-in-time learning (IJITL) technique is proposed for permanent magnet synchronous motor (PMSM) drive. Firstly, the traditional JITL technique is improved. The new IJITL technique has less computational burden and is more suitable for online identification of the PMSM drive system which is highly real-time compared to traditional JITL. In this way, the PMSM drive system is identified by IJITL technique, which provides information to an adaptive PI controller. Secondly, the adaptive PI controller is designed in discrete time domain which is composed of a PI controller and a supervisory controller. The PI controller is capable of automatically online tuning the control gains based on the gradient descent method and the supervisory controller is developed to eliminate the effect of the approximation error introduced by the PI controller upon the system stability in the Lyapunov sense. Finally, experimental results on the PMSM drive system show accurate identification and favorable tracking performance. Copyright © 2013 ISA. Published by Elsevier Ltd. All rights reserved.

Design aspects of harmonic drive gear and performance improvement of its by problems identification: A review

NASA Astrophysics Data System (ADS)

Routh, Bikash

2018-04-01

The present paper aims at review on different aspects of harmonic drive gear to identify literature gap for future research. The present article is started first making the comparative study of harmonic drive gear over conventional gear, highlighting its historical background, its application, limitation etc. and then describing working principle of each and every components of it with detail dimensioning and modelling. The present article is further extended to study the different design aspects i.e. synthesis of tooth profiles, lubrication, stress, strain, torque, load sharing, kinematics error and vibration in details etc., identifying problems and then suggesting future perspective for the performance improvement of harmonic drive gear.

A new approach to the tradeoff between quality and accessibility of health care.

PubMed

Tanke, Marit A C; Ikkersheim, David E

2012-05-01

Quality of care is associated with patient volume. Regionalization of care is therefore one of the approaches that is suited to improve quality of care. A disadvantage of regionalization is that the accessibility of the facilities can decrease. By investigating the tradeoff between quality and accessibility it is possible to determine the optimal amount of treatment locations in a health care system. In this article we present a new model to quantitatively 'solve' this tradeoff. We use the condition breast cancer in the Netherlands as an example. We calculated the expected quality gains in Quality Adjusted Lifetime Years (QALY's) due to stepwise regionalization using 'volume-outcome' literature for breast cancer. Decreased accessibility was operationalized as increased (travel) costs due to regionalization by using demographic data, drive-time information, and the national median income. The total sum of the quality and accessibility function determines the optimum range of treatment locations for this particular condition, given the 'volume-quality' relationship and Dutch demographics and geography. Currently, 94 locations offer breast cancer treatment in the Netherlands. Our model estimates that the optimum range of treatment locations for this particular condition in the Netherlands varies from 15 locations to 44 locations. Our study shows that the Dutch society would benefit from regionalization of breast cancer care as possible quality gains outweigh heightened travel costs. In addition, this model can be used for other medical conditions and in other countries. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Bringing MapReduce Closer To Data With Active Drives

NASA Astrophysics Data System (ADS)

Golpayegani, N.; Prathapan, S.; Warmka, R.; Wyatt, B.; Halem, M.; Trantham, J. D.; Markey, C. A.

2017-12-01

Moving computation closer to the data location has been a much theorized improvement to computation for decades. The increase in processor performance, the decrease in processor size and power requirement combined with the increase in data intensive computing has created a push to move computation as close to data as possible. We will show the next logical step in this evolution in computing: moving computation directly to storage. Hypothetical systems, known as Active Drives, have been proposed as early as 1998. These Active Drives would have a general-purpose CPU on each disk allowing for computations to be performed on them without the need to transfer the data to the computer over the system bus or via a network. We will utilize Seagate's Active Drives to perform general purpose parallel computing using the MapReduce programming model directly on each drive. We will detail how the MapReduce programming model can be adapted to the Active Drive compute model to perform general purpose computing with comparable results to traditional MapReduce computations performed via Hadoop. We will show how an Active Drive based approach significantly reduces the amount of data leaving the drive when performing several common algorithms: subsetting and gridding. We will show that an Active Drive based design significantly improves data transfer speeds into and out of drives compared to Hadoop's HDFS while at the same time keeping comparable compute speeds as Hadoop.

Augmented Reality Cues and Elderly Driver Hazard Perception

PubMed Central

Schall, Mark C.; Rusch, Michelle L.; Lee, John D.; Dawson, Jeffrey D.; Thomas, Geb; Aksan, Nazan; Rizzo, Matthew

2013-01-01

Objective Evaluate the effectiveness of augmented reality (AR) cues in improving driving safety in elderly drivers who are at increased crash risk due to cognitive impairments. Background Cognitively challenging driving environments pose a particular crash risk for elderly drivers. AR cueing is a promising technology to mitigate risk by directing driver attention to roadway hazards. This study investigates whether AR cues improve or interfere with hazard perception in elderly drivers with age-related cognitive decline. Methods Twenty elderly (Mean= 73 years, SD= 5 years), licensed drivers with a range of cognitive abilities measured by a speed of processing (SOP) composite participated in a one-hour drive in an interactive, fixed-base driving simulator. Each participant drove through six, straight, six-mile-long rural roadway scenarios following a lead vehicle. AR cues directed attention to potential roadside hazards in three of the scenarios, and the other three were uncued (baseline) drives. Effects of AR cueing were evaluated with respect to: 1) detection of hazardous target objects, 2) interference with detecting nonhazardous secondary objects, and 3) impairment in maintaining safe distance behind a lead vehicle. Results AR cueing improved the detection of hazardous target objects of low visibility. AR cues did not interfere with detection of nonhazardous secondary objects and did not impair ability to maintain safe distance behind a lead vehicle. SOP capacity did not moderate those effects. Conclusion AR cues show promise for improving elderly driver safety by increasing hazard detection likelihood without interfering with other driving tasks such as maintaining safe headway. PMID:23829037

Evolution of an innovative role: the clinical nurse leader.

PubMed

Wilson, Lauri; Orff, Sonja; Gerry, Terilee; Shirley, Bobbi R; Tabor, Danielle; Caiazzo, Kathryn; Rouleau, Darlene

2013-01-01

This study describes the evolution of the clinical nurse leader (CNL(®) ) role and its utility in a tertiary care and community hospital. In the US, quality and safety metrics are being publically reported and healthcare organizations are just beginning to experience pay-for-performance and its impact. The American Association of the Colleges of Nursing (AACN) developed the role of the CNL to address the complexities and challenges of providing high-quality care in the current environment. Since 2007, a cohort of CNLs in practice has evaluated the effectiveness of the role with measures of clinical outcomes, financial savings and case studies. Having CNLs with a strategic perspective acting as facilitators and integrators of care has proven invaluable. Leadership support has been critical and commitment to maintaining the integrity of the role has ensured its success and sustainability. This role has established its value in risk assessment, strategic quality improvement, interdisciplinary collaboration and the implementation of evidence-based solutions. The flexibility and broad scope of this role allows for its use across practice settings and represents an exciting opportunity for nursing to drive quality of care to new levels while managing costs. © 2012 Blackwell Publishing Ltd.

An improved driving waveform reference grayscale of electrophoretic displays

NASA Astrophysics Data System (ADS)

Wang, Li; Yi, Zichuan; Peng, Bao; Zhou, Guofu

2015-10-01

Driving waveform is an important component for gray scale display on the electrophoretic display (EPD). In the traditional driving waveform, a white reference gray scale is formed before writing a new image. However, the reflectance value can not reach agreement in each gray scale transformation. In this paper, a new driving waveform, which has a short waiting time after the formation of reference gray scale, is proposed to improve the consistency of reference gray scale. Firstly, the property of the particles in the microcapsule is analyzed and the change of the EPD reflectance after the white reference gray scale formation is studied. Secondly, the reflectance change curve is fitted by using polynomial and the duration of the waiting time is determined. Thirdly, a set of the new driving waveform is designed by using the rule of DC balance and some real E-ink commercial EPDs are used to test the performance. Experimental results show that the effect of the new driving waveform has a better performance than traditional waveforms.

The effects of sleep loss on young drivers’ performance: A systematic review

PubMed Central

Smith, Simon S.

2017-01-01

Young drivers (18–24 years) are over-represented in sleep-related crashes (comprising one in five fatal crashes in developed countries) primarily due to decreased sleep opportunity, lower tolerance for sleep loss, and ongoing maturation of brain areas associated with driving-related decision making. Impaired driving performance is the proximal reason for most car crashes. There is still a limited body of evidence examining the effects of sleep loss on young drivers’ performance, with discrepancies in the methodologies used, and in the definition of outcomes. This study aimed to identify the direction and magnitude of the effects of sleep loss on young drivers’ performance, and to appraise the quality of current evidence via a systematic review. Based on the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) approach, 16 eligible studies were selected for review, and their findings summarised. Next, critical elements of these studies were identified, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines augmented to rate those elements. Using those criteria, the quality of individual papers was calculated and the overall body of evidence for each driving outcome were assigned a quality ranking (from ‘very low’ to ‘high-quality’). Two metrics, the standard deviation of lateral position and number of line crossings, were commonly reported outcomes (although in an overall ‘low-quality’ body of evidence), with significant impairments after sleep loss identified in 50% of studies. While speed-related outcomes and crash events (also with very low- quality evidence) both increased under chronic sleep loss, discrepant findings were reported under conditions of acute total sleep deprivation. It is crucial to obtain more reliable data about the effects of sleep loss on young drivers’ performance by using higher quality experimental designs, adopting common protocols, and the use of consistent metrics and reporting of findings based on GRADE criteria and the PRISMA statement. Key words: Young drivers, sleep loss, driving performance, PRISMA, the GRADE, systematic review. PMID:28859144

Merit-Based Incentive Payment System (MIPS): Harsh Choices For Interventional Pain Management Physicians.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

2016-01-01

The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score. Additionally, Clinical Practice Improvement Activities (CPIA), contributing 15% of the composite score, create multiple strategic goals to design incentives that drive movement toward delivery system reform principles with inclusion of Advanced Alternative Payment Models (APMs). Under the present proposal, the Centers for Medicare and Medicaid Services (CMS) has estimated approximately 30,000 to 90,000 providers from a total of over 761,000 providers will be exempt from MIPS. About 87% of solo practitioners and 70% of practitioners in groups of less than 10 will be subjected to negative payments or penalties ranging from 4% to 9%. In addition, MIPS also will affect a provider's reputation by making performance measures accessible to consumers and third-party physician rating Web sites.The MIPS composite performance scoring method, at least in theory, utilizes weights for each performance category, exceptional performance factors to earn bonuses, and incorporates the special circumstances of small practices.In conclusion, MIPS has the potential to affect practitioners negatively. Interventional Pain Medicine practitioners must understand the various MIPS measures and how they might participate in order to secure a brighter future. Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, clinical practice improvement activities, advancing care information performance category.

Implementation of hospital-wide reform at improving access and flow: Impact on time to antibiotics in the emergency department.

PubMed

Roman, Cristina P; Poole, Susan G; Dooley, Michael J; Smit, De Villiers; Mitra, Biswadev

2016-04-01

ED overcrowding has been associated with increased mortality, morbidity and delays to essential treatment. It was hypothesised that hospital-wide reforms designed to improve patient access and flow, in addition to improving ED overcrowding, would impact on clinically important processes within the ED, such as timely delivery of antibiotics. A single pre-implementation and post-implementation prospective cohort study was conducted prior to and after a hospital-wide reform (Timely Quality Care (TQC)). Among patients who had intravenous antibiotics prescribed in the ED, data were prospectively collected on times of presentation, prescription and administration of antibiotics. Demographics and discharge diagnoses were retrospectively extracted. There were 380 cases included with 179 cases prior to introduction of the TQC model and 201 cases after its introduction. Time from presentation to administration of antibiotics improved significantly from 192 (99-320) min to 142 (81-209) min (P < 0.01). The time from presentation to prescription pre-TQC and post-TQC was 120 (51-230) min and 92 (49-153) min, respectively (P < 0.01). The times from prescription to administration pre-TQC and post-TQC were 43 (20-83) min and 34 (15-66) min, respectively (P = 0.03). Following implementation of hospital-wide reform directed at mitigating ED overcrowding through improved access and flow, times to administration of antibiotics were significantly reduced. These findings suggest that improved quality of care in this area may be achieved with processes aimed at improved hospital access and flow. Ongoing evaluation and vigilance is necessary to ensure sustainability and drive further improvements. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Performance Based Logistics: A Readiness Strategy Tailor Made for Austere Times

DTIC Science & Technology

2015-06-01

reducing cost and improving support performance to conclude that if it is effectively implemented and managed, PBL yields significant benefits. Key...These include outcomes that facilitate both product and process improvements to drive out cost and drive up readiness as well as outcomes that... improvements , and proactive obsolescence and the mitigation of Diminishing Manufacturing Sources and Material Shortages (DMSMS). In short, we are looking for

The long road to improving the water quality of the Western Bug River (Ukraine) - A multi-scale analysis

NASA Astrophysics Data System (ADS)

Hagemann, N.; Blumensaat, F.; Tavares Wahren, F.; Trümper, J.; Burmeister, C.; Moynihan, R.; Scheifhacken, N.

2014-11-01

River basin management (RMB) was introduced to combat high levels of water pollution across Ukraine. The Western Bug River provides an example of how water quality is impacted by industrial and domestic wastewater discharges as well as pollution from agriculture and mining activities. The paper draws from a broader interdisciplinary study which aims to outline the sources of pollution within the upper Western Bug River catchment and identify the driving institutional forces behind this enduring environmental problem. The results of this study show that the administrative and spatial scales concerning river catchment management in the Western Bug River basin are not aligned. Furthermore, the temporal scale is often conflicting with the two above mentioned scales. The current political and financial situation of the State, as well as outdated administrative structures hinders effective water governance and results in low water quality. Despite these findings, there is also some evidence that in the longer term the RBM approach could succeed in the Western Bug River, especially if political and legal reforms are properly implemented and enforced.

Regulatory neutrality is essential to establishing a level playing field for accountable care organizations.

PubMed

Bacher, Gary E; Chernew, Michael E; Kessler, Daniel P; Weiner, Stephen M

2013-08-01

Accountable care organizations (ACOs) are among the most widely discussed models for encouraging movement away from fee-for-service payment arrangements. Although ACOs have the potential to slow health spending growth and improve quality of care, regulating them poses special challenges. Regulations, particularly those that affect both ACOs and Medicare Advantage plans, could inadvertently favor or disfavor certain kinds of providers or payers. Such favoritism could drive efficient organizations from the market and thus increase costs or reduce quality of and access to care. To avoid this type of outcome, we propose a general principle: Regulation of ACOs should strive to preserve a level playing field among different kinds of organizations seeking the same cost, quality, and access objectives. This is known as regulatory neutrality. We describe the implications of regulatory neutrality in four key areas: antitrust, financial solvency regulation, Medicare governance requirements, and Medicare payment models. We also discuss issues relating to short-term versus long-term perspectives--to promote the goal of regulatory neutrality and allow the most efficient organizations to prevail in the marketplace.

Automotive HMI design and participatory user involvement: review and perspectives.

PubMed

François, Mathilde; Osiurak, François; Fort, Alexandra; Crave, Philippe; Navarro, Jordan

2017-04-01

Automotive human-machine interface (HMI) design is facing new challenges due to the technological advances of the last decades. The design process has to be adapted in order to address human factors and road safety challenges. It is now widely accepted that user involvement in the HMI design process is valuable. However, the current form of user involvement in industry remains at the stages of concept assessment and usability tests. Moreover, the literature in other fields (e.g. information systems) promotes a broader user involvement with participatory design (i.e. the user is fully involved in the development process). This article reviews the established benefits of participatory design and reveals perspectives for automotive HMI quality improvement in a cognitive ergonomic framework. Practitioner Summary: Automotive HMI quality determines, in part, drivers' ability to perform primary driving tasks while using in-vehicle devices. User involvement in the design process is a key point to contribute to HMI quality. This article reports the potential benefits of a broad involvement from drivers to meet automotive HMI design challenges.

Cancer patterns, trends, and transitions in Peru: a regional perspective.

PubMed

Piñeros, Marion; Ramos, Willy; Antoni, Sébastien; Abriata, Graciela; Medina, Luis E; Miranda, J Jaime; Payet, Eduardo; Bray, Freddie

2017-10-01

Peru, like several other South American countries, is experiencing remarkable population growth, ageing, and urbanisation, which has given rise to profound changes in its epidemiological profile. Prostate and breast cancer are the most frequent cancers in men and women, respectively, in Lima and Arequipa, the two areas with population-based cancer registries. However, infection-associated cancers (cervix and stomach) are also common, and rank highest in the national cancer mortality profile. Although a foundation of surveillance informs cancer-control initiatives in Peru, improvements in the vital statistics system, and the quality and use of incidence data for the planning and assessment of cancer prevention and control actions, are needed. Existing population-based cancer registries in Lima and Arequipa, and linkages to the established national mandatory cancer reporting system, are crucial for the collection of high-quality data on national cancer incidence. The delivery of effective cancer prevention and control measures requires sustained investment in the collection of high-quality data capable of informing policies and driving research programmes. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Rocket Equation Improvement under ICF Implosion Experiment

NASA Astrophysics Data System (ADS)

Wang, Yanbin; Zheng, Zhijian

2013-10-01

The ICF explosion process has been studied in details. The rocket equation has been improved in explosive process by introducing the pressure parameter of fuel. Some methods could be drawn by the improved rocket equation. And the methods could be used to improve ICF target design, driving pulse design and experimental design. The First is to increase ablation pressure. The second is to decrease pressure of fuel. The third is to use larger diameter of target sphere. And the forth is to a shorten driving pulse.

Soil quality succession of mudflat in coastal area of China under different types of man-made land uses

NASA Astrophysics Data System (ADS)

Lu, Haiying; Shao, Hongbo; Xu, Zhaolong; Peng, Cheng

2017-04-01

Marshy reclamation in coastal area is becoming an important strategy for food safety security and economic development in China. After the reclamation of mudflat, the nutrient concentration in soil is one of the dominated factors restricting the development of marshy agriculture. However, little information is available for soil nutrient dynamics and its driving mechanisms under different types of man-made land uses. In this review, we summarized the soil nutrient dynamics under different types of man-made land uses (bare mudflat soil, rice-wheat rotation soil, aquaculture soil, and forest soil), including the change of physical and chemical features of the reclaimed soil; ii) the dynamics of soil organic matters and its driving mechanism in marshy land; iii) the migration of N, P, and K in marshy soil; and iv) the oriented cultivation and improvement for soil nutrient in marshy soil. This study contributes not only to understanding the soil nutrient cycling in marshy land, but also to providing valuable information for the sustainable development of salt-soil agriculture in marshy land along seaside cities of China.

Modified Navigation Instructions for Spatial Navigation Assistance Systems Lead to Incidental Spatial Learning

PubMed Central

Gramann, Klaus; Hoepner, Paul; Karrer-Gauss, Katja

2017-01-01

Spatial cognitive skills deteriorate with the increasing use of automated GPS navigation and a general decrease in the ability to orient in space might have further impact on independence, autonomy, and quality of life. In the present study we investigate whether modified navigation instructions support incidental spatial knowledge acquisition. A virtual driving environment was used to examine the impact of modified navigation instructions on spatial learning while using a GPS navigation assistance system. Participants navigated through a simulated urban and suburban environment, using navigation support to reach their destination. Driving performance as well as spatial learning was thereby assessed. Three navigation instruction conditions were tested: (i) a control group that was provided with classical navigation instructions at decision points, and two other groups that received navigation instructions at decision points including either (ii) additional irrelevant information about landmarks or (iii) additional personally relevant information (i.e., individual preferences regarding food, hobbies, etc.), associated with landmarks. Driving performance revealed no differences between navigation instructions. Significant improvements were observed in both modified navigation instruction conditions on three different measures of spatial learning and memory: subsequent navigation of the initial route without navigation assistance, landmark recognition, and sketch map drawing. Future navigation assistance systems could incorporate modified instructions to promote incidental spatial learning and to foster more general spatial cognitive abilities. Such systems might extend mobility across the lifespan. PMID:28243219

Power conversion process in magnetoelectric gyrators

NASA Astrophysics Data System (ADS)

Zhuang, X.; Leung, C. M.; Li, J.; Viehland, D.

2017-09-01

We have investigated the power conversion and loss processes in magnetoelectric gyrators. Two types of loss mechanisms were identified by using a transformer-gyrator structure, which transfers power between magnetic and magnetomechanical forms. A missing portion of the power in a gyrator was then identified to be a returned power from the load resistor under low drive conditions. Under high drive conditions, decreases in both the magnetostriction and mechanical quality factor resulted in additional inefficiencies. Power transfer efficiencies of greater than 70% and 50% were achieved for magnetoelectric (ME) gyrators based on Metglas/Pb(Zr,Ti)O3 laminated composites under low power drive and high power density drive (60 W/in.3) conditions, respectively.

Daily and peak 1 h indoor air pollution and driving factors in a rural Chinese village.

PubMed

Fischer, Susan L; Koshland, Catherine P

2007-05-01

We investigate wintertime indoor air quality and personal exposures to carbon monoxide (CO) in a rural village in Jilin province, where relatively homogeneous climatic and sociocultural factors facilitate investigation of household structural, fuel-related, and behavioral determinants of air pollution as well as relationships between different measures of air quality. Our time-resolved wintertime measurements of carbon monoxide and respirable particles (RSP) enable exploration of peak pollution periods in a village in Jilin Province, China, characterized by household use of both coal and biomass, as well as several "improved" (gas or electric) fuels. Our data indicate a 6-fold increase in peak 1 h PM (1.9 mg/m3) concentrations relative to 24 h mean PM (0.31 mg/m3). Peak 1 h CO concentrations (20.5 ppm) routinely approached and often (27%) exceeded the World Health Organization's 1 h guideline of 26 ppm, although the vast majority (95%) of kitchens were within China's residential indoor air quality guideline for CO on a 24 h basis. Choice of heating fuel and household smoking status were significant predictors of indoor air quality. Whether solid or "improved" (gas or electric) fuel was used for cooking had an even stronger effect, but in the opposite direction from expected, on both peak and daily average measures of air pollution. Peak pollution period concentrations of CO and PM were strongly correlated to daily concentrations of CO and RSP, respectively. Our results suggestthat due to the primary role of heating as a determinant of wintertime indoor air quality in northern Chinese villages, health-oriented interventions limited to provision of improved cooking fuel are insufficient. Our results illustrate that peak pollution periods may routinely exceed exposure regulations and evacuation limits, although this and previous studies document typical 24 h CO concentrations in rural Chinese kitchens to be within guidelines. Within a given village and for a given pollutant, daily pollutant concentrations may be strong predictors of peak pollution period concentrations.

Modafinil Improves Real Driving Performance in Patients with Hypersomnia: A Randomized Double-Blind Placebo-Controlled Crossover Clinical Trial

PubMed Central

Philip, Pierre; Chaufton, Cyril; Taillard, Jacques; Capelli, Aurore; Coste, Olivier; Léger, Damien; Moore, Nicholas; Sagaspe, Patricia

2014-01-01

Study Objective: Patients with excessive daytime sleepiness (EDS) are at high risk for driving accidents, and physicians are concerned by the effect of alerting drugs on driving skills of sleepy patients. No study has up to now investigated the effect of modafinil (a reference drug to treat EDS in patients with hypersomnia) on on-road driving performance of patients suffering from central hypersomnia. The objective is to evaluate in patients with central hypersomnia the effect of a wake-promoting drug on real driving performance and to assess the relationship between objective sleepiness and driving performance. Design and Participants: Randomized, crossover, double-blind placebo-controlled trial conducted among 13 patients with narcolepsy and 14 patients with idiopathic hypersomnia. Patients were randomly assigned to receive modafinil (400 mg) or placebo for 5 days prior to the driving test. Each condition was separated by at least 3 weeks of washout. Measurements: Mean number of Inappropriate Line Crossings, Standard Deviation of Lateral Position of the vehicle and mean sleep latency in the Maintenance of Wakefulness Test were assessed. Results: Modafinil reduced the mean number of Inappropriate Line Crossings and Standard Deviation of Lateral Position of the vehicle compared to placebo (F(1,25) = 4.88, P < 0.05 and F(1,25) = 3.87, P = 0.06 tendency). Mean sleep latency at the Maintenance of Wakefulness Test significantly correlated with the mean number of Inappropriate Line Crossings (r = -0.41, P < 0.001). Conclusions: Modafinil improves driving performance in patients with narcolepsy and idiopathic hypersomnia. The Maintenance of Wakefulness Test is a suitable clinical tool to assess fitness to drive in this population. Citation: Philip P; Chaufton C; Taillard J; Capelli A; Coste O; Léger D; Moore N; Sagaspe P. Modafinil improves real driving performance in patients with hypersomnia: a randomized double-blind placebo-controlled crossover clinical trial. SLEEP 2014;37(3):483-487. PMID:24587570

Driving Performance Improvements by Integrating Competencies with Human Resource Practices

ERIC Educational Resources Information Center

Lee, Jin Gu; Park, Yongho; Yang, Gi Hun

2010-01-01

This study explores the issues in the development and application of a competency model and provides implications for more precise integration of competencies into human resource (HR) functions driving performance improvement. This research is based on a case study from a Korean consumer corporation. This study employed document reviews,…

Driving While Interacting With Google Glass: Investigating the Combined Effect of Head-Up Display and Hands-Free Input on Driving Safety and Multitask Performance.

PubMed

Tippey, Kathryn G; Sivaraj, Elayaraj; Ferris, Thomas K

2017-06-01

This study evaluated the individual and combined effects of voice (vs. manual) input and head-up (vs. head-down) display in a driving and device interaction task. Advances in wearable technology offer new possibilities for in-vehicle interaction but also present new challenges for managing driver attention and regulating device usage in vehicles. This research investigated how driving performance is affected by interface characteristics of devices used for concurrent secondary tasks. A positive impact on driving performance was expected when devices included voice-to-text functionality (reducing demand for visual and manual resources) and a head-up display (HUD) (supporting greater visibility of the driving environment). Driver behavior and performance was compared in a texting-while-driving task set during a driving simulation. The texting task was completed with and without voice-to-text using a smartphone and with voice-to-text using Google Glass's HUD. Driving task performance degraded with the addition of the secondary texting task. However, voice-to-text input supported relatively better performance in both driving and texting tasks compared to using manual entry. HUD functionality further improved driving performance compared to conditions using a smartphone and often was not significantly worse than performance without the texting task. This study suggests that despite the performance costs of texting-while-driving, voice input methods improve performance over manual entry, and head-up displays may further extend those performance benefits. This study can inform designers and potential users of wearable technologies as well as policymakers tasked with regulating the use of these technologies while driving.

A Traction Control Strategy with an Efficiency Model in a Distributed Driving Electric Vehicle

PubMed Central

Lin, Cheng

2014-01-01

Both active safety and fuel economy are important issues for vehicles. This paper focuses on a traction control strategy with an efficiency model in a distributed driving electric vehicle. In emergency situation, a sliding mode control algorithm was employed to achieve antislip control through keeping the wheels' slip ratios below 20%. For general longitudinal driving cases, an efficiency model aiming at improving the fuel economy was built through an offline optimization stream within the two-dimensional design space composed of the acceleration pedal signal and the vehicle speed. The sliding mode control strategy for the joint roads and the efficiency model for the typical drive cycles were simulated. Simulation results show that the proposed driving control approach has the potential to apply to different road surfaces. It keeps the wheels' slip ratios within the stable zone and improves the fuel economy on the premise of tracking the driver's intention. PMID:25197697

A traction control strategy with an efficiency model in a distributed driving electric vehicle.

PubMed

Lin, Cheng; Cheng, Xingqun

2014-01-01

Both active safety and fuel economy are important issues for vehicles. This paper focuses on a traction control strategy with an efficiency model in a distributed driving electric vehicle. In emergency situation, a sliding mode control algorithm was employed to achieve antislip control through keeping the wheels' slip ratios below 20%. For general longitudinal driving cases, an efficiency model aiming at improving the fuel economy was built through an offline optimization stream within the two-dimensional design space composed of the acceleration pedal signal and the vehicle speed. The sliding mode control strategy for the joint roads and the efficiency model for the typical drive cycles were simulated. Simulation results show that the proposed driving control approach has the potential to apply to different road surfaces. It keeps the wheels' slip ratios within the stable zone and improves the fuel economy on the premise of tracking the driver's intention.