Patient handover in orthopaedics, improving safety using Information Technology.

PubMed

Pearkes, Tim

2015-01-01

Good inpatient handover ensures patient safety and continuity of care. An adjunct to this is the patient list which is routinely managed by junior doctors. These lists are routinely created and managed within Microsoft Excel or Word. Following the merger of two orthopaedic departments into a single service in a new hospital, it was felt that a number of safety issues within the handover process needed to be addressed. This quality improvement project addressed these issues through the creation and implementation of a new patient database which spanned the department, allowing trouble free, safe, and comprehensive handover. Feedback demonstrated an improved user experience, greater reliability, continuity within the lists and a subsequent improvement in patient safety.

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

None

Since its creation in 1946, Argonne National Laboratory has addressed the nation’s most pressing challenges in science, energy, the environment, and national security. United by a common goal – to improve the world – Argonne continues to drive the scientific and technological breakthroughs needed to ensure a sustainable future.

Technology, Students and Faculty...How To Make It Happen!

ERIC Educational Resources Information Center

Cummings, Debra; Buzzard, Connie

2002-01-01

A plan was developed by Fort Scott Community College (Kansas) to implement continuous improvement with technology integration. In addition to ensuring that college employees acquired and used high-tech computer skills, faculty had to use and incorporate technology in the classroom. (JOW)

Report: EPA’s Management of Interim Status Permitting Needs Improvement to Ensure Continued Progress

EPA Pesticide Factsheets

Report #2007-P-00005, December 4, 2006. Interim status is a temporary designation, but some units have existed for as many as 25 years without formal issuance or denial of a permit, or other regulatory controls.

10 CFR 850.40 - Performance feedback.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Performance feedback. (a) The responsible employer must conduct periodic analyses and assessments of... reporting data. (b) To ensure that information is available to maintain and improve all elements of the CBDPP continuously, the responsible employer must give results of periodic analyses and assessments to...

10 CFR 850.40 - Performance feedback.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Performance feedback. (a) The responsible employer must conduct periodic analyses and assessments of... reporting data. (b) To ensure that information is available to maintain and improve all elements of the CBDPP continuously, the responsible employer must give results of periodic analyses and assessments to...

10 CFR 850.40 - Performance feedback.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Performance feedback. (a) The responsible employer must conduct periodic analyses and assessments of... reporting data. (b) To ensure that information is available to maintain and improve all elements of the CBDPP continuously, the responsible employer must give results of periodic analyses and assessments to...

10 CFR 850.40 - Performance feedback.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Performance feedback. (a) The responsible employer must conduct periodic analyses and assessments of... reporting data. (b) To ensure that information is available to maintain and improve all elements of the CBDPP continuously, the responsible employer must give results of periodic analyses and assessments to...

10 CFR 850.40 - Performance feedback.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Performance feedback. (a) The responsible employer must conduct periodic analyses and assessments of... reporting data. (b) To ensure that information is available to maintain and improve all elements of the CBDPP continuously, the responsible employer must give results of periodic analyses and assessments to...

Pavement damage due to different tire and loading configurations on secondary roads.

DOT National Transportation Integrated Search

2009-10-15

Due to the large percentage of goods moved by commercial trucks and its ever-growing freight industry, the U.S. needs innovative technologies to improve the efficiency of trucking operations and ensure continuous growth of the economy. One example of...

Asset Reuse of Images from a Repository

ERIC Educational Resources Information Center

Herman, Deirdre

2014-01-01

According to Markus's theory of reuse, when digital repositories are deployed to collect and distribute organizational assets, they supposedly help ensure accountability, extend information exchange, and improve productivity. Such repositories require a large investment due to the continuing costs of hardware, software, user licenses, training,…

The impact of chemical pollution on biodiversity and ecosystem services: the need for an improved understanding

EPA Science Inventory

The Millennium Ecosystem Assessment (2005) provided a framework that acknowledges biodiversity as one key factor for ensuring the continuous supply of ecosystem services, facilitating ecosystem stability and consequently as a critical basis for sustainable development. The close...

The office surgical suite: pros and cons.

PubMed

Simons, R L

1980-05-01

Today interest and enthusiasm regarding facial plastic surgery is burgeoning. Office surgery provides a new, more expedient, comfortable method of delivery of health care while directly responding to the growing concern among the public and government for improved cost containment of medical services. Awareness of improved surgical techniques and facilities will help to ensure tomorrow's continued growth and satisfaction for both the surgeon and his patient.

Response to Intervention and Continuous School Improvement: How to Design, Implement, Monitor, and Evaluate a School-Wide Prevention System, 2nd Edition

ERIC Educational Resources Information Center

Bernhardt, Victoria L.; Hébert, Connie L.

2017-01-01

Experts Bernhardt and Hébert's latest book demonstrates strategies to ensure your entire staff works together to design, implement, monitor, and evaluate a schoolwide prevention system with integrity and fidelity. Each step in this important resource is designed to help administrators, teachers, and other educators improve the learning of every…

A Resource Guide for Head Start Programs: Moving beyond a Culture of Compliance to a Culture of Continuous Improvement. OPRE Report 2015-02

ERIC Educational Resources Information Center

Derrick-Mills, Teresa; Winkler, Mary K.; Healy, Olivia; Greenberg, Erica

2015-01-01

Head Start has long focused on assessing and improving program quality to ensure that the children served receive the best possible preparation for school and life. Most research has been focused inside the classroom--the classroom environment, teacher qualifications, and teacher interactions. Of course, the classroom is important because that is…

LANL Multiyear Strategy Performance Improvement (MYSPI), Fiscal Years 2017–2021

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

Leasure, Craig Scott

2016-05-03

Los Alamos National Laboratory (LANL) protects the nation and the world using innovative science, technology, and engineering through an integrated approach that harnesses the strength of our people, capabilities, and operations. The Laboratory’s Strategic Plan and Purpose statement provide the framework for scientific excellence and operational excellence now and in the future. Our Strategic Plan and Purpose help position Los Alamos for continuing mission success that ensures the safety, security, and effectiveness of the nation’s deterrent; protects the nation from nuclear and emerging threats through our larger global security missions; provides energy security to the nation; and ensures that themore » nation’s scientific reputation and capabilities remain robust enough to assure our allies and deter our adversaries. Moreover, we use these principles and guidance to ensure that Los Alamos is successful in attracting, recruiting, and retaining the next generation of world-class talent, while creating an efficient, environmentally responsible workplace that provides our employees with access to modern scientific tools and resources. Using this guidance and its underlying principles, we are continuing to restore credibility and operational effectiveness to the Laboratory, deliver mission success and continuing scientific excellence, and protect our employees and the nation’s secrets.« less

LANL Multiyear Strategy Performance Improvement (MYSPI), Fiscal Years 2018-2022

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

Leasure, Craig Scott

Los Alamos National Laboratory (LANL) protects the nation and the world using innovative science, technology, and engineering through an integrated approach that harnesses the strength of our people, capabilities, and operations. The Laboratory’s Strategic Plan and Purpose statement provide the framework for scientific excellence and operational excellence now and in the future. Our Strategic Plan and Purpose help position Los Alamos for continuing mission success that ensures the safety, security, and effectiveness of the nation’s deterrent; protects the nation from nuclear and emerging threats through our larger global security missions; provides energy security to the nation; and ensures that themore » nation’s scientific reputation and capabilities remain robust enough to assure our allies and deter our adversaries. Moreover, we use these principles and guidance to ensure that Los Alamos is successful in attracting, recruiting, and retaining the next generation of excellent talent, while creating an efficient, environmentally responsible workplace that provides our employees with access to modern scientific tools and resources. Using this guidance and its underlying principles, we are continuing to restore credibility and operational effectiveness to the Laboratory, deliver mission success and continuing scientific excellence, and protect our employees and the nation’s secrets.« less

It Is Risky Business: Three Essays on Ensuring Reliability, Security and Privacy in Technology-Mediated Settings

ERIC Educational Resources Information Center

Anderson, Catherine L.

2010-01-01

Today's interconnected technical environment creates unprecedented opportunities while simultaneously introducing risks. With economic, social and personal interactions increasingly occurring in technology-mediated settings new vulnerabilities are continually being introduced. This dissertation seeks to improve extant understanding of how…

Organizational Diagnosis: Its Role in Organizational Learning.

ERIC Educational Resources Information Center

Beer, Michael; Spector, Bert

1993-01-01

Sees diagnosis as process that helps organizations enhance their capacity to assess and change dysfunctional aspects of culture and patterns of behavior as basis for developing greater effectiveness and ensuring continuous improvement. Presents framework for understanding "learning diagnosis" in which diagnostic process is part of large-scale…

A Program Manager’s Guide for Program Improvement in Ongoing Psychological Health and Traumatic Brain Injury Programs. The RAND Toolkit, Volume 4

DTIC Science & Technology

2014-01-01

Hughes EFX, Boerstler H, O’Connor EJ. “Assessing the Impact of Continuous Quality Improvement/ Total Quality Management : Concept versus...facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity. Gery...RAND Program Manager’s Guide helps managers assess program performance, consider options for improvement, implement solutions, then assess whether the

Full Spectrum Information Operations and the Information Professional Officer Intermediate Qualification Process: Filling the Gap to Ensure the Continued Leadership of the Information Professional Community in the Area of Information Dominance

DTIC Science & Technology

2005-09-01

information dominance . This thesis provides recommended line items for injection into the IP IQ in the appropriate format with discussions and definitions that address the specific line items. The thesis also provides further recommendations for the continuing improvement and refinement of the IP qualification process, especially in the area of

Improvement of mammalian cell culture performance through surfactant enabled concentrated feed media.

PubMed

Hossler, Patrick; McDermott, Sean; Racicot, Christopher; Fann, John C H

2013-01-01

The design of basal and feed media in mammalian cell culture is paramount towards ensuring acceptable upstream process performance in various operation modes, especially fed-batch culture. Mammalian cell culture media designs have evolved from the classical formulations designed by Eagle and Ham, to today's formulations designed from continuous improvement and statistical frameworks. Feed media is especially important for ensuring robust cell growth, productivity, and ensuring the product quality of recombinant therapeutics are within acceptable ranges. Numerous studies have highlighted the benefit of various media designs, supplements, and feed addition strategies towards the resulting cell culture process. In this work we highlight the use of a top-down level approach towards feed media design enabled by the use of select surfactants for the targeted enrichment of a chemically defined feed media. The use of the enriched media was able to improve product titers at g/L levels, without adversely impacting the growth of multiple Chinese Hamster Ovary cell lines or the product quality of multiple recombinant antibodies. © 2013 American Institute of Chemical Engineers.

Total Quality Management in Higher Education.

ERIC Educational Resources Information Center

Sherr, Lawrence A.; Lozier, G. Gredgory

1991-01-01

Total Quality Management, based on theories of W. Edward Deming and others, is a style of management using continuous process improvement characterized by mission and customer focus, a systematic approach to operations, vigorous development of human resources, long-term thinking, and a commitment to ensuring quality. The values espoused by this…

Financial Literacy: Mathematics and Money Improving Student Engagement

ERIC Educational Resources Information Center

Attard, Catherine

2018-01-01

The low levels of student engagement with mathematics has been of significant concern in Australia for some time (Attard, 2013). This is a particularly important issue in mathematics education given the current attention to science, technology, engineering and mathematics (STEM) education to ensure "the continued prosperity of Australia on…

Projecting Changes in Climate & Air Quality for the Southeastern U.S.

EPA Science Inventory

Recent improvements in air quality in the United States have been due to significant reductions in emissions of precursors of ozone and particulate matter (PM), and these downward emissions trends are expected to continue in the next few decades. To ensure that planned air quali...

76 FR 72220 - Incorporation of Risk Management Concepts in Regulatory Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-22

... and support the adoption of improved designs or processes. \\1\\ A deterministic approach to regulation... longstanding goal to move toward more risk-informed, performance- based approaches in its regulatory programs... regulatory approach that would continue to ensure the safe and secure use of nuclear material. As part of...

"Changes in US Regional Air Quality at 2030 Simulated Using RCP 6.0"

EPA Science Inventory

Recent improvements in air quality in the United States have been due to significant reductions in emissions of ozone and particulate matter (PM) precursors, and these downward emissions trends are expected to continue in the next few decades. To ensure that planned air quality ...

The Quality Education Checklist: An Instrument for Self-Auditing. Developing Quality Schools: Learning Module #2. Making It Work--The Quality Schools Approach.

ERIC Educational Resources Information Center

Barlosky, Martin; Lawton, Stephen

The Quality Education Checklist focuses on key inputs, processes, and outputs of schools needed to ensure continuous improvement. Intended as a self-auditing aid for schools, the checklist may also be used as a method to define the priority of areas for improvement, as a way to gather information from customers, as a professional development…

Creating and Sustaining an Effective Government-Defense Industry Partnership

DTIC Science & Technology

2011-07-01

relationship could be improved. A September 2008 report published by the U.S. Government Accountability Office (GAO) stated: To better ensure Warfighter...through continuous improvement and new technologies to drive down the overall product cost on the products being delivered. (Mills, 2010a) The manner...in industry” (Mills, 2010a), and “Government acquisition personnel are generally not aware of the real cost of goods and services provided by

Process Improvements in Training Device Acceptance Testing: A Study in Total Quality Management

DTIC Science & Technology

1990-12-12

Quality Management , a small group of Government and industry specialists examined the existing training device acceptance test process for potential improvements. The agreed-to mission of the Air Force/Industry partnership was to continuously identify and promote implementable approaches to minimize the cost and time required for acceptance testing while ensuring that validated performance supports the user training requirements. Application of a Total Quality process improvement model focused on the customers and their requirements, analyzed how work was accomplished, and

Talking about the Automobile Braking System

NASA Astrophysics Data System (ADS)

Xu, Zhiqiang

2017-12-01

With the continuous progress of society, the continuous development of the times, people’s living standards continue to improve, people continue to improve the pursuit. With the rapid development of automobile manufacturing, the car will be all over the tens of thousands of households, the increase in car traffic, a direct result of the incidence of traffic accidents. Brake system is the guarantee of the safety of the car, its technical condition is good or bad, directly affect the operational safety and transportation efficiency, so the brake system is absolutely reliable. The requirements of the car on the braking system is to have a certain braking force to ensure reliable work in all cases, light and flexible operation. Normal braking should be good performance, in addition to a foot sensitive, the emergency brake four rounds can not be too long, not partial, not ring.

Total quality management - It works for aerospace information services

NASA Technical Reports Server (NTRS)

Erwin, James; Eberline, Carl; Colquitt, Wanda

1993-01-01

Today we are in the midst of information and 'total quality' revolutions. At the NASA STI Program's Center for AeroSpace Information (CASI), we are focused on using continuous improvements techniques to enrich today's services and products and to ensure that tomorrow's technology supports the TQM-based improvement of future STI program products and services. The Continuous Improvements Program at CASI is the foundation for Total Quality Management in products and services. The focus is customer-driven; its goal, to identify processes and procedures that can be improved and new technologies that can be integrated with the processes to gain efficiencies, provide effectiveness, and promote customer satisfaction. This Program seeks to establish quality through an iterative defect prevention approach that is based on the incorporation of standards and measurements into the processing cycle.

Practical Approaches to Quality Improvement for Radiologists.

PubMed

Kelly, Aine Marie; Cronin, Paul

2015-10-01

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

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

PubMed

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

2016-12-01

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

What Works in Coaching and Sport Instructor Certification Programs? The Participants' View

ERIC Educational Resources Information Center

Mccullick, Bryan A.; Belcher, Don; Schempp, Paul G.

2005-01-01

Coaching and sport instructor certification (CSIC) programs provide teachers with a substantial content and pedagogical knowledge base. Continual improvement of these programs helps ensure that those certified are effective and competent. The purpose of this study was to ascertain the strengths of a CSIC program based on the perceptions of the…

Uncovering Teacher Leadership

ERIC Educational Resources Information Center

Ackerman, Richard; Mackenzie, Sarah V.

2006-01-01

Teacher leaders are the pack mules of effective school improvement because they carry the weight of responsibility for ensuring that reforms take root in the classroom and deepen the learning of all students. They continually think about the gap in schools between the real and the ideal, and the discrepancies that they witness compel them to push…

34 CFR 280.1 - What is the Magnet Schools Assistance Program?

Code of Federal Regulations, 2012 CFR

2012-07-01

... schools; (e) Improvement of the capacity of LEAs, including through professional development, to continue... terminated; and (f) Ensuring that all students enrolled in the magnet school programs have equitable access... 34 Education 1 2012-07-01 2012-07-01 false What is the Magnet Schools Assistance Program? 280.1...

34 CFR 280.1 - What is the Magnet Schools Assistance Program?

Code of Federal Regulations, 2014 CFR

2014-07-01

... schools; (e) Improvement of the capacity of LEAs, including through professional development, to continue... terminated; and (f) Ensuring that all students enrolled in the magnet school programs have equitable access... 34 Education 1 2014-07-01 2014-07-01 false What is the Magnet Schools Assistance Program? 280.1...

34 CFR 280.1 - What is the Magnet Schools Assistance Program?

Code of Federal Regulations, 2013 CFR

2013-07-01

... schools; (e) Improvement of the capacity of LEAs, including through professional development, to continue... terminated; and (f) Ensuring that all students enrolled in the magnet school programs have equitable access... 34 Education 1 2013-07-01 2013-07-01 false What is the Magnet Schools Assistance Program? 280.1...

Bennett Public Schools Principal Induction Program

ERIC Educational Resources Information Center

Wilson, Ross; Beaudoin, Colleen; Carmona, Ruben; Delahanty, Michael; Gartside, William; Oyedele, Abidemi; Teta, Lynne Mooney

2012-01-01

Ensuring equity in education and academic success for all students requires a highly skilled principal engages others in continually improving the instructional program in order to meet the needs of students. Over the past few years, a number of reports have indicated that the role of principal is becoming more challenging. School districts are…

Rethinking Online Discourse: Improving Learning through Discussions in the Online Classroom

ERIC Educational Resources Information Center

Johnson, Cass M.

2016-01-01

As colleges continue to expand online offerings, student participation within courses should be assessed to ensure that teachers can best implement effective, responsible lesson plans. This study examined discourse in an online classroom in order to gauge student participation by observing student-to-student and student-to-instructor exchanges…

The quest to standardize hemodialysis care.

PubMed

Hegbrant, Jörgen; Gentile, Giorgio; Strippoli, Giovanni F M

2011-01-01

A large global dialysis provider's core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence-based guidelines and clinical protocols; consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner, incorporating information on interclinic and intercountry variations; and revising targets, guidelines and clinical protocols based on sound scientific data. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice; and auditing of clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety. Copyright © 2011 S. Karger AG, Basel.

Existence and global exponential stability of periodic solution to BAM neural networks with periodic coefficients and continuously distributed delays

NASA Astrophysics Data System (ADS)

Zhou, distributed delays [rapid communication] T.; Chen, A.; Zhou, Y.

2005-08-01

By using the continuation theorem of coincidence degree theory and Liapunov function, we obtain some sufficient criteria to ensure the existence and global exponential stability of periodic solution to the bidirectional associative memory (BAM) neural networks with periodic coefficients and continuously distributed delays. These results improve and generalize the works of papers [J. Cao, L. Wang, Phys. Rev. E 61 (2000) 1825] and [Z. Liu, A. Chen, J. Cao, L. Huang, IEEE Trans. Circuits Systems I 50 (2003) 1162]. An example is given to illustrate that the criteria are feasible.

Approaches to ensuring and improving quality in the context of health system strengthening: a cross-site analysis of the five African Health Initiative Partnership programs

PubMed Central

2013-01-01

Background Integrated into the work in health systems strengthening (HSS) is a growing focus on the importance of ensuring quality of the services delivered and systems which support them. Understanding how to define and measure quality in the different key World Health Organization building blocks is critical to providing the information needed to address gaps and identify models for replication. Description of approaches We describe the approaches to defining and improving quality across the five country programs funded through the Doris Duke Charitable Foundation African Health Initiative. While each program has independently developed and implemented country-specific approaches to strengthening health systems, they all included quality of services and systems as a core principle. We describe the differences and similarities across the programs in defining and improving quality as an embedded process essential for HSS to achieve the goal of improved population health. The programs measured quality across most or all of the six WHO building blocks, with specific areas of overlap in improving quality falling into four main categories: 1) defining and measuring quality; 2) ensuring data quality, and building capacity for data use for decision making and response to quality measurements; 3) strengthened supportive supervision and/or mentoring; and 4) operational research to understand the factors associated with observed variation in quality. Conclusions Learning the value and challenges of these approaches to measuring and improving quality across the key components of HSS as the projects continue their work will help inform similar efforts both now and in the future to ensure quality across the critical components of a health system and the impact on population health. PMID:23819662

The National Space Science Data Center: An operational perspective

NASA Technical Reports Server (NTRS)

Blitstein, Ronald; Green, James L.

1991-01-01

The National Space Science Data Center (NSSDC) manages over 110,000 data tapes with over 4,000 data sets. The size of the digital archive is approximately 6,000 GBytes and is expected to grow to more than 28,000 GBytes by 1995. The NSSDC is involved in several initiatives to better serve the scientific community and improve the management of current and future data holdings. These initiatives address the need to manage data to ensure ready access by the user and manage the media to ensure continuing accessibility and integrity of the data. An operational view of the NSSDC, outlining current policies and procedures that have been implemented to ensure the effective use of available resources to support service and mission goals, and maintain compliance with prescribed data management directives is presented.

The National Space Science Data Center: An operational perspective

NASA Technical Reports Server (NTRS)

Blitstein, Ronald; Green, James L.

1992-01-01

The National Space Science Data Center (NSSDC) manages over 110,000 data tapes with over 4,000 data sets. The size of the digital archive is approximately 6,000 GBytes and is expected to grow to more than 28,000 GBytes by 1995. The NSSDC is involved in several initiatives to better serve the scientific community and improve the management of current and future data holdings. These initiatives address the need to manage data to ensure ready access by the user and manage the media to ensure continuing accessibility and integrity of the data. This paper will present an operational view of the NSSDC, outlining current policies and procedures that were implemented to ensure the effective use of available resources to support service and mission goals, and maintain compliance with prescribed data management directives.

International quality improvement initiatives.

PubMed

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

2017-12-01

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

Opportunities for improving the efficiency of paediatric HIV treatment programmes

PubMed Central

Revill, Paul A.; Walker, Simon; Mabugu, Travor; Nathoo, Kusum J.; Mugyenyi, Peter; Kekitinwa, Adeodata; Munderi, Paula; Bwakura-Dangarembizi, Mutsawashe; Musiime, Victor; Bakeera-Kitaka, Sabrina; Nahirya-Ntege, Patricia; Walker, A. Sarah; Sculpher, Mark J.; Gibb, Diana M.

2015-01-01

Objectives: To conduct two economic analyses addressing whether to: routinely monitor HIV-infected children on antiretroviral therapy (ART) clinically or with laboratory tests; continue or stop cotrimoxazole prophylaxis when children become stabilized on ART. Design and methods: The ARROW randomized trial investigated alternative strategies to deliver paediatric ART and cotrimoxazole prophylaxis in 1206 Ugandan/Zimbabwean children. Incremental cost-effectiveness and value of implementation analyses were undertaken. Scenario analyses investigated whether laboratory monitoring (CD4+ tests for efficacy monitoring; haematology/biochemistry for toxicity) could be tailored and targeted to be delivered cost-effectively. Cotrimoxazole use was examined in malaria-endemic and non-endemic settings. Results: Using all trial data, clinical monitoring delivered similar health outcomes to routine laboratory monitoring, but at a reduced cost, so was cost-effective. Continuing cotrimoxazole improved health outcomes at reduced costs. Restricting routine CD4+ monitoring to after 52 weeks following ART initiation and removing toxicity testing was associated with an incremental cost-effectiveness ratio of $6084 per quality-adjusted life-year (QALY) across all age groups, but was much lower for older children (12+ years at initiation; incremental cost-effectiveness ratio = $769/QALY). Committing resources to improve cotrimoxazole implementation appears cost-effective. A healthcare system that could pay $600/QALY should be willing to spend up to $12.0 per patient-year to ensure continued provision of cotrimoxazole. Conclusion: Clinically driven monitoring of ART is cost-effective in most circumstances. Routine laboratory monitoring is generally not cost-effective at current prices, except possibly CD4+ testing amongst adolescents initiating ART. Committing resources to ensure continued provision of cotrimoxazole in health facilities is more likely to represent an efficient use of resources. PMID:25396263

Certification renewal process of the American Board of Orthodontics.

PubMed

Castelein, Paul T; DeLeon, Eladio; Dugoni, Steven A; Chung, Chun-Hsi; Tadlock, Larry P; Barone, Nicholas D; Kulbersh, Valmy P; Sabott, David G; Kastrop, Marvin C

2015-05-01

The American Board of Orthodontics was established in 1929 and is the oldest specialty board in dentistry. Its goal is to protect the public by ensuring competency through the certification of eligible orthodontists. Originally, applicants for certification submitted a thesis, 5 case reports, and a set of casts with appliances. Once granted, the certification never expired. Requirements have changed over the years. In 1950, 15 cases were required, and then 10 in 1987. The Board has continued to refine and improve the certification process. In 1998, certification became time limited, and a renewal process was initiated. The Board continues to improve the recertification process. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Gainsharing Strategies, Physician Champions, Getting Physician Buy In.

PubMed

Anoushiravani, Afshin A; Nunley, Ryan M

2017-06-01

As healthcare spending continues to outpace economic growth, legislators and healthcare economists have explored many processes aimed at improving efficiency and reducing waste. Gainsharing or the general concept that organizations and their employees can work together to continually improve outcomes at reduced expenditures in exchange for a portion of the savings has been shown to be effective within the healthcare system. Although gainsharing principles may be applicable to healthcare organizations and their physician partners, specific parameters should be followed when implementing these arrangements. This article will discuss 10 gainsharing strategies aimed at properly aligning healthcare organizations and physicians, which if followed will ensure the successful implementation of gainsharing initiatives. Copyright © 2017. Published by Elsevier Inc.

Genetic analysis of some agronomic and fiber traits in Gossypium hirsutum L. grown in field conditions

USDA-ARS?s Scientific Manuscript database

Cotton production is an essential component of the economy of Pakistan, and continuing to improve the yield and fiber quality of this crop will ensure the future stability of this industry. Combining ability describes the performance of genotypes when they are crossed together, and it is a common me...

Aim Higher: Lofty Goals and an Aligned System Keep a High Performer on Top

ERIC Educational Resources Information Center

McCommons, David P.

2014-01-01

Every school district is feeling the pressure to ensure higher academic achievement for all students. A focus on professional learning for an administrative team not only improves student learning and achievement, but also assists in developing a systemic approach for continued success. This is how the Fox Chapel Area School District in…

Continuing Medical Education and Continuing Professional Development: a credit system for monitoring and promoting excellence.

PubMed

Matos-Ferreira, A

2001-06-01

Probably the most important demand on the career of a medical specialist is that of having to keep up-to-date both scientifically and professionally. But the onus does not fall only on the practitioner. The institutions involved in medical teaching and professional development also have a crucial role to play by providing opportunities for continuing education and assuring that the specialist carries out enough relevant, experience-enhancing tasks to ensure continuous professional growth. As upgrading medical knowledge and developing professionally is a life-long task, both the need and the obligation to learn and improve apply to doctors of all ages and at all hierarchical levels.

Learning from error: leading a culture of safety.

PubMed

Gibson, Russell; Armstrong, Alexander; Till, Alex; McKimm, Judy

2017-07-02

A recent shift towards more collective leadership in the NHS can help to achieve a culture of safety, particularly through encouraging frontline staff to participate and take responsibility for improving safety through learning from error and near misses. Leaders must ensure that they provide psychological safety, organizational fairness and learning systems for staff to feel confident in raising concerns, that they have the autonomy and skills to lead continual improvement, and that they have responsibility for spreading this learning within and across organizations.

Developing future clinical leaders for quality improvement: experience from a London children's hospital.

PubMed

Runnacles, Jane; Moult, Beki; Lachman, Peter

2013-11-01

Medical training does not necessarily prepare graduates for the real world of healthcare in which continual improvement is required. Doctors in postgraduate training (DrPGT) rarely have the opportunity to develop skills to implement changes where they work. Paradoxically they are often best placed to identify safety and quality concerns and can innovate across organisational boundaries. In order to address this, educational programmes require a supportive educational environment and should include experiential learning on a safety and quality project, alongside teaching of quality improvement (QI) knowledge and systems theory. Enabling Doctors in Quality Improvement and Patient Safety (EQuIP) has been designed for DrPGT at a London children's hospital. The aim is to prepare trainees for the future of continual improvement to ensure safe and effective services are developed through effective clinical microsystems. This paper describes the rationale and design of EQuIP with evaluation built in the evolving programme. EQuIP supports DrPGTs through a QI project within their department, aligned to the Great Ormond Street NHS Foundation Trust's objectives. This changes the way DrPGTs view healthcare as they become quality champions for their department. A three-level approach to the programme is described. The innovation involves a peer-designed programme while being work-based, delivering organisational strategies. Results of the preprogramme and postprogramme evaluations demonstrate an improvement in knowledge, skills and attitudes. Benefits to both the DrPGTs and the organisation are emphasised and key factors to achieve success and barriers identified by the participants. The design and evaluation of EQuIP may inform similar educational programmes in other organisations. This capacity building is crucial to ensure that future clinical leaders have the skills and motivation to improve the effectiveness of clinical microsystems.

Current and future perspectives on the management of polypharmacy.

PubMed

Molokhia, Mariam; Majeed, Azeem

2017-06-06

Because of ageing populations, the growth in the number of people with multi-morbidity and greater compliance with disease-specific guidelines, polypharmacy is becoming increasingly common. Although the correct drug treatment in patients with complex medical problems can improve clinical outcomes, quality of life and life expectancy, polypharmacy is also associated with an increased risk of adverse drug events, some severe enough to result in hospital admission and even death. Hence, having systems in place to ensure that medications are started only when there is a suitable indication, ensuring patients are fully aware of the benefits and complications that may arise from their treatment, and reviewing patients regularly to ensure their medication regime remains appropriate, are essential. The development and rapid uptake of electronic patient records - particularly in primary care settings where the majority of prescribing takes place - makes monitoring of patients more straightforward than in the past; and allows identification of sub-groups of patients at particularly high risk of adverse drug events and complications. It also facilitates 'deprescribing' the process by which medications are reviewed and stopped if not clinically beneficial. In recent years, we have also seen the development of smartphone 'apps' to improve communication between patients and healthcare professionals, improve people's understanding of their conditions and their treatment, and maintain a record of changes made to patient's medication. In the longer term, developments such as the introduction of artificial intelligence and clinical decision support systems also have the potential to improve prescribing and minimise the risks from polypharmacy. Finally, there is considerable scope to improve the quality of prescribing and reduce risks from poly-pharmacy using non-medical groups such as pharmacists, specialist nurses and physician assistants. Polypharmacy has increased in recent decades and will continue to increase as populations age and the number of people with multiple long-term conditions increases. As with all areas of medicine, the evidence-base in this area continues to evolve. Further trials on the impact on patients with polypharmacy of new interventions such as technology-based solutions and the use of different professional groups are needed to improve the evidence-base in this area.

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

PubMed

Jones, S B

1995-01-01

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

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

PubMed

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

2014-01-01

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

Brazil's National Program for Improving Primary Care Access and Quality (PMAQ)

PubMed Central

Harris, Matthew J.; Rocha, Marcia Gomes

2017-01-01

Despite some remarkable achievements, there are several challenges facing Brazil's Family Health Strategy (FHS), including expanding access to primary care and improving its quality. These concerns motivated the development of the National Program for Improving Primary Care Access and Quality (PMAQ). Although voluntary, the program now includes nearly 39 000 FHS teams in the country and has led to a near doubling of the federal investment in primary care in its first 2 rounds. In this article, we introduce the PMAQ and advance several recommendations to ensure that it continues to improve primary care access and quality in Brazil. PMID:28252498

[Clinical laboratory medicine: continuous amelioration with a book of objectives and satisfaction survey].

PubMed

Reix, Nathalie; Agin, Arnaud; Bahram, Seiamak; Dali-Youcef, Nassim; Grucker, Daniel; Jaulhac, Benoît; Lepiller, Quentin; Lessinger, Jean-Marc; Mauvieux, Laurent; Monier, Laurie; Schramm, Frédéric; Stoll-Keller, Françoise; Vallat, Laurent; Ludes, Bertrand; Candolfi, Ermanno; Filisetti, Denis

2015-01-01

We report in this publication the use of two educational tools, a questionnaire of satisfaction and a training book, to improve the training of students during their internship in clinical laboratory at the "Pôle de biologie des Hôpitaux universitaires de Strasbourg" in France. First, the ongoing training was assessed by the interns with a questionnaire measuring satisfaction. The analysis of this questionnaire identified four key points to improve: 1) define the teaching objectives, 2) organize the training with a schedule, 3) revise certain teaching methods and 4) ensure better integration of the students in the team of medical biologists. After this assessment, we implemented a training book to answer these four points. Indeed, the training book presents the objectives, the schedule of training, and how to validate the educational objectives. A new assessment was performed again using the same methodology. Results showed an improvement in student satisfaction from 74 to 88 %. The questionnaire of satisfaction and the training book are presented in this article. The aim of the assessment of training combined with the training book is to incite the actors of the training (students and teachers) to continually improve the training. The objectives of the Pôle de Biologie are to obtain an 80 % satisfaction rate during the 6 months trainings and to reduce or eliminate dissatisfaction, and finally to ensure the validation by students of 80 to 100 % of their predetermined objectives.

Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program.

PubMed

Lutz, Mark F; Haines, Stuart T; Lesch, Christine A; Szumita, Paul M

2016-10-01

Results of the MENTORED QUALITY IMPROVEMENT IMPACT PROGRAM℠ (MQIIP) on Ensuring Insulin Pen Safety in Hospitals, which was part of an ASHP educational initiative aimed at ensuring the safe use of insulin pens in hospitals, are described. During this ASHP initiative, which also included continuing-education activities and Web-based resources, distance mentoring by pharmacists with expertise in the safe use of insulin pens was provided to interprofessional teams at 14 hospitals between September 2014 and May 2015. The results of baseline assessments of nursing staff knowledge of insulin pen use, insulin pen storage and labeling audits, and insulin pen injection observations conducted in September and October 2014 were the basis for insulin pen quality-improvement plans. Postintervention data were collected in April and May 2015. Compared with the baseline period, significant improvements in nurses' knowledge of insulin pen use, insulin pen labeling and storage, and insulin pen administration were observed in the postintervention period despite the relatively short time frame for implementation of quality-improvement plans. Program participants are committed to sustaining and building on improvements achieved during the program. The outcome measures described in this report could be adapted by other health systems to identify opportunities to improve the safety of insulin pen use. Focused attention on insulin pen safety through an interprofessional team approach during the MQIIP enabled participating sites to detect potential safety issues based on collected data, develop targeted process changes, document improvements, and identify areas requiring further intervention. A sustained organizational commitment is required to ensure the safe use of insulin pen devices in hospitals. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Ensuring Patient Safety in Care Transitions: An Empirical Evaluation of a Handoff Intervention Tool

PubMed Central

Abraham, Joanna; Kannampallil, Thomas; Patel, Bela; Almoosa, Khalid; Patel, Vimla L.

2012-01-01

Successful handoffs ensure smooth, efficient and safe patient care transitions. Tools and systems designed for standardization of clinician handoffs often focuses on ensuring the communication activity during transitions, with limited support for preparatory activities such as information seeking and organization. We designed and evaluated a Handoff Intervention Tool (HAND-IT) based on a checklist-inspired, body system format allowing structured information organization, and a problem-case narrative format allowing temporal description of patient care events. Based on a pre-post prospective study using a multi-method analysis we evaluated the effectiveness of HAND-IT as a documentation tool. We found that the use of HAND-IT led to fewer transition breakdowns, greater tool resilience, and likely led to better learning outcomes for less-experienced clinicians when compared to the current tool. We discuss the implications of our results for improving patient safety with a continuity of care-based approach. PMID:23304268

Positioning hospitals for improved access to capital.

PubMed

Ponton, Kevin T; Sandrick, Karen M

2002-11-01

Hospitals need to actively position themselves in the next 18 to 24 months to ensure continued access to financing. Hospitals need to shift their focus from investment income to operations. Hospitals should recognize the importance of balance-sheet liquidity to institutional investors. Not-for-profit hospitals should focus on both sides of the balance sheet. Healthcare executives need to develop effective leadership and investor-relations skills.

Defense Commissaries: DOD Needs to Improve Business Processes to Ensure Patron Benefits and Achieve Operational Efficiencies

DTIC Science & Technology

2017-03-01

sales, leverage efficiencies, and achieve savings in commissary operations. Second, DeCA has not conducted cost - benefit analyses for costs ...conduct comprehensive cost - benefit analyses for service contracts and distribution options. DOD concurred with GAO’s first two recommendations and...partially concurred with the third recommendation. GAO continues to believe the cost - benefit analysis recommendation is valid

Comparing the Differences in Access to Professional Development for General Education and Special Education Teachers and the Subsequent Impact on Instructional Practice

ERIC Educational Resources Information Center

Slater, Lori L.

2017-01-01

The demands on schools, teachers, and students continue to increase as greater accountability measures are put into place at all levels. For teachers to meet these increased demands, it is important that they be provided opportunities to improve and enhance their content knowledge and pedagogy. One way to ensure the provision of these…

Major Management Challenges and Program Risks. Department of Agriculture

DTIC Science & Technology

2001-01-01

environment, ensure food safety , improve the well-being of rural America, promote domestic marketing and the export of food and farm products, conduct...meat and poultry. USDA must also determine if foreign countries have implemented equivalent food safety and inspection systems before those countries...continuing fundamental problem facing USDA, namely, that the current food safety system is highly fragmented with as many as 12 different federal

Introduction to Quality Control in a Compounding Pharmacy.

PubMed

Allen, Loyd V

2016-01-01

A quality-based program is vital in every compounding pharmacy to ensure that each preparation is compounded properly and is stable for its expected duration of use. This article discusses quality control, quality assurance, continuous quality improvement, and also describes the components of an in-house (in-pharmacy) quality program, as well as the role of outside laboratories. Copyright© by International Journal of Pharmaceutical Compounding, Inc.

Work-related factors influencing home care nurse intent to remain employed.

PubMed

Tourangeau, Ann E; Patterson, Erin; Saari, Margaret; Thomson, Heather; Cranley, Lisa

Health care is shifting out of hospitals into community settings. In Ontario, Canada, home care organizations continue to experience challenges recruiting and retaining nurses. However, factors influencing home care nurse retention that can be modified remain largely unexplored. Several groups of factors have been identified as influencing home care nurse intent to remain employed including job characteristics, work structures, relationships and communication, work environment, responses to work, and conditions of employment. The aim of this study was to test and refine a model that identifies which factors are related to home care nurse intentions to remain employed for the next 5 years with their current home care employer organization. A cross-sectional survey design was implemented to test and refine a hypothesized model of home care nurse intent to remain employed. Logistic regression was used to determine which factors influence home care nurse intent to remain employed. Home care nurse intent to remain employed for the next 5 years was associated with increasing age, higher nurse-evaluated quality of care, having greater variety of patients, experiencing greater meaningfulness of work, having greater income stability, having greater continuity of client care, experiencing more positive relationships with supervisors, experiencing higher work-life balance, and being more satisfied with salary and benefits. Home care organizations can promote home care nurse intent to remain employed by (a) ensuring nurses have adequate training and resources to provide quality client care, (b) improving employment conditions to increase income stability and satisfaction with pay and benefits, (c) ensuring manageable workloads to facilitate improved work-life balance, and (d) ensuring leaders are accessible and competent.

The role of productivity in improving the environmental sustainability of ruminant production systems.

PubMed

Capper, Judith L; Bauman, Dale E

2013-01-01

The global livestock industry is charged with providing sufficient animal source foods to supply the global population while improving the environmental sustainability of animal production. Improved productivity within dairy and beef systems has demonstrably reduced resource use and greenhouse gas emissions per unit of food over the past century through the dilution of maintenance effect. Further environmental mitigation effects have been gained through the current use of technologies and practices that enhance milk yield or growth in ruminants; however, the social acceptability of continued intensification and use of productivity-enhancing technologies is subject to debate. As the environmental impact of food production continues to be a significant issue for all stakeholders within the field, further research is needed to ensure that comparisons among foods are made based on both environmental impact and nutritive value to truly assess the sustainability of ruminant products.

Process analytical technology in the pharmaceutical industry: a toolkit for continuous improvement.

PubMed

Scott, Bradley; Wilcock, Anne

2006-01-01

Process analytical technology (PAT) refers to a series of tools used to ensure that quality is built into products while at the same time improving the understanding of processes, increasing efficiency, and decreasing costs. It has not been widely adopted by the pharmaceutical industry. As the setting for this paper, the current pharmaceutical manufacturing paradigm and PAT guidance to date are discussed prior to the review of PAT principles and tools, benefits, and challenges. The PAT toolkit contains process analyzers, multivariate analysis tools, process control tools, and continuous improvement/knowledge management/information technology systems. The integration and implementation of these tools is complex, and has resulted in uncertainty with respect to both regulation and validation. The paucity of staff knowledgeable in this area may complicate adoption. Studies to quantitate the benefits resulting from the adoption of PAT within the pharmaceutical industry would be a valuable addition to the qualitative studies that are currently available.

Application of flywheel battery in mobile power station

NASA Astrophysics Data System (ADS)

Wang, Xinggui; Zhang, Bing; Li, Xiaoying; Sun, Xiaojing

2013-03-01

The flywheel battery is used to the mobile station for continuous power supply, once the commercial power or other independent power supply is outage or failure, the flywheel battery will provide uninterrupted power supply during the switch to the commercial power and the diesel generator sets, ensuring the power supply system is continuous and maintaining the performance and parameters of the power supply which will not influence or discontinuous change because of commercial power failure. Simulation results show that the flywheel battery used to the mobile station can effectively improve the performance of the mobile power station system.

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

PubMed

Rela, Mohamed; Reddy, Mettu Srinivas

2017-03-01

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

Building and Maintaining Organizational Infrastructure to Attain Clinical Excellence.

PubMed

Lebak, Kelly; Lane, Jason; Taus, Richard; Kim, Hansol; Stecker, Michael S; Hall, Michael; Lane-Fall, Meghan B; Weiss, Mark S

2017-12-01

Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non-operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. For anesthesiologists, this training must begin during residency. The training should be supplemented with continuing education in this field for providers who find themselves working in the NORA space. As NORA continues to grow, robust NORA-specific quality assurance and improvement programs will empower anesthesiologists with the tools they need to best care for these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

ESD coating of copper with TiC and TiB2 based ceramic matrix composites

NASA Astrophysics Data System (ADS)

Talas, S.; Mertgenç, E.; Gökçe, B.

2016-08-01

In automotive industry, the spot welding is a general practice to join smaller sections of a car. This welding is specifically carried out in short time and in an elevated number with certain pressure applied on copper electrodes. In addition, copper electrodes are expected to endure against cyclic mechanical pressure and temperature that is released during the passage of the current. The deformation and oxidation behaviour of copper electrodes during service appear with increasing temperature of medium and they also need to be cleaned and cooled or replaced for the continuation of joining process. The coating of copper electrodes with ceramic matrix composites can provide alternative excellent high temperature strength and ensures both economic and efficient use of resources. This study shows that the ESD coating of copper electrodes with a continuous film of ceramic phase ensures an improved resistance to thermal effects during the service and the change in content of film may be critical for cyclic alloying.

Continuous quality improvement: a shared governance model that maximizes agent-specific knowledge.

PubMed

Burkoski, Vanessa; Yoon, Jennifer

2013-01-01

Motivate, Innovate, Celebrate: an innovative shared governance model through the establishment of continuous quality improvement (CQI) councils was implemented across the London Health Sciences Centre (LHSC). The model leverages agent-specific knowledge at the point of care and provides a structure aimed at building human resources capacity and sustaining enhancements to quality and safe care delivery. Interprofessional and cross-functional teams work through the CQI councils to identify, formulate, execute and evaluate CQI initiatives. In addition to a structure that facilitates collaboration, accountability and ownership, a corporate CQI Steering Committee provides the forum for scaling up and spreading this model. Point-of-care staff, clinical management and educators were trained in LEAN methodology and patient experience-based design to ensure sufficient knowledge and resources to support the implementation.

Improving service quality in NHS Trust hospitals: lessons from the hotel sector.

PubMed

Desombre, T; Eccles, G

1998-01-01

This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction.

Quality assurance and quality improvement in U.S. clinical molecular genetic laboratories.

PubMed

Chen, Bin; Richards, C Sue; Wilson, Jean Amos; Lyon, Elaine

2011-04-01

A robust quality-assurance program is essential for laboratories that perform molecular genetic testing to maintain high-quality testing and be able to address challenges associated with performance or delivery of testing services as the use of molecular genetic tests continues to expand in clinical and public health practice. This unit discusses quality-assurance and quality-improvement considerations that are critical for molecular genetic testing performed for heritable diseases and conditions. Specific discussion is provided on applying regulatory standards and best practices in establishing/verifying test performance, ensuring quality of the total testing process, monitoring and maintaining personnel competency, and continuing quality improvement. The unit provides a practical reference for laboratory professionals to use in recognizing and addressing essential quality-assurance issues in human molecular genetic testing. It should also provide useful information for genetics researchers, trainees, and fellows in human genetics training programs, as well as others who are interested in quality assurance and quality improvement for molecular genetic testing. 2011 by John Wiley & Sons, Inc.

Geometry control of long-span continuous girder concrete bridge during construction through finite element model updating

NASA Astrophysics Data System (ADS)

Wu, Jie; Yan, Quan-sheng; Li, Jian; Hu, Min-yi

2016-04-01

In bridge construction, geometry control is critical to ensure that the final constructed bridge has the consistent shape as design. A common method is by predicting the deflections of the bridge during each construction phase through the associated finite element models. Therefore, the cambers of the bridge during different construction phases can be determined beforehand. These finite element models are mostly based on the design drawings and nominal material properties. However, the accuracy of these bridge models can be large due to significant uncertainties of the actual properties of the materials used in construction. Therefore, the predicted cambers may not be accurate to ensure agreement of bridge geometry with design, especially for long-span bridges. In this paper, an improved geometry control method is described, which incorporates finite element (FE) model updating during the construction process based on measured bridge deflections. A method based on the Kriging model and Latin hypercube sampling is proposed to perform the FE model updating due to its simplicity and efficiency. The proposed method has been applied to a long-span continuous girder concrete bridge during its construction. Results show that the method is effective in reducing construction error and ensuring the accuracy of the geometry of the final constructed bridge.

Improving Palliative Care Team Meetings: Structure, Inclusion, and "Team Care".

PubMed

Brennan, Caitlin W; Kelly, Brittany; Skarf, Lara Michal; Tellem, Rotem; Dunn, Kathleen M; Poswolsky, Sheila

2016-07-01

Increasing demands on palliative care teams point to the need for continuous improvement to ensure teams are working collaboratively and efficiently. This quality improvement initiative focused on improving interprofessional team meeting efficiency and subsequently patient care. Meeting start and end times improved from a mean of approximately 9 and 6 minutes late in the baseline period, respectively, to a mean of 4.4 minutes late (start time) and ending early in our sustainability phase. Mean team satisfaction improved from 2.4 to 4.5 on a 5-point Likert-type scale. The improvement initiative clarified communication about patients' plans of care, thus positively impacting team members' ability to articulate goals to other professionals, patients, and families. We propose several recommendations in the form of a team meeting "toolkit." © The Author(s) 2015.

Life...Pass It On. [How Educators Can Help, How the Farmer and Rancher Can Help, How the Homemaker Can Help, How the Outdoorsman Can Help, How You Can Help].

ERIC Educational Resources Information Center

Environmental Protection Agency, Denver, CO.

These materials are an attempt at continued cooperation between the diverse economic groups of the Rocky Mountain-Prairie Region of the Environmental Protection Agency. This cooperation between educators, outdoorsmen, homemakers, students, farmers, and ranchers is vital to the improvement of present environmental quality and the ensuring of its…

Landsat: building a strong future

USGS Publications Warehouse

Loveland, Thomas R.; Dwyer, John L.

2012-01-01

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

Improving Access and Systems of Care for Evidence-Based Childhood Obesity Treatment: Conference Key Findings and Next Steps

PubMed Central

Wilfley, Denise E.; Staiano, Amanda E.; Altman, Myra; Lindros, Jeanne; Lima, Angela; Hassink, Sandra G.; Dietz, William H.; Cook, Stephen

2017-01-01

Objectives To improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment (i.e. clinicians offer/refer children with obesity to intensive, multicomponent behavioral interventions of >25 hours over 6–12 months to improve weight status) and to expand payment for these services. Methods In July 2015, forty-three cross-sector stakeholders attended a conference supported by the Agency for Healthcare Research and Quality, American Academy of Pediatrics Institute for Healthy Childhood Weight, and The Obesity Society. Plenary sessions presenting scientific evidence and clinical and payment practices were interspersed with breakout sessions to identify consensus recommendations. Results Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multi-disciplinary care team. The use of evidence-based protocols, a well-trained healthcare team, medical oversight, and treatment at or above the minimum dose (e.g. >25 hours) are critical components to ensure effective delivery of high-quality care and to achieve clinically meaningful weight loss. Approaches to secure reimbursement for evidence-based obesity treatment within payment models were recommended. Conclusion Continued cross-sector collaboration is crucial to ensure a unified approach to increase payment and access for childhood obesity treatment and to scale-up training to ensure quality of care. PMID:27925451

Improving access and systems of care for evidence-based childhood obesity treatment: Conference key findings and next steps.

PubMed

Wilfley, Denise E; Staiano, Amanda E; Altman, Myra; Lindros, Jeanne; Lima, Angela; Hassink, Sandra G; Dietz, William H; Cook, Stephen

2017-01-01

To improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment (i.e., clinicians offer/refer children with obesity to intensive, multicomponent behavioral interventions of >25 h over 6 to 12 months to improve weight status) and to expand payment for these services. In July 2015, 43 cross-sector stakeholders attended a conference supported by the Agency for Healthcare Research and Quality, American Academy of Pediatrics Institute for Healthy Childhood Weight, and The Obesity Society. Plenary sessions presenting scientific evidence and clinical and payment practices were interspersed with breakout sessions to identify consensus recommendations. Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multidisciplinary care team. The use of evidence-based protocols, a well-trained healthcare team, medical oversight, and treatment at or above the minimum dose (e.g., >25 h) are critical components to ensure effective delivery of high-quality care and to achieve clinically meaningful weight loss. Approaches to secure reimbursement for evidence-based obesity treatment within payment models were recommended. Continued cross-sector collaboration is crucial to ensure a unified approach to increase payment and access for childhood obesity treatment and to scale up training to ensure quality of care. © 2016 The Obesity Society.

In the face of increasing subspecialisation, how does the specialty ensure that the management of ENT emergencies is timely, appropriate and safe?

PubMed

Rouhani, M J

2016-06-01

The field of ENT surgery is one of the most varied specialties, with numerous subspecialties and continuing divergence. With this evolution there comes, however, a risk that specialists become de-skilled in certain areas. In the case of ENT emergencies, this can be particularly dangerous. Current guidance from relevant UK professional membership bodies regarding emergency surgery provision was inspected and a literature search was performed to identify studies relating to management of ENT emergencies in the context of increasing subspecialisation. The specialty currently has provisions in place to ensure timely, appropriate and safe management of emergencies, in the form of guidelines and emergency clinics; however, there is scope for improvement of the system.

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.

Sigma Metrics Across the Total Testing Process.

PubMed

Charuruks, Navapun

2017-03-01

Laboratory quality control has been developed for several decades to ensure patients' safety, from a statistical quality control focus on the analytical phase to total laboratory processes. The sigma concept provides a convenient way to quantify the number of errors in extra-analytical and analytical phases through the defect per million and sigma metric equation. Participation in a sigma verification program can be a convenient way to monitor analytical performance continuous quality improvement. Improvement of sigma-scale performance has been shown from our data. New tools and techniques for integration are needed. Copyright © 2016 Elsevier Inc. All rights reserved.

Homeland security and virtual reality: building a Strategic Adaptive Response System (STARS).

PubMed

Swift, Christopher; Rosen, Joseph M; Boezer, Gordon; Lanier, Jaron; Henderson, Joseph V; Liu, Alan; Merrell, Ronald C; Nguyen, Sinh; Demas, Alex; Grigg, Elliot B; McKnight, Matthew F; Chang, Janelle; Koop, C Everett

2005-01-01

The advent of the Global War on Terrorism (GWOT) underscored the need to improve the U.S. disaster response paradigm. Existing systems involve numerous agencies spread across disparate functional and geographic jurisdictions. The current architecture remains vulnerable to sophisticated terrorist strikes. To address these vulnerabilities, we must continuously adapt and improve our Homeland Security architecture. Virtual Reality (VR) technologies will help model those changes and integrate technologies. This paper provides a broad overview of the strategic threats, together with a detailed examination of how specific VR technologies could be used to ensure successful disaster responses.

Student-oriented learning outlines: a valuable supplement to traditional instruction.

PubMed

VanArsdale, S K; Hammons, J O

1998-01-01

In a time of changing health care and funding restraints in institutions, continuing education and staff development departments are being challenged to produce better prepared nurses at reduced costs per employee. Improvements in how nurses are prepared are needed to ensure higher levels of competence without increasing the cost. This article describes the development and use of a practical strategy for mastery learning known as Student-Oriented Learning Outlines or SOLOs. This approach has been found to be effective in producing improvements in learning and ultimately patient care while reducing cost to the institution.

Strategic Positioning of United States Air Force Civil Engineer Contingency Equipment within the Supply Chain

DTIC Science & Technology

2014-03-27

discussed. Background In a dynamic world full of uncertain threats, the United States military is constantly required to evolve and enhance its...capabilities to effectively defend the nation. One of the military capabilities requiring continuous improvement to ensure pursuit of American...force the right personnel, equipment, and supplies in the right place, at the right time, and in the right quantity, across the full range of military

Conducting Research on the International Space Station Using the EXPRESS Rack Facilities

NASA Technical Reports Server (NTRS)

Thompson, Sean W.; Lake, Robert E.

2014-01-01

EXPRESS Racks provide capability for payload access to ISS resources. The successful on-orbit operations and versatility of the EXPRESS Rack has facilitated the operations of many scientific areas, with the promise of continued payload support for years to come. EXPRESS Racks are currently deployed in the US Lab, Columbus and JEM. Process improvements and enhancements continue to improve the accommodations and make the integration and operations process more efficient. Payload Integration Managers serve as the primary interface between the ISS Program and EXPRESS Payload Developers. EXPRESS Project coordinates across multiple functional areas and organizations to ensure integrated EXPRESS Rack and subrack products and hardware are complete, accurate, on time, safe, and certified for flight. NASA is planning to expand the EXPRESS payload capacity by developing new Basic Express Racks expected to be on ISS in 2018.

Asynchronous variational integration using continuous assumed gradient elements.

PubMed

Wolff, Sebastian; Bucher, Christian

2013-03-01

Asynchronous variational integration (AVI) is a tool which improves the numerical efficiency of explicit time stepping schemes when applied to finite element meshes with local spatial refinement. This is achieved by associating an individual time step length to each spatial domain. Furthermore, long-term stability is ensured by its variational structure. This article presents AVI in the context of finite elements based on a weakened weak form (W2) Liu (2009) [1], exemplified by continuous assumed gradient elements Wolff and Bucher (2011) [2]. The article presents the main ideas of the modified AVI, gives implementation notes and a recipe for estimating the critical time step.

The lab without walls: a deployable approach to tropical infectious diseases.

PubMed

Inglis, Timothy J J

2013-04-01

The Laboratory Without Walls is a modular field application of molecular biology that provides clinical laboratory support in resource-limited, remote locations. The current repertoire arose from early attempts to deliver clinical pathology and public health investigative services in remote parts of tropical Australia, to address the shortcomings of conventional methods when faced with emerging infectious diseases. Advances in equipment platforms and reagent chemistry have enabling rapid progress, but also ensure the Laboratory Without Walls is subject to continual improvement. Although new molecular biology methods may lead to more easily deployable clinical laboratory capability, logistic and technical governance issues continue to act as important constraints on wider implementation.

The right care, every time: improving adherence to evidence-based guidelines.

PubMed

Runnacles, Jane; Roueché, Alice; Lachman, Peter

2018-02-01

Guidelines are integral to reducing variation in paediatric care by ensuring that children receive the right care, every time. However, for reasons discussed in this paper, clinicians do not always follow evidence-based guidelines. Strategies to improve guideline usage tend to focus on dissemination and education. These approaches, however, do not address some of the more complex factors that influence whether a guideline is used in clinical practice. In this article, part of the Equipped Quality Improvement series, we outline the literature on barriers to guideline adherence and present practical solutions to address these barriers. Examples outlined include the use of care bundles, integrated care pathways and quality improvement collaboratives. A sophisticated information technology system can improve the use of evidence-based guidelines and provide organisations with valuable data for learning and improvement. Key to success is the support of an organisation that places reliability of service delivery as the way business is done. To do this requires leadership from clinicians in multidisciplinary teams and a system of continual improvement. By learning from successful approaches, we believe that all healthcare organisations can ensure the right care for each patient, every time. © 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.

Continuity of care from the perspective of users.

PubMed

Mendes, Felismina Rosa P; Gemito, Maria Laurência G Parreirinha; Caldeira, Ermelinda do Carmo; Serra, Isaura da Conceição; Casas-Novas, Maria Vitória

2017-03-01

Continuity of care, in addition to ensuring improvement of the quality of care, contributes to the reduction of health costs. The objective of this study was to analyse the continuity of care in health units in the municipality of Évora (south of Portugal), from the perspective of users. This is across-sectional, exploratory and descriptive study with a quantitative approach, with a sample consisting of 342 users of health units. The instrument was a questionnaire adapted from English and Spanish studies. The results show that elements of continuity were identified in the different dimensions of the continuity of care - relational, management, information and some items of flexible continuity. Longitudinal continuity has the lowest values in nursing care. In conclusion, what stands out positively, and in its different dimensions, is relational continuity, in which most users recommend their family doctor and nurse to family and friends, and flexible continuity, which translates into reduced waiting times to be attended by a doctor or nurse and access to care. What stands out negatively is the weak involvement of the user in care by health professionals, in the dimensions of relational continuity.

Transformation of Mental Health Care for U.S. Soldiers and Families During the Iraq and Afghanistan Wars: Where Science and Politics Intersect.

PubMed

Hoge, Charles W; Ivany, Christopher G; Brusher, Edward A; Brown, Millard D; Shero, John C; Adler, Amy B; Warner, Christopher H; Orman, David T

2016-04-01

The cumulative strain of 14 years of war on service members, veterans, and their families, together with continuing global threats and the unique stresses of military service, are likely to be felt for years to come. Scientific as well as political factors have influenced how the military has addressed the mental health needs resulting from these wars. Two important differences between mental health care delivered during the Iraq and Afghanistan wars and previous wars are the degree to which research has directly informed care and the consolidated management of services. The U.S. Army Medical Command implemented programmatic changes to ensure delivery of high-quality standardized mental health services, including centralized workload management; consolidation of psychiatry, psychology, psychiatric nursing, and social work services under integrated behavioral health departments; creation of satellite mental health clinics embedded within brigade work areas; incorporation of mental health providers into primary care; routine mental health screening throughout soldiers' careers; standardization of clinical outcome measures; and improved services for family members. This transformation has been accompanied by reduction in psychiatric hospitalizations and improved continuity of care. Challenges remain, however, including continued underutilization of services by those most in need, problems with treatment of substance use disorders, overuse of opioid medications, concerns with the structure of care for chronic postdeployment (including postconcussion) symptoms, and ongoing questions concerning the causes of historically high suicide rates, efficacy of resilience training initiatives, and research priorities. It is critical to ensure that remaining gaps are addressed and that knowledge gained during these wars is retained and further evolved.

Methods for engaging stakeholders in comparative effectiveness research: a patient-centered approach to improving diabetes care.

PubMed

Schmittdiel, Julie A; Desai, Jay; Schroeder, Emily B; Paolino, Andrea R; Nichols, Gregory A; Lawrence, Jean M; O'Connor, Patrick J; Ohnsorg, Kris A; Newton, Katherine M; Steiner, John F

2015-06-01

Engaging stakeholders in the research process has the potential to improve quality of care and the patient care experience. Online patient community surveys can elicit important topic areas for comparative effectiveness research. Stakeholder meetings with substantial patient representation, as well as representation from health care delivery systems and research funding agencies, are a valuable tool for selecting and refining pilot research and quality improvement projects. Giving patient stakeholders a deciding vote in selecting pilot research topics helps ensure their 'voice' is heard. Researchers and health care leaders should continue to develop best-practices and strategies for increasing patient involvement in comparative effectiveness and delivery science research.

Improvement of radiology services based on the process management approach.

PubMed

Amaral, Creusa Sayuri Tahara; Rozenfeld, Henrique; Costa, Janaina Mascarenhas Hornos; Magon, Maria de Fátima de Andrade; Mascarenhas, Yvone Maria

2011-06-01

The health sector requires continuous investments to ensure the improvement of products and services from a technological standpoint, the use of new materials, equipment and tools, and the application of process management methods. Methods associated with the process management approach, such as the development of reference models of business processes, can provide significant innovations in the health sector and respond to the current market trend for modern management in this sector (Gunderman et al. (2008) [4]). This article proposes a process model for diagnostic medical X-ray imaging, from which it derives a primary reference model and describes how this information leads to gains in quality and improvements. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Partnership for Continuous Improvement

NASA Technical Reports Server (NTRS)

1990-01-01

The proceedings are presented of the sixth annual conference on quality control between NASA and its contractors. The emphasis is placed on a commitment to quality and excellence that guarantees mission success. A forum is provided for representatives from government, industry, and academia to exchange ideas and experiences, encouraging total quality performance that results in high quality products and services. Key points are highlighted from the presentations and activities are described that have resulted in a broad range of improvements in products and services from government, industry, and academia. Long term commitment to quality is an essential requirement that ensures future success. That commitment reinterates the dedication to excellence in space exploration and to national quality and productivity improvement.

40 CFR 142.306 - What are the responsibilities of the public water system, State and the Administrator in ensuring...

Code of Federal Regulations, 2012 CFR

2012-07-01

...) Alternative sources of water supply; (iii) Restructuring or consolidation changes, including ownership change... public water system, State and the Administrator in ensuring that sufficient information is available and... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING...

40 CFR 142.306 - What are the responsibilities of the public water system, State and the Administrator in ensuring...

Code of Federal Regulations, 2013 CFR

2013-07-01

...) Alternative sources of water supply; (iii) Restructuring or consolidation changes, including ownership change... public water system, State and the Administrator in ensuring that sufficient information is available and... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING...

Advanced planning for ISS payload ground processing

NASA Astrophysics Data System (ADS)

Page, Kimberly A.

2000-01-01

Ground processing at John F. Kennedy Space Center (KSC) is the concluding phase of the payload/flight hardware development process and is the final opportunity to ensure safe and successful recognition of mission objectives. Planning for the ground processing of on-orbit flight hardware elements and payloads for the International Space Station is a responsibility taken seriously at KSC. Realizing that entering into this operational environment can be an enormous undertaking for a payload customer, KSC continually works to improve this process by instituting new/improved services for payload developer/owner, applying state-of-the-art technologies to the advanced planning process, and incorporating lessons learned for payload ground processing planning to ensure complete customer satisfaction. This paper will present an overview of the KSC advanced planning activities for ISS hardware/payload ground processing. It will focus on when and how KSC begins to interact with the payload developer/owner, how that interaction changes (and grows) throughout the planning process, and how KSC ensures that advanced planning is successfully implemented at the launch site. It will also briefly consider the type of advance planning conducted by the launch site that is transparent to the payload user but essential to the successful processing of the payload (i.e. resource allocation, executing documentation, etc.) .

Speaking the right language: the scientific method as a framework for a continuous quality improvement program within academic medical research compliance units.

PubMed

Nolte, Kurt B; Stewart, Douglas M; O'Hair, Kevin C; Gannon, William L; Briggs, Michael S; Barron, A Marie; Pointer, Judy; Larson, Richard S

2008-10-01

The authors developed a novel continuous quality improvement (CQI) process for academic biomedical research compliance administration. A challenge in developing a quality improvement program in a nonbusiness environment is that the terminology and processes are often foreign. Rather than training staff in an existing quality improvement process, the authors opted to develop a novel process based on the scientific method--a paradigm familiar to all team members. The CQI process included our research compliance units. Unit leaders identified problems in compliance administration where a resolution would have a positive impact and which could be resolved or improved with current resources. They then generated testable hypotheses about a change to standard practice expected to improve the problem, and they developed methods and metrics to assess the impact of the change. The CQI process was managed in a "peer review" environment. The program included processes to reduce the incidence of infections in animal colonies, decrease research protocol-approval times, improve compliance and protection of animal and human research subjects, and improve research protocol quality. This novel CQI approach is well suited to the needs and the unique processes of research compliance administration. Using the scientific method as the improvement paradigm fostered acceptance of the project by unit leaders and facilitated the development of specific improvement projects. These quality initiatives will allow us to improve support for investigators while ensuring that compliance standards continue to be met. We believe that our CQI process can readily be used in other academically based offices of research.

Integration of biochemical sensors into wearable biomaterial platforms

NASA Astrophysics Data System (ADS)

Jandhyala, Sidhartha; Walper, Scott A.; Cargill, Allison A.; Ozual, Abigail; Daniele, Michael A.

2016-05-01

With rapidly inflating healthcare costs, a limited supply of physicians and an alarming surge in lifestyle diseases, radical changes must be made to improve preventative medicine and ensure a sustainable healthcare system. A compelling solution is to equip the population with wearable health monitors to continuously record representative and actionable physiological data. Herein, we present a preliminary design and evaluation of a biochemical sensor node enabled by a substrate comprised of a nanocellulose thin-film that conforms to the skin and carries a printed sensor element. The nanocellulose layer ensures conformal and biocompatible contact with the skin, while a printed layer provides a high surface-area electrode. While the recognition/transduction element can be exchanged for many different sensing motifs, we utilize the general structure of an electrochemical glucose sensor.

Opinion & Special Articles: Mentoring in neurology

PubMed Central

Lee, Paul R.

2014-01-01

Effective academic mentoring significantly affects a physician's choice of career, academic productivity, and professional trajectory. The mentoring relationship is necessary for the continued success of medical training. It is critical to cultivate a climate in which mentoring can thrive. In order to improve the quality and outcomes of mentoring, we must adopt a comprehensive plan. There are interventions at every level of training that will ensure that the current cohort of neurologists receives the requisite expertise needed to flourish and inspire future trainees. Professional organizations must articulate a comprehensive vision of mentoring. Institutions must create an infrastructure to support mentors. Mentors should work in active partnerships with their mentees to forge sustained, productive relationships. Mentees must actively contribute to their own mentoring. Proper mentorship will ensure a bright future for academic neurology. PMID:24616198

Cross-border collaboration for improved tuberculosis prevention and care: policies, tools and experiences.

PubMed

Dara, M; Sulis, G; Centis, R; D'Ambrosio, L; de Vries, G; Douglas, P; Garcia, D; Jansen, N; Zuroweste, E; Migliori, G B

2017-07-01

As tuberculosis (TB) spreads beyond borders with people movements, several interventions ensuring the continuity of care are essential, although difficult to put in place in the absence of well-defined agreements allowing data sharing and easy referral of patients to appropriate health facilities. This article first sets out general principles for cross-border collaboration and continuity of care. It then presents a series of case studies. Policies and practices on cross-border collaboration in selected low-incidence countries (Australia, Italy, Norway, The Netherlands, the United Kingdom and the United States) are described and critically appraised. Details of the World Health Organization's (WHO's) European Respiratory Society TB Consilium for transborder migration and those of the Health Network's TBNet activities are described. With increasing population movement, including migrants and travellers, it is time to build on good practices and existing tools and to remove legal, financial and social barriers to ensure early diagnosis, full treatment and continuity of care across our world. Data sharing between the sending and the receiving countries is of utmost importance and must be conducted in line with privacy protection rules. Successful implementation of these interventions is key to being on track with the WHO's End TB strategy targets for 2030.

Using Evidence as the Driver of Policy Change: The Next Steps in Supporting Innovation, Continuous Improvement, and Accountability. Testimony of Gordon L. Berlin, President of MDRC, before the Senate Finance Committee

ERIC Educational Resources Information Center

Berlin, Gordon L.

2016-01-01

Over the last decade and a half, during a period defined in the public consciousness by political partisanship, the legislative and executive branches have quietly forged a bipartisan consensus around the need to build evidence of effectiveness that would ensure high rates of return on investment for the nation's social programs. The establishment…

Defense Management. DOD Needs to Reexamine Its Extensive Reliance on Contractors and Continue to Improve Management and Oversight

DTIC Science & Technology

2008-03-11

guidance dealing with contractors who support deployed forces in October 2005. However, as we recently testified , DOD’s leadership needs to ensure...GAO-08-572T may be “ borderline inherently governmental.”14 We have also found problems with contractors having too much control at other...contract oversight personnel, lessons learned, and training of military commanders and contract oversight personnel. More recently, we testified that DOD’s

Influence of mileage accumulation on the particle mass and number emissions of two gasoline direct injection vehicles.

PubMed

Maricq, M Matti; Szente, Joseph J; Adams, Jack; Tennison, Paul; Rumpsa, Todd

2013-10-15

Gasoline direct injection (GDI) is a new engine technology intended to improve fuel economy and greenhouse gas emissions as required by recently enacted legislative and environmental regulations. The development of this technology must also ensure that these vehicles meet new LEV III and Tier 3 emissions standards as they phase in between 2017 and 2021. The aim of the present paper is to examine, at least for a small set, how the PM emissions from GDI vehicles change over their lifetime. The paper reports particle mass and number emissions of two GDI vehicles as a function of mileage up to 150K miles. These vehicles exhibit PM emissions that are near or below the upcoming 3 mg/mi FTP and 10 mg/mi US06 mass standards with little, if any, deterioration over 150K miles. Particle number emissions roughly follow the previously observed 2 × 10(12) particles/mg correlation between solid particle number and PM mass. They remained between the interim and final EU stage 6 solid particle count standard for gasoline vehicles throughout the mileage accumulation study. These examples demonstrate feasibility to meet near-term 3 mg/mi and interim EU solid particle number standards, but continued development is needed to ensure that this continues as further fuel economy improvements are made.

Patient safety principles in family medicine residency accreditation standards and curriculum objectives

PubMed Central

Kassam, Aliya; Sharma, Nishan; Harvie, Margot; O’Beirne, Maeve; Topps, Maureen

2016-01-01

Abstract Objective To conduct a thematic analysis of the College of Family Physicians of Canada’s (CFPC’s) Red Book accreditation standards and the Triple C Competency-based Curriculum objectives with respect to patient safety principles. Design Thematic content analysis of the CFPC’s Red Book accreditation standards and the Triple C curriculum. Setting Canada. Main outcome measures Coding frequency of the patient safety principles (ie, patient engagement; respectful, transparent relationships; complex systems; a just and trusting culture; responsibility and accountability for actions; and continuous learning and improvement) found in the analyzed CFPC documents. Results Within the analyzed CFPC documents, the most commonly found patient safety principle was patient engagement (n = 51 coding references); the least commonly found patient safety principles were a just and trusting culture (n = 5 coding references) and complex systems (n = 5 coding references). Other patient safety principles that were uncommon included responsibility and accountability for actions (n = 7 coding references) and continuous learning and improvement (n = 12 coding references). Conclusion Explicit inclusion of patient safety content such as the use of patient safety principles is needed for residency training programs across Canada to ensure the full spectrum of care is addressed, from community-based care to acute hospital-based care. This will ensure a patient safety culture can be cultivated from residency and sustained into primary care practice. PMID:27965349

The need to improve health care in prisons

PubMed Central

Fernandes, Luiz Henrique; Alvarenga, Carlos Willie; dos Santos, Luciane Loures; Pazin, Antonio

2014-01-01

OBJECTIVE To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons. METHODS We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher’s tests were used to compare categorical and continuous variables, respectively, between the groups. RESULTS The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment. CONCLUSIONS This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes. PMID:24897049

An Orthopedic Performance Improvement Initiative at a Small Military Treatment Facility.

PubMed

McGee, John Christopher; Bise, Christopher G; Stevens, Joel M

2017-03-01

The scientific literature demonstrates a cost-benefit associated with early access to physical therapy. The purpose of this case study is to report the results of an orthopedic performance improvement initiative (OPII) at a small military treatment facility (approximately 4.5K active duty beneficiaries). The OPII was introduced to (1) limit variation by ensuring that all active duty orthopedic consults were audited ensuring proper timing of appropriate services and (2) establish contractual agreement for shared resources with the U.S. Naval Jacksonville Orthopedic Department. OPII was accomplished through consensus development and strong leadership support. All orthopedic referrals (n = 260) were audited for 6 months. Appropriate recommendations were provided to either continue with orthopedic care or to redirect to a physical therapy first approach. Orthopedic referrals decreased 27% with concomitant 32% increase in physical therapy referrals producing overall savings of $462K (33%). Meanwhile, surgical throughput improved 45%. Seventy percent of the savings were attributed to improved utilization translating to a relative value unit savings per beneficiary of $17.64 (23.7%). Our results support the value of a conservative physical therapy first approach for musculoskeletal conditions and shared mil-to-mil resourcing agreements. Success requires an iterative audit/feedback process balanced with stakeholder consensus. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Recent progress and future directions for reduction, refinement, and replacement of animal use in veterinary vaccine potency and safety testing: a report from the 2010 NICEATM-ICCVAM International Vaccine Workshop.

PubMed

Stokes, W S; Kulpa-Eddy, J; Brown, K; Srinivas, G; McFarland, R

2012-01-01

Veterinary vaccines contribute to improved animal and human health and welfare by preventing infectious diseases. However, testing necessary to ensure vaccine effectiveness and safety can involve large numbers of animals and significant pain and distress. NICEATM and ICCVAM recently convened an international workshop to review the state of the science of human and veterinary vaccine potency and safety testing, and to identify priority activities to advance new and improved methods that can further reduce, refine and replace animal use. Rabies, Clostridium sp., and Leptospira sp. vaccines were identified as the highest priorities, while tests requiring live viruses and bacteria hazardous to laboratory workers, livestock, pets, and wildlife were also considered high priorities. Priority research, development and validation activities to address critical knowledge and data gaps were identified, including opportunities to apply new science and technology. Enhanced international harmonization and cooperation and closer collaborations between human and veterinary researchers were recommended to expedite progress. Implementation of the workshop recommendations is expected to advance new methods for vaccine testing that will benefit animal welfare and ensure continued and improved protection of human and animal health.

Rural health care support mechanism. Final rule; denial of petition for reconsideration.

PubMed

2003-12-24

In this document, the Commission modifies its rules to improve the effectiveness of the rural health care support mechanism, which provides discounts to rural health care providers to access modern telecommunications for medical and health maintenance purposes. Because participation in the rural health care support mechanism has not met the Commission's initial projections, the Commission amends its rules to improve the program, increase participation by rural health care providers, and ensure that the benefits of the program continue to be distributed in a fair and equitable manner. In addition, the Commission denies Mobile Satellite Ventures Subsidiary's petition for reconsideration of the 1997 Universal Service Order.

The changing face of an epidemic: healthy old age with HIV.

PubMed

Nugent, D B; Chowdhury, M; Waters, L J

2017-09-02

The demographics of the HIV epidemic in the UK have changed significantly. Owing to a steady rate of new diagnoses and improved survival, the population of individuals living with HIV continues to increase. HIV is now widely considered to be a chronic condition and HIV-positive individuals are expected to live into old age. Increasing rates of age-related comorbidities challenge HIV care providers to deliver durable viral suppression, ensure long-term adherence to antiretroviral treatment and promote wellbeing into old age. High rates of mental health disorders and social stigma continue to have a negative impact on the quality of life of people living with HIV. Models of care must adapt to this evolving epidemic.

How do medical doctors in the European Union demonstrate that they continue to meet criteria for registration and licencing?

PubMed

Solé, Meritxell; Panteli, Dimitra; Risso-Gill, Isabelle; Döring, Nora; Busse, Reinhard; McKee, Martin; Legido-Quigley, Helena

2014-12-01

This paper reviews procedures for ensuring that physicians in the European Union (EU) continue to meet criteria for registration and the implications of these procedures for cross-border movement of health professionals following implementation of the 2005/36/EC Directive on professional qualifications. A questionnaire was completed by key informants in 10 EU member states, supplemented by a review of peer-reviewed and grey literature and a review conducted by key experts in each country. The questionnaire covered three aspects: actors involved in processes for ensuring continued adherence to standards for registration and/or licencing (such as revalidation), including their roles and functions; the processes involved, including continuing professional development (CPD) and/or continuing medical education (CME); and contextual factors, particularly those impacting professional mobility. All countries included in the study view CPD/CME as one mechanism to demonstrate that doctors continue to meet key standards. Although regulatory bodies in a few countries have established explicit systems of ensuring continued competence, at least for some doctors (in Belgium, Germany, Hungary, the Netherlands, Slovenia and the UK), self-regulation is considered sufficient to ensure that physicians are up to date and fit to practice in others (Austria, Finland, Estonia and Spain). Formal systems vary greatly in their rationale, structure, and coverage. Whereas in Germany, Hungary and Slovenia, systems are exclusively focused on CPD/CME, the Netherlands also includes peer review and minimum activity thresholds. Belgium and the UK have developed more complex mechanisms, comprising a review of complaints or compliments on performance and (in the UK) colleague and patient questionnaires. Systems for ensuring that doctors continue to meet criteria for registration and licencing across the EU are complex and inconsistent. Participation in CPD/CME is only one aspect of maintaining professional competence but it is the only one common to all countries. Thus, there is a need to bring clarity to this confused landscape. © 2014 Royal College of Physicians.

Free Flyer Total and Spectral Solar Irradiance Sensor (TSIS) and Climate Services Mission

NASA Technical Reports Server (NTRS)

Cahalan, R.; Pilewskie, P.; Woods, T.

2012-01-01

NOAA's planned Total and Spectral Solar Irradiance Sensor (TSIS) mission will fly along with the NOAA user service payloads Advanced Data Collection System (ADCS) and Search and Rescue Satellite Aided Tracking (SARSAT). In ' order to guarantee continuity in the 33-year solar irradiance climate data record, TSIS must be launched in time to overlap with current on-orbit solar irradiance instruments. Currently TSIS is moving towards a launch rcadinss date of January 2015. TSIS provides for continuation of the Total Irradiance Monitor (TIM) and the Spectral Irradiance Monitor (SIM) ,currently onboard NASA's Solar Radiation and Climate Experiment (SORCE) platform, launched in January 2003. The difficulty of ensuring continuity has increased due to the launch failure of NASA's Glory mission with its improved TIM. Achieving the needed overlap must now rely on extending SORCE. and maintaining the TSIS schedule. TSIS is one component of a NASA-NOAA joint program (JPSS) planned to transition certain climate observations to operational mode. We summarize issues of continuity, improvements being made to the TIM and 81M sensors, and plans to provide for traceability of total and spectral irradiance measurements to ground-based cryogenic standards.

Preventing Rehospitalization through effective home health nursing care.

PubMed

Vasquez, Monica S

2009-01-01

To identify strategies to improve patient outcomes and prevent rehospitalizations in home healthcare. PRIMARY PRACTICE SETTINGS(S): Primarily for home healthcare but can also be a tool for all other fields in nursing. Through team collaboration and the proper resources, patient outcomes can improve and be cost-effective for home healthcare agencies despite the changes implemented after the Medicare change in payment for services, the prospective payment system. The main goal for home healthcare is to improve patient outcomes. Nurses experienced in case management can devise creative strategies to ensure patient outcomes are met in a cost-effective manner. With continuous changes in reimbursement and payment incentives, case managers in every level of care must know about, and be responsible for, fiscal initiatives.

Methods for Engaging Stakeholders in Comparative Effectiveness Research: A Patient-Centered Approach to Improving Diabetes Care

PubMed Central

Schmittdiel, Julie A.; Desai, Jay; Schroeder, Emily B.; Paolino, Andrea R.; Nichols, Gregory A.; Lawrence, Jean M.; O’Connor, Patrick J.; Ohnsorg, Kris A.; Newton, Katherine M.; Steiner, John F.

2016-01-01

ABSTRACT/Implementation Lessons Engaging stakeholders in the research process has the potential to improve quality of care and the patient care experience.Online patient community surveys can elicit important topic areas for comparative effectiveness research.Stakeholder meetings with substantial patient representation, as well as representation from health care delivery systems and research funding agencies, are a valuable tool for selecting and refining pilot research and quality improvement projects.Giving patient stakeholders a deciding vote in selecting pilot research topics helps ensure their ‘voice’ is heard.Researchers and health care leaders should continue to develop best-practices and strategies for increasing patient involvement in comparative effectiveness and delivery science research. PMID:26179728

Total quality management: It works for aerospace information services

NASA Technical Reports Server (NTRS)

Erwin, James; Eberline, Carl; Colquitt, Wanda

1993-01-01

Today we are in the midst of information and 'total quality' revolutions. At the NASA STI Program's Center for AeroSpace Information (CASI), we are focused on using continuous improvements techniques to enrich today's services and products and to ensure that tomorrow's technology supports the TQM-based improvement of future STI program products and services. The Continuous Improvements Program at CASI is the foundation for Total Quality Management in products and services. The focus is customer-driven; its goal, to identify processes and procedures that can be improved and new technologies that can be integrated with the processes to gain efficiencies, provide effectiveness, and promote customer satisfaction. This Program seeks to establish quality through an iterative defect prevention approach that is based on the incorporation of standards and measurements into the processing cycle. Four projects are described that utilize cross-functional, problem-solving teams for identifying requirements and defining tasks and task standards, management participation, attention to critical processes, and measurable long-term goals. The implementation of these projects provides the customer with measurably improved access to information that is provided through several channels: the NASA STI Database, document requests for microfiche and hardcopy, and the Centralized Help Desk.

Strategies to integrate patient and family education into patient care redesign.

PubMed

Yingling, L; Trocino, L

1997-05-01

This article discusses five strategies to effectively integrate patient and family education into patient care redesign. The strategies include building the plan, building a shared mission and vision, building involvement, building collaboration through initiatives, and building accountability. Each strategy or "building block" is vital to the resulting structure of patient and family education. Effective results of the strategies are discussed as milestones. The process must be ongoing to ensure continuous improvement in quality patient care outcomes, consumer satisfaction and cost-effectiveness.

What drives health policy formulation: insights from the Nepal maternity incentive scheme?

PubMed

Ensor, Tim; Clapham, Susan; Prasai, Devi Prasad

2009-05-01

Although maternal health outcomes have improved considerably in Nepal, continued low levels of skilled attendance and unequal access to safe emergency obstetric care continues to be central policy concern. The financial costs of delivery exacerbated are thought to continue to represent a major barrier to care to accessing services. Policy interest in this area moved swiftly. Skilled birth attendance came under the spotlight in 2001 while research on costs was commissioned in 2003. The resulting conclusions suggested substantial costs particularly on the demand side in the form of transport costs. After the research was completed the Government moved quickly to develop policy on financial barriers to skilled attendance leading to the Maternity Incentive Scheme that was implemented in 2005. We explored the reasons for policy acceptance and implementation based on recent studies in this area and a series of key informant interviews in the country. A variety of reasons can be shown to be important in ensuring that the research was utilised quickly. The conduct of the research process was importance, particularly by ensuring that results were communicated widely in a way that responded to both technical and political policy-making concerns. A convergence of political interests that meant that the policy became an ideal vehicle for improving the flagging fortunes of the government was also seen as crucial in expediting policy change although it also meant that the policy had to be adjusted to cater to political rather purely technical concerns. The experience also underlines the importance of political champions within or close to government in advocating a strong policy line through channels that researchers can rarely access.

Keys to strengthening the supply of routinely recommended vaccines: view from industry.

PubMed

Pisano, Wayne

2006-03-01

The vaccine enterprise in the United States is a remarkable success story that has resulted in freedom from disease for millions of children. Although some persons believe that this success is in danger because of recent vaccine shortages, the reality is otherwise. The existing system fundamentally works and should be strengthened and stabilized, to improve delivery of current vaccines and to establish a firm structure into which a new generation of vaccines can be integrated. Ten practical actions to strengthen supplies of vaccine and ensure the stability of these supplies were presented to the National Vaccine Advisory Committee in February 2002. The present article has been updated to include progress made since that time. By building on what is already in place and on what we know works, we can continue to ensure success for years to come.

Improvements in State and Local Planning for Mass Dispensing of Medical Countermeasures: The Technical Assistance Review Program, United States, 2007-2014.

PubMed

Renard, Paul G; Vagi, Sara J; Reinold, Chris M; Silverman, Brenda L; Avchen, Rachel N

2017-09-01

To evaluate and describe outcomes of state and local medical countermeasure preparedness planning, which is critical to ensure rapid distribution and dispensing of a broad spectrum of life-saving medical assets during a public health emergency. We used 2007 to 2014 state and local data collected from the Centers for Disease Control and Prevention's Technical Assistance Review. We calculated descriptive statistics from 50 states and 72 local Cities Readiness Initiative jurisdictions that participated in the Technical Assistance Review annually. From 2007 to 2014, the average overall Technical Assistance Review score increased by 13% for states and 41% for Cities Readiness Initiative jurisdictions. In 2014, nearly half of states achieved the maximum possible overall score (100), and 94% of local Cities Readiness Initiative jurisdictions achieved a score of 90 or more. Despite challenges, effective and timely medical countermeasure distribution and dispensing is possible with appropriate planning, staff, and resources. However, vigilance in training, exercising, and improving plans from lessons learned in a sustained, coordinated way is critical to ensure continued public health preparedness success.

Core principles of assessment in competency-based medical education.

PubMed

Lockyer, Jocelyn; Carraccio, Carol; Chan, Ming-Ka; Hart, Danielle; Smee, Sydney; Touchie, Claire; Holmboe, Eric S; Frank, Jason R

2017-06-01

The meaningful assessment of competence is critical for the implementation of effective competency-based medical education (CBME). Timely ongoing assessments are needed along with comprehensive periodic reviews to ensure that trainees continue to progress. New approaches are needed to optimize the use of multiple assessors and assessments; to synthesize the data collected from multiple assessors and multiple types of assessments; to develop faculty competence in assessment; and to ensure that relationships between the givers and receivers of feedback are appropriate. This paper describes the core principles of assessment for learning and assessment of learning. It addresses several ways to ensure the effectiveness of assessment programs, including using the right combination of assessment methods and conducting careful assessor selection and training. It provides a reconceptualization of the role of psychometrics and articulates the importance of a group process in determining trainees' progress. In addition, it notes that, to reach its potential as a driver in trainee development, quality care, and patient safety, CBME requires effective information management and documentation as well as ongoing consideration of ways to improve the assessment system.

Understanding the distributed cognitive processes of intensive care patient discharge.

PubMed

Lin, Frances; Chaboyer, Wendy; Wallis, Marianne

2014-03-01

To better understand and identify vulnerabilities and risks in the ICU patient discharge process, which provides evidence for service improvement. Previous studies have identified that 'after hours' discharge and 'premature' discharge from ICU are associated with increased mortality. However, some of these studies have largely been retrospective reviews of various administrative databases, while others have focused on specific aspects of the process, which may miss crucial components of the discharge process. This is an ethnographic exploratory study. Distributed cognition and activity theory were used as theoretical frameworks. Ethnographic data collection techniques including informal interviews, direct observations and collecting existing documents were used. A total of 56 one-to-one interviews were conducted with 46 participants; 28 discharges were observed; and numerous documents were collected during a five-month period. A triangulated technique was used in both data collection and data analysis to ensure the research rigour. Under the guidance of activity theory and distributed cognition theoretical frameworks, five themes emerged: hierarchical power and authority, competing priorities, ineffective communication, failing to enact the organisational processes and working collaboratively to optimise the discharge process. Issues with teamwork, cognitive processes and team members' interaction with cognitive artefacts influenced the discharge process. Strategies to improve shared situational awareness are needed to improve teamwork, patient flow and resource efficiency. Tools need to be evaluated regularly to ensure their continuous usefulness. Health care professionals need to be aware of the impact of their competing priorities and ensure discharges occur in a timely manner. Activity theory and distributed cognition are useful theoretical frameworks to support healthcare organisational research. © 2013 John Wiley & Sons Ltd.

Good laboratory practices for biochemical genetic testing and newborn screening for inherited metabolic disorders.

PubMed

2012-04-06

Biochemical genetic testing and newborn screening are essential laboratory services for the screening, detection, diagnosis, and monitoring of inborn errors of metabolism or inherited metabolic disorders. Under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations, laboratory testing is categorized on the basis of the level of testing complexity as either waived (i.e., from routine regulatory oversight) or nonwaived testing (which includes tests of moderate and high complexity). Laboratories that perform biochemical genetic testing are required by CLIA regulations to meet the general quality systems requirements for nonwaived testing and the personnel requirements for high-complexity testing. Laboratories that perform public health newborn screening are subject to the same CLIA regulations and applicable state requirements. As the number of inherited metabolic diseases that are included in state-based newborn screening programs continues to increase, ensuring the quality of performance and delivery of testing services remains a continuous challenge not only for public health laboratories and other newborn screening facilities but also for biochemical genetic testing laboratories. To help ensure the quality of laboratory testing, CDC collaborated with the Centers for Medicare & Medicaid Services, the Food and Drug Administration, the Health Resources and Services Administration, and the National Institutes of Health to develop guidelines for laboratories to meet CLIA requirements and apply additional quality assurance measures for these areas of genetic testing. This report provides recommendations for good laboratory practices that were developed based on recommendations from the Clinical Laboratory Improvement Advisory Committee, with additional input from the Secretary's Advisory Committee on Genetics, Health, and Society; the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children; and representatives of newborn screening laboratories. The recommended practices address the benefits of using a quality management system approach, factors to consider before introducing new tests, establishment and verification of test performance specifications, the total laboratory testing process (which consists of the preanalytic, analytic, and postanalytic phases), confidentiality of patient information and test results, and personnel qualifications and responsibilities for laboratory testing for inherited metabolic diseases. These recommendations are intended for laboratories that perform biochemical genetic testing to improve the quality of laboratory services and for newborn screening laboratories to ensure the quality of laboratory practices for inherited metabolic disorders. These recommendations also are intended as a resource for medical and public health professionals who evaluate laboratory practices, for users of laboratory services to facilitate their collaboration with newborn screening systems and use of biochemical genetic tests, and for standard-setting organizations and professional societies in developing future laboratory quality standards and practice recommendations. This report complements Good Laboratory Practices for Molecular Genetic Testing for Heritable Diseases and Conditions (CDC. Good laboratory practices for molecular genetic testing for heritable diseases and conditions. MMWR 2009;58 [No. RR-6]) to provide guidance for ensuring and improving the quality of genetic laboratory services and public health outcomes. Future recommendations for additional areas of genetic testing will be considered on the basis of continued monitoring and evaluation of laboratory practices, technology advancements, and the development of laboratory standards and guidelines.

Observatory Improvements for SOFIA

NASA Technical Reports Server (NTRS)

Peralta, Robert A.; Jensen, Stephen C.

2012-01-01

The Stratospheric Observatory for Infrared Astronomy (SOFIA) is a joint project between NASA and Deutsches Zentrum fuer Luft- und Raumfahrt (DLR), the German Space Agency. SOFIA is based in a Boeing 747 SP and flown in the stratosphere to observe infrared wavelengths unobservable from the ground. In 2007 Dryden Flight Research Center (DFRC) inherited and began work on improving the plane and its telescope. The improvements continue today with upgrading the plane and improving the telescope. The Observatory Verification and Validation (V&V) process is to ensure that the observatory is where the program says it is. The Telescope Status Display (TSD) will provide any information from the on board network to monitors that will display the requested information. In order to assess risks to the program, one must work through the various threats associate with that risk. Once all the risks are closed the program can work towards improving the observatory.

A Program Manager's Guide for Program Improvement in Ongoing Psychological Health and Traumatic Brain Injury Programs.

PubMed

Ryan, Gery W; Farmer, Carrie M; Adamson, David M; Weinick, Robin M

2014-01-01

Between 2001 and 2011, the U.S. Department of Defense has implemented numerous programs to support service members and their families in coping with the stressors from a decade of the longstanding conflicts in Iraq and Afghanistan. These programs, which address both psychological health and traumatic brain injury (TBI), number in the hundreds and vary in their size, scope, and target population. To ensure that resources are wisely invested and maximize the benefits of such programs, RAND developed a tool to help assess program performance, consider options for improvement, implement solutions, then assess whether the changes worked, with the intention of helping those responsible for managing or implementing programs to conduct assessments of how well the program is performing and to implement solutions for improving performance. Specifically, the tool is intended to provide practical guidance in program improvement and continuous quality improvement for all programs.

Improving and ensuring best practice continence management in residential aged care.

PubMed

Heckenberg, Gayle

2008-06-01

Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness of what best practice means and the impact their practices have on continence management. The JBI clinical audit and feedback cycle will continue to facilitate the measuring and implementation of best practice for resident outcomes in residential aged care. © 2008 The Author. Journal Compilation © Blackwell Publishing Asia Pty Ltd.

Examining the potential of information technology to improve public insurance application processes: enrollee assessments from a concurrent mixed method analysis.

PubMed

Mishra, Abhay Nath; Ketsche, Patricia; Marton, James; Snyder, Angela; McLaren, Susan

2014-01-01

To assess the perceived readiness of Medicaid and Children's Health Insurance Program (CHIP) enrollees to use information technologies (IT) in order to facilitate improvements in the application processes for these public insurance programs. We conducted a concurrent mixed method study of Medicaid and CHIP enrollees in a southern state. We conducted focus groups to identify enrollee concerns regarding the current application process and their IT proficiency. Additionally, we surveyed beneficiaries via telephone about their access to and use of the Internet, and willingness to adopt IT-enabled processes. 2013 households completed the survey. We used χ(2) analysis for comparisons across different groups of respondents. A majority of enrollees will embrace IT-enabled enrollment, but a small yet significant group continues to lack access to facilitating technologies. Moreover, a segment of beneficiaries in the two programs continues to place a high value on personal interactions with program caseworkers. IT holds the promise of improving efficiency and reducing barriers for enrollees, but state and federal agencies managing public insurance programs need to ensure access to traditional processes and make caseworkers available to those who require and value such assistance, even after implementing IT-enabled processes. The use of IT-enabled processes is essential for effectively managing eligibility and enrollment determinations for public programs and private plans offered through state or federally operated exchanges. However, state and federal officials should be cognizant of the technological readiness of recipients and provide offline help to ensure broad participation in the insurance market. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

BioTapestry now provides a web application and improved drawing and layout tools

PubMed Central

Paquette, Suzanne M.; Leinonen, Kalle; Longabaugh, William J.R.

2016-01-01

Gene regulatory networks (GRNs) control embryonic development, and to understand this process in depth, researchers need to have a detailed understanding of both the network architecture and its dynamic evolution over time and space. Interactive visualization tools better enable researchers to conceptualize, understand, and share GRN models. BioTapestry is an established application designed to fill this role, and recent enhancements released in Versions 6 and 7 have targeted two major facets of the program. First, we introduced significant improvements for network drawing and automatic layout that have now made it much easier for the user to create larger, more organized network drawings. Second, we revised the program architecture so it could continue to support the current Java desktop Editor program, while introducing a new BioTapestry GRN Viewer that runs as a JavaScript web application in a browser. We have deployed a number of GRN models using this new web application. These improvements will ensure that BioTapestry remains viable as a research tool in the face of the continuing evolution of web technologies, and as our understanding of GRN models grows. PMID:27134726

BioTapestry now provides a web application and improved drawing and layout tools.

PubMed

Paquette, Suzanne M; Leinonen, Kalle; Longabaugh, William J R

2016-01-01

Gene regulatory networks (GRNs) control embryonic development, and to understand this process in depth, researchers need to have a detailed understanding of both the network architecture and its dynamic evolution over time and space. Interactive visualization tools better enable researchers to conceptualize, understand, and share GRN models. BioTapestry is an established application designed to fill this role, and recent enhancements released in Versions 6 and 7 have targeted two major facets of the program. First, we introduced significant improvements for network drawing and automatic layout that have now made it much easier for the user to create larger, more organized network drawings. Second, we revised the program architecture so it could continue to support the current Java desktop Editor program, while introducing a new BioTapestry GRN Viewer that runs as a JavaScript web application in a browser. We have deployed a number of GRN models using this new web application. These improvements will ensure that BioTapestry remains viable as a research tool in the face of the continuing evolution of web technologies, and as our understanding of GRN models grows.

'Governance of' and 'Governance by': implementing a clinical governance framework in an area mental health service.

PubMed

O'Connor, Nick; Paton, Michael

2008-04-01

A framework developed to promote the understanding and application of clinical governance principles in an area mental health service is described. The framework is operationalized through systems, processes, roles and responsibilities. The development of an explicit and operationalizable framework for clinical governance arose from the authors' experiences in leading and managing mental health services. There is a particular emphasis on improvement of quality of care and patient safety. The framework is informed by recent developments in thinking about clinical governance, including key documents from Australia and the United Kingdom. The operational nature of the framework allows for key components of clinical governance to be described explicitly, communicated effectively, and continually tested and improved. Further consideration and assessment of the value of differing approaches to this task are required. For example, a general, illustrative approach to raise clinician awareness can be contrasted with prescriptive and specified approaches which progressively encompass the many functions and processes of a mental health service. Mental health clinicians and managers can be guided by a framework that will ensure safe, high quality and continually improving processes of care.

Increasing retention in care of HIV-positive women in PMTCT services through continuous quality improvement-breakthrough (CQI-BTS) series in primary and secondary health care facilities in Nigeria: a cluster randomized controlled trial. The Lafiyan Jikin Mata Study.

PubMed

Oyeledun, Bolanle; Oronsaye, Frank; Oyelade, Taiwo; Becquet, Renaud; Odoh, Deborah; Anyaike, Chukwuma; Ogirima, Francis; Ameh, Bernice; Ajibola, Abiola; Osibo, Bamidele; Imarhiagbe, Collins; Abutu, Inedu

2014-11-01

Rates of retention in care of HIV-positive pregnant women in care programs in Nigeria remain generally poor with rates around 40% reported for specific programs. Poor quality of services in health facilities and long waiting times are among the critical factors militating against retention of these women in care. The aim of the interventions in this study is to assess whether a continuous quality improvement intervention using a Breakthrough Series approach in local district hospitals and primary health care clinics will lead to improved retention of HIV-positive women and mothers. A cluster randomized controlled trial with 32 health facilities randomized to receive a continuous quality improvement/Breakthrough Series intervention or not. The care protocol for HIV-infected pregnant women and mothers is the same in all sites. The quality improvement intervention started 4 months before enrollment of individual HIV-infected pregnant women and initially focused on reducing waiting times for women and also ensuring that antiretroviral drugs are dispensed on the same day as clinic attendance. The primary outcome measure is retention of HIV-positive mothers in care at 6 months postpartum. Results of this trial will inform whether quality improvement interventions are an effective means of improving retention in prevention of mother-to-child transmission of HIV programs and will also guide where health system interventions should focus to improve the quality of care for HIV-positive women. This will benefit policymakers and program managers as they seek to improve retention rates in HIV care programs.

Ultrasound-Guided Cryoanalgesia of Peripheral Nerve Lesions.

PubMed

Djebbar, Sahlya; Rossi, Ignacio M; Adler, Ronald S

2016-11-01

The real-time nature of ultrasound makes it ideally suited to provide guidance for a variety of musculoskeletal interventional procedures involving peripheral nerves. Continuous observation of the needle ensures proper placement and allows continuous monitoring when performing localized ablative therapy and therefore more accurate positioning of a cryoprobe, use of smaller needles, as well as access to small structures. We describe our experience performing cryoablative procedures. Patients undergoing cryoneurolysis have largely reported varying degrees of long-term pain relief and improvement in function; no serious complications have yet been identified. Ultrasound-guided cryoneurolysis can provide a useful, safe alternative to other ablative techniques to achieve long-term analgesia from painful peripheral nerve lesions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Transforming Regions into High-Performing Health Systems Toward the Triple Aim of Better Health, Better Care and Better Value for Canadians.

PubMed

Bergevin, Yves; Habib, Bettina; Elicksen-Jensen, Keesa; Samis, Stephen; Rochon, Jean; Denis, Jean-Louis; Roy, Denis

2016-01-01

A study on the impact of regionalization on the Triple Aim of Better Health, Better Care and Better Value across Canada in 2015 identified major findings including: (a) with regard to the Triple Aim, the Canadian situation is better than before but variable and partial, and Canada continues to underperform compared with other industrialized countries, especially in primary healthcare where it matters most; (b) provinces are converging toward a two-level health system (provincial/regional); (c) optimal size of regions is probably around 350,000-500,000 population; d) citizen and physician engagement remains weak. A realistic and attainable vision for high-performing regional health systems is presented together with a way forward, including seven areas for improvement: 1. Manage the integrated regionalized health systems as results-driven health programs; 2. Strengthen wellness promotion, public health and intersectoral action for health; 3. Ensure timely access to personalized primary healthcare/family health and to proximity services; 4. Involve physicians in clinical governance and leadership, and partner with them in accountability for results including the required changes in physician remuneration; 5. Engage citizens in shaping their own health destiny and their health system; 6. Strengthen health information systems, accelerate the deployment of electronic health records and ensure their interoperability with health information systems; 7. Foster a culture of excellence and continuous quality improvement. We propose a turning point for Canada, from Paradigm Freeze to Paradigm Shift: from hospital-centric episodic care toward evidence-informed population-based primary and community care with modern family health teams, ensuring integrated and coordinated care along the continuum, especially for high users. We suggest goals and targets for 2020 and time-bound federal/provincial/regional working groups toward reaching the identified goals and targets and placing Canada on a rapid path toward the Triple Aim.

The ISOLDE facility

NASA Astrophysics Data System (ADS)

Catherall, R.; Andreazza, W.; Breitenfeldt, M.; Dorsival, A.; Focker, G. J.; Gharsa, T. P.; J, Giles T.; Grenard, J.-L.; Locci, F.; Martins, P.; Marzari, S.; Schipper, J.; Shornikov, A.; Stora, T.

2017-09-01

The ISOLDE facility has undergone numerous changes over the last 17 years driven by both the physics and technical community with a common goal to improve on beam variety, beam quality and safety. Improvements have been made in civil engineering and operational equipment while continuing developments aim to ensure operations following a potential increase in primary beam intensity and energy. This paper outlines the principal technical changes incurred at ISOLDE by building on a similar publication of the facility upgrades by Kugler (2000 Hyperfine Interact. 129 23-42). It also provides an insight into future perspectives through a brief summary issues addressed in the HIE-ISOLDE design study Catherall et al (2013 Nucl. Instrum. Methods Phys. Res. B 317 204-207).

The Business Change Initiative: A Novel Approach to Improved Cost and Schedule Management

NASA Technical Reports Server (NTRS)

Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param

2016-01-01

Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.

VVER Reactor Safety in Eastern Europe and Former Soviet Union

NASA Astrophysics Data System (ADS)

Papadopoulou, Demetra

2012-02-01

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

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

Sorensen, Christian

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

Earthdata Search Client: Usability Review Process, Results, and Implemented Changes, Using Earthdata Search Client as a Case Study

NASA Technical Reports Server (NTRS)

Siarto, Jeff; Reese, Mark; Shum, Dana; Baynes, Katie

2016-01-01

User experience and visual design are greatly improved when usability testing is performed on a periodic basis. Design decisions should be tested by real users so that application owners can understand the effectiveness of each decision and identify areas for improvement. It is important that applications be tested not just once, but as a part of a continuing process that looks to build upon previous tests. NASA's Earthdata Search Client has undergone a usability study to ensure its users' needs are being met and that users understand how to use the tool efficiently and effectively. This poster will highlight the process followed for usability study, the results of the study, and what has been implemented in light of the results to improve the application's interface.

Management of complex implant aesthetics: ensuring restorative design continuity with a comprehensive outcome-based strategy.

PubMed

Lee, E A; Jun, S K

2001-09-01

Since implant therapy must be dictated by prosthetic requirements, a protocol for the comprehensive and continuous integration of the restorative blueprint through the entire treatment planning and clinical execution phases is mandatory. This article demonstrates a systematic approach where the establishment of a final restorative treatment objective is incorporated into the diagnosis and subsequently integrated through every phase of clinical execution. Design continuity is ensured, and multidisciplinary cohesiveness is enhanced by providing clearly defined treatment objectives to every member of the clinical team.

What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review.

PubMed

Rotter, Thomas; Plishka, Christopher; Lawal, Adegboyega; Harrison, Liz; Sari, Nazmi; Goodridge, Donna; Flynn, Rachel; Chan, James; Fiander, Michelle; Poksinska, Bonnie; Willoughby, Keith; Kinsman, Leigh

2018-01-01

Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.

[Continuous quality improvement in anesthesia].

PubMed

Gaitini, L; Vaida, S; Madgar, S

1998-01-01

Slow continuous quality improvement (SCQI) in anesthesia is a process that allows identification of problems and their causes. Implementing measures to correct them and continuous monitoring to ensure that the problems have been eliminated are necessary. The basic assumption of CQI is that the employees of an organization are competent and working to the best of their abilities. If problems occur they are the consequences of inadequacies in the process rather that in the individual. The CQI program is a dynamic but gradual system that invokes a slower rate of response in comparison with other quality methods, like quality assurance. Spectacular results following a system change are not to be expected an the ideal is slow and continuous improvement. A SCQI program was adapted by our department in May 1994, according to the recommendations of the American Society of Anesthesiologists. Problem identification was based on 65 clinical indicators, reflecting negative events related to anesthesia. Data were collected using a specially designed computer database. 4 events were identified as crossing previously established thresholds (hypertension, hypotension, hypoxia and inadequate nerve block). Statistical process control was used to establish stability of the system and whether negative events were influenced only by the common causes. The causes responsible for these negative events were identified using specific SCQI tools, such as control-charts, cause-effect diagrams and Pareto diagrams. Hypertension and inadequate nerve block were successfully managed. The implementation of corrective measures for the other events that cross the threshold is still in evolution. This program requires considerable dedication on the part of the staff, and it is hoped that it will improve our clinical performance.

[Technological innovations in radiation oncology require specific quality controls].

PubMed

Lenaerts, E; Mathot, M

2014-01-01

During the last decade, the field of radiotherapy has benefited from major technological innovations and continuously improving treatment efficacy, comfort and safety of patients. This mainly concerns the imaging techniques that allow 4D CT scan recording the respiratory phases, on-board imaging on linear accelerators that ensure perfect positioning of the patient for treatment and irradiation techniques that reduce very significantly the duration of treatment sessions without compromising quality of the treatment plan, including IMRT (Intensity Modulated Radiation Therapy) and VMAT (Volumetric Modulated Arc therapy). In this context of rapid technological change, it is the responsibility of medical physicists to regularly and precisely monitor the perfect functioning of new techniques to ensure patient safety. This requires the use of specific quality control equipment best suited to these new techniques. We will briefly describe the measurement system Delta4 used to control individualized treatment plan for each patient treated with VMAT technology.

Establishment of CDC Global Rapid Response Team to Ensure Global Health Security.

PubMed

Stehling-Ariza, Tasha; Lefevre, Adrienne; Calles, Dinorah; Djawe, Kpandja; Garfield, Richard; Gerber, Michael; Ghiselli, Margherita; Giese, Coralie; Greiner, Ashley L; Hoffman, Adela; Miller, Leigh Ann; Moorhouse, Lisa; Navarro-Colorado, Carlos; Walsh, James; Bugli, Dante; Shahpar, Cyrus

2017-12-01

The 2014-2016 Ebola virus disease epidemic in West Africa highlighted challenges faced by the global response to a large public health emergency. Consequently, the US Centers for Disease Control and Prevention established the Global Rapid Response Team (GRRT) to strengthen emergency response capacity to global health threats, thereby ensuring global health security. Dedicated GRRT staff can be rapidly mobilized for extended missions, improving partner coordination and the continuity of response operations. A large, agencywide roster of surge staff enables rapid mobilization of qualified responders with wide-ranging experience and expertise. Team members are offered emergency response training, technical training, foreign language training, and responder readiness support. Recent response missions illustrate the breadth of support the team provides. GRRT serves as a model for other countries and is committed to strengthening emergency response capacity to respond to outbreaks and emergencies worldwide, thereby enhancing global health security.

A 'systems' approach to suicide prevention: radical change or doing the same things better?

PubMed

Fitzpatrick, Scott J; Hooker, Claire

2017-04-27

Suicide is a significant public health concern. Continued high suicide rates, coupled with emerging international evidence, have led to the development of a 'systems' approach to suicide prevention, which is now being trialled as part of a proposed Suicide Prevention Framework for NSW (New South Wales, Australia). The Framework replicates successful international approaches. It is organised around nine components, ranging from individual to population-level approaches, to improve coordination and integration of existing services. If implemented fully, the Framework may lead to a significant reduction in suicide. However, to ensure its long-term success, we must attend to underlying structures within the system and their interrelationships. Such an approach will also ensure that policy makers and local suicide prevention action groups, particularly in rural areas, are able to respond to local challenges and incorporate multiple perspectives into their practice, including evidence for the broader social determinants of suicide.

Advances in solid dosage form manufacturing technology.

PubMed

Andrews, Gavin P

2007-12-15

Currently, the pharmaceutical and healthcare industries are moving through a period of unparalleled change. Major multinational pharmaceutical companies are restructuring, consolidating, merging and more importantly critically assessing their competitiveness to ensure constant growth in an ever-more demanding market where the cost of developing novel products is continuously increasing. The pharmaceutical manufacturing processes currently in existence for the production of solid oral dosage forms are associated with significant disadvantages and in many instances provide many processing problems. Therefore, it is well accepted that there is an increasing need for alternative processes to dramatically improve powder processing, and more importantly to ensure that acceptable, reproducible solid dosage forms can be manufactured. Consequently, pharmaceutical companies are beginning to invest in innovative processes capable of producing solid dosage forms that better meet the needs of the patient while providing efficient manufacturing operations. This article discusses two emerging solid dosage form manufacturing technologies, namely hot-melt extrusion and fluidized hot-melt granulation.

Preparing for the Flu: Department Of Education Recommendations to Ensure the Continuity of Learning for Schools (K-12) During Extended Student Absence or School Dismissal

ERIC Educational Resources Information Center

US Department of Education, 2009

2009-01-01

As the Centers for Disease Control (CDC) releases its "Guidance for School Responses to Influenza During the 2009-2010 School Year," the U.S. Department of Education reminds states, districts, schools, students, staff, families, and communities about the importance of ensuring the continuity of learning in the event of student or school…

Preparing for Infectious Disease: Department of Education Recommendations to Ensure the Continuity of Teaching and Learning for Schools (K-12) during Extended Student Absence or School Dismissal

ERIC Educational Resources Information Center

US Department of Education, 2014

2014-01-01

The U.S. Department of Education (ED) wishes to remind states, districts, schools, students, staff, families, and guardians as well as communities about the importance of: (1) addressing the prevention of infectious disease in schools, including the seasonal flu, viral meningitis, enterovirus, and Ebola; and (2) ensuring the continuity of teaching…

Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association.

PubMed

Meaney, Peter A; Bobrow, Bentley J; Mancini, Mary E; Christenson, Jim; de Caen, Allan R; Bhanji, Farhan; Abella, Benjamin S; Kleinman, Monica E; Edelson, Dana P; Berg, Robert A; Aufderheide, Tom P; Menon, Venu; Leary, Marion

2013-07-23

The "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" increased the focus on methods to ensure that high-quality cardiopulmonary resuscitation (CPR) is performed in all resuscitation attempts. There are 5 critical components of high-quality CPR: minimize interruptions in chest compressions, provide compressions of adequate rate and depth, avoid leaning between compressions, and avoid excessive ventilation. Although it is clear that high-quality CPR is the primary component in influencing survival from cardiac arrest, there is considerable variation in monitoring, implementation, and quality improvement. As such, CPR quality varies widely between systems and locations. Victims often do not receive high-quality CPR because of provider ambiguity in prioritization of resuscitative efforts during an arrest. This ambiguity also impedes the development of optimal systems of care to increase survival from cardiac arrest. This consensus statement addresses the following key areas of CPR quality for the trained rescuer: metrics of CPR performance; monitoring, feedback, and integration of the patient's response to CPR; team-level logistics to ensure performance of high-quality CPR; and continuous quality improvement on provider, team, and systems levels. Clear definitions of metrics and methods to consistently deliver and improve the quality of CPR will narrow the gap between resuscitation science and the victims, both in and out of the hospital, and lay the foundation for further improvements in the future.

Analysis on electronic control unit of continuously variable transmission

NASA Astrophysics Data System (ADS)

Cao, Shuanggui

Continuously variable transmission system can ensure that the engine work along the line of best fuel economy, improve fuel economy, save fuel and reduce harmful gas emissions. At the same time, continuously variable transmission allows the vehicle speed is more smooth and improves the ride comfort. Although the CVT technology has made great development, but there are many shortcomings in the CVT. The CVT system of ordinary vehicles now is still low efficiency, poor starting performance, low transmission power, and is not ideal controlling, high cost and other issues. Therefore, many scholars began to study some new type of continuously variable transmission. The transmission system with electronic systems control can achieve automatic control of power transmission, give full play to the characteristics of the engine to achieve optimal control of powertrain, so the vehicle is always traveling around the best condition. Electronic control unit is composed of the core processor, input and output circuit module and other auxiliary circuit module. Input module collects and process many signals sent by sensor and , such as throttle angle, brake signals, engine speed signal, speed signal of input and output shaft of transmission, manual shift signals, mode selection signals, gear position signal and the speed ratio signal, so as to provide its corresponding processing for the controller core.

3D simulation of LISM oxygen flux with PUIs inside of heliosphere

DOE PAGES

Kawamura, Akito D.; Heerikhuisen, Jacob; Pogorelov, Nikolai V.; ...

2012-11-20

The structure of the heliospheric interface has attracted increasing attention with continual improvements in modelling and observations, during the last half decade. The Interstellar Boundary Explore (IBEX) spacecraft is returning important data that require a theoretical model of Heliosphere to ensure proper interpretation. Furthermore, we develop a framework for understanding the measurements of heavier-than-hydrogen atoms by IBEX in terms of a 3D MHD-neutral numerical solution of the sun's interaction with the interstellar medium, combined with a test particle approach for heavy atoms and ions.

Electron tubes for industrial applications

NASA Astrophysics Data System (ADS)

Gellert, Bernd

1994-05-01

This report reviews research and development efforts within the last years for vacuum electron tubes, in particular power grid tubes for industrial applications. Physical and chemical effects are discussed that determine the performance of todays devices. Due to the progress made in the fundamental understanding of materials and newly developed processes the reliability and reproducibility of power grid tubes could be improved considerably. Modern computer controlled manufacturing methods ensure a high reproducibility of production and continuous quality certification according to ISO 9001 guarantees future high quality standards. Some typical applications of these tubes are given as an example.

Changing Patterns of Work in America, 1976: Hearings Before the Subcommittee on Employment, Poverty, and Migration Labor of the Committee on Labor and Public Welfare, United States Senate, Ninety-Fourth Congress, Second Session on Examination of Alternative Working Hours and Arrangements, April 7 and 8, 1976.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Labor and Public Welfare.

Several programs designed to improve work life in the United States are reviewed. The subcommittee solicits opinions from leaders in business, labor, and government about what legislative and institutional changes can be made to ensure continued progress in the status of the working people. The hearings cover a broad range of topics including job…

Orion Heat Shield Manufacturing Producibility Improvements for the EM-1 Flight Test Program

NASA Technical Reports Server (NTRS)

Koenig, William J.; Stewart, Michael; Harris, Richard F.

2018-01-01

This paper describes how the ORION program is incorporating improvements in the heat shield design and manufacturing processes reducing programmatic risk and ensuring crew safety in support of NASA's Exploration missions. The approach for the EFT-1 heat shield utilized a low risk Apollo heritage design and manufacturing process using an Avcoat TPS ablator with a honeycomb substrate to provide a one piece heat shield to meet the mission re-entry heating environments. The EM-1 mission will have additional flight systems installed to fly to the moon and return to Earth. Heat shield design and producibility improvements have been incorporated in the EM-1 vehicle to meet deep space mission requirements. The design continues to use the Avcoat material, but in a block configuration to enable improvements in consistant and repeatable application processes using tile bonding experience developed on the Space Shuttle Transportation System Program.

Should the United States Continue to Provide Aid to Africa?

DTIC Science & Technology

2012-03-22

this choice.75 History has shown that no amount of foreign aid can lead Africa to a meaningful developmental process without effective governance...aid and what approaches need to be taken into account to ensure it remains an effective ‘strategic investment.” 15. SUBJECT TERMS Foreign Policy...account to ensure it remains an effective ‘strategic investment.” SHOULD THE UNITED STATES CONTINUE TO PROVIDE AID TO AFRICA? The

Sustaining a Mature Risk Management Process: Ensuring the International Space Station for a Vibrant Future

NASA Technical Reports Server (NTRS)

Raftery, Michael; Carter-Journet, Katrina

2013-01-01

The International Space Station (ISS) risk management methodology is an example of a mature and sustainable process. Risk management is a systematic approach used to proactively identify, analyze, plan, track, control, communicate, and document risks to help management make risk-informed decisions that increase the likelihood of achieving program objectives. The ISS has been operating in space for over 14 years and permanently crewed for over 12 years. It is the longest surviving habitable vehicle in low Earth orbit history. Without a mature and proven risk management plan, it would be increasingly difficult to achieve mission success throughout the life of the ISS Program. A successful risk management process must be able to adapt to a dynamic program. As ISS program-level decision processes have evolved, so too has the ISS risk management process continued to innovate, improve, and adapt. Constant adaptation of risk management tools and an ever-improving process is essential to the continued success of the ISS Program. Above all, sustained support from program management is vital to risk management continued effectiveness. Risk management is valued and stressed as an important process by the ISS Program.

Child Health Disparities: What Can a Clinician Do?

PubMed

Cheng, Tina L; Emmanuel, Mickey A; Levy, Daniel J; Jenkins, Renee R

2015-11-01

Pediatric primary and specialty practice has changed, with more to do, more regulation, and more family needs than in the past. Similarly, the needs of patients have changed, with more demographic diversity, family stress, and continued health disparities by race, ethnicity, and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This article outlines specific, practical, actionable, and evidence-based activities to help clinicians assess and address health disparities in practice. These tools may also support patient-centered medical home recognition, national and state cultural and linguistic competency standards, and quality benchmarks that are increasingly tied to payment. Clinicians can play a critical role in (1) diagnosing disparities in one's community and practice, (2) innovating new models to address social determinants of health, (3) addressing health literacy of families, (4) ensuring cultural competence and a culture of workplace equity, and (5) advocating for issues that address the root causes of health disparities. Culturally competent care that is sensitive to the needs, health literacy, and health beliefs of families can increase satisfaction, improve quality of care, and increase patient safety. Clinical care approaches to address social determinants of health and interrupting the intergenerational cycle of disadvantage include (1) screening for new health "vital signs" and connecting families to resources, (2) enhancing the comprehensiveness of services, (3) addressing family health in pediatric encounters, and (4) moving care outside the office into the community. Health system investment is required to support clinicians and practice innovation to ensure equity. Copyright © 2015 by the American Academy of Pediatrics.

Treatment of end-stage renal disease with continuous ambulatory peritoneal dialysis in rural Guatemala

PubMed Central

Moore, Jillian; Garcia, Pablo; Flood, David

2018-01-01

A 42-year-old indigenous Maya man presented to a non-profit clinic in rural Guatemala with signs, symptoms and laboratory values consistent with uncontrolled diabetes. Despite appropriate treatment, approximately 18 months after presentation, he was found to have irreversible end-stage renal disease (ESRD) of uncertain aetiology. He was referred to the national public nephrology clinic and subsequently initiated home-based continuous ambulatory peritoneal dialysis. With primary care provided by the non-profit clinic, his clinical status improved on dialysis, but socioeconomic and psychological challenges persisted for the patient and his family. This case shows how care for people with ESRD in low- and middle-income countries requires scaling up renal replacement therapy and ensuring access to primary care, mental healthcare and social work services. PMID:29705734

Continuous Evaluation in Ethics Education: A Case Study.

PubMed

McIntosh, Tristan; Higgs, Cory; Mumford, Michael; Connelly, Shane; DuBois, James

2018-04-01

A great need for systematic evaluation of ethics training programs exists. Those tasked with developing an ethics training program may be quick to dismiss the value of training evaluation in continuous process improvement. In the present effort, we use a case study approach to delineate how to leverage formative and summative evaluation measures to create a high-quality ethics education program. With regard to formative evaluation, information bearing on trainee reactions, qualitative data from the comments of trainees, in addition to empirical findings, can ensure that the training program operates smoothly. Regarding summative evaluation, measures examining trainee cognition, behavior, and organization-level results provide information about how much trainees have changed as a result of taking the ethics training. The implications of effective training program evaluation are discussed.

Benefits of regular walking exercise in advanced pre-dialysis chronic kidney disease.

PubMed

Kosmadakis, George C; John, Stephen G; Clapp, Emma L; Viana, Joao L; Smith, Alice C; Bishop, Nicolette C; Bevington, Alan; Owen, Paul J; McIntyre, Christopher W; Feehally, John

2012-03-01

There is increasing evidence of the benefit of regular physical exercise in a number of long-term conditions including chronic kidney disease (CKD). In CKD, this evidence has mostly come from studies in end stage patients receiving regular dialysis. There is little evidence in pre-dialysis patients with CKD Stages 4 and 5. A prospective study compared the benefits of 6 months regular walking in 40 pre-dialysis patients with CKD Stages 4 and 5. Twenty of them were the exercising group and were compared to 20 patients who were continuing with usual physical activity. In addition, the 40 patients were randomized to receive additional oral sodium bicarbonate (target venous bicarbonate 29 mmol/L) or continue with previous sodium bicarbonate treatment (target 24 mmol/L). Improvements noted after 1 month were sustained to 6 months in the 18 of 20 who completed the exercise study. These included improvements in exercise tolerance (reduced exertion to achieve the same activity), weight loss, improved cardiovascular reactivity, avoiding an increase in blood pressure medication and improvements in quality of health and life and uraemic symptom scores assessed by questionnaire. Sodium bicarbonate supplementation did not produce any significant alterations. This study provides further support for the broad benefits of aerobic physical exercise in CKD. More studies are needed to understand the mechanisms of these benefits, to study whether resistance exercise will add to the benefit and to evaluate strategies to promote sustained lifestyle changes, that could ensure continued increase in habitual daily physical activity levels.

Continuity of care to optimize chronic disease management in the community setting: an evidence-based analysis.

PubMed

2013-01-01

This evidence-based analysis reviews relational and management continuity of care. Relational continuity refers to the duration and quality of the relationship between the care provider and the patient. Management continuity ensures that patients receive coherent, complementary, and timely care. There are 4 components of continuity of care: duration, density, dispersion, and sequence. The objective of this evidence-based analysis was to determine if continuity of care is associated with decreased health resource utilization, improved patient outcomes, and patient satisfaction. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and the Centre for Reviews and Dissemination database were searched for studies on continuity of care and chronic disease published from January 2002 until December 2011. Systematic reviews, randomized controlled trials, and observational studies were eligible if they assessed continuity of care in adults and reported health resource utilization, patient outcomes, or patient satisfaction. Eight systematic reviews and 13 observational studies were identified. The reviews concluded that there is an association between continuity of care and outcomes; however, the literature base is weak. The observational studies found that higher continuity of care was frequently associated with fewer hospitalizations and emergency department visits. Three systematic reviews reported that higher continuity of care is associated with improved patient satisfaction, especially among patients with chronic conditions. Most of the studies were retrospective cross-sectional studies of large administrative databases. The databases do not capture information on trust and confidence in the provider, which is a critical component of relational continuity of care. The definitions for the selection of patients from the databases varied across studies. There is low quality evidence that: Higher continuity of care is associated with decreased health service utilization.There is insufficient evidence on the relationship of continuity of care with disease-specific outcomes.There is an association between high continuity of care and patient satisfaction, particularly among patients with chronic diseases.

[Measurement of customer satisfaction and participation of citizens in improving the quality of healthcare services.].

PubMed

Degrassi, Flori; Sopranzi, Cristina; Leto, Antonella; Amato, Simona; D'Urso, Antonio

2009-01-01

Managing quality in health care whilst ensuring equity is a fundamental aspect of the provision of services by healthcare organizations. Measuring perceived quality of care is an important tool for evaluating the quality of healthcare delivery in that it allows the implementation of corrective actions to meet the healthcare needs of patients. The Rome B (ASL RMB) local health authority adopted the UNI EN 10006:2006 norms as a management tool, therefore introducing the evaluation of customer satisfaction as an opportunity to involve users in the creation of quality healthcare services with and for the citizens. This paper presents the activities implemented and the results achieved with regards to shared and integrated continuous improvement of services.

Patient safety culture and leadership within Canada's Academic Health Science Centres: towards the development of a collaborative position paper.

PubMed

Nicklin, Wendy; Mass, Heather; Affonso, Dyanne D; O'Connor, Patricia; Ferguson-Paré, Mary; Jeffs, Lianne; Tregunno, Deborah; White, Peggy

2004-03-01

Currently, the Academy of Canadian Executive Nurses (ACEN) is working with the Association of Canadian Academic Healthcare Organizations (ACAHO) to develop a joint position paper on patient safety cultures and leadership within Academic Health Science Centres (AHSCs). Pressures to improve patient safety within our healthcare system are gaining momentum daily. Because AHSCs in Canada are the key organizations that are positioned regionally and nationally, where service delivery is the platform for the education of future healthcare providers, and where the development of new knowledge and innovation through research occurs, leadership for patient safety logically must emanate from them. As a primer, ACEN provides an overview of current patient safety initiatives in AHSCs to date. In addition, the following six key areas for action are identified to ensure that AHSCs continue to be leaders in delivering quality, safe healthcare in Canada. These include: (1) strategic orientation to safety culture and quality improvement, (2) open and transparent disclosure policies, (3) health human resources integral to ensuring patient safety practices, (4) effective linkages between AHSCs and academic institutions, (5) national patient safety accountability initiatives and (6) collaborative team practice.

Opportunities and challenges of real-time release testing in biopharmaceutical manufacturing.

PubMed

Jiang, Mo; Severson, Kristen A; Love, John Christopher; Madden, Helena; Swann, Patrick; Zang, Li; Braatz, Richard D

2017-11-01

Real-time release testing (RTRT) is defined as "the ability to evaluate and ensure the quality of in-process and/or final drug product based on process data, which typically includes a valid combination of measured material attributes and process controls" (ICH Q8[R2]). This article discusses sensors (process analytical technology, PAT) and control strategies that enable RTRT for the spectrum of critical quality attributes (CQAs) in biopharmaceutical manufacturing. Case studies from the small-molecule and biologic pharmaceutical industry are described to demonstrate how RTRT can be facilitated by integrated manufacturing and multivariable control strategies to ensure the quality of products. RTRT can enable increased assurance of product safety, efficacy, and quality-with improved productivity including faster release and potentially decreased costs-all of which improve the value to patients. To implement a complete RTRT solution, biologic drug manufacturers need to consider the special attributes of their industry, particularly sterility and the measurement of viral and microbial contamination. Continued advances in on-line and in-line sensor technologies are key for the biopharmaceutical manufacturing industry to achieve the potential of RTRT. Related article: http://onlinelibrary.wiley.com/doi/10.1002/bit.26378/full. © 2017 Wiley Periodicals, Inc.

An overview of clinical governance policies, practices and initiatives.

PubMed

Braithwaite, Jeffrey; Travaglia, Joanne F

2008-02-01

To map the emergence of, and define, clinical governance; to discuss current best practices, and to explore the implications of these for boards of directors and executives wishing to promote a clinical governance approach in their health services. Review and analysis of the published and grey literature on clinical governance from 1966 to 2006. Medline and CINAHL databases, key journals and websites were systematically searched. Central issues were identified in the literature as key to effective clinical governance. These include: ensuring that links are made between health services' clinical and corporate governance; the use of clinical governance to promote quality and safety through a focus on quality assurance and continuous improvement; the creation of clinical governance structures to improve safety and quality and manage risk and performance; the development of strategies to ensure the effective exchange of data, knowledge and expertise; and the sponsoring of a patient-centred approach to service delivery. A comprehensive approach to clinical governance necessarily includes the active participation of boards and executives in sponsoring and promoting clinical governance as a quality and safety strategy. Although this is still a relatively recent development, the signs are promising.

Operational radiological support for the US manned space program

NASA Technical Reports Server (NTRS)

Golightly, Michael J.; Hardy, Alva C.; Atwell, William; Weyland, Mark D.; Kern, John; Cash, Bernard L.

1993-01-01

Radiological support for the manned space program is provided by the Space Radiation Analysis Group at NASA/JSC. This support ensures crew safety through mission design analysis, real-time space environment monitoring, and crew exposure measurements. Preflight crew exposure calculations using mission design information are used to ensure that crew exposures will remain within established limits. During missions, space environment conditions are continuously monitored from within the Mission Control Center. In the event of a radiation environment enhancement, the impact to crew exposure is assessed and recommendations are provided to flight management. Radiation dosimeters are placed throughout the spacecraft and provided to each crewmember. During a radiation contingency, the crew could be requested to provide dosimeter readings. This information would be used for projecting crew dose enhancements. New instrumentation and computer technology are being developed to improve the support. Improved instruments include tissue equivalent proportional counter (TEPC)-based dosimeters and charged particle telescopes. Data from these instruments will be telemetered and will provide flight controllers with unprecedented information regarding the radiation environment in and around the spacecraft. New software is being acquired and developed to provide 'smart' space environmental data displays for use by flight controllers.

Improvements in State and Local Planning for Mass Dispensing of Medical Countermeasures: The Technical Assistance Review Program, United States, 2007–2014

PubMed Central

Vagi, Sara J.; Reinold, Chris M.; Silverman, Brenda L.; Avchen, Rachel N.

2017-01-01

Objectives. To evaluate and describe outcomes of state and local medical countermeasure preparedness planning, which is critical to ensure rapid distribution and dispensing of a broad spectrum of life-saving medical assets during a public health emergency. Methods. We used 2007 to 2014 state and local data collected from the Centers for Disease Control and Prevention’s Technical Assistance Review. We calculated descriptive statistics from 50 states and 72 local Cities Readiness Initiative jurisdictions that participated in the Technical Assistance Review annually. Results. From 2007 to 2014, the average overall Technical Assistance Review score increased by 13% for states and 41% for Cities Readiness Initiative jurisdictions. In 2014, nearly half of states achieved the maximum possible overall score (100), and 94% of local Cities Readiness Initiative jurisdictions achieved a score of 90 or more. Conclusions. Despite challenges, effective and timely medical countermeasure distribution and dispensing is possible with appropriate planning, staff, and resources. However, vigilance in training, exercising, and improving plans from lessons learned in a sustained, coordinated way is critical to ensure continued public health preparedness success. PMID:28892441

Domestic Banks in Bangladesh Could Ensure Efficiency by Improving Human Resource Management Practices

PubMed Central

Muhammad Masum, Abdul Kadar; Azad, Md. Abul Kalam; Hoque, Kazi Enamul; Beh, Loo-See

2015-01-01

The paper aims to examine the influence of human resource management (HRM) practices on bank efficiency using Malmquist index of total factor productivity. The model comprises HRM index that represents the quality of HRM practices. The results are decomposed into three efficiency scores, namely, technical efficiency, pure efficiency, and scale efficiency. In this study, panel data for 44 banks in Bangladesh are used for the period 2008-2013. This paper reveals that foreign banks are ahead in converting the influence of HRM practices into efficiency scores (0.946>0.833). On the other hand, domestic banks performed better than foreign banks in terms of pure efficiency and scale efficiency. But, in terms of technical efficiency, the domestic banks are regressed by 6.7% annually whereas foreign banks are progressed with a yearly value of 5.8%. The results are robust, because the Mann-Whitney test and Kruskall-Wallis test (non-parametric tests) also confirm the same results. This study emphasizes HRM practices in the banking industry to ensure efficiency in the long-term scenario. Domestic banks are suggested to ensure continuous development in HRM practices in order to compete with foreign banks. PMID:26221727

Domestic Banks in Bangladesh Could Ensure Efficiency by Improving Human Resource Management Practices.

PubMed

Masum, Abdul Kadar Muhammad; Azad, Md Abul Kalam; Hoque, Kazi Enamul; Beh, Loo-See

2015-01-01

The paper aims to examine the influence of human resource management (HRM) practices on bank efficiency using Malmquist index of total factor productivity. The model comprises HRM index that represents the quality of HRM practices. The results are decomposed into three efficiency scores, namely, technical efficiency, pure efficiency, and scale efficiency. In this study, panel data for 44 banks in Bangladesh are used for the period 2008-2013. This paper reveals that foreign banks are ahead in converting the influence of HRM practices into efficiency scores (0.946>0.833). On the other hand, domestic banks performed better than foreign banks in terms of pure efficiency and scale efficiency. But, in terms of technical efficiency, the domestic banks are regressed by 6.7% annually whereas foreign banks are progressed with a yearly value of 5.8%. The results are robust, because the Mann-Whitney test and Kruskall-Wallis test (non-parametric tests) also confirm the same results. This study emphasizes HRM practices in the banking industry to ensure efficiency in the long-term scenario. Domestic banks are suggested to ensure continuous development in HRM practices in order to compete with foreign banks.

Manufacturing Bms/Iso System Review

NASA Technical Reports Server (NTRS)

Gomez, Yazmin

2004-01-01

The Quality Management System (QMS) is one that recognizes the need to continuously change and improve an organization s products and services as determined by system feedback, and corresponding management decisions. The purpose of a Quality Management System is to minimize quality variability of an organization's products and services. The optimal Quality Management System balances the need for an organization to maintain flexibility in the products and services it provides with the need for providing the appropriate level of discipline and control over the processes used to provide them. The goal of a Quality Management System is to ensure the quality of the products and services while consistently (through minimizing quality variability) meeting or exceeding customer expectations. The GRC Business Management System (BMS) is the foundation of the Center's ISO 9001:2000 registered quality system. ISO 9001 is a quality system model developed by the International Organization for Standardization. BMS supports and promote the Glenn Research Center Quality Policy and wants to ensure the customer satisfaction while also meeting quality standards. My assignment during this summer is to examine the manufacturing processes used to develop research hardware, which in most cases are one of a kind hardware, made with non conventional equipment and materials. During this process of observation I will make a determination, based on my observations of the hardware development processes the best way to meet customer requirements and at the same time achieve the GRC quality standards. The purpose of my task is to review the manufacturing processes identifying opportunities in which to optimize the efficiency of the processes and establish a plan for implementation and continuous improvement.

Sasquatch Footprint Tool

NASA Technical Reports Server (NTRS)

Bledsoe, Kristin

2013-01-01

The Crew Exploration Vehicle Parachute Assembly System (CPAS) is the parachute system for NASA s Orion spacecraft. The test program consists of numerous drop tests, wherein a test article rigged with parachutes is extracted or released from an aircraft. During such tests, range safety is paramount, as is the recoverability of the parachutes and test article. It is crucial to establish an aircraft release point that will ensure that the article and all items released from it will land in safe locations. A new footprint predictor tool, called Sasquatch, was created in MATLAB. This tool takes in a simulated trajectory for the test article, information about all released objects, and atmospheric wind data (simulated or actual) to calculate the trajectories of the released objects. Dispersions are applied to the landing locations of those objects, taking into account the variability of winds, aircraft release point, and object descent rate. Sasquatch establishes a payload release point (e.g., where the payload will be extracted from the carrier aircraft) that will ensure that the payload and all objects released from it will land in a specified cleared area. The landing locations (the final points in the trajectories) are plotted on a map of the test range. Sasquatch was originally designed for CPAS drop tests and includes extensive information about both the CPAS hardware and the primary test range used for CPAS testing. However, it can easily be adapted for more complex CPAS drop tests, other NASA projects, and commercial partners. CPAS has developed the Sasquatch footprint tool to ensure range safety during parachute drop tests. Sasquatch is well correlated to test data and continues to ensure the safety of test personnel as well as the safe recovery of all equipment. The tool will continue to be modified based on new test data, improving predictions and providing added capability to meet the requirements of more complex testing.

Control Systems Engineering in Continuous Pharmaceutical Manufacturing May 20-21, 2014 Continuous Manufacturing Symposium.

PubMed

Myerson, Allan S; Krumme, Markus; Nasr, Moheb; Thomas, Hayden; Braatz, Richard D

2015-03-01

This white paper provides a perspective of the challenges, research needs, and future directions for control systems engineering in continuous pharmaceutical processing. The main motivation for writing this paper is to facilitate the development and deployment of control systems technologies so as to ensure quality of the drug product. Although the main focus is on small-molecule pharmaceutical products, most of the same statements apply to biological drug products. An introduction to continuous manufacturing and control systems is followed by a discussion of the current status and technical needs in process monitoring and control, systems integration, and risk analysis. Some key points are that: (1) the desired objective in continuous manufacturing should be the satisfaction of all critical quality attributes (CQAs), not for all variables to operate at steady-state values; (2) the design of start-up and shutdown procedures can significantly affect the economic operation of a continuous manufacturing process; (3) the traceability of material as it moves through the manufacturing facility is an important consideration that can at least in part be addressed using residence time distributions; and (4) the control systems technologies must assure quality in the presence of disturbances, dynamics, uncertainties, nonlinearities, and constraints. Direct measurement, first-principles and empirical model-based predictions, and design space approaches are described for ensuring that CQA specifications are met. Ways are discussed for universities, regulatory bodies, and industry to facilitate working around or through barriers to the development of control systems engineering technologies for continuous drug manufacturing. Industry and regulatory bodies should work with federal agencies to create federal funding mechanisms to attract faculty to this area. Universities should hire faculty interested in developing first-principles models and control systems technologies for drug manufacturing that are easily transportable to industry. Industry can facilitate the move to continuous manufacturing by working with universities on the conception of new continuous pharmaceutical manufacturing process unit operations that have the potential to make major improvements in product quality, controllability, or reduced capital and/or operating costs. Regulatory bodies should ensure that: (1) regulations and regulatory practices promote, and do not derail, the development and implementation of continuous manufacturing and control systems engineering approaches; (2) the individuals who approve specific regulatory filings are sufficiently trained to make good decisions regarding control systems approaches; (3) provide regulatory clarity and eliminate/reduce regulatory risks; (4) financially support the development of high-quality training materials for use of undergraduate students, graduate students, industrial employees, and regulatory staff; (5) enhance the training of their own technical staff by financially supporting joint research projects with universities in the development of continuous pharmaceutical manufacturing processes and the associated control systems engineering theory, numerical algorithms, and software; and (6) strongly encourage the federal agencies that support research to fund these research areas. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Control systems engineering in continuous pharmaceutical manufacturing. May 20-21, 2014 Continuous Manufacturing Symposium.

PubMed

Myerson, Allan S; Krumme, Markus; Nasr, Moheb; Thomas, Hayden; Braatz, Richard D

2015-03-01

This white paper provides a perspective of the challenges, research needs, and future directions for control systems engineering in continuous pharmaceutical processing. The main motivation for writing this paper is to facilitate the development and deployment of control systems technologies so as to ensure quality of the drug product. Although the main focus is on small-molecule pharmaceutical products, most of the same statements apply to biological drug products. An introduction to continuous manufacturing and control systems is followed by a discussion of the current status and technical needs in process monitoring and control, systems integration, and risk analysis. Some key points are that: (1) the desired objective in continuous manufacturing should be the satisfaction of all critical quality attributes (CQAs), not for all variables to operate at steady-state values; (2) the design of start-up and shutdown procedures can significantly affect the economic operation of a continuous manufacturing process; (3) the traceability of material as it moves through the manufacturing facility is an important consideration that can at least in part be addressed using residence time distributions; and (4) the control systems technologies must assure quality in the presence of disturbances, dynamics, uncertainties, nonlinearities, and constraints. Direct measurement, first-principles and empirical model-based predictions, and design space approaches are described for ensuring that CQA specifications are met. Ways are discussed for universities, regulatory bodies, and industry to facilitate working around or through barriers to the development of control systems engineering technologies for continuous drug manufacturing. Industry and regulatory bodies should work with federal agencies to create federal funding mechanisms to attract faculty to this area. Universities should hire faculty interested in developing first-principles models and control systems technologies for drug manufacturing that are easily transportable to industry. Industry can facilitate the move to continuous manufacturing by working with universities on the conception of new continuous pharmaceutical manufacturing process unit operations that have the potential to make major improvements in product quality, controllability, or reduced capital and/or operating costs. Regulatory bodies should ensure that: (1) regulations and regulatory practices promote, and do not derail, the development and implementation of continuous manufacturing and control systems engineering approaches; (2) the individuals who approve specific regulatory filings are sufficiently trained to make good decisions regarding control systems approaches; (3) provide regulatory clarity and eliminate/reduce regulatory risks; (4) financially support the development of high-quality training materials for use of undergraduate students, graduate students, industrial employees, and regulatory staff; (5) enhance the training of their own technical staff by financially supporting joint research projects with universities in the development of continuous pharmaceutical manufacturing processes and the associated control systems engineering theory, numerical algorithms, and software; and (6) strongly encourage the federal agencies that support research to fund these research areas. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Resiliency scoring for business continuity plans.

PubMed

Olson, Anna; Anderson, Jamie

Through this paper readers will learn of a scoring methodology, referred to as resiliency scoring, which enables the evaluation of business continuity plans based upon analysis of their alignment with a predefined set of criteria that can be customised and are adaptable to the needs of any organisation. This patent pending tool has been successful in driving engagement and is a powerful resource to improve reporting capabilities, identify risks and gauge organisational resilience. The role of business continuity professionals is to aid their organisations in planning and preparedness activities aimed at mitigating the impacts of potential disruptions and ensuring critical business functions can continue in the event of unforeseen circumstances. This may seem like a daunting task for what can typically be a small team of individuals. For this reason, it is important to be able to leverage industry standards, documented best practices and effective tools to streamline and support your continuity programme. The resiliency scoring methodology developed and implemented at Target has proven to be a valuable tool in taking the organisation's continuity programme to the next level. This paper will detail how the tool was developed and provide guidance on how it can be customised to fit your organisation's unique needs.

Curriculum renewal in child psychiatry.

PubMed

Hanson, M; Tiberius, R; Charach, A; Ulzen, T; Sackin, D; Jain, U; Reiter, S; Shomair, G

1999-11-01

To ensure uniform design and evaluation of a clerkship curriculum for child and adolescent psychiatry teaching common disorders and problems in an efficient manner across 5 teaching sites and to include structures for continuous improvement. The curriculum committee selected for course inclusion disorders and problems of child psychiatry that were commonly encountered by primary care physicians. Instruction methods that encouraged active student learning were selected. Course coordination across sites was encouraged by several methods: involving faculty, adopting a centralized examination format, and aligning teaching methods with examination format. Quantitative and qualitative methods were used to measure students' perceptions of the course's value. These evaluative results were reviewed, and course modifications were implemented and reevaluated. The average adjusted student return rate for course evaluation questionnaires for the 3-year study period was 63%. Clerks' ratings of course learning value demonstrated that the course improved significantly and continually across all sites, according to a Scheffé post-hoc analysis. Analysis of student statements from focus-group transcripts contributed to course modifications, such as the Brief Focused Interview (BFI). Our curriculum in child psychiatry, which focused on common problems and used active learning methods, was viewed as a valuable learning experience by clinical clerks. Curriculum coordination across multiple teaching sites was accomplished by including faculty in the process and by using specific teaching and examination strategies. Structures for continuous course improvement were effective.

Quality of Diabetes Management in Saudi Arabia: A Review of Existing Barriers.

PubMed

Almutairi, Khalid M

2015-12-01

Diabetes mellitus is a complex disorder that requires continuous management and medical care. The purpose of this review is to identify and summarize the barriers that affect diabetes management in Saudi Arabia. Studies that have examined the quality of diabetes management in Saudi Arabia were identified through online and manual literature searches. Two researchers independently searched and assessed for inclusion/exclusion criteria. All studies were screened by a specialist for the significance of the review. Studies that were included were evaluated for relevance, methodological rigor, and credibility by giving a quality score based on Russell and Gregory's criteria. This review presents an overview of the quality of diabetes management and issues and barriers concerning the improvement of diabetes care in Saudi Arabia. The online literature search yielded 11 studies which met the inclusion criteria. Factors affecting the quality of diabetes care can be categorized into patient factors (such as adherence, compliance, attitudes, beliefs, knowledge, financial resources and co-morbidities) and healthcare providers' factors (including beliefs, attitudes and knowledge, patient - provider interaction and communication). The identified barriers, both from patients and healthcare providers, will help healthcare authorities to improve diabetes management in Saudi Arabia. Improvement of health awareness about disease and disease management should be tailored through continuous patient education. Continuous training and seminars will also expand providers' knowledge that will ensure quality and effective diabetes management.

Lennie: a smartphone application with novel implications for the management of animal colonies.

PubMed

Allwood, M A; Griffith, D; Allen, C; Reed, J; Mahmoud, Q H; Brunt, K R; Simpson, J A

2015-07-01

Researchers rely on animals for their clinical applicability and ease of monitoring. However, careful management is required to ensure the animal and financial costs are minimized. The incorporation of 'smartphone' technology in research has increased exponentially, with a focus on the development of innovative research-based applications. We have developed a smartphone application designed to address the needs of modern researchers in the management of their colonies. 'Lennie' introduces a new method for the management of small to medium-sized animal colonies. Lennie allows users wireless access to their colonies with the ability to create and edit from virtually anywhere. Lennie also offers the ability to manage colonies based on experiments by assigning animals based on priority. Experimental time-points are also recorded with integrated scheduling options using the calendar function. Lennie represents an alternative to current large-scale software options, as the application design is simple, and requires no training or manuals. As the technological landscape is constantly evolving, we must continue to find ways to improve upon current practices to ensure that research is completed with efficiency and efficacy. With this new method of animal management, researchers are able to spend less time record keeping and can focus their efforts on continued innovation. © The Author(s) 2015.

Establishment, Present Condition, and Developmental Direction of the New Korean Healthcare Accreditation System

PubMed Central

Chang, Hoo-Sun

2012-01-01

On July 23rd, 2010 a revised medical law (Article 58) was passed to change existing evaluation system of medical institutions to an accreditation system. The new healthcare accreditation system was introduced to encourage medical institutions to work voluntarily and continuously to improve patient safety and medical service quality. Changes regarding the healthcare accreditation system included the establishment of an accreditation agency, the voluntary participation of medical institutions, accreditation standards centering on the treatment process and patient safety, tracing methodology, and the announcement of comprehensive results concerning accreditation. Despite varying views on the healthcare accreditation system, including some that are critical, it is meaningful that the voluntary nature of the system acknowledges that the medical institutions must be active agents in improving medical service quality. Healthcare quality is not improved instantaneously, but instead gradually through continuous communication within the clinical field. For this accreditation system to be successful, followings are essential: the accreditation agency becomes financially independent and is managed efficiently, the autonomy and regulation surrounding the system are balanced, the professionalism of the system is ensured, and the medical field plays an active role in the operation of the system. PMID:22661873

Patient-Centered Specialty Practice: Defining the Role of Specialists in Value-Based Health Care.

PubMed

Ward, Lawrence; Powell, Rhea E; Scharf, Michael L; Chapman, Andrew; Kavuru, Mani

2017-04-01

Health care is at a crossroads and under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. However, primary care accounts for only a small portion of total health-care spending, and there is a need for policies and frameworks to support high-quality, cost-efficient care in specialty practices of the medical neighborhood. The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance. The key elements of the PCSP model include processes to support timely access to referral requests, improved communication and coordination with patients and referring clinicians, reduced unnecessary and duplicative testing, and an emphasis on continuous measurement of quality, safety, and performance improvement for a population of patients. Evidence to support the model remains limited, and estimates of net costs and value to practices are not fully understood. The PCSP model holds promise for promoting value-based health care in specialty practices. The continued development of appropriate incentives is required to ensure widespread adoption. Copyright © 2017. Published by Elsevier Inc.

Finding a balance between "value added" and feeling valued: revising models of care. The human factor of implementing a quality improvement initiative using Lean methodology within the healthcare sector.

PubMed

Deans, Rachel; Wade, Shawna

2011-01-01

Growing demand from clients waiting to access vital services in a healthcare sector under economic constraint, coupled with the pressure for ongoing improvement within a multi-faceted organization, can have a significant impact on the front-line staff, who are essential to the successful implementation of any quality improvement initiative. The Lean methodology is a management system for continuous improvement based on the Toyota Production System; it focuses on two main themes: respect for people and the elimination of waste or non-value-added activities. Within the Lean process, value-added is used to describe any activity that contributes directly to satisfying the needs of the client, and non-value-added refers to any activity that takes time, space or resources but does not contribute directly to satisfying client needs. Through the revision of existing models of service delivery, the authors' organization has made an impact on increasing access to care and has supported successful engagement of staff in the process, while ensuring that the focus remains on the central needs of clients and families accessing services. While the performance metrics continue to exhibit respectable results for this strategic priority, further gains are expected over the next 18-24 months.

Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?

PubMed

Maina, Robert N; Mengo, Doris M; Mohamud, Abdikher D; Ochieng, Susan M; Milgo, Sammy K; Sexton, Connie J; Moyo, Sikhulile; Luman, Elizabeth T

2014-01-01

Kenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation. Audits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist. All laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5-45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (≥ 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs. Whilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories.

Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?

PubMed Central

Mengo, Doris M.; Mohamud, Abdikher D.; Ochieng, Susan M.; Milgo, Sammy K.; Sexton, Connie J.; Moyo, Sikhulile; Luman, Elizabeth T.

2014-01-01

Background Kenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation. Methods Audits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist. Results All laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5–45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (≥ 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs. Conclusion Whilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories. PMID:29043193

Methods for maintaining the continuity of power supply in hospitals

NASA Astrophysics Data System (ADS)

Mihut, V. V.; Panoiu, M.; Panoiu, C.; Baciu, I.

2018-01-01

This paper presents alternative solutions to ensure power supply of critical consumer, such hospitals. In a hospital it is extremely important to have a power supply without any interruption. This is the reason of the using various solutions that ensure continuity of power supply. In this paper it is presented a solution used in a hospital in Romania. Here is used a generator controlled by microprocessor capable of taking over power supply in case there are problems with power supply from the national power grid.

EPA to Host June 21, 2018, Webinar on Strategy to Ensure Effectiveness of Hospital Disinfectants

EPA Pesticide Factsheets

EPA will host a listening session via webinar to seek stakeholders' input on the development of a risk-based product testing strategy to ensure continued effectiveness of hospital disinfectant products on June 21, 2018

Developing a systematic strategy incorporating ethical , animal welfare and practice principles to guide the genetic improvement of dairy cattle.

PubMed

Fisher, M W; Mellor, D J

2008-06-01

People have complex and diverse relationships and interactions with, and expectations of, animals; relationships which are very important. In making sense of this complexity, we draw on our values. The objective of this study was to reflect upon, develop and articulate key values guiding the genetic improvement of dairy cattle. Animal husbandry is guided by the philosophy that while animals serve our needs, we must ensure that their needs are met, and any compromises to those needs justified and minimised. In applying modern technology to the genetic improvement of animals, this philosophy should be enacted through consideration of all the broader goals of agriculture, and the ecology and biology of the farming system. It should also be informed by the differing perspectives of interested parties, including stock handlers, veterinarians, animal welfare groups, consumers, and the public. Monitoring the consequences of technology applications, managing and avoiding any harms, and considering the future of animals and ourselves, should also be part of decision making in this area. Transparent consideration of these principles will help to ensure that any compromises to animal welfare resulting from trait selection are both reasonable and necessary, and that any harms are minimised, thereby helping to safeguard continuation of the important contribution that animal agriculture, and in particular the dairy sector, makes to society.

Priapism: new concepts in medical and surgical management.

PubMed

Burnett, Arthur L; Bivalacqua, Trinity J

2011-05-01

Advances have recently been made in both medical and surgical management of priapism, and these offer improvements in the level of care afforded such patients. Further developments can be expected based on ongoing progress, particularly in the area of molecular science, which is the primary source for driving novel therapeutic approaches. Continued action to address the health care administrative concerns of those most commonly affected by priapism, specifically individuals with sickle cell disease, is also appropriate. All successes in these arenas ensure that afflicted individuals avoid the health burdens of priapism and preserve sexual function. 2011 Elsevier Inc. All rights reserved.

Proteome complexity and the forces that drive proteome imbalance.

PubMed

Harper, J Wade; Bennett, Eric J

2016-09-15

The cellular proteome is a complex microcosm of structural and regulatory networks that requires continuous surveillance and modification to meet the dynamic needs of the cell. It is therefore crucial that the protein flux of the cell remains in balance to ensure proper cell function. Genetic alterations that range from chromosome imbalance to oncogene activation can affect the speed, fidelity and capacity of protein biogenesis and degradation systems, which often results in proteome imbalance. An improved understanding of the causes and consequences of proteome imbalance is helping to reveal how these systems can be targeted to treat diseases such as cancer.

Lithuanian female physicists: Reality and plans for the future

NASA Astrophysics Data System (ADS)

Šatkovskienė, Dalia; Giriunienė, Ramutė; Ruželė, Živilė; Rutkunienė, Živilė

2013-03-01

Changes in the issue of women in physics in Lithuanian in the three years since the 3rd IUPAP International Conference on Women in Physics are discussed on the basis of statistics as well as an exploratory study recently conducted among women physicists. The situation has changed slowly since 2008. However, the study shows that women physicists more clearly understand the inequities and the need for changes, including an active European Union mainstreaming policy targeted to ensure gender equality in the sciences, which gives hope for accelerating changes. Continued plans for improving women physicists' situation in Lithuania are discussed.

Impact of the shape of the implantable ports on their efficiency of flow (injection and flushing)

PubMed Central

Guiffant, Gérard; Flaud, Patrice; Durussel, Jean Jacques; Merckx, Jacques

2014-01-01

Now widely used, totally implantable venous access devices allow mid- and long-term, frequent, repeated, or continuous injection of therapeutic products by vascular, cavitary, or perineural access. The effective flushing of these devices is a key factor that ensures their long-lasting use. We present experimental results and a numerical simulation to demonstrate that the implementation of rounded edge wall cavities improves flushing efficiency. We use the same approaches to suggest that the deposit amount may be reduced by the use of rounded edge wall cavities. PMID:25258561

Contraceptive Counseling: Best Practices to Ensure Quality Communication and Enable Effective Contraceptive Use

PubMed Central

Dehlendorf, Christine; Krajewski, Colleen; Borrero, Sonya

2014-01-01

Improving the quality of contraceptive counseling is one strategy to prevent unintended pregnancy. We identify aspects of relational and task-oriented communication in family planning care that can assist providers in meeting their patients’ needs. Approaches to optimizing women's experiences of contraceptive counseling include working to develop a close, trusting relationship with patients and using a shared decision-making approach that focuses on eliciting and responding to patient preferences. Providing counseling about side effects and using strategies to promote contraceptive continuation and adherence can also help optimize women's use of contraception. PMID:25264697

Content Integrity, Conflict of Interest, and Commercial Support: Defining and Operationalizing the Terms.

PubMed

Dickerson, Pam; Chappell, Kathy

2015-01-01

One of the hallmarks of quality continuing education developed using accreditation criteria is content integrity. Components of content integrity include identifying, resolving, and disclosing conflict of interest; ensuring content is based on the best available evidence; managing commercial support (if applicable); and presenting the educational activity free of promotion or bias. This article explores content integrity, conflict of interest, and commercial support. Understanding and being able to operationalize these concepts will enable providers to offer high-quality educational activities that promote the professional development of nurses and/or improve the quality of patient care.

Formerly Used Defense Sites. The U.S. Army Corps of Engineers Needs to Improve Its Process for Reviewing Completed Cleanup Remedies to Ensure Continued Protection

DTIC Science & Technology

2009-10-01

inspections for MMRP sites by September 30, 2010.28 In addition, the delay for the 5-year review for an IRP site at the Former Weldon Spring Ordnance Works...810.573 $810.573 $889.785 Spring Valley, Washington, D.C. 65.762 89.243 155.005 9.701 16.177 25.878 180.883 Buckley Field, CO 0.543...the Association of State and Territorial Solid Waste Management Officials. In the spring of 2008, the association surveyed the states about the

Modeling of Karachaganak field development

NASA Astrophysics Data System (ADS)

Sadvakasov, A. A.; Shamsutdinova, G. F.; Almukhametova, E. M.; Gabdrakhmanov, N. Kh

2018-05-01

Management of a geological deposit includes the study and analysis of oil recovery, identification of factors influencing production performance and oil-bearing rock flooding, reserve recovery and other indicators characterizing field development in general. Regulation of oil deposits exploitation is a mere control over the fluid flow within a reservoir, which is ensured through the designed system of development via continuous improvement of production and injection wells placement, optimum performance modes, service conditions of downhole and surface oil-field equipment taking into account various changes and physical-geological properties of a field when using modern equipment to obtain the best performance indicators.

Assimilation and High Resolution Forecasts of Surface and Near Surface Conditions for the 2010 Vancouver Winter Olympic and Paralympic Games

NASA Astrophysics Data System (ADS)

Bernier, Natacha B.; Bélair, Stéphane; Bilodeau, Bernard; Tong, Linying

2014-01-01

A dynamical model was experimentally implemented to provide high resolution forecasts at points of interests in the 2010 Vancouver Olympics and Paralympics Region. In a first experiment, GEM-Surf, the near surface and land surface modeling system, is driven by operational atmospheric forecasts and used to refine the surface forecasts according to local surface conditions such as elevation and vegetation type. In this simple form, temperature and snow depth forecasts are improved mainly as a result of the better representation of real elevation. In a second experiment, screen level observations and operational atmospheric forecasts are blended to drive a continuous cycle of near surface and land surface hindcasts. Hindcasts of the previous day conditions are then regarded as today's optimized initial conditions. Hence, in this experiment, given observations are available, observation driven hindcasts continuously ensure that daily forecasts are issued from improved initial conditions. GEM-Surf forecasts obtained from improved short-range hindcasts produced using these better conditions result in improved snow depth forecasts. In a third experiment, assimilation of snow depth data is applied to further optimize GEM-Surf's initial conditions, in addition to the use of blended observations and forecasts for forcing. Results show that snow depth and summer temperature forecasts are further improved by the addition of snow depth data assimilation.

Integrating UF6 Cylinder RF Tracking With Continuous Load Cell Monitoring for Verifying Declared UF6 Feed and Withdrawal Operations Verifying Declared UF6 Feed and Withdrawal Operations

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

Krichinsky, Alan M; Miller, Paul; Pickett, Chris A

2009-01-01

Oak Ridge National Laboratory is demonstrating the integration of UF6 cylinder tracking, using RF technology, with continuous load cell monitoring (CLCM) at mock UF6 feed and withdrawal (F&W) stations. CLCM and cylinder tracking are two of several continuous-monitoring technologies that show promise in providing integrated safeguards of F&W operations at enrichment plants. Integrating different monitoring technologies allows advanced, automated event processing to screen innocuous events thereby minimizing false alerts to independent inspectors. Traditionally, international inspectors rely on batch verification of material inputs and outputs derived from operator declarations and periodic on-site inspections at uranium enrichment plants or other nuclear processingmore » facilities. Continuously monitoring F&W activities between inspections while providing filtered alerts of significant operational events will substantially increase the amount of valuable information available to inspectors thereby promising to enhance the effectiveness of safeguards and to improve efficiency in conducting on-site inspections especially at large plants for ensuring that all operations are declared.« less

Patient Hospital Experience Improved Modestly, But No Evidence Medicare Incentives Promoted Meaningful Gains.

PubMed

Papanicolas, Irene; Figueroa, José F; Orav, E John; Jha, Ashish K

2017-01-01

The Centers for Medicare and Medicaid Services (CMS) has played a leading role in efforts to improve patients' experiences with hospital care. Yet little is known about how much patient experience has changed over the past decade, and even less is known about the impact of CMS's most recent strategy: tying payments to performance under the Value-Based Purchasing (VBP) program. We examined trends in multiple measures of patient satisfaction in the period 2008-14. We found that patient experience has improved modestly at US hospitals-both those participating in the VBP program and others-with the majority of improvement concentrated in the period before the program was implemented. While certain subsets of hospitals improved more than others, we found no evidence that the program has had a beneficial effect. As policy makers continue to promote value-based payment as a way to improve patient experience, it will be critical to ensure that payment is structured in ways that actually drive improvement. Project HOPE—The People-to-People Health Foundation, Inc.

Is it time to move to nucleic acid amplification tests screening for pharyngeal and rectal gonorrhoea in men who have sex with men to improve gonorrhoea control?

PubMed

Fairley, Christopher K; Chen, Marcus Y; Bradshaw, Catriona S; Tabrizi, Sepehr N

2011-03-01

The use of nucleic acid amplification tests (NAAT), as well as or in preference to culture for non-genital sites is now recommended both in Australia and overseas because of their greater sensitivity and improved specificity. A survey of 22 Australian sexual health clinics who each year test over 14500 men who have sex with men (MSM) show that culture remains the predominate method for detecting gonorrhoea at pharyngeal (64%) and rectal (73%) sites. This editorial discusses the potential disadvantages of using culture over NAAT in relation to optimal gonorrhoea control among MSM and advocates that significantly improved control would be achieved by moving to NAAT with the proviso that culture samples are taken wherever possible on NAAT-positive samples and from clients with urethritis to ensure continued surveillance for antimicrobial resistance.

Data acquisition and PV module power production in upgraded TEP/AzRISE solar test yard

NASA Astrophysics Data System (ADS)

Bennett, Whit E.; Fishgold, Asher D.; Lai, Teh; Potter, Barrett G.; Simmons-Potter, Kelly

2017-08-01

The Tucson Electric Power (TEP)/University of Arizona AzRISE (Arizona Research Institute for Solar Energy) solar test yard is continuing efforts to improve standardization and data acquisition reliability throughout the facility. Data reliability is ensured through temperature-insensitive data acquisition devices with battery backups in the upgraded test yard. Software improvements allow for real-time analysis of collected data, while uploading to a web server. Sample data illustrates high fidelity monitoring of the burn-in period of a polycrystalline silicon photovoltaic module test string with no data failures over 365 days of data collection. In addition to improved DAQ systems, precision temperature monitoring has been implemented so that PV module backside temperatures are routinely obtained. Weather station data acquired at the test yard provides local ambient temperature, humidity, wind speed, and irradiance measurements that have been utilized to enable characterization of PV module performance over an extended test period

Health status, sexual and drug risk, and psychosocial factors relevant to postrelease planning for HIV+ prisoners.

PubMed

Feaster, Daniel J; Reznick, Olga Grinstead; Zack, Barry; McCartney, Kathleen; Gregorich, Steven E; Brincks, Ahnalee M

2013-10-01

The prevalence of HIV infection among male prison inmates is significantly higher than in the U.S. population. Adequate planning to ensure continued medication adherence and continuity of care after release is important for this population. This study describes the prerelease characteristics of 162 incarcerated HIV-positive men (40 from jails and 122 from prisons). The results include a demographic description of the sample and the participants' sexual risk behaviors, substance use, health status and HIV medication adherence, health care utilization, mental health, and family and social support. The results highlight a potentially high level of need for services and low levels of support and social connectedness. Postrelease planning should include support for improving HIV medication adherence as well as reducing both sexual and injection drug-related transmission risk for these individuals.

Maximum entropy formalism for the analytic continuation of matrix-valued Green's functions

NASA Astrophysics Data System (ADS)

Kraberger, Gernot J.; Triebl, Robert; Zingl, Manuel; Aichhorn, Markus

2017-10-01

We present a generalization of the maximum entropy method to the analytic continuation of matrix-valued Green's functions. To treat off-diagonal elements correctly based on Bayesian probability theory, the entropy term has to be extended for spectral functions that are possibly negative in some frequency ranges. In that way, all matrix elements of the Green's function matrix can be analytically continued; we introduce a computationally cheap element-wise method for this purpose. However, this method cannot ensure important constraints on the mathematical properties of the resulting spectral functions, namely positive semidefiniteness and Hermiticity. To improve on this, we present a full matrix formalism, where all matrix elements are treated simultaneously. We show the capabilities of these methods using insulating and metallic dynamical mean-field theory (DMFT) Green's functions as test cases. Finally, we apply the methods to realistic material calculations for LaTiO3, where off-diagonal matrix elements in the Green's function appear due to the distorted crystal structure.

Extra projection data identification method for fast-continuous-rotation industrial cone-beam CT.

PubMed

Yang, Min; Duan, Shengling; Duan, Jinghui; Wang, Xiaolong; Li, Xingdong; Meng, Fanyong; Zhang, Jianhai

2013-01-01

Fast-continuous-rotation is an effective measure to improve the scanning speed and decrease the radiation dose for cone-beam CT. However, because of acceleration and deceleration of the motor, as well as the response lag of the scanning control terminals to the host PC, uneven-distributed and redundant projections are inevitably created, which seriously decrease the quality of the reconstruction images. In this paper, we first analyzed the aspects of the theoretical sequence chart of the fast-continuous-rotation mode. Then, an optimized sequence chart was proposed by extending the rotation angle span to ensure the effective 2π-span projections were situated in the stable rotation stage. In order to match the rotation angle with the projection image accurately, structure similarity (SSIM) index was used as a control parameter for extraction of the effective projection sequence which was exactly the complete projection data for image reconstruction. The experimental results showed that SSIM based method had a high accuracy of projection view locating and was easy to realize.

Leveraging health information exchange to improve population health reporting processes: lessons in using a collaborative-participatory design process.

PubMed

Revere, Debra; Dixon, Brian E; Hills, Rebecca; Williams, Jennifer L; Grannis, Shaun J

2014-01-01

Surveillance, or the systematic monitoring of disease within a population, is a cornerstone function of public health. Despite significant investment in information technologies (IT) to improve the public's health, health care providers continue to rely on manual, spontaneous reporting processes that can result in incomplete and delayed surveillance activities. Participatory design principles advocate including real users and stakeholders when designing an information system to ensure high ecological validity of the product, incorporate relevance and context into the design, reduce misconceptions designers can make due to insufficient domain expertise, and ultimately reduce barriers to adoption of the system. This paper focuses on the collaborative and informal participatory design process used to develop enhanced, IT-enabled reporting processes that leverage available electronic health records in a health information exchange to prepopulate notifiable-conditions report forms used by public health authorities. Over nine months, public health stakeholders, technical staff, and informatics researchers were engaged in a multiphase participatory design process that included public health stakeholder focus groups, investigator-engineering team meetings, public health survey and census regarding high-priority data elements, and codesign of exploratory prototypes and final form mock-ups. A number of state-mandated report fields that are not highly used or desirable for disease investigation were eliminated, which allowed engineers to repurpose form space for desired and high-priority data elements and improve the usability of the forms. Our participatory design process ensured that IT development was driven by end user expertise and needs, resulting in significant improvements to the layout and functionality of the reporting forms. In addition to informing report form development, engaging with public health end users and stakeholders through the participatory design process provided new insights into public health workflow and allowed the team to quickly triage user requests while managing user expectations within the realm of engineering possibilities. Engaging public health, engineering staff, and investigators in a shared codesigning process ensured that the new forms will not only meet real-life needs but will also support development of a product that will be adopted and, ultimately, improve communicable and infectious disease reporting by clinicians to public health.

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

PubMed

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

2011-10-01

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

Compressed-air energy storage: Commercialization potential and EPRI roles in the commercialization process

NASA Astrophysics Data System (ADS)

Boyd, D. W.; Buckley, O. E.; Clark, C. E.

1982-12-01

This report describes an assessment of potential roles that EPRI might take to facilitate the commercial acceptance of compressed air energy storage (CAES) systems. The assessment is based on (1) detailed analyses of the market potential of utility storage technologies, (2) interviews with representatives of key participants in the CAES market, and (3) a decision analysis synthesizing much of the information about market and technology status. The results indicate a large potential market for CAES systems if the overall business environment for utilities improves. In addition, it appears that EPRI can have a valuable incremental impact in ensuring that utilities realize the potential of CAES by (1) continuing an aggressive information dissemination and technology transfer program, (2) working to ensure the success of the first United States CAES installation at Soyland Power Cooperative, (3) developing planning methods to allow utilities to evaluate CAES and other storage options more effectively and more realistically, and (4) supporting R and D to resolve residual uncertainties in first-generation CAES cost and performance characteristics.

The Canadian clinician-scientist training program must be reinstated.

PubMed

Twa, David D W; Squair, Jordan W; Skinnider, Michael A; Ji, Jennifer X

2015-11-03

Clinical investigators within the Canadian and international communities were shocked when the Canadian Institutes of Health Research (CIHR) announced that their funding for the MD/PhD program would be terminated after the 2015-2016 academic year. The program has trained Canadian clinician-scientists for more than two decades. The cancellation of the program is at odds with the CIHR's mandate, which stresses the translation of new knowledge into improved health for Canadians, as well as with a series of internal reports that have recommended expanding the program. Although substantial evidence supports the analogous Medical Scientist Training Program in the United States, no parallel analysis of the MD/PhD program has been performed in Canada. Here, we highlight the long-term consequences of the program's cancellation in the context of increased emphasis on translational research. We argue that alternative funding sources cannot ensure continuous support for students in clinician-scientist training programs and that platform funding of the MD/PhD program is necessary to ensure leadership in translational research.

Controversies in Antimicrobial Stewardship: Focus on New Rapid Diagnostic Technologies and Antimicrobials

PubMed Central

Wenzler, Eric; Wong, Jordan R.; Goff, Debra A.; Jankowski, Christopher A.; Bauer, Karri A.

2016-01-01

Antimicrobial stewardship programs (ASPs) are challenged with ensuring appropriate antimicrobial use while minimizing expenditures. ASPs have consistently demonstrated improved patient outcomes and significant cost reductions but are continually required to justify the costs of their existence and interventions due to the silo mentality often adopted by hospital administrators. As new technologies and antimicrobials emerge, ASPs are in a constant tug-of-war between providing optimal clinical outcomes and ensuring cost containment. Additionally, robust data on cost-effectiveness of new rapid diagnostic technologies and antimicrobials with subsequent ASP interventions to provide justification are lacking. As the implementation of an ASP will soon be mandatory for acute care hospitals in the United States, ASPs must find ways to justify novel interventions to align themselves with healthcare administrators. This review provides a framework for the justification of implementing a rapid diagnostic test or adding a new antimicrobial to formulary with ASP intervention, reviews approaches to demonstrating cost-effectiveness, and proposes methods for which ASPs may reduce healthcare expenditures via alternative tactics. PMID:27025521

Peer Review and Surgical Innovation: Robotic Surgery and Its Hurdles.

PubMed

Vyas, Dinesh; Cronin, Sean

2015-12-01

The peer review processes as outlined in the Health Care Quality Improvement Act (HCQIA) is meant ensure quality standard of care through a self-policing mechanism by the medical community. This process grants immunity for people filing a peer review, which is meant to protect whistleblowers. However, it also creates a loophole that can be used maliciously to hinder competition. This is accentuated when surgeons are integrating new technologies, such as robotic surgery, into their practice. With more than 2000 da Vinci robots in use and more than 300 new units being shipped each year, robotic surgery has become a mainstay in the surgical field. The applications for robots continue to expand as surgeons discover their expanding capability. We need a better peer review process. That ensures the peer review is void of competitive bias. Peer reviewers need to be familiar with the procedure and the technology. The current process could stymie innovation in the name of competition.

Design and implementation of disaster recovery and business continuity solution for radiology PACS.

PubMed

Mansoori, Bahar; Rosipko, Beverly; Erhard, Karen K; Sunshine, Jeffrey L

2014-02-01

In the digital era of radiology, picture archiving and communication system (PACS) has a pivotal role in retrieving and storing the images. Integration of PACS with all the health care information systems e.g., health information system, radiology information system, and electronic medical record has greatly improved access to patient data at anytime and anywhere throughout the entire enterprise. In such an integrated setting, seamless operation depends critically on maintaining data integrity and continuous access for all. Any failure in hardware or software could interrupt the workflow or data and consequently, would risk serious impact to patient care. Thus, any large-scale PACS now have an indispensable requirement to include deployment of a disaster recovery plan to ensure secure sources of data. This paper presents our experience with designing and implementing a disaster recovery and business continuity plan. The selected architecture with two servers in each site (local and disaster recovery (DR) site) provides four different scenarios to continue running and maintain end user service. The implemented DR at University Hospitals Health System now permits continuous access to the PACS application and its contained images for radiologists, other clinicians, and patients alike.

28 CFR 115.322 - Policies to ensure referrals of allegations for investigations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Policies to ensure referrals of allegations for investigations. 115.322 Section 115.322 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Juvenile Facilities Responsive...

28 CFR 115.322 - Policies to ensure referrals of allegations for investigations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Policies to ensure referrals of allegations for investigations. 115.322 Section 115.322 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Juvenile Facilities Responsive...

28 CFR 115.322 - Policies to ensure referrals of allegations for investigations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Policies to ensure referrals of allegations for investigations. 115.322 Section 115.322 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Juvenile Facilities Responsive...

Workshop on Discovery Lessons-Learned

NASA Technical Reports Server (NTRS)

Saunders, M. (Editor)

1995-01-01

As part of the Discovery Program's continuous improvement effort, a Discovery Program Lessons-Learned workshop was designed to review how well the Discovery Program is moving toward its goal of providing low-cost research opportunities to the planetary science community while ensuring continued U.S. leadership in solar system exploration. The principal focus of the workshop was on the recently completed Announcement of Opportunity (AO) cycle, but the program direction and program management were also open to comment. The objective of the workshop was to identify both the strengths and weaknesses of the process up to this point, with the goal of improving the process for the next AO cycle. The process for initializing the workshop was to solicit comments from the communities involved in the program and to use the feedback as the basis for establishing the workshop agenda. The following four sessions were developed after reviewing and synthesizing both the formal feedback received and informal feedback obtained during discussions with various participants: (1) Science and Return on Investment; (2) Technology vs. Risk; Mission Success and Other Factors; (3) Cost; and (4) AO.AO Process Changes and Program Management.

The role of telemedicine in obstructive sleep apnea management.

PubMed

Lugo, Vera; Villanueva, Jair Asir; Garmendia, Onintza; Montserrat, Josep M

2017-09-01

Obstructive sleep apnea (OSA) is a common disease that leads in notorious symptoms and comorbidities. Although general measures are important, continuous positive airway pressure (CPAP) is the best treatment option. However, compliance can be suboptimal and telemedicine may play a role to improve it. Areas covered: Review authors searched EMBASE, PubMed and Cochrane data bases using the following keywords: continuous positive airway pressure, Obstructive sleep apnea, telemedicine, respiratory telemedicine, information and communication technology. Papers published between 2000 and 2016 in English language were considered. Expert commentary: To improve OSA management, there is a pressing need to develop new cost-effective strategies, particularly those related to OSA treatment, from measures such as lifestyle changes to CPAP use. Two broad strategies should be implemented: 1) adequate pre-, peri-, and post-titration measures to ensure correct diagnosis, adequate training, and appropriate support during follow up; and 2) the use of technological advances including both the optimization of CPAP devices and the use of telemedicine, specially focused on the first days or weeks of treatment. Telemedicine can help with these processes, especially when it is personalized to the needs of each patient group.

[How to write, how to implement and how to evaluate a practice guideline in order to improve quality of care?].

PubMed

Moret, L; Lefort, C; Terrien, N

2012-11-01

Initiatives of clinical practices improvement have been gradually developing in France for 20 years. Nevertheless, effective implementation of change is still difficult for numerous reasons. The use of clinical practices guidelines is one of the different ways of improvement. It is however necessary to adapt these national guidelines to the specificities of the hospital and the team, to ensure implementation and appropriation by the professionals. These recommendations are thus translated into applicable and concrete standard operating procedures. These documents have to be built by and for the concerned professionals. They are also communication and training tools, precise, directive, uniform in terms of presentation and attractive visually. Once drafted, they have to be distributed widely to the professionals to facilitate implementation. The simple distribution of the recommendations is insufficient to modify the clinical practices and require association of several methods of promotion for an optimal appropriation. How then to make sure of their effective use? Practices evaluation is one of the steps of continuous professional development, including continuous training and analysis of clinical practices by using methods promoted by the "Haute Autorité de santé". One of them is the clinical audit; use of method assessing non-pertinent treatment is interesting too. Analysis of the non-conformities and gaps between theory and practice allows identifying various possible causes (professional, institutional, organizational or personal) in order to implement corrective action plans, in a logic of continuous improvement. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

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

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

Ghobadi,; Li, W; Chung, C

2015-06-15

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

28 CFR 91.3 - General eligibility requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... construct, develop, expand, operate or improve correctional facilities to ensure that secure space is..., development, expansion, modification, operation or improvement of correctional facilities designed to ensure... of the multi-state compact agreement that specifies the construction, development, expansion...

28 CFR 91.3 - General eligibility requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... construct, develop, expand, operate or improve correctional facilities to ensure that secure space is..., development, expansion, modification, operation or improvement of correctional facilities designed to ensure... of the multi-state compact agreement that specifies the construction, development, expansion...

28 CFR 91.3 - General eligibility requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... construct, develop, expand, operate or improve correctional facilities to ensure that secure space is..., development, expansion, modification, operation or improvement of correctional facilities designed to ensure... of the multi-state compact agreement that specifies the construction, development, expansion...

28 CFR 91.3 - General eligibility requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... construct, develop, expand, operate or improve correctional facilities to ensure that secure space is..., development, expansion, modification, operation or improvement of correctional facilities designed to ensure... of the multi-state compact agreement that specifies the construction, development, expansion...

28 CFR 91.3 - General eligibility requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... construct, develop, expand, operate or improve correctional facilities to ensure that secure space is..., development, expansion, modification, operation or improvement of correctional facilities designed to ensure... of the multi-state compact agreement that specifies the construction, development, expansion...

Improvement of Productivity in TIG Welding Plant by Equipment Design in Orbit

NASA Astrophysics Data System (ADS)

Gnanavel, C.; Saravanan, R.; Chandrasekaran, M.; Jayakanth, J. J.

2017-03-01

Measurements and improvements are very indispensable task at all levels of management. Here some samples are, at operator level: Measuring operating parameters to ensure OEE (Overall Equipment Effectiveness) and measuring Q components performance to ensure quality, at supervisory level: measuring operator’s performance to ensure labour utility at managerial level: production and productivity measurements and at top level capital and capacity utilization. An often accepted statement is “Improvement is impossible without measurement”. Measurements often referred as observation. The case study was conducted at Government Boiler factory in India. The scientific approach followed for indentifying non value added activities. Personalised new equipment designed and installed to achieve productivity improvement of 85% for a day. The new equipment can serve 360o around its axis hence it simplified loading and unloading procedures as well as reduce their times and ensured effective space and time.

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

NASA Astrophysics Data System (ADS)

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

2015-02-01

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

The requirements of a specialist Breast Centre.

PubMed

Wilson, A R M; Marotti, L; Bianchi, S; Biganzoli, L; Claassen, S; Decker, T; Frigerio, A; Goldhirsch, A; Gustafsson, E G; Mansel, R E; Orecchia, R; Ponti, A; Poortmans, P; Regitnig, P; Rosselli Del Turco, M; Rutgers, E J Th; van Asperen, C; Wells, C A; Wengström, Y; Cataliotti, L

2013-11-01

In recognition of the advances and evidence based changes in clinical practice that have occurred in recent years and taking into account the knowledge and experience accumulated through the voluntary breast unit certification programme, Eusoma has produced this up-dated and revised guidelines on the requirements of a Specialist Breast Centre (BC). The content of these guidelines is based on evidence from the recent relevant peer reviewed literature and the consensus of a multidisciplinary team of European experts. The guidelines define the requirements for each breast service and for the specialists who work in specialist Breast Centres. The guidelines identify the minimum requirements needed to set up a BC, these being an integrated Breast Centre, dealing with a sufficient number of cases to allow effective working and continuing expertise, dedicated specialists working with a multidisciplinary approach, providing all services throughout the patients pathway and data collection and audit. It is essential that the BC also guarantees the continuity of care for patients with advanced (metastatic) disease offering treatments according to multidisciplinary competencies and a high quality palliative care service. The BC must ensure that comprehensive support and expertise may be needed, not only through the core BC team, but also ensure that all other medical and paramedical expertise that may be necessary depending on the individual case are freely available, referring the patient to the specific care provider depending on the problem. Applying minimum requirements and quality indicators is essential to improve organisation, performance and outcome in breast care. Efficacy and compliance have to be constantly monitored to evaluate the quality of patient care and to allow appropriate corrective actions leading to improvements in patient care. Copyright © 2013 Elsevier Ltd. All rights reserved.

The U.S./IAEA Workshop on Software Sustainability for Safeguards Instrumentation: Report to the NNSA DOE Office of International Nuclear Safeguards (NA-241)

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

Pepper, Susan E.; Pickett, Chris A.; Queirolo, Al

The U.S Department of Energy (DOE) National Nuclear Security Administration (NNSA) Next Generation Safeguards Initiative (NGSI) and the International Atomic Energy Agency (IAEA) convened a workshop on Software Sustainability for Safeguards Instrumentation in Vienna, Austria, May 6-8, 2014. Safeguards instrumentation software must be sustained in a changing environment to ensure existing instruments can continue to perform as designed, with improved security. The approaches to the development and maintenance of instrument software used in the past may not be the best model for the future and, therefore, the organizers’ goal was to investigate these past approaches and to determine an optimalmore » path forward. The purpose of this report is to provide input for the DOE NNSA Office of International Nuclear Safeguards (NA-241) and other stakeholders that can be utilized when making decisions related to the development and maintenance of software used in the implementation of international nuclear safeguards. For example, this guidance can be used when determining whether to fund the development, upgrade, or replacement of a particular software product. The report identifies the challenges related to sustaining software, and makes recommendations for addressing these challenges, supported by summaries and detailed notes from the workshop discussions. In addition the authors provide a set of recommendations for institutionalizing software sustainability practices in the safeguards community. The term “software sustainability” was defined for this workshop as ensuring that safeguards instrument software and algorithm functionality can be maintained efficiently throughout the instrument lifecycle, without interruption and providing the ability to continue to improve that software as needs arise.« less

The Landsat 7 mission: terrestrial research and applications for the 21st century

USGS Publications Warehouse

Goward, Samuel N.; Masek, Jeffrey G.; Williams, Darrel L.; Irons, James R.; Thompson, R.J.

2001-01-01

The Landsat Earth observation approach introduced in 1972 created a new way of monitoring land cover and land use globally. The Landsat 7 mission, successfully launched on April 15, 1999, continues those observations and demonstrates significant progress in precise numerical radiometry, spectral differentiation, and seasonally repetitive monitoring. Substantial improvements in calibration procedures, both prior to launch and during normal operations, have also been made to ensure long-term stability in the acquired spectral radiometry. Landsat 7 data acquisitions are being driven by a long-term data acquisition plan that was designed to ensure that substantially cloud-free, seasonal coverage would be recorded and archived in the US for all land areas of the globe. NASA competitively selected a Landsat Science Team, consisting of representatives from US universities and government agencies, to exploit the Landsat 7 record for global change research. This team is addressing the technical and analytical means to process and analyze the core of this observation record, and for the first time in the history of the Landsat mission, the technical and operational aspects of the mission are being driven by the goals of the US science community. The expected outcome of these efforts is a rapid improvement in understanding the Earth system, as well as conceptual knowledge that will underpin significant advancements in the application of this technology for commercial, operational, educational, and research purposes. Pathways to achieve effective Landsat continuity in the early decades of the 21st century are also being given careful attention, and there is no question that the lessons learned from the Landsat 7 mission will strongly influence these next-generation sensor systems.

Katrina's Legacy: Processes for Patient Disaster Preparation have Improved but Important Gaps Remain

PubMed Central

Icenogle, Marjorie; Eastburn, Sasha; Arrieta, Martha

2016-01-01

Background Ensuring continuity of care for the chronically ill, who are elderly or indigent presents unique challenges after disasters; this population has fewer financial resources, is less likely to evacuate, has limited access to recovery resources, and is significantly dependent on charitable and government-funded institutions for care. This study expands a previous investigation of the extent to which healthcare providers in coastal Mississippi and Alabama have made changes to facilitate continued care to these populations after disasters. Methods Key informants representing healthcare and social services organizations serving health disparate residents of the Mississippi and Alabama Gulf Coast were interviewed regarding disaster preparation planning for the period 2009-2012. Interview transcripts were qualitatively coded and analyzed for emerging themes using Atlas.ti® software. Results Participant organizations have implemented changes to ensure continuity of care for the chronically ill in case of disasters. Changes include patient assistance with pre-disaster preparation and training; evacuation planning and assistance; support to find resources in evacuation destinations; equipping patients with prescription information, diagnoses, treatment plans, and advance medications when a disaster is imminent; multiple methods for patients to communicate with providers; and more mandated medical needs shelters. Patients whose chronic conditions were diagnosed post-Katrina are more likely to underestimate the need to prepare. Further, patients' lack of compliance tends to increase as time passes from disasters. Conclusions Although changes were implemented, results indicate these may be inadequate to completely address patient needs. Thus, additional efforts may be needed, underscoring the complexity of adequate disaster preparation among disparate populations. PMID:27865292

Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting.

PubMed

Clarke, Christina M; Persaud, Drepaul David

2011-03-01

Many contemporary acute care facilities lack safe and effective clinical handover practices resulting in patient transitions that are vulnerable to discontinuities in care, medical errors, and adverse patient safety events. This article is intended to supplement existing handover improvement literature by providing practical guidance for leaders and managers who are seeking to improve the safety and the effectiveness of clinical handovers in the acute care setting. A 4-stage change model has been applied to guide the application of strategies for handover improvement. Change management and quality improvement principles, as well as concepts drawn from safety science and high-reliability organizations, were applied to inform strategies. A model for handover improvement respecting handover complexity is presented. Strategies targeted to stages of change include the following: 1. Enhancing awareness of handover problems and opportunities with the support of strategic directions, accountability, end user involvement, and problem complexity recognition. 2. Identifying solutions by applying and adapting best practices in local contexts. 3. Implementing locally adapted best practices supported by communication, documentation, and training. 4. Institutionalizing practice changes through integration, monitoring, and active dissemination. Finally, continued evaluation at every stage is essential. Although gaps in handover process and function knowledge remain, efforts to improve handover safety and effectiveness are still possible. Continued evaluation is critical in building this understanding and to ensure that practice changes lead to improvements in patient safety, organizational effectiveness, and patient and provider satisfaction. Through handover knowledge building, fundamental changes in handover policies and practices may be possible.

Good Work Ensures Employment Success. Myths and Realities No. 2.

ERIC Educational Resources Information Center

Brown, Bettina Lankard

It is a myth that skills alone ensure employment. Other keys to workplace success include continuous learning, emotional intelligence, networking, flexibility, and commitment to business objectives. Although academic degrees, skill certifications, and other documentation of accomplishments provide access to employment, they are significant only at…

28 CFR 115.122 - Policies to ensure referrals of allegations for investigations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Policies to ensure referrals of allegations for investigations. 115.122 Section 115.122 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Responsive Planning § 115...

28 CFR 115.122 - Policies to ensure referrals of allegations for investigations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Policies to ensure referrals of allegations for investigations. 115.122 Section 115.122 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Responsive Planning § 115...

28 CFR 115.122 - Policies to ensure referrals of allegations for investigations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Policies to ensure referrals of allegations for investigations. 115.122 Section 115.122 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Responsive Planning § 115...

From Eradication to Resistance: Five Continuing Concerns About Pediculosis.

ERIC Educational Resources Information Center

Brainerd, Elaine

1998-01-01

Discusses the five major concerns that govern a school nurse's thinking in managing head louse infestations, including dispelling misconceptions about head lice; ensuring that infestations are not missed; ensuring that parents understand instructions for effective treatment; educating the community about the correct use of pediculicides; and…

34 CFR 602.18 - Ensuring consistency in decision-making.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false Ensuring consistency in decision-making. 602.18 Section 602.18 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION THE SECRETARY'S RECOGNITION OF ACCREDITING AGENCIES The...

12 CFR 1750.10 - General.

Code of Federal Regulations, 2010 CFR

2010-01-01

... establishes the methodology for computing the risk-based capital level for each Enterprise. The board of directors of each Enterprise is responsible for ensuring that the Enterprise maintains total capital at a level that is sufficient to ensure the continued financial viability of the Enterprise and is equal to...

Improving Quality of Seal Leak Test Product using Six Sigma

NASA Astrophysics Data System (ADS)

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

2016-02-01

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

Outsourcing your medical practice call center: how to choose a vendor to ensure regulatory compliance.

PubMed

Johnson, Bill

2014-01-01

Medical practices receive hundreds if not thousands of calls every week from patients, payers, pharmacies, and others. Outsourcing call centers can be a smart move to improve efficiency, lower costs, improve customer care, ensure proper payer management, and ensure regulatory compliance. This article discusses how to know when it's time to move to an outsourced call center, the benefits of making the move, how to choose the right call center, and how to make the transition. It also provides tips on how to manage the call center to ensure the objectives are being met.

Implementation and utilization of a comprehensive information network in an integrated private not-for-profit regional health care system

NASA Astrophysics Data System (ADS)

Long, James M., III

1995-10-01

The capacity to access, integrate, and analyze demographic, financial, and clinical data within a regional health care system represents an opportunity to ensure and enhance clinical quality and to reduce costs in a carefully planned and controlled manner. Properly used, such capability should improve health care delivery for local populations and provide the institution with a level of integration of services achieved by few health care organizations. The Baptist Health System (BHS), based in Birmingham, Alabama, is currently standardizing operating procedures among its various components and implementing a comprehensive, enterprise-wide information network. Clinical quality improvement and case management are being promulgated throughout the enterprise using a continuum-of-care model developed internally. Having successfully completed a pilot project using teleconferences for core lectures in internal medicine between two large teaching hospitals, BHS is taking advantage of enterprise- wide teleconference capability using a combination of fiberoptic (T3) and standard digital telephone (T1) transmission to speed installation and reduce the cost of implementation into two office buildings and eleven hospitals. The information system will serve to prepare BHS for the advent of managed care and other anticipated changes in health care, while ensuring continued ability to deliver high quality, cost-effective medical and health-related services.

Improving the review of standard operating procedures: a novel electronic system for compounding pharmacies.

PubMed

Brensel, Robert; Brensel, Scott; Ng, Amy

2013-01-01

Since the New England Compounding Center disaster in 2012, the importance of following correct procedures during every phase of customized pharmacy has been a focus of governmental interest and action as well as public scrutiny. Many pharmacies rely on the rote review of standard operating procedures to ensure that staff members understand and follow protocols that ensure the safety and potency of all compounds prepared, but that approach to continuing education can be cumbersome and needlessly time-consuming. In addition, documenting and retrieving evidence of employee competence can be difficult. In this article, we describe our use of online technology to improve our methods of educating staff about the full range of standard operating procedures that must be followed in our pharmacy. The system we devised and implemented has proven to be effective, easy to update and maintain, very inexpensive, and user friendly. Its use has reduced the time previously required for a read-over review of standard operating procedures from 30 or 40 minutes to 5 or 10 minutes in weekly staff meetings, and we can now easily document and access proof of employees' comprehension of that content. It is our hope that other small compounding pharmacies will also find this system of online standard operating procedure review helpful.

Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalised patients.

PubMed

Smeulers, Marian; Lucas, Cees; Vermeulen, Hester

2014-06-24

An accurate handover of clinical information is of great importance to continuity and safety of care. If clinically relevant information is not shared accurately and in a timely manner it may lead to adverse events, delays in treatment and diagnosis, inappropriate treatment and omission of care. During the last decade the call for interventions to improve handovers has increased. These interventions aim to reduce the risk of miscommunication, misunderstanding and the omission of critical information. To determine the effectiveness of interventions designed to improve hospital nursing handover, specifically:to identify which nursing handover style(s) are associated with improved outcomes for patients in the hospital setting and which nursing handover style(s) are associated with improved nursing process outcomes. We searched the following electronic databases for primary studies: Cochrane EPOC Group specialised register (to 19 September 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (to 1 March 2013), MEDLINE (1950 to 1 March 2013) OvidSP, EMBASE (1947 to 1 March 2013) OvidSP, CINAHL (Cumulative Index to Nursing and Allied Health Literature) (1980 to 1 March 2013) EbscoHost and ISI Web of Knowledge (Science Citation Index and Social Sciences Citation Index) (to 9 July 2012). The Database of Abstracts of Reviews (DARE) was searched for related reviews. We screened the reference lists of included studies and relevant reviews. We also searched the WHO International Clinical Trials Registry Platform (ICTRP) http://www.who.int/ictrp/en/ and Current Controlled Trials www.controlled-trials.com/mrct and we conducted a search of grey literature web sites. Randomised controlled trials (RCTs or cluster-RCTs) evaluating any nursing handover style between nurses in a hospital setting with the aim of preventing adverse events or optimising the transfer of accurate essential information required for continuity of care, or both. Two review authors independently assessed trial quality and extracted data. The search identified 2178 citations, 28 of which were considered potentially relevant. After independent review of the full text of these studies, no eligible studies were identified for inclusion in this review due to the absence of studies with a randomised controlled study design. There was no evidence available to support conclusions about the effectiveness of nursing handover styles for ensuring continuity of information in hospitalised patients because we found no studies that fulfilled the methodological criteria for this review. As a consequence, uncertainty about the most effective practice remains. Research efforts should focus on strengthening the evidence abut the effectiveness of nursing handover styles using well designed, rigorous studies. According to current knowledge, the following guiding principles can be applied when redesigning the nursing handover process: face-to-face communication, structured documentation, patient involvement and use of IT technology to support the process.

Does appraisal enhance learning, improve practice and encourage continuing professional development? A survey of general practitioners' experiences of appraisal.

PubMed

Finlay, Karen; McLaren, Susan

2009-01-01

Revalidation of the medical profession is under review and a system has been proposed to ensure doctors meet standards of practice and professionalism. The current appraisal system allows clinicians to chart their progress and identify developmental needs in order to improve performance. Appraisal is now an annual compulsory requirement for all doctors. The aim of the study was to investigate the experiences of general practitioners (GPs) of the current appraisal process. The specific objectives were to consider the impact the appraisal process had exerted on their learning, practice and individual continuing professional development (CPD). We employed a cross-sectional design using a postal questionnaire sent to all doctors who work as GPs (n = 385) in West Kent. Questionnaires were returned from 71.7% of doctors (n = 276). The key findings obtained were that 47.5% (n = 131) of doctors stated that taking part in the appraisal process had enhanced their learning, 40.2% (n = 111) felt that the appraisal process had improved their practice and 55.8% (n = 154) stated that the appraisal process had encouraged their CPD. Qualitative findings derived from thematic analysis of open questions revealed that participants viewed the role of the appraiser as respected peer to be vital and there was a need for independence in the appraiser's appointment. The time-consuming nature of the appraisal process was emphasised, with little protected time for preparation of documentation and engagement in CPD. Concerns were expressed about links between appraisal and revalidation. Many doctors considered that the appraisal process had enhanced their learning, improved their practice and encouraged their CPD. A vital, independent role for the appraiser was emphasised as was a need to review the time-consuming nature of the current appraisal process, together with identifying protected time to complete this and CPD engagement. As the role of appraisal within the revalidation process changes it is recognised that ensuring the quality, consistency and nature of appraisal will be essential to maintain the confidence of patients and doctors.

7 CFR Exhibit F to Subpart G of... - Implementation Procedures for the Coastal Barrier Resources Act

Code of Federal Regulations, 2011 CFR

2011-01-01

... (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) GENERAL... distributed by the Department of the Interior. Each State Director is responsible for ensuring that those...

7 CFR Exhibit F to Subpart G of... - Implementation Procedures for the Coastal Barrier Resources Act

Code of Federal Regulations, 2010 CFR

2010-01-01

... (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) GENERAL... distributed by the Department of the Interior. Each State Director is responsible for ensuring that those...

28 CFR 115.22 - Policies to ensure referrals of allegations for investigations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Policies to ensure referrals of allegations for investigations. 115.22 Section 115.22 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Adult Prisons and Jails Responsive Planning...

7 CFR 799.9 - Ensuring that environmental factors are considered in agency decisionmaking.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Ensuring that environmental factors are considered in agency decisionmaking. 799.9 Section 799.9 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE ENVIRONMENTAL PROTECTION ENVIRONMENTAL QUALITY AND...

7 CFR 799.9 - Ensuring that environmental factors are considered in agency decisionmaking.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Ensuring that environmental factors are considered in agency decisionmaking. 799.9 Section 799.9 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE ENVIRONMENTAL PROTECTION ENVIRONMENTAL QUALITY AND...

7 CFR 799.9 - Ensuring that environmental factors are considered in agency decisionmaking.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 7 2014-01-01 2014-01-01 false Ensuring that environmental factors are considered in agency decisionmaking. 799.9 Section 799.9 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE ENVIRONMENTAL PROTECTION ENVIRONMENTAL QUALITY AND...

28 CFR 115.22 - Policies to ensure referrals of allegations for investigations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Policies to ensure referrals of allegations for investigations. 115.22 Section 115.22 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Adult Prisons and Jails Responsive Planning...

28 CFR 115.22 - Policies to ensure referrals of allegations for investigations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Policies to ensure referrals of allegations for investigations. 115.22 Section 115.22 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Adult Prisons and Jails Responsive Planning...

40 CFR 165.90 - Operational, inspection and maintenance requirements for all new and existing containment...

Code of Federal Regulations, 2012 CFR

2012-07-01

... recovered in a manner that ensures protection of human health and the environment (including surface water... to human health or the environment. (3) Ensure that all materials resulting from spills and leaks and... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL...

40 CFR 165.90 - Operational, inspection and maintenance requirements for all new and existing containment...

Code of Federal Regulations, 2014 CFR

2014-07-01

... recovered in a manner that ensures protection of human health and the environment (including surface water... to human health or the environment. (3) Ensure that all materials resulting from spills and leaks and... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL...

40 CFR 165.90 - Operational, inspection and maintenance requirements for all new and existing containment...

Code of Federal Regulations, 2011 CFR

2011-07-01

... recovered in a manner that ensures protection of human health and the environment (including surface water... to human health or the environment. (3) Ensure that all materials resulting from spills and leaks and... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL...

40 CFR 165.90 - Operational, inspection and maintenance requirements for all new and existing containment...

Code of Federal Regulations, 2013 CFR

2013-07-01

... recovered in a manner that ensures protection of human health and the environment (including surface water... to human health or the environment. (3) Ensure that all materials resulting from spills and leaks and... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL...

40 CFR 165.90 - Operational, inspection and maintenance requirements for all new and existing containment...

Code of Federal Regulations, 2010 CFR

2010-07-01

... recovered in a manner that ensures protection of human health and the environment (including surface water... to human health or the environment. (3) Ensure that all materials resulting from spills and leaks and... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL...

Accountability Pillar Results for Annual Education Results Report (AERR)

ERIC Educational Resources Information Center

Alberta Education, 2008

2008-01-01

Alberta has developed an innovative new way of measuring performance to ensure we continue to provide the best possible education opportunities for all of our students. This accountability framework, called the Accountability Pillar, recognizes and respects the outstanding work seen in our school authorities every day. It ensures school…

Learning about Governance through Nonprofit Board Service

ERIC Educational Resources Information Center

Purdy, Jill M.; Lawless, Joseph

2012-01-01

Business educators have a responsibility to ensure that future managers, employees, and shareholders are well versed in governance. Governance provides a vital link between organizations and society, allowing people to place their trust in an organization, support its mission, and ensure a continuing flow of resources to accomplish the mission.…

Adapting viral safety assurance strategies to continuous processing of biological products.

PubMed

Johnson, Sarah A; Brown, Matthew R; Lute, Scott C; Brorson, Kurt A

2017-01-01

There has been a recent drive in commercial large-scale production of biotechnology products to convert current batch mode processing to continuous processing manufacturing. There have been reports of model systems capable of adapting and linking upstream and downstream technologies into a continuous manufacturing pipeline. However, in many of these proposed continuous processing model systems, viral safety has not been comprehensively addressed. Viral safety and detection is a highly important and often expensive regulatory requirement for any new biological product. To ensure success in the adaption of continuous processing to large-scale production, there is a need to consider the development of approaches that allow for seamless incorporation of viral testing and clearance/inactivation methods. In this review, we outline potential strategies to apply current viral testing and clearance/inactivation technologies to continuous processing, as well as modifications of existing unit operations to ensure the successful integration of viral clearance into the continuous processing of biological products. Biotechnol. Bioeng. 2017;114: 21-32. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Relevance of stroke code, stroke unit and stroke networks in organization of acute stroke care--the Madrid acute stroke care program.

PubMed

Alonso de Leciñana-Cases, María; Gil-Núñez, Antonio; Díez-Tejedor, Exuperio

2009-01-01

Stroke is a neurological emergency. The early administration of specific treatment improves the prognosis of the patients. Emergency care systems with early warning for the hospital regarding patients who are candidates for this treatment (stroke code) increases the number of patients treated. Currently, reperfusion via thrombolysis for ischemic stroke and attention in stroke units are the bases of treatment. Healthcare professionals and health provision authorities need to work together to organize systems that ensure continuous quality care for the patients during the whole process of their disease. To implement this, there needs to be an appropriate analysis of the requirements and resources with the objective of their adjustment for efficient use. It is necessary to provide adequate information and continuous training for all professionals who are involved in stroke care, including primary care physicians, extrahospital emergency teams and all physicians involved in the care of stroke patients within the hospital. The neurologist has the function of coordinating the protocols of intrahospital care. These organizational plans should also take into account the process beyond the acute phase, to ensure the appropriate application of measures of secondary prevention, rehabilitation, and chronic care of the patients that remain in a dependent state. We describe here the stroke care program in the Community of Madrid (Spain). (c) 2009 S. Karger AG, Basel.

Promoting healthy food consumption: a review of state-level policies to improve access to fruits and vegetables.

PubMed

Hood, Carlyn; Martinez-Donate, Ana; Meinen, Amy

2012-12-01

Research indicates poor nutrition is a leading determinant of the development of chronic disease, and increasing fruit and vegetable consumption is one method for decreasing obesity. Many policies have focused on increasing the demand for fruits and vegetables through price reductions and coupons. However, without ensuring a stable supply, increased demand can continue to raise prices, crowding out individuals who may otherwise have purchased fruits and vegetables and ultimately leading to continued disparities in access. This paper presents a review of selected state-level policy options recently proposed or implemented in states across the United States, and provides an evidence-based lens through which food access policy can be shaped in the Midwest. This review and potential framework uses Wisconsin to illustrate the feasibility of different state-level decisions and their potential impact on particular populations. Future supply-side policies to consider include expanding Electronic Benefit Transfer to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC),program and farmers markets, incentivizing the purchase of locally grown produce, assisting local specialty farmers directly, and/or establishing a state-level food policy council. This review reveals that a food policy council would create a more sustainable policy analysis process to better ensure future policy adoption is truly comprehensive, encompassing the production, distribution and purchase of locally grown fruits and vegetables.

Quality of Cardiac Care in Canada: Recommendations for Building a Sustainable Future.

PubMed

Young, Courtney; Lambert, Laurie; Abel, James; O'Neill, Blair J

2018-06-01

Cardiovascular (CV) disease continues to present a significant disease and economic burden in Canada. To improve the quality of care and ensure sustainability of services, a national quality improvement initiative is required. The purpose of this analysis was to review the evidence for public reporting (PR) and external benchmarking (EB) to improve patient outcomes, and to recommend a strategy to improve CV care in Canada. To incorporate recent literature, the Canadian Cardiovascular Society (CCS) commissioned the Institute of Health Economics to provide a rapid update on the literature of PR and EB. The review showed that EB is more likely to promote positive effects, such as improved mortality, morbidity, and evidence-based clinical practice, and to limit negative effects, such as access restrictions or unintended provider behaviour associated with some forms of "top-down" PR. On the basis of these findings, this we recommend the following: (1) secure funding for the provincial collection of CV quality indicators and the creation of annual National CV Quality Reports; (2) enhance the culture of using CV quality indicator data for continuous quality improvement and opportunities for national or regional EB and sharing best practices; and (3) implement ongoing evaluation and revision of CCS clinical practice guidelines incorporating key quality indicators. This is already under way to a limited extent by the CCS with its Quality Project, but intentional, sustained support needs to be secured to enhance this ongoing effort and improve the quality of CV care for all Canadians. Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Perceived Factors Associated with Sustained Improvement Following Participation in a Multicenter Quality Improvement Collaborative.

PubMed

Stone, Sohini; Lee, Henry C; Sharek, Paul J

2016-07-01

The California Perinatal Quality Care Collaborative led the Breastmilk Nutrition Quality Improvement Collaborative from October 2009 to September 2010 to increase the percentage of very low birth weight infants receiving breast milk at discharge in 11 collaborative neonatal ICUs (NICUs). Observed increases in breast milk feeding and decreases in necrotizing enterocolitis persisted for 6 months after the collaborative ended. Eighteen to 24 months after the end of the collaborative, some sites maintained or further increased their gains, while others trended back toward baseline. A study was conducted to assess the qualitative factors that affect sustained improvement following participation. Collaborative leaders at each of the 11 NICUs that participated in the Breastmilk Nutrition Quality Improvement Collaborative were invited to participate in a site-specific one-hour phone interview. Interviews were recorded and transcribed and then analyzed using qualitative research analysis software to identify themes associated with sustained improvement. Eight of 11 invited centers agreed to participate in the interviews. Thematic saturation was achieved by the sixth interview, so further interviews were not pursued. Factors contributing to sustainability included physician involvement within the multidisciplinary teams, continuous education, incorporation of interventions into the daily work flow, and integration of a data-driven feedback system. Early consideration by site leaders of how to integrate best-practice interventions into the daily work flow, and ensuring physician commitment and ongoing education based in continuous data review, should enhance the likelihood of sustaining improvements. To maximize sustained success, future collaborative design should consider proactively identifying and supporting these factors at participating sites.

Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: A retrospective database study

PubMed Central

Sermon, Jan; Geerts, Paul; Denee, Tom R.; De Vos, Cedric; Malfait, Bart; Lamotte, Mark; Mulder, Cornelis L.

2017-01-01

Achieving greater continuation of treatment is a key element to improve treatment outcomes in schizophrenia patients. However, reported treatment continuation can differ markedly depending on the study design. In a retrospective setting, treatment continuation remains overall poor among patients using antipsychotics. This study aimed to document the difference in treatment continuation between four long-acting injectable antipsychotics based on the QuintilesIMS LRx databases, national, longitudinal, panel based prescription databases of retail pharmacies, in the Netherlands and Belgium. Paliperidone palmitate once monthly, risperidone microspheres, haloperidol decanoate, and olanzapine pamoate were studied. This study demonstrated significantly higher treatment continuation of paliperidone palmitate once monthly compared to risperidone microspheres (p-value<0,01) and haloperidol decanoate (p-value<0,01) in both countries, a significantly higher treatment continuation of paliperidone palmitate once monthly compared to olanzapine pamoate in the Netherlands (p-value<0,01), and a general trend towards better treatment continuation versus olanzapine pamoate in Belgium. Analysing the subgroup of patients without previous exposure to long-acting antipsychotic treatment revealed the positive impact of previous exposure on treatment continuation with a subsequent long acting treatment. Additionally, the probability of restarting the index therapy was higher among patients treated with paliperidone palmitate once monthly compared to patients treated with risperidone microspheres and haloperidol decanoate. The data source used and the methodology defined ensured for the first time a comparison of treatment continuation in a non-interventional study design for the four long-acting injectable antipsychotics studied. PMID:28614404

Six Lessons We Learned Applying Six Sigma

NASA Technical Reports Server (NTRS)

Carroll, Napoleon; Casleton, Christa H.

2005-01-01

As Chief Financial Officer of Kennedy Space Center (KSC), I'm not only responsible for financial planning and accounting but also for building strong partnerships with the CFO customers, who include Space Shuttle and International Space Station operations as well all who manage the KSC Spaceport. My never ending goal is to design, manage and continuously improve our core business processes so that they deliver world class products and services to the CFO's customers. I became interested in Six Sigma as Christa Casleton (KSC's first Six Sigma Black belt) applied Six Sigma tools and methods to our Plan and Account for Travel Costs Process. Her analysis was fresh, innovative and thorough but, even more impressive, was her approach to ensure ongoing, continuous process improvement. Encouraged by the results, I launched two more process improvement initiatives aimed at applying Six Sigma principles to CFO processes that not only touch most of my employees but also have direct customer impact. As many of you know, Six Sigma is a measurement scale that compares the output of a process with customer requirements. That's straight forward, but demands that you not only understand your processes but also know your products and the critical customer requirements. The objective is to isolate and eliminate the causes of process variation so that the customer sees consistently high quality.

Implementation and evaluation of a community-based interprofessional learning activity.

PubMed

Luebbers, Ellen L; Dolansky, Mary A; Vehovec, Anton; Petty, Gayle

2017-01-01

Implementation of large-scale, meaningful interprofessional learning activities for pre-licensure students has significant barriers and requires novel approaches to ensure success. To accomplish this goal, faculty at Case Western Reserve University, Ohio, USA, used the Ottawa Model of Research Use (OMRU) framework to create, improve, and sustain a community-based interprofessional learning activity for large numbers of medical students (N = 177) and nursing students (N = 154). The model guided the process and included identification of context-specific barriers and facilitators, continual monitoring and improvement using data, and evaluation of student learning outcomes as well as programme outcomes. First year Case Western Reserve University medical students and undergraduate nursing students participated in team-structured prevention screening clinics in the Cleveland Metropolitan Public School District. Identification of barriers and facilitators assisted with overcoming logistic and scheduling issues, large class size, differing ages and skill levels of students and creating sustainability. Continual monitoring led to three distinct phases of improvement and resulted in the creation of an authentic team structure, role clarification, and relevance for students. Evaluation of student learning included both qualitative and quantitative methods, resulting in statistically significant findings and qualitative themes of learner outcomes. The OMRU implementation model provided a useful framework for successful implementation resulting in a sustainable interprofessional learning activity.

Childrens' health, community networks, and the NII: making the connections

NASA Astrophysics Data System (ADS)

Deutsch, Larry; Bronzino, Joseph D.; Farmer, Samuel J.

1996-02-01

To provide quality health care, clinicians need to be well informed. For health care to be cost effective and efficient, redundant services must be eliminated. Urban centers and rural areas need regional health information networks to ensure that primary health care is delivered with good continuity and coordination among providers. This paper describes the development of a city-wide computer-based pediatric health care network to improve decision-making and follow-through, and to provide aggregate data for public health purposes. The design criteria and process for this regional system are presented, addressing issues of network architecture, establishment of a uniform data base, and confidentiality.

Structural and Functional Evaluations for the Early Detection of Glaucoma.

PubMed

Lucy, Katie A; Wollstein, Gadi

2016-01-01

The early detection of glaucoma is imperative in order to preserve functional vision. Structural and functional methods are utilized to detect and monitor glaucomatous damage and the vision loss it causes. The relationship between these detection measures is complex and differs between individuals, especially in early glaucoma. Using both measures together is advised in order to ensure the highest probability of glaucoma detection, and new testing methods are continuously developed with the goals of earlier disease detection and improvement of disease monitoring. The purpose of this review is to explore the relationship between structural and functional glaucoma detection and discuss important technological advances for early glaucoma detection.

Structural and Functional Evaluations for the Early Detection of Glaucoma

PubMed Central

Lucy, Katie A.; Wollstein, Gadi

2016-01-01

The early detection of glaucoma is imperative in order to preserve functional vision. Structural and functional methods are utilized to detect and monitor glaucomatous damage and the vision loss it causes. The relationship between these detection measures is complex and differs between individuals, especially in early glaucoma. Using both measures together is advised in order to ensure the highest probability of glaucoma detection, and new testing methods are continuously developed with the goals of earlier disease detection and improvement of disease monitoring. The purpose of this review is to explore the relationship between structural and functional glaucoma detection and discuss important technological advances for early glaucoma detection. PMID:28603546

Use of software engineering techniques in the design of the ALEPH data acquisition system

NASA Astrophysics Data System (ADS)

Charity, T.; McClatchey, R.; Harvey, J.

1987-08-01

The SASD methodology is being used to provide a rigorous design framework for various components of the ALEPH data acquisition system. The Entity-Relationship data model is used to describe the layout and configuration of the control and acquisition systems and detector components. State Transition Diagrams are used to specify control applications such as run control and resource management and Data Flow Diagrams assist in decomposing software tasks and defining interfaces between processes. These techniques encourage rigorous software design leading to enhanced functionality and reliability. Improved documentation and communication ensures continuity over the system life-cycle and simplifies project management.

Policy Perspective: Ensuring Comprehensive Care and Support for Gender Nonconforming Children and Adolescents

PubMed Central

Dowshen, Nadia; Meadows, Rachel; Byrnes, Maureen; Hawkins, Linda; Eder, Jennifer; Noonan, Kathleen

2016-01-01

Abstract Despite recent notable advances in societal equality for lesbian, gay, bisexual, and transgender (LGBT) individuals, youth who identify as trans* or gender nonconforming, in particular, continue to experience significant challenges accessing the services they need to grow into healthy adults. This policy perspective first offers background information describing this population, their unique healthcare needs, and obstacles when seeking care, including case study examples. The authors then provide recommendations for medical education, health systems, and insurance payers, as well as recommendations for school systems and broader public policy changes to improve the health and well-being of gender nonconforming youth. PMID:28861528

Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction.

PubMed

Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel

2011-01-01

Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

Proteome complexity and the forces that drive proteome imbalance

PubMed Central

Harper, J. Wade; Bennett, Eric J.

2016-01-01

Summary The cellular proteome is a complex microcosm of structural and regulatory networks that requires continuous surveillance and modification to meet the dynamic needs of the cell. It is therefore crucial that the protein flux of the cell remains in balance to ensure proper cell function. Genetic alterations that range from chromosome imbalance to oncogene activation can affect the speed, fidelity and capacity of protein biogenesis and degradation systems, which often results in proteome imbalance. An improved understanding of the causes and consequences of proteome imbalance is helping to reveal how these systems can be targeted to treat diseases such as cancer. PMID:27629639

Advances in dental veneers: materials, applications, and techniques

PubMed Central

Pini, Núbia Pavesi; Aguiar, Flávio Henrique Baggio; Lima, Débora Alves Nunes Leite; Lovadino, José Roberto; Terada, Raquel Sano Suga; Pascotto, Renata Corrêa

2012-01-01

Laminate veneers are a conservative treatment of unaesthetic anterior teeth. The continued development of dental ceramics offers clinicians many options for creating highly aesthetic and functional porcelain veneers. This evolution of materials, ceramics, and adhesive systems permits improvement of the aesthetic of the smile and the self-esteem of the patient. Clinicians should understand the latest ceramic materials in order to be able to recommend them and their applications and techniques, and to ensure the success of the clinical case. The current literature was reviewed to search for the most important parameters determining the long-term success, correct application, and clinical limitations of porcelain veneers. PMID:23674920

[Total hip replacement in the G-DRG-system].

PubMed

Kaufmann, M M; Franz, D; Lassahn, C; Siebert, C H

2007-01-01

Due to the continuing increase in life expectancy, the ageing process of the German population in general and the high demands placed on activity levels and quality of life today, the demand for primary and secondary joint replacement surgery continues to increase. To distribute the economic and medical resources properly, while still making technical and surgical innovations available to a broad public, hospitals must be able to adequately finance these procedures with the help of the proper diagnosis related groups. The development of the German DRG-system over the past years, as well as the new calculation for the year 2006 are to be reviewed and analysed in this article with this in mind. An improvement in the degree of differentiation between the individual procedures can be documented. Whether or not these changes will ensure the long-term financial survival of the German health care system will remain to be seen.

Exploring the complexities of prostate cancer screening with a view to supporting informed consent.

PubMed

Laws, Tom A

2004-10-01

Men request to be screened for prostate cancer because they believe they are exhibiting responsible health promotion behaviour and there are definite benefits from the early detection of the disease. This belief about the benefits is in contrast to several national guidelines recommending that screening for prostate cancer not be done. Despite the guidelines men continue to request to be screened and doctors continue to supply screening tests to asymptomatic males. The lack of an appropriate screening test has been a key factor in supporting recommendations not to screen. However, recent studies show improved accuracy in the use of serum prostate specific antigens (PSA) as a screening tool. This implies that a revision of the guidelines might soon be appropriate. It is important that nurses and other health professionals are kept abreast of developments in prostate screening to assist men with their screening options to ensure their fully informed consent.

Board oversight of patient care quality in community health systems.

PubMed

Prybil, Lawrence D; Peterson, Richard; Brezinski, Paul; Zamba, Gideon; Roach, William; Fillmore, Ammon

2010-01-01

In hospitals and health systems, ensuring that standards for the quality of patient care are established and continuous improvement processes are in place are among the board's most fundamental responsibilities. A recent survey has examined governance oversight of patient care quality at 123 nonprofit community health systems and compared their practices with current benchmarks of good governance. The findings show that 88% of the boards have established standing committees on patient quality and safety, nearly all chief executive officers' performance expectations now include targets related to patient quality and safety, and 96% of the boards regularly receive formal written reports regarding their organizations' performance in relation to quality measures and standards. However, there continue to be gaps between present reality and current benchmarks of good governance in several areas. These gaps are somewhat greater for independent systems than for those affiliated with a larger parent organization.

Anonymous voting for multi-dimensional CV quantum system

NASA Astrophysics Data System (ADS)

Rong-Hua, Shi; Yi, Xiao; Jin-Jing, Shi; Ying, Guo; Moon-Ho, Lee

2016-06-01

We investigate the design of anonymous voting protocols, CV-based binary-valued ballot and CV-based multi-valued ballot with continuous variables (CV) in a multi-dimensional quantum cryptosystem to ensure the security of voting procedure and data privacy. The quantum entangled states are employed in the continuous variable quantum system to carry the voting information and assist information transmission, which takes the advantage of the GHZ-like states in terms of improving the utilization of quantum states by decreasing the number of required quantum states. It provides a potential approach to achieve the efficient quantum anonymous voting with high transmission security, especially in large-scale votes. Project supported by the National Natural Science Foundation of China (Grant Nos. 61272495, 61379153, and 61401519), the Research Fund for the Doctoral Program of Higher Education of China (Grant No. 20130162110012), and the MEST-NRF of Korea (Grant No. 2012-002521).

[Innovative thinking in nursing practice].

PubMed

Lin, Chia-Ling; Wang, Ya-Ni; Tsai, Hsiu-Min

2013-04-01

The nursing profession is patient-centered and responsible to meet the disparate health needs of a wide range of client "groups". Ensuring continued innovation and change to further improve care quality in an evolving health care system is an important issue. A focus on resolving minor points rather than on achieving major change may be the best approach to realizing continuous innovation in nursing. The advantages include not only promoting nursing quality and decreasing costs and manpower, but also giving satisfaction and self-fulfillment to the innovator. Successful innovation is affected by environmental structural support as well as the characteristics of the innovation and innovator. A successful innovator is sensitive to each opportunity, but is not a risk creator. This article describes innovator characteristics and innovation execution, and investigates the content and process of nursing innovation from various points of view in order to create new ideas and values related to the traditional nursing role.

Prenatal and infancy home visiting by nurses: from randomized trials to community replication.

PubMed

Olds, David L

2002-09-01

This paper summarizes a 25-year program of research that has attempted to improve the early health and development of low-income mothers and children and their future life trajectories with prenatal and infancy home visiting by nurses. The program has been tested in two separate large-scale randomized controlled trials with different populations living in different contexts. The program has been successful in improving parental care of the child as reflected in fewer injuries and ingestions that may be associated with child abuse and neglect; and maternal life-course, reflected in fewer subsequent pregnancies, greater work force participation, and reduced use of public assistance and food stamps. In the first trial, the program also produced long-term effects on the number of arrests, convictions, emergent substance use, and promiscuous sexual activity of 15-year-old children whose nurse-visited mothers were low-income and unmarried when they registered in the study during pregnancy. Since 1996, the program has been offered for public investment outside of research contexts. Careful attention has been given to ensuring that the program is replicated with fidelity to the model tested in the scientifically controlled studies by working with community leaders to ensure that organization and community contexts are favorable for the program; by providing the nurses with excellent training and technical assistance and detailed visit-by-visit guidelines; and by providing organizations with a web-based clinical information system that creates a basis for monitoring program performance and continuous quality improvement.

A study examining the impact of 12-hour shifts on critical care staff.

PubMed

Richardson, Annette; Turnock, Christopher; Harris, Liz; Finley, Alison; Carson, Sarah

2007-11-01

Twelve-hour shifts contribute to flexible patterns of work, but the effects on delivery of direct care and staff fatigue are important topics for deeper examination. To examine the impact and implications of 12-hour shifts on critical care staff. A staged dual approach using two focus groups (n = 16) and questionnaires (n = 147) with critical care staff from three critical care units. Positive effects were found with planning and prioritizing care, improved relationships with patients/relatives, good-quality time off work and ease of travelling to work. Less favourable effects were with caring for patients in isolation cubicles and the impact on staff motivation and tiredness. Acceptable patterns of work were suggested for 'numbers of consecutive shifts' and 'rest periods between shifts'. Most participants believed 12-hour shifts should continue. The challenge is to ensure existing systems and practices develop to improve on the less positive effects of working 12-hour shifts. This study provides nurse managers with important and relevant staff views on the impact of working 12-hour shifts. In particular to those working within a critical care environment and suggests the challenge is to ensure existing systems and practices develop to improve on the less encouraging effects of working 12-hour shifts. It adds an understanding of the senior nurse's view on the positive and negative effects of managing and organizing staff off duty to safely run a department with 12-hour shifts.

What makes a successful volunteer Expert Patients Programme tutor? Factors predicting satisfaction, productivity and intention to continue tutoring of a new public health workforce in the United Kingdom.

PubMed

Macdonald, Wendy; Kontopantelis, Evangelos; Bower, Peter; Kennedy, Anne; Rogers, Anne; Reeves, David

2009-04-01

Better management of chronic conditions is a challenge for public health policy. The Expert Patients Programme was introduced into the United Kingdom to improve self-care in people with long-term conditions. To deliver self-care courses, the programme relies on the recruitment and continued commitment to delivering the courses of volunteer lay tutors who have long-term conditions. Ensuring the tutor workforce is productive, satisfied in their role and retained long-term is central to the viability of the programme. This exploratory study aimed to determine what factors predict productivity, intention to continue tutoring, and satisfaction in a sample of volunteer tutors from the Expert Patients Programme. A cross-sectional survey of 895 tutors was carried out and 518 (58%) responded. The questionnaire was designed to describe the characteristics, productivity, intention to continue tutoring, and satisfaction of tutors. Multiple linear regression analyses were used to examine the determinants of productivity, intention to continue tutoring, and satisfaction, such as patient demographics, attitudes, physical and mental health, mastery and self-esteem. Attitudes relating to personal goals, and better health were significant predictors of satisfaction with the tutor role. Only a small proportion of the variance in productivity was accounted for, and tutors were more likely to be productive when they were single, homeowners, car owners, and had lower scores on the depression scale. Overall satisfaction and personal goals were predictors of intention to continue tutoring. Demographic factors, health measures and attitudes each predicted different aspects of the experience of work conducted by the volunteer tutors. The results should prove useful for planning interventions to enhance the success of this new workforce initiative. Attempts to increase participation in courses by people from deprived backgrounds are likely to be enhanced if tutors come from similar backgrounds. This study demonstrated that material advantage and attitudes that value personal goals were predictors of satisfaction and productivity in the tutor role. Specific incentives and strategies may be required to recruit and support tutors from more marginalised groups in order to ensure equitable access to effective self-care support for all.

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

PubMed

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

2005-06-01

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

Grading the commercial optical biosensor literature-Class of 2008: 'The Mighty Binders'.

PubMed

Rich, Rebecca L; Myszka, David G

2010-01-01

Optical biosensor technology continues to be the method of choice for label-free, real-time interaction analysis. But when it comes to improving the quality of the biosensor literature, education should be fundamental. Of the 1413 articles published in 2008, less than 30% would pass the requirements for high-school chemistry. To teach by example, we spotlight 10 papers that illustrate how to implement the technology properly. Then we grade every paper published in 2008 on a scale from A to F and outline what features make a biosensor article fabulous, middling or abysmal. To help improve the quality of published data, we focus on a few experimental, analysis and presentation mistakes that are alarmingly common. With the literature as a guide, we want to ensure that no user is left behind. (c) 2009 John Wiley & Sons, Ltd.

Improving practice using action research: resolving the problem of kinking with non-metal cannulae.

PubMed

Griffith, Sue

2011-11-01

In one UK hospice, inpatient unit records showed that over 8 years 12 needlestick injuries related to continuous subcutaneous infusion of medication occurred. Following a change-over to Teflon cannulae no further incidents were reported. However, when the more sensitive and accurate McKinley T34 syringe drivers were introduced in 2007 a new problem of recurrent occlusion alarm sounding manifested. Investigation revealed that the Teflon cannulae were often kinking, delaying medication delivery and necessitating re-siting of the cannula. The action research approach was used to find an alternative device to improve practice and ensure that both staff and patients were safeguarded. This paper explains how that process was followed until a satisfactory alternative was sourced and evidenced, including an account of the problems that were experienced along the way.

Quality management, a directive approach to patient safety.

PubMed

Ayuso-Murillo, Diego; de Andrés-Gimeno, Begoña; Noriega-Matanza, Concha; López-Suárez, Rafael Jesús; Herrera-Peco, Ivan

Nowadays the implementation of effective quality management systems and external evaluation in healthcare is a necessity to ensure not only transparency in activities related to health but also access to health and patient safety. The key to correctly implementing a quality management system is support from the managers of health facilities, since it is managers who design and communicate to health professionals the strategies of action involved in quality management systems. This article focuses on nursing managers' approach to quality management through the implementation of cycles of continuous improvement, participation of improvement groups, monitoring systems and external evaluation quality models (EFQM, ISO). The implementation of a quality management system will enable preventable adverse effects to be minimized or eliminated, and promote patient safety and safe practice by health professionals. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Impact of Provider Incentives on Quality and Value of Health Care.

PubMed

Doran, Tim; Maurer, Kristin A; Ryan, Andrew M

2017-03-20

The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value-Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.

Improved molding process ensures plastic parts of higher tensile strength

NASA Technical Reports Server (NTRS)

Heier, W. C.

1968-01-01

Single molding process ensures that plastic parts /of a given mechanical design/ produced from a conventional thermosetting molding compound will have a maximum tensile strength. The process can also be used for other thermosetting compounds to produce parts with improved physical properties.

78 FR 70163 - Communication of Operational Information between Natural Gas Pipelines and Electric Transmission...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-22

... a continued high level of reliability of interstate natural gas pipelines and that this will, in turn, ensure a continued high level of reliability of the electric transmission grid.\\40\\ Consumers...

21 CFR 212.20 - What activities must I perform to ensure drug quality?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false What activities must I perform to ensure drug quality? 212.20 Section 212.20 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR POSITRON EMISSION TOMOGRAPHY...

21 CFR 212.20 - What activities must I perform to ensure drug quality?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 4 2011-04-01 2011-04-01 false What activities must I perform to ensure drug quality? 212.20 Section 212.20 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR POSITRON EMISSION TOMOGRAPHY...

Transitions for Young Children: Creating Connections across Early Childhood Systems

ERIC Educational Resources Information Center

Kagan, Sharon Lynn, Ed.; Tarrant, Kate, Ed.

2010-01-01

Smooth early childhood transitions are key to ensuring positive outcomes for young children the world over--but in today's fragmented early education systems, it's difficult to ensure continuity among programs and services. Early childhood professionals will help change that with this book, the first to propose a comprehensive, practical framework…

High Performance Computing and Communications Act of 1991. Hearing Before the Subcommittee on Science, Technology, and Space of the Committee on Commerce, Science, and Transportation. One Hundred Second Congress, First Session on S. 272 To Provide for a Coordinated Federal Research Program To Ensure Continued United States Leadership in High-Performance Computing.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Commerce, Science, and Transportation.

This hearing before the Senate Subcommittee on Science, Technology, and Space focuses on S. 272, the High-Performance Computing and Communications Act of 1991, a bill that provides for a coordinated federal research and development program to ensure continued U.S. leadership in this area. Performance computing is defined as representing the…

SAVY-4000 Surveillance and Life Extension Program Fiscal Year 2013 Annual Report

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

Stone, Timothy A.; Blair, Michael W.; Weis, Eric

2014-03-03

The Packaging Surveillance Program section of the DOE M441.1-1 /sup>1, Nuclear Material Packaging Manual (DOE, 2008) requires DOE contractors to “ensure that a surveillance program is established and implemented to ensure the nuclear material storage package continues to meet its design criteria.” In order to ensure continuing safe storage of nuclear material and the maximization of risk reduction, TA-55 has established a Surveillance Program to ensure storage container integrity for operations within its specified design life. The LANL SAVY-4000 Field Surveillance Plan2 defines the near-term field surveillance plan for SAVY-4000 containers as required by the Manual. A long-term surveillance planmore » will be established based on the results of the first several years of surveillance and the results of the lifetime extension studies as defined in the Accelerated Aging Plan3. This report details progress in positioning the Surveillance Program for successful implementation in FY14 and status of the Design Life Extension Program in terms of its implementation and data collection for FY13.« less

Share the Sky: Concepts and Technologies That Will Shape Future Airspace Use

NASA Technical Reports Server (NTRS)

Ballin, Mark G.; Cotton, William; Kopardekar, Parimal

2011-01-01

The airspace challenge for the United States is to protect national sovereignty and ensure the safety and security of those on the ground and in the air, while at the same time ensuring the efficiency of flight, reducing the costs involved, protecting the environment, and protecting the freedom of access to the airspace. Many visions of the future NAS hold a relatively near-term perspective, focusing on existing uses of the airspace and assuming that new uses will make up a small fraction of total use. In the longer term, the skies will be filled with diverse and amazing new air vehicles filling our societal needs. Anticipated new vehicles include autonomous air vehicles acting both independently and in coordinated groups, unpiloted cargo carriers, and large numbers of personal air vehicles and small-scale point-to-point transports. These vehicles will enable new capabilities that have the potential to increase societal mobility, transport freight at lower cost and with lower environmental impact, improve the study of the Earth s atmosphere and ecosystem, and increase societal safety and security by improving or drastically lowering the cost of critical services such as firefighting, emergency medical evacuation, search and rescue, border and neighborhood surveillance, and the inspection of our infrastructure. To ensure that uses of the airspace can continue to grow for the benefit of all, a new paradigm for operations is needed: equitably and safely sharing the airspace. This paper is an examination of such a vision, concentrating on the operations of all types of air vehicles and future uses of the National Airspace. Attributes of a long-term future airspace system are provided, emerging operations technologies are described, and initial steps in research and development are recommended.

Training, Simulation, the Learning Curve, and How to Reduce Complications in Urology.

PubMed

Brunckhorst, Oliver; Volpe, Alessandro; van der Poel, Henk; Mottrie, Alexander; Ahmed, Kamran

2016-04-01

Urology is at the forefront of minimally invasive surgery to a great extent. These procedures produce additional learning challenges and possess a steep initial learning curve. Training and assessment methods in surgical specialties such as urology are known to lack clear structure and often rely on differing operative flow experienced by individuals and institutions. This article aims to assess current urology training modalities, to identify the role of simulation within urology, to define and identify the learning curves for various urologic procedures, and to discuss ways to decrease complications in the context of training. A narrative review of the literature was conducted through December 2015 using the PubMed/Medline, Embase, and Cochrane Library databases. Evidence of the validity of training methods in urology includes observation of a procedure, mentorship and fellowship, e-learning, and simulation-based training. Learning curves for various urologic procedures have been recommended based on the available literature. The importance of structured training pathways is highlighted, with integration of modular training to ensure patient safety. Valid training pathways are available in urology. The aim in urology training should be to combine all of the available evidence to produce procedure-specific curricula that utilise the vast array of training methods available to ensure that we continue to improve patient outcomes and reduce complications. The current evidence for different training methods available in urology, including simulation-based training, was reviewed, and the learning curves for various urologic procedures were critically analysed. Based on the evidence, future pathways for urology curricula have been suggested to ensure that patient safety is improved. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Improving healthcare empowerment through breast cancer patient navigation: a mixed methods evaluation in a safety-net setting.

PubMed

Gabitova, Guzyal; Burke, Nancy J

2014-09-19

Breast cancer mortality rates in the U.S. remain relatively high, particularly among ethnic minorities and low-income populations. Unequal access to quality care, lower follow up rates, and poor treatment adherence contribute to rising disparities among these groups. Healthcare empowerment (HCE) is theorized to improve patient outcomes through collaboration with providers and improving understanding of and compliance with treatment. Patient navigation is a health care organizational intervention that essentially improves healthcare empowerment by providing informational, emotional, and psychosocial support. Patient navigators address barriers to care through multilingual coordination of treatment and incorporation of access to community services, support, and education into the continuum of cancer care. Utilizing survey and qualitative methods, we evaluated the patient navigation program in a Northern California safety-net hospital Breast Clinic by assessing its impact on patients' experiences with cancer care and providers' perspectives on the program. We conducted qualitative interviews with 16 patients and 4 service providers, conducted approximately 66 hours of clinic observations, and received feedback through the self-administered survey from 66 patients. The role of the patient navigator at the Breast Clinic included providing administrative assistance, psychosocial support, improved knowledge, better understanding of treatment process, and ensuring better communication between patients and providers. As such, patient navigators facilitated improved collaboration between patients and providers and understanding of interdisciplinary care processes. The survey results suggested that the majority of patients across all ethnic backgrounds and age groups were highly satisfied with the program and had a positive perception of their navigator. Interviews with patients and providers highlighted the roles of a navigator in ensuring continuity of care, improving treatment completion rates, and reducing providers' workload and waiting time. Uncertainty about the navigator's role among the patients was a weakness of the program. Patient navigation in the Breast Clinic had a positive impact on patients' experiences with care and healthcare empowerment. Clarifying uncertainties about the navigators' role would aid successful outcomes.

Competence by Simulation: The Expert Nurse Continuing Education Experience Utilizing Simulation

ERIC Educational Resources Information Center

Underwood, Douglas W.

2013-01-01

Registered nurses practice in an environment that involves complex healthcare issues requiring continuous learning and evaluation of cognitive and technical skills to ensure safe and quality patient care. The purpose of this basic qualitative study was to gain a better understanding of the continuing educational needs of the expert nurse. This…

Producing Cochrane systematic reviews-a qualitative study of current approaches and opportunities for innovation and improvement.

PubMed

Turner, Tari; Green, Sally; Tovey, David; McDonald, Steve; Soares-Weiser, Karla; Pestridge, Charlotte; Elliott, Julian

2017-08-01

Producing high-quality, relevant systematic reviews and keeping them up to date is challenging. Cochrane is a leading provider of systematic reviews in health. For Cochrane to continue to contribute to improvements in heath, Cochrane Reviews must be rigorous, reliable and up to date. We aimed to explore existing models of Cochrane Review production and emerging opportunities to improve the efficiency and sustainability of these processes. To inform discussions about how to best achieve this, we conducted 26 interviews and an online survey with 106 respondents. Respondents highlighted the importance and challenge of creating reliable, timely systematic reviews. They described the challenges and opportunities presented by current production models, and they shared what they are doing to improve review production. They particularly highlighted significant challenges with increasing complexity of review methods; difficulty keeping authors on board and on track; and the length of time required to complete the process. Strong themes emerged about the roles of authors and Review Groups, the central actors in the review production process. The results suggest that improvements to Cochrane's systematic review production models could come from improving clarity of roles and expectations, ensuring continuity and consistency of input, enabling active management of the review process, centralising some review production steps; breaking reviews into smaller "chunks", and improving approaches to building capacity of and sharing information between authors and Review Groups. Respondents noted the important role new technologies have to play in enabling these improvements. The findings of this study will inform the development of new Cochrane Review production models and may provide valuable data for other systematic review producers as they consider how best to produce rigorous, reliable, up-to-date reviews.

29 CFR 1915.94 - Work in confined or isolated spaces.

Code of Federal Regulations, 2010 CFR

2010-07-01

....94 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR SHIPYARD EMPLOYMENT General..., frequent checks shall be made to ensure the safety of the employees. ...

40 CFR 264.271 - Treatment program.

Code of Federal Regulations, 2013 CFR

2013-07-01

....271 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Land... land treatment program that is designed to ensure that hazardous constituents placed in or on the...

40 CFR 264.271 - Treatment program.

Code of Federal Regulations, 2010 CFR

2010-07-01

....271 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Land... land treatment program that is designed to ensure that hazardous constituents placed in or on the...

40 CFR 264.271 - Treatment program.

Code of Federal Regulations, 2014 CFR

2014-07-01

....271 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Land... land treatment program that is designed to ensure that hazardous constituents placed in or on the...

40 CFR 264.271 - Treatment program.

Code of Federal Regulations, 2011 CFR

2011-07-01

....271 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Land... land treatment program that is designed to ensure that hazardous constituents placed in or on the...

40 CFR 264.271 - Treatment program.

Code of Federal Regulations, 2012 CFR

2012-07-01

....271 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Land... land treatment program that is designed to ensure that hazardous constituents placed in or on the...

Katrina's Legacy: Processes for Patient Disaster Preparation Have Improved but Important Gaps Remain.

PubMed

Icenogle, Marjorie; Eastburn, Sasha; Arrieta, Martha

2016-11-01

Ensuring continuity of care for patients with chronic illness, who are elderly or indigent presents unique challenges after disasters; this population has fewer financial resources, is less likely to evacuate, has limited access to recovery resources and is significantly dependent on charitable and government-funded institutions for care. This study expands a previous investigation of the extent to which healthcare providers in coastal Mississippi and Alabama have made changes to facilitate continued care to these populations after disasters. Key informants representing healthcare and social services organizations serving health-disparate residents of the Mississippi and Alabama Gulf Coast were interviewed regarding disaster preparation planning for the period of 2009-2012. Interview transcripts were qualitatively coded and analyzed for emerging themes using ATLAS.ti software. Participant organizations have implemented changes to ensure continuity of care for patients with chronic illness in case of disasters. Changes include patient assistance with predisaster preparation and training; evacuation planning and assistance; support to find resources in evacuation destinations; equipping patients with prescription information, diagnoses, treatment plans and advance medications when a disaster is imminent; multiple methods for patients to communicate with providers and more mandated medical needs shelters. Patients whose chronic conditions were diagnosed post-Katrina are more likely to underestimate the need to prepare. Further, patients' lack of compliance tends to increase as time passes from disasters. Although changes were implemented, results indicate that these may be inadequate to completely address patient needs. Thus, additional efforts may be needed, underscoring the complexity of adequate disaster preparation among disparate populations. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Building Bridges, Paediatric Palliative Care in Belgium: A secondary data analysis of annual paediatric liaison team reports from 2010 to 2014.

PubMed

Friedel, Marie; Brichard, Bénédicte; Fonteyne, Christine; Renard, Marleen; Misson, Jean-Paul; Vandecruys, Els; Tonon, Corinne; Verfaillie, Françoise; Hendrijckx, Georgette; Andersson, Nathalie; Ruysseveldt, Ilse; Moens, Katrien; Degryse, Jean-Marie; Aujoulat, Isabelle

2018-05-22

Although continuity of care in paediatric palliative care (PPC) is considered to be an essential element of quality of care, it's implementation is challenging. In Belgium, five paediatric liaison teams (PLTs) deliver palliative care. A Royal Decree issued in 2010 provides the legal framework that defines the PLTs' missions, as ensuring continuity of curative and palliative care between the hospital and home for children diagnosed with life-limiting conditions. This national study describes how PLTs ensure continuity of care by describing their activities and the characteristics of the children they cared for from 2010 to 2014. Thematic analysis of open-ended questions was performed and descriptive statistics of aggregated data issued from annual reports, collected by the Belgian Ministry of Public Health through the Cancer Plan was used. A review panel of PLT members discussed the results and contributed to their interpretation. Between 2010 and 2014, 3607 children and young adults (0-21 years) were cared for by the 5 Belgian PLTs (mean of 721/per year). Of these children, 50% were diagnosed with an oncological disease, 27% with a neurological or metabolic disease. Four hundred and twenty eight (428) children had died. For 51% of them, death took place at home. PLT activities include coordination; communication; curative and palliative care; education; research and fundraising. Different perceptions of what constitutes a palliative stage, heterogeneity in reporting diagnosis and the current lack of specific valid indicators to report PPC activities were found. PLTs are offering highly individualised, flexible and integrated care from diagnosis to bereavement in all care settings. Improvements in data registration and implementation of outcome measures are foreseen.

Changes in second-line regimen durability and continuity of care in relation to national ART guideline changes in South Africa

PubMed Central

Onoya, Dorina; Brennan, Alana T; Berhanu, Rebecca; van der Berg, Liudmyla; Buthelezi, Thulasizwe; Fox, Matthew P

2016-01-01

Abstract Introduction: Little is known about the impact of antiretroviral therapy (ART) guideline changes on the durability of second-line ART and continuity of care. This study examines predictors of early drug substitutions and treatment interruptions using a cohort analysis of HIV positive adults switched to second-line ART between January 2004 and September 2013 in Johannesburg, South Africa. Methods: The main outcomes were having a drug substitution or treatment interruption in the first 24 months on second-line ART. Kaplan Meiers analyses and Cox proportional hazards regression were used to identify predictors of drug substitutions and treatment interruptions. Results: Of 3028 patients on second-line ART, 353 (11.7%) had a drug substitution (8.6 per 100PY, 95% CI: 7.8–9.6) and 260 (8.6%) had a treatment interruption (6.3 per 100PY, 95% CI: 5.6–7.1). While treatment interruptions decreased from 32.5 per 100PY for the 2004 cohort to 2.3 per 100PY for the 2013 cohort, the rates of drug substitutions steadily increased, peaking at an incidence of 26.7 per 100PY for the 2009 cohort and then decreased to 4.2 per 100PY in the 2011 cohort. Compared to the 2004 to 2008 cohorts, the hazard of early drug substitutions was highest among patients switched to AZT + ddI + LPVr in 2009 to 2010 (aHR 5.1, 95% CI: 3.4–7.1) but remained low over time among patients switched to TDF + 3TC/FTC + LPVr or AZT/ABC + 3TC + LPVr. The main common predictor of both treatment interruption and drug substitution was drug toxicity. Conclusions: Our results show a rapid transition between 2004 and 2010 ART guidelines and concurrent improvements in continuity of care among second-line ART patients. Drug toxicity reporting and monitoring systems need improvements to inform timely regimen changes and ensure that patients remain in care. However, reasons for drug substitutions should be closely monitored to ensure that patients do not run out of treatment options in the future. PMID:28364563

Using an expanded outcomes framework and continuing education evidence to improve facilitation of patient-centered medical home recognition and transformation.

PubMed

Van Hoof, Thomas J; Kelvey-Albert, Michele; Katz, Matthew; Lalime, Ken; Sacks, Ken; Meehan, Thomas P

2014-01-01

The patient-centered medical home is a model for delivering primary care in the United States. Primary care clinicians and their staffs require assistance in understanding the innovation and in applying it to practice. The purpose of this article is to describe and to critique a continuing education program that is relevant to, and will become more common in, primary care. A multifaceted educational strategy prepared 20 primary care private practices to achieve National Committee for Quality Assurance Level 3 recognition as Patient-Centered Medical Homes. Eighteen (90%) practices submitted an application to the National Committee for Quality Assurance. On the first submission attempt, 13 of 18 (72%) achieved Level 3 recognition and 5 (28%) achieved Level 1 recognition. An interactive multifaceted educational strategy can be successful in preparing primary care practices for Patient-Centered Medical Homes recognition, but the strategy may not ensure transformation. Future educational activities should consider an expanded outcomes framework and the evidence of effective continuing education to be more successful with recognition and transformation.

The production of consumption: addressing the impact of mineral mining on tuberculosis in southern Africa

PubMed Central

Basu, Sanjay; Stuckler, David; Gonsalves, Gregg; Lurie, Mark

2009-01-01

Background Miners in southern Africa experience incident rates of tuberculosis up to ten times greater than the general population. Migration to and from mines may be amplifying tuberculosis epidemics in the general population. Discussion Migration to and from mineral mines contributes to HIV risks and associated tuberculosis incidence. Health and safety conditions within mines also promote the risk of silicosis (a tuberculosis risk factor) and transmission of tuberculosis bacilli in close quarters. In the context of migration, current tuberculosis prevention and treatment strategies often fail to provide sufficient continuity of care to ensure appropriate tuberculosis detection and treatment. Reports from Lesotho and South Africa suggest that miners pose transmission risks to other household or community members as they travel home undetected or inadequately treated, particularly with drug-resistant forms of tuberculosis. Reducing risky exposures on the mines, enhancing the continuity of primary care services, and improving the enforcement of occupational health codes may mitigate the harmful association between mineral mining activities and tuberculosis incidence among affected communities. Summary Tuberculosis incidence appears to be amplified by mineral mining operations in southern Africa. A number of immediately-available measures to improve continuity of care for miners, change recruitment and compensation practices, and reduce the primary risk of infection may critically mitigate the negative association between mineral mining and tuberculosis. PMID:19785769

The Miracle Baby Grows Up: Hypoplastic Left Heart Syndrome in the Adult.

PubMed

Lewis, Matthew; Rosenbaum, Marlon

2017-08-01

Hypoplastic left heart syndrome (HLHS) is characterized by underdevelopment of the mitral valve, left ventricle, and aorta and is ultimately palliated with a single-ventricle repair. Universally fatal in infancy prior to the advent of modern surgical techniques, the majority of HLHS patients will now reach adulthood. However, despite improvements in early survival, the HLHS population continues to face significant morbidity and early mortality. This review delineates common sources of patient morbidity and highlights areas in need of additional research for this growing segment of the adult congenital heart disease population. It has become increasingly clear that palliated adult single ventricle patients, like those with HLHS, face significant life-long morbidity from elevated systemic venous pressures as a consequence of the Fontan procedure. Downstream organ dysfunction secondary to elevated Fontan pressures has the potential to significantly impact long-term management decisions, including strategies of organ allocation. Because of the presence of a morphologic systemic right ventricle, HLHS patients may be at even higher risk than other adult patients with a Fontan. Because the adult HLHS population continues to grow, recognition of common sources of patient morbidity and mortality is becoming increasingly important. A coordinated effort between patients and providers is necessary to address the many remaining areas of clinical uncertainty to help ensure continued improvement in patient prognosis and quality of life.

The role of emerging technologies to ensure the microbial safety of fresh produce, milk and eggs

USDA-ARS?s Scientific Manuscript database

This article reviews emerging techniques that are applied in the produce and dairy industry to ensure product safety. Microbial safety of produce, dairy and egg continues to be a major concern. According to Economic Research Service, USDA the cost of foodborne illnesses in the U.S. tops $15.6 billio...

34 CFR 611.51 - How does a grantee ensure that a scholarship recipient understands the terms and conditions of...

Code of Federal Regulations, 2010 CFR

2010-07-01

... program? 611.51 Section 611.51 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TEACHER QUALITY ENHANCEMENT GRANTS... 34 Education 3 2010-07-01 2010-07-01 false How does a grantee ensure that a scholarship recipient...

Louisiana Birth Outcomes Initiative: improving birth outcomes with interventions before, during, and after pregnancy.

PubMed

Gee, Rebekah E; Johnson, Kay A

2012-01-01

The costs of poor birth outcomes to the United States in both human and fiscal terms are large and a continuing concern. Louisiana has among the worst birth outcomes in our nation, which include preterm and low birth weight births, and maternal and infant mortality. In response to these poor birth outcomes, the Louisiana Department of Health and Hospitals is implementing a statewide, multi-faceted Birth Outcomes Initiative at the level of the secretary. The Birth Outcomes Initiative aims to adopt evidence-based and best practices along the continuum of care for women and infants. Of particular importance is ending all non-medically indicated deliveries prior to 39 weeks, administration of the hormone 17-hydroxyprogesterone to eligible women for prematurity prevention, optimal behavioral health counseling and referral for reproductive aged women, and ensuring optimal health for women between pregnancies. Opportunities exist to improve outcomes for primary care and obstetrical providers. Louisiana is the first state to aim at improving birth outcomes with interventions before, during, and after pregnancy.

New Medicaid Enrollees In Oregon Report Health Care Successes And Challenges

PubMed Central

Allen, Heidi; Wright, Bill J.; Baicker, Katherine

2014-01-01

Medicaid expansions will soon cover millions of new enrollees, but insurance alone may not ensure that they receive high-quality care. This study examines health care interactions and the health perceptions of an Oregon cohort three years after they gained Medicaid coverage. During in-depth qualitative interviews, 120 enrollees reported a wide range of interactions with the health care system. Forty percent of the new enrollees sought care infrequently because they were confused about coverage, faced access barriers, had bad interactions with providers, or felt that care was unnecessary. For the 60 percent who had multiple health care interactions, continuity and ease of the provider-patient relationship were critical to improved health. Some newly insured Medicaid enrollees recounted rapid improvements in health. However, most reported that gains came after months or years of working closely and systematically with a provider. Our findings suggest that improving communication with beneficiaries and increasing the availability of coordinated care across settings could reduce the barriers that new enrollees are likely to face. PMID:24493773

Inter-organisational response to disasters.

PubMed

Paturas, James L; Smith, Stewart R; Albanese, Joseph; Waite, Geraldine

2016-01-01

Inter-organisational communication failures during times of real-world disasters impede the collaborative response of agencies responsible for ensuring the public's health and safety. In the best of circumstances, communications across jurisdictional boundaries are ineffective. In times of crisis, when communities are grappling with the impact of a disaster, communications become critically important and more complex. Important factors for improving inter-organisational communications are critical thinking and problem-solving skills; inter-organisational relationships; as well as strategic, tactical and operational communications. Improving communication, critical thinking, problem-solving and decision-making requires a review of leadership skills. This discussion begins with an analysis of the existing disaster management research and moves to an examination of the importance of inter-organisational working relationships. Before a successful resolution of a disaster by multiple levels of first responders, the group of organisations must have a foundation of trust, collegiality, flexibility, expertise, openness, relational networking and effective communications. Leaders must also be prepared to improve leadership skills through continual development in each of these foundational areas.

Time course of clinical change following neurofeedback.

PubMed

Rance, Mariela; Walsh, Christopher; Sukhodolsky, Denis G; Pittman, Brian; Qiu, Maolin; Kichuk, Stephen A; Wasylink, Suzanne; Koller, William N; Bloch, Michael; Gruner, Patricia; Scheinost, Dustin; Pittenger, Christopher; Hampson, Michelle

2018-05-02

Neurofeedback - learning to modulate brain function through real-time monitoring of current brain state - is both a powerful method to perturb and probe brain function and an exciting potential clinical tool. For neurofeedback effects to be useful clinically, they must persist. Here we examine the time course of symptom change following neurofeedback in two clinical populations, combining data from two ongoing neurofeedback studies. This analysis reveals a shared pattern of symptom change, in which symptoms continue to improve for weeks after neurofeedback. This time course has several implications for future neurofeedback studies. Most neurofeedback studies are not designed to test an intervention with this temporal pattern of response. We recommend that new studies incorporate regular follow-up of subjects for weeks or months after the intervention to ensure that the time point of greatest effect is sampled. Furthermore, this time course of continuing clinical change has implications for crossover designs, which may attribute long-term, ongoing effects of real neurofeedback to the control intervention that follows. Finally, interleaving neurofeedback sessions with assessments and examining when clinical improvement peaks may not be an appropriate approach to determine the optimal number of sessions for an application. Copyright © 2018 Elsevier Inc. All rights reserved.

High-resolution seismic-reflection imaging 25 years of change in I-70 sinkhole, Russell County, Kansas

USGS Publications Warehouse

Miller, R.D.; Steeples, D.W.; Lambrecht, J.L.; Croxton, N.

2006-01-01

Time-lapse seismic reflection imaging improved our understanding of the consistent, gradual surface subsidence ongoing at two sinkholes in the Gorham Oilfield discovered beneath a stretch of Interstate Highway 70 through Russell and Ellis Counties in Kansas in 1966. With subsidence occurring at a rate of around 10 cm per year since discovery, monitoring has been beneficial to ensure public safety and optimize maintenance. A miniSOSIE reflection survey conducted in 1980 delineated the affected subsurface and successfully predicted development of a third sinkhole at this site. In 2004 and 2005 a high-resolution vibroseis survey was completed to ascertain current conditions of the subsurface, rate and pattern of growth since 1980, and potential for continued growth. With time and improved understanding of the salt dissolution affected subsurface in this area it appears that these features represent little risk to the public from catastrophic failure. However, from an operational perspective the Kansas Department of Transportation should expect continued subsidence, with future increases in surface area likely at a slightly reduced vertical rate. Seismic characteristics appear empirically consistent with gradual earth material compaction/settling. ?? 2005 Society of Exploration Geophysicists.

Improvement of Linde Kryotechnik's internal purifier

NASA Astrophysics Data System (ADS)

Decker, Lutz; Meier, Albert; Wilhelm, Hanspeter

2014-01-01

With the recent shortage in supply of helium, recovery solutions have experienced a new focus with a tendency to recover streams with higher impurity content. This development calls for purifier systems operating efficiently and with low impact on liquefaction capacity for helium streams with impurity levels in the percentage range. Linde Kryotechnik has answered this demand by improving the performance of its purifier technology. Since 1983, its standardized helium liquefiers of the L- and former TCF-series type contain an internal purifier which already allows efficient impurity removal with minimized space demand. Along with a line dryer to absorb humidity, it is designed to remove air impurities up to 5 mol%. However, with increasing impurity level, liquefaction capacity reduced significantly being furthermore restricted to an upper level of approx. 180 l/h and continuous purification became limited in time. With the current redesign of this purifier, the impact on liquefaction capacity is now minimized without any limitation within the capacity range of the L-series plants. Continuous purification is hence ensured beyond previous maximum impurity content. This paper provides the key design changes and the achievable performance, which has been verified in the recent L-series plants delivered to customers.

Fit for purpose quality management system for military forensic exploitation.

PubMed

Wilson, Lauren Elizabeth; Gahan, Michelle Elizabeth; Robertson, James; Lennard, Chris

2018-03-01

In a previous publication we described a systems approach to forensic science applied in the military domain. The forensic science 'system of systems' describes forensic science as a sub-system in the larger criminal justice, law enforcement, intelligence, and military systems, with quality management being an important supporting system. Quality management systems help to ensure that organisations achieve their objective and continually improve their capability. Components of forensic science quality management systems can include standardisation of processes, accreditation of facilities to national/international standards, and certification of personnel. A fit for purpose quality management system should be balanced to allow organisations to meet objectives, provide continuous improvement; mitigate risk; and impart a positive quality culture. Considerable attention over the last decades has been given to the need for forensic science quality management systems to meet criminal justice and law enforcement objectives. More recently, the need for the forensic quality management systems to meet forensic intelligence objectives has been considered. This paper, for the first time, discusses the need for a fit for purpose quality management system for military forensic exploitation. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

The PBRN Initiative

PubMed Central

Curro, F.A.; Vena, D.; Naftolin, F.; Terracio, L.; Thompson, V.P.

2012-01-01

The NIDCR-supported Practice-based Research Network initiative presents dentistry with an unprecedented opportunity by providing a pathway for modifying and advancing the profession. It encourages practitioner participation in the transfer of science into practice for the improvement of patient care. PBRNs vary in infrastructure and design, and sustaining themselves in the long term may involve clinical trial validation by regulatory agencies. This paper discusses the PBRN concept in general and uses the New York University College of Dentistry’s Practitioners Engaged in Applied Research and Learning (PEARL) Network as a model to improve patient outcomes. The PEARL Network is structured to ensure generalizability of results, data integrity, and to provide an infrastructure in which scientists can address clinical practitioner research interests. PEARL evaluates new technologies, conducts comparative effectiveness research, participates in multidisciplinary clinical studies, helps evaluate alternative models of healthcare, educates and trains future clinical faculty for academic positions, expands continuing education to include “benchmarking” as a form of continuous feedback to practitioners, adds value to dental schools’ educational programs, and collaborates with the oral health care and pharmaceutical industries and medical PBRNs to advance the dental profession and further the integration of dental research and practice into contemporary healthcare (NCT00867997, NCT01268605). PMID:22699662

5 CFR 723.160 - Communications.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED... PERSONNEL MANAGEMENT § 723.160 Communications. (a) The agency shall take appropriate steps to ensure... action that it can demonstrate would result in a fundamental alteration in the nature of a program or...

Assessment of market potential of compressed air energy storage systems

NASA Astrophysics Data System (ADS)

Boyd, D. W.; Buckley, O. E.; Clark, C. E., Jr.

1983-12-01

This report describes an assessment of potential roles that EPRI might take to facilitate the commercial acceptance of compressed air energy storage (CAES) systems. The assessment is based on (1) detailed analyses of the market potential of utility storage technologies, (2) interviews with representatives of key participants in the CAES market, and (3) a decision analysis synthesizing much of the information about market and technology status. The results indicate a large potential market for CAES systems if the overall business environment for utilities improves. In addition, it appears that EPRI can have a valuable incremental impact in ensuring that utilities realize the potential of CAES by (1) continuing an aggressive information dissemination and technology transfer program, (2) working to ensure the success of the first United States CAES installation at Soyland Power Cooperative, (3) developing planning methods to allow utilities to evaluate CAES and other storage options more effectively and more realistically, and (4) supporting R and D to resolve residual uncertainties in first-generation CAES cost and performance characteristics. Previously announced in STAR as N83-25121

XDS-I outsourcing proxy: ensuring confidentiality while preserving interoperability.

PubMed

Ribeiro, Luís S; Viana-Ferreira, Carlos; Oliveira, José Luís; Costa, Carlos

2014-07-01

The interoperability of services and the sharing of health data have been a continuous goal for health professionals, patients, institutions, and policy makers. However, several issues have been hindering this goal, such as incompatible implementations of standards (e.g., HL7, DICOM), multiple ontologies, and security constraints. Cross-enterprise document sharing (XDS) workflows were proposed by Integrating the Healthcare Enterprise (IHE) to address current limitations in exchanging clinical data among organizations. To ensure data protection, XDS actors must be placed in trustworthy domains, which are normally inside such institutions. However, due to rapidly growing IT requirements, the outsourcing of resources in the Cloud is becoming very appealing. This paper presents a software proxy that enables the outsourcing of XDS architectural parts while preserving the interoperability, confidentiality, and searchability of clinical information. A key component in our architecture is a new searchable encryption (SE) scheme-Posterior Playfair Searchable Encryption (PPSE)-which, besides keeping the same confidentiality levels of the stored data, hides the search patterns to the adversary, bringing improvements when compared to the remaining practical state-of-the-art SE schemes.

Coronary artery disease in Brazil: contemporary management and future perspectives.

PubMed

Polanczyk, C A; Ribeiro, J P

2009-06-01

Cardiovascular diseases are responsible for 32% of total mortality in Brazil, mostly due to cerebrovascular and coronary artery disease. Epidemiological and socio-economical factors play a pivotal role on the distribution, severity and management of coronary artery disease, and the burden is greater in the southeast and south regions of the country, with a higher mortality in low-income populations. The Brazilian healthcare structure is divided into two complementary systems-public and private-but 75% of the population is covered exclusively by the public system. Some Brazilian institutions offer state-of-the-art care to patients with acute and chronic coronary artery disease, but regional inequalities in medical care are still significant. National policies will have to be implemented to fight risk factors, to ensure primary prevention strategies, including assistance on drugs with known protective effects, areas to be tackled by both the private and the public health sectors. Finally, large investments will have to be made to improve tertiary care, to reorganise systems of care for acute patients and mainly to ensure prompt access and continuity of cardiac care and secondary prevention strategies for the whole population.

Opportunities to Apply the 3Rs in Safety Assessment Programs

PubMed Central

Sewell, Fiona; Edwards, Joanna; Prior, Helen; Robinson, Sally

2016-01-01

Abstract Before a potential new medicine can be administered to humans it is essential that its safety is adequately assessed. Safety assessment in animals forms an integral part of this process, from early drug discovery and initial candidate selection to the program of recommended regulatory tests in animals. The 3Rs (replacement, reduction, and refinement of animals in research) are integrated in the current regulatory requirements and expectations and, in the EU, provide a legal and ethical framework for in vivo research to ensure the scientific objectives are met whilst minimizing animal use and maintaining high animal welfare standards. Though the regulations are designed to uncover potential risks, they are intended to be flexible, so that the most appropriate approach can be taken for an individual product. This article outlines current and future opportunities to apply the 3Rs in safety assessment programs for pharmaceuticals, and the potential (scientific, financial, and ethical) benefits to the industry, across the drug discovery and development process. For example, improvements to, or the development of, novel, early screens (e.g., in vitro, in silico, or nonmammalian screens) designed to identify compounds with undesirable characteristics earlier in development have the potential to reduce late-stage attrition by improving the selection of compounds that require regulatory testing in animals. Opportunities also exist within the current regulatory framework to simultaneously reduce and/or refine animal use and improve scientific outcomes through improvements to technical procedures and/or adjustments to study designs. It is important that approaches to safety assessment are continuously reviewed and challenged to ensure they are science-driven and predictive of relevant effects in humans. PMID:28053076

Big data privacy protection model based on multi-level trusted system

NASA Astrophysics Data System (ADS)

Zhang, Nan; Liu, Zehua; Han, Hongfeng

2018-05-01

This paper introduces and inherit the multi-level trusted system model that solves the Trojan virus by encrypting the privacy of user data, and achieve the principle: "not to read the high priority hierarchy, not to write the hierarchy with low priority". Thus ensuring that the low-priority data privacy leak does not affect the disclosure of high-priority data privacy. This paper inherits the multi-level trustworthy system model of Trojan horse and divides seven different risk levels. The priority level 1˜7 represent the low to high value of user data privacy, and realize seven kinds of encryption with different execution efficiency Algorithm, the higher the priority, the greater the value of user data privacy, at the expense of efficiency under the premise of choosing a more encrypted encryption algorithm to ensure data security. For enterprises, the price point is determined by the unit equipment users to decide the length of time. The higher the risk sub-group algorithm, the longer the encryption time. The model assumes that users prefer the lower priority encryption algorithm to ensure efficiency. This paper proposes a privacy cost model for each of the seven risk subgroups. Among them, the higher the privacy cost, the higher the priority of the risk sub-group, the higher the price the user needs to pay to ensure the privacy of the data. Furthermore, by introducing the existing pricing model of economics and the human traffic model proposed by this paper and fluctuating with the market demand, this paper improves the price of unit products when the market demand is low. On the other hand, when the market demand increases, the profit of the enterprise will be guaranteed under the guidance of the government by reducing the price per unit of product. Then, this paper introduces the dynamic factors of consumers' mood and age to optimize. At the same time, seven algorithms are selected from symmetric and asymmetric encryption algorithms to define the enterprise costs at different levels. Therefore, the proposed model solves the continuous influence caused by cascading events and ensures that the disclosure of low-level data privacy of users does not affect the high-level data privacy, thus greatly improving the safety of the private information of user.

The role of physiology in the development of golf performance.

PubMed

Smith, Mark F

2010-08-01

The attainment of consistent high performance in golf requires effective physical conditioning that is carefully designed and monitored in accordance with the on-course demands the player will encounter. Appreciating the role that physiology plays in the attainment of consistent performance, and how a player's physicality can inhibit performance progression, supports the notion that the application of physiology is fundamental for any player wishing to excel in golf. With cardiorespiratory, metabolic, hormonal, musculoskeletal and nutritional demands acting on the golfer within and between rounds, effective physical screening of a player will ensure physiological and anatomical deficiencies that may influence performance are highlighted. The application of appropriate golf-specific assessment methods will ensure that physical attributes that have a direct effect on golf performance can be measured reliably and accurately. With the physical development of golf performance being achieved through a process of conditioning with the purpose of inducing changes in structural and metabolic functions, training must focus on foundation whole-body fitness and golf-specific functional strength and flexibility activities. For long-term player improvement to be effective, comprehensive monitoring will ensure the player reaches an optimal physical state at predetermined times in the competitive season. Through continual assessment of a player's physical attributes, training effectiveness and suitability, and the associated adaptive responses, key physical factors that may impact most on performance success can be determined.

Continuous cultivation of photosynthetic microorganisms: Approaches, applications and future trends.

PubMed

Fernandes, Bruno D; Mota, Andre; Teixeira, Jose A; Vicente, Antonio A

2015-11-01

The possibility of using photosynthetic microorganisms, such as cyanobacteria and microalgae, for converting light and carbon dioxide into valuable biochemical products has raised the need for new cost-efficient processes ensuring a constant product quality. Food, feed, biofuels, cosmetics and pharmaceutics are among the sectors that can profit from the application of photosynthetic microorganisms. Biomass growth in a photobioreactor is a complex process influenced by multiple parameters, such as photosynthetic light capture and attenuation, nutrient uptake, photobioreactor hydrodynamics and gas-liquid mass transfer. In order to optimize productivity while keeping a standard product quality, a permanent control of the main cultivation parameters is necessary, where the continuous cultivation has shown to be the best option. However it is of utmost importance to recognize the singularity of continuous cultivation of cyanobacteria and microalgae due to their dependence on light availability and intensity. In this sense, this review provides comprehensive information on recent breakthroughs and possible future trends regarding technological and process improvements in continuous cultivation systems of microalgae and cyanobacteria, that will directly affect cost-effectiveness and product quality standardization. An overview of the various applications, techniques and equipment (with special emphasis on photobioreactors) in continuous cultivation of microalgae and cyanobacteria are presented. Additionally, mathematical modeling, feasibility, economics as well as the applicability of continuous cultivation into large-scale operation, are discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

Leveraging Health Information Exchange to Improve Population Health Reporting Processes: Lessons in Using a Collaborative-Participatory Design Process

PubMed Central

Revere, Debra; Dixon, Brian E.; Hills, Rebecca; Williams, Jennifer L.; Grannis, Shaun J.

2014-01-01

Introduction: Surveillance, or the systematic monitoring of disease within a population, is a cornerstone function of public health. Despite significant investment in information technologies (IT) to improve the public’s health, health care providers continue to rely on manual, spontaneous reporting processes that can result in incomplete and delayed surveillance activities. Background: Participatory design principles advocate including real users and stakeholders when designing an information system to ensure high ecological validity of the product, incorporate relevance and context into the design, reduce misconceptions designers can make due to insufficient domain expertise, and ultimately reduce barriers to adoption of the system. This paper focuses on the collaborative and informal participatory design process used to develop enhanced, IT-enabled reporting processes that leverage available electronic health records in a health information exchange to prepopulate notifiable-conditions report forms used by public health authorities. Methods: Over nine months, public health stakeholders, technical staff, and informatics researchers were engaged in a multiphase participatory design process that included public health stakeholder focus groups, investigator-engineering team meetings, public health survey and census regarding high-priority data elements, and codesign of exploratory prototypes and final form mock-ups. Findings: A number of state-mandated report fields that are not highly used or desirable for disease investigation were eliminated, which allowed engineers to repurpose form space for desired and high-priority data elements and improve the usability of the forms. Our participatory design process ensured that IT development was driven by end user expertise and needs, resulting in significant improvements to the layout and functionality of the reporting forms. Discussion: In addition to informing report form development, engaging with public health end users and stakeholders through the participatory design process provided new insights into public health workflow and allowed the team to quickly triage user requests while managing user expectations within the realm of engineering possibilities. Conclusion: Engaging public health, engineering staff, and investigators in a shared codesigning process ensured that the new forms will not only meet real-life needs but will also support development of a product that will be adopted and, ultimately, improve communicable and infectious disease reporting by clinicians to public health. PMID:25848615

Quality improvement: the nurse's role.

PubMed

Moran, M J; Johnson, J E

1992-06-01

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

Training for Three Wars Ago: Antiquated C-130H Pilot Training

DTIC Science & Technology

2015-10-01

Computers/Air Operations Center] integration .14 The purpose of continuation training is to ensure pilots are current, qualified, and proficient in the...Historical Operational Missions ................................................................ 4 C-130 PILOT CONTINUATION TRAINING PROGRAM...together watching movies or TV. Without you, all this work is for naught. vi ABSTRACT Being one of the longest continually produced combat

EVMS Self-Surveillance of Remote Handled Low Level Waste (RHLLW) Project

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

Nelson, Michael L.; Case, Kimberly; Hergesheimer, Linda

2013-07-01

DOE G 413.3-10A, Section 3.a states: “The Contractor has primary responsibility for implementing and maintaining a surveillance program to ensure continued compliance of the system with ANSI/EIA-748B. DOE O 413.3B requires the FPD to ensure the contractor conducts a Self-Surveillance annually. This annual Self-Surveillance,…should cover all 32 guidelines of the ANSI/EIA748B. Documentation of the Self-Surveillance is sent to the CO and the PMSO (copy to OECM) confirming the continued compliance of their EVMS ANSI/EIA748B...” This review, and the associated report, is deemed to satisfy this requirement.

The roles of government in improving health care quality and safety.

PubMed

Tang, Ning; Eisenberg, John M; Meyer, Gregg S

2004-01-01

Discussions surrounding the role of government have been and continue to be a favorite American pastime. A framework is provided for understanding the 10 roles that government plays in improving health care quality and safety in the United States. Examples of proposed federal actions to reduce medical errors and enhance patient safety are provided to illustrate the 10 roles: (1) purchase health care, (2) provide health care, (3) ensure access to quality care for vulnerable populations, (4) regulate health care markets, (5) support acquisition of new knowledge, (6) develop and evaluate health technologies and practices, (7) monitor health care quality, (8) inform health care decision makers, (9) develop the health care workforce, and (10) convene stakeholders from across the health care system. Government's responsibility to protect and advance the interests of society includes the delivery of high-quality health care. Because the market alone cannot ensure all Americans access to quality health care, the government must preserve the interests of its citizens by supplementing the market where there are gaps and regulating the market where there is inefficiency or unfairness. The ultimate goal of achieving high quality of care will require strong partnerships among federal, state, and local governments and the private sector. Translating general principles regarding the appropriate role of government into specific actions within a rapidly changing, decentralized delivery system will require the combined efforts of the public and private sectors.

Experiences that develop the ability to think strategically.

PubMed

Goldman, Ellen; Cahill, Terrence; Filho, Rubens Pessanha

2009-01-01

The ability to think strategically is an admired and a sought-after leadership requirement, yet we know little about how it develops. The purpose of this study is to identify specific experiences that contribute to the development of an individual's ability to think strategically. We identified eight work experiences, including different types of organizational projects, processes, and relationships, that contribute to an individual's strategic thinking ability. We also delineate specific characteristics material to each experience. These characteristics indicate that considerable time and focus are required to develop the ability to think strategically. In addition, the experiences are not all accessed equally: Women are less likely to have nonrelational experiences, while chief executive officers are more likely to have the most challenging ones. In addition, we found differences regarding work-related continuing education activities. Respondents rated nonhealthcare conferences and reading behind all other identified experiences that contribute to strategic thinking ability. Individuals can implement several strategies to improve their strategic thinking ability, including deliberately incorporating the requisite experiences into their development plans, ensuring that the experiences incorporate the required characteristics, and improving the benefit received from attending educational programs in nonhealthcare industries. Organizations can implement several strategies to ensure the experiences are as effective as possible, such as appraising gender differences across the experiences and reviewing the organization's strategic planning processes for the characteristics that best encourage strategic thinking.

Report of the Federal Advisory Committee on the Bird Banding Laboratory

USGS Publications Warehouse

Haseltine, Susan D.; Schmidt, Paul R.; Bales, Bradley D.; Bonter, David N.; DeSante, David F.; Doherty, Paul F.; Francis, Charles M.; Green, Paul T.; Howes, Lesley-Anne; James, Daniel L.; Lament, J. Jasper; Lancia, Richard A.; Paul, Ellen I.; Ralph, C. John; Rogers, John G.; Young, Richard E.

2008-01-01

In the fall of 2005, the Directors of the U.S. Geological Survey (USGS) and the U.S. Fish and Wildlife Service (FWS) determined that to ensure that the Bird Banding Laboratory (BBL) of the USGS maintains and continues its important support of conservation and management of birds, it should be guided by a clear vision for the future. In order to carry out this task, they impaneled a fourteen-member Federal Advisory Committee (FAC) on the Bird Banding Laboratory. It was made up of representatives of the broad bird-banding community, public and private, and was cochaired by a senior representative from each agency. The Committee met four times and a writing subgroup met three times over the course of its work. The Committee identified a new vision and mission for the BBL and identified six goals that it believes should be integral to the development of a strategic plan to achieve them. Those goals are: 1. Facilitate the identification of individual birds through marking. 2. Create automated, electronic systems that efficiently verify, accept, store, and manage data associated with individually marked birds. 3. Facilitate access to and use of data from marked birds for science, conservation, and management. 4. Administer permits in an efficient, timely, and modern manner, and use them to ensure that bird welfare and data quality remain top priorities. 5. Work closely with national and international partners to achieve the mission of the BBL. 6. Manage the BBL in an efficient, cost-effective manner to maximize use of available resources. Most of the report is structured around these goals. The Committee made 2 programmatic recommendations and identified 23 objectives and 58 specific recommendations. The programmatic recommendations are: (1) that the primary role of the BBL is and should continue to be to support the use of banding and banding data by researchers and managers engaged in science, conservation, and management of birds, and not to play a lead role in original research; and (2) that the BBL be managed nationally by USGS headquarters as a research and operational support unit and provided with the resources appropriate to its national and international functions and responsibilities; it should continue to be located physically at the Patuxent Wildlife Research Center (PWRC). In order to achieve its vision and mission, the Committee believes that the BBL must work towards achieving all of the recommendations in this report. Nevertheless, it identified five objectives that stand out as high priority, and they are as follows: *Objective 1.1?to ensure a continuing, adequate supply of high-quality, Federally issued numeric bands of required sizes, materials, and types; *Objective 2.1?to improve mechanisms for verifying, accepting, storing, and managing bird-banding data; *Objective 2.3?to accommodate recapture data; *Objective 4.1?to ensure through the permitting process that banders know how to safely handle birds, collect data accurately, and maintain birds in humane and healthful conditions; and *Objective 5.3?to encourage the development of banding programs in Latin America and the Caribbean. Finally, this Committee believes that the BBL will be well served if it continues to support a Federal Advisory Committee, composed similarly to this one, to continue offering guidance and direction from the broad bird-banding community.

40 CFR 273.36 - Employee training.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 27 2011-07-01 2011-07-01 false Employee training. 273.36 Section 273.36 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED... Employee training. A large quantity handler of universal waste must ensure that all employees are...

40 CFR 273.36 - Employee training.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Employee training. 273.36 Section 273.36 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED... Employee training. A large quantity handler of universal waste must ensure that all employees are...

32 CFR 326.5 - Responsibilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... files subject to the provisions of this part. (g) Directorate and Office Managers, NRO: (1) Ensure that... Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) PRIVACY PROGRAM NATIONAL RECONNAISSANCE OFFICE PRIVACY ACT PROGRAM § 326.5 Responsibilities. (a) The Director, NRO (DNRO...

32 CFR 326.5 - Responsibilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... files subject to the provisions of this part. (g) Directorate and Office Managers, NRO: (1) Ensure that... Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) PRIVACY PROGRAM NATIONAL RECONNAISSANCE OFFICE PRIVACY ACT PROGRAM § 326.5 Responsibilities. (a) The Director, NRO (DNRO...

32 CFR 326.5 - Responsibilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... files subject to the provisions of this part. (g) Directorate and Office Managers, NRO: (1) Ensure that... Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) PRIVACY PROGRAM NATIONAL RECONNAISSANCE OFFICE PRIVACY ACT PROGRAM § 326.5 Responsibilities. (a) The Director, NRO (DNRO...

32 CFR 326.5 - Responsibilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... files subject to the provisions of this part. (g) Directorate and Office Managers, NRO: (1) Ensure that... Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) PRIVACY PROGRAM NATIONAL RECONNAISSANCE OFFICE PRIVACY ACT PROGRAM § 326.5 Responsibilities. (a) The Director, NRO (DNRO...

Assessment of public vs private MSW management: a case study.

PubMed

Massoud, M A; El-Fadel, M; Abdel Malak, A

2003-09-01

Public-private partnerships in urban environmental services have witnessed increased interest in recent years primarily to reform the weak performance of the public sector, reduce cost, improve efficiency, and ensure environmental protection. In this context, successful public-private partnerships require a thorough analysis of opportunities, a deliberate attention to process details, and a continuous examination of services to determine whether they are more effectively performed by the private sector. A comparative assessment of municipal solid waste collection services in the two largest cities in Lebanon where until recently municipal solid waste collection is private in one and public in the other is conducted. While quality of municipal solid waste collection improved, due to private sector participation, the corresponding cost did not, due to monopoly and an inadequate organizational plan defining a proper division of responsibilities between the private and the public sector.

Do piped water and flush toilets prevent child diarrhea in rural Philippines?

PubMed

Capuno, Joseph J; Tan, Carlos Antonio R; Fabella, Vigile Marie

2015-03-01

Similar to other developing countries, diarrhea in the Philippines continues to be among the top causes of child mortality and morbidity. In pursuit of its Millennium Development Goals, the Philippine government commits to reduce child deaths and provide water and sanitation services to more rural households by 2015. Applying propensity score matching on the 1993, 1998, 2003, and 2008 rounds of the National Demographic and Health Survey to estimate the average treatment effect on the treated, it is found that the incidence of diarrhea among under-5 children is lower by as much as 4.5% in households with access to piped water and 10% in those with their own flush toilets, relative to comparable households. These findings underscore the need to ensure the quality of drinking water from the pipe or from other improved sources at the point of use, and the provision of improved and own sanitation facilities. © 2011 APJPH.

Clearing the Air About Surgical Smoke: An Education Program.

PubMed

Chavis, Sherry; Wagner, Vicki; Becker, Melanie; Bowerman, Mercelita I; Jamias, Mary Shirley

2016-03-01

Evidence of the harmful effects of surgical smoke has been recognized in the literature and by professional organizations for many years, yet surgical smoke continues to pose a safety hazard for patients and perioperative personnel. A team of perioperative nurses and educators sought to improve compliance with policies and procedures for surgical smoke management in the OR. The team quantified smoke-evacuator use, assessed staff members' knowledge using a pre-education survey, and presented a three-part multimodal education program. The team conducted a posteducation survey that showed significant improvement in staff members' knowledge. Ninety-day postimplementation quantitative data showed a 14.6% increase in surgical smoke-evacuation use. This educational initiative increased staff members' awareness about reducing the presence of surgical smoke in the OR and helped ensure a safer environment for patients, staff members, and the surgical team. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

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

NASA Technical Reports Server (NTRS)

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

2001-01-01

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

Top 10 metrics for life science software good practices.

PubMed

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

2016-01-01

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

Continuous patient engagement in cardiovascular disease clinical comparative effectiveness research.

PubMed

Vandigo, Joseph; Oloyede, Ebenezer; Aly, Abdalla; Laird, Aurelia L; Cooke, Catherine E; Mullins, C Daniel

2016-01-01

Researchers have produced evidence that identifies interventions that reduce cardiovascular disease (CVD) risk; however, despite a significant investment in research CVD remains the leading cause of death. Engaging patients in the research process has the potential to ensure that evidence-based treatments are adopted in real-world practice to improve patient outcomes. The Patient-Centered Outcomes Research Institute has created an Engagement Rubric to guide meaningful engagement in the research process. A 10-step systematic framework to enhance patient engagement throughout the comparative effectiveness research process also has been proposed. This special report identifies the relationship between these two approaches to patient engagement and describes examples of how patients could be engaged in a hypothetical CVD study.

Classification and Management of Pediatric Subaxial Cervical Spine Injuries.

PubMed

Madura, Casey J; Johnston, James M

2017-01-01

Appropriate management of subaxial spine injury in children requires an appreciation for the differences in anatomy, biomechanics, injury patterns, and treatment options compared with adult patients. Increased flexibility, weak neck muscles, and cranial disproportion predispose younger children to upper cervical injuries and spinal cord injury without radiographic abnormality. A majority of subaxial cervical spine injuries can be treated nonoperatively. Surgical instrumentation options for children have significantly increased in recent years. Future studies of outcomes for children with subaxial cervical spine injury should focus on injury classification and standardized outcome measures to ensure continued improvement in quality of care for this patient population. Copyright © 2016 Elsevier Inc. All rights reserved.

[Care continuity for patients with Prader-Willi syndrome during transition from childhood to adulthood].

PubMed

Saitoh, Shinji

2010-01-01

Prader-Willi syndrome(PWS) is a complex multisystem genetic disorder, of which characteristic phenotypes include neonatal hypotonia, hyperphagia resulting in obesity, mental retardation, hypogonadism, and behavioral and psychiatric problems. The diagnosis can be obtained as early as during neonatal period thanks to development of genetic testing. Clinical features of PWS will change depending on age, although core phenotypes of hyperphagia, obesity and psychiatric issues stay for lifetime. Therefore, integrated multidisciplinary approach starting from neonatal period is mandatory to ensure optimal management to improve lifelong quality of life. For successful transition from childhood to adulthood, multidisciplinary team need to share clinical information, and should keep the same policy about food, environment and psychiatric issues.

Top 10 metrics for life science software good practices

PubMed Central

2016-01-01

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

Using evaluation to improve program quality based on the BELL model.

PubMed

Phalen, Earl Martin; Cooper, Tiffany M

2007-01-01

Building Educated Leaders for Life (BELL) is a national not-for-profit organization whose mission is to increase the educational achievements, self-esteem, and life opportunities of elementary school children living in low-income urban communities. BELL has been engaged in formal evaluation, internally and externally, for more than five years and has built internal evaluation capacity by investing in a specialized full-time evaluation team. As part of a continuous program improvement model of evaluation, BELL uses the data to refine program implementation and replicate successful elements of the services and operations. In this chapter, the authors highlight best practices from the field by outlining BELL's approach to using evaluation data for continuous program improvement. Key strategies include (1) carefully identifying intended users of the evaluation throughout the organization and among its external stakeholders, then working closely with intended users throughout the evaluation process, ensuring full engagement at every step of the process; (2) reporting findings in a readable, user-friendly format and timing the reporting so that it is aligned with programmatic decision making and planning cycles; and (3) making and supporting explicit recommendations for the next program cycle, where intended users have agreed to recommendations and ownership is assigned. BELL's successful use of data for improvement is evidenced by the consistently strong outcomes for the students it serves as well as increased efficiency and satisfaction related to service delivery that has supported the replication of BELL's programs nationally.

Promoting and Protecting Public Health: How the European Union Pharmacovigilance System Works.

PubMed

Santoro, Aniello; Genov, Georgy; Spooner, Almath; Raine, June; Arlett, Peter

2017-10-01

This article provides an overview of the European Union pharmacovigilance system resulting from the rationalisation and strengthening delivered through the implementation of the revised pharmacovigilance legislation. It outlines the system aims, underlying principles, components and drivers for future change. At its core, the Pharmacovigilance Risk Assessment Committee is responsible for assessing all aspects of the risk management of medicinal products, thus ensuring that medicines approved for the European Union market are optimally used by maximising their benefits and minimising risks. The main objectives of the system are to promote and protect public health by supporting the availability of medicines including those that fulfil previously unmet medical needs, and reducing the burden of adverse drug reactions. These are achieved through a proactive, risk proportionate and patient-centred approach, with high levels of transparency and engagement of civil society. In the European Union, pharmacovigilance is now fully integrated into the life cycle of medicinal products, with the planning of pharmacovigilance activities commencing before a medicine is placed on the market, and companies encouraged to start planning very early in development for high-innovation products. After authorisation, information on the safety of medicines continues to be obtained through a variety of sources, including spontaneous reports of adverse drug reactions or monitoring real-world data. Finally, the measurement of the impact of pharmacovigilance activities, auditing and inspections, as well as capacity building ensure that the system undergoes continuous improvement and can always rely on the best methodologies to safeguard public health.

Difficult airway response team: a novel quality improvement program for managing hospital-wide airway emergencies.

PubMed

Mark, Lynette J; Herzer, Kurt R; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I; Berkow, Lauren C; Haut, Elliott R; Hillel, Alexander T; Miller, Christina R; Feller-Kopman, David J; Schiavi, Adam J; Xie, Yanjun J; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W; Mirski, Marek A

2015-07-01

Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which >200 providers were trained. DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.

Difficult Airway Response Team: A Novel Quality Improvement Program for Managing Hospital-Wide Airway Emergencies

PubMed Central

Mark, Lynette J.; Herzer, Kurt R.; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I.; Berkow, Lauren C.; Haut, Elliott R.; Hillel, Alexander T.; Miller, Christina R.; Feller-Kopman, David J.; Schiavi, Adam J.; Xie, Yanjun J.; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W.; Mirski, Marek A.

2015-01-01

Background Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. Methods We developed a quality improvement program—the Difficult Airway Response Team (DART)—to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had three core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Results Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index > 40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which more than 200 providers were trained. Conclusions DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care. PMID:26086513

30 CFR 885.16 - After OSM approves my grant, what responsibilities do I have?

Code of Federal Regulations, 2010 CFR

2010-07-01

... expend any funds until we have ensured that all necessary actions have been taken by you and us to ensure compliance with the National Environmental Policy Act of 1969 (NEPA) (42 U.S.C. 4321 et seq.) and any other... continuation grant or to enter into any grant revision, including grant increases to cover cost overruns. ...

Throwing down the Gauntlet: Ten Ways to Ensure That Higher Education Research Continues to Matter

ERIC Educational Resources Information Center

Perna, Laura W.

2016-01-01

As members of ASHE, we have an obligation to ensure that ASHE is an association that both promotes career development of members and advances the production and dissemination of high-quality research-based knowledge on current and emerging issues in higher education. In this presidential address, I look to the future of ASHE, offering questions…

Power Parenting for Children with ADD/ADHD: A Practical Parent's Guide for Managing Difficult Behaviors.

ERIC Educational Resources Information Center

Flick, Grad L.

The first step in dealing with an attention deficit disorder (ADD/ADHD) child's difficult behavior is to understand its origins. This book presents behavior management techniques to help parents care for their ADD child while ensuring that the child continues to develop positive, healthy self-esteem. The guide shows how to: (1) ensure an accurate…

Promoting Strong ISO 50001 Outcomes with Supportive National Infrastructure

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

McKane, Aimee, T.; Siciliano, Graziella; de los Reyes, Pamela

The ISO 50001 standard is a key mechanism for reducing greenhouse gas emissions and improving energy efficiency globally. An increasing number of companies are seeking certification, creating the need for personnel that are competent to conduct ISO 50001 certification audits. The growth of ISO 50001 is expected to accelerate as more companies integrate ISO 50001 into their corporate sustainability strategies and supplier requirements. Robust implementation of ISO 50001 represents an important tool for countries with climate change mitigation goals. Because of its dual focus on continual improvement of an organization’s energy management system (EnMS) and its energy performance improvement, ISOmore » 50001 requires skills of both implementers and certification auditors that are not well-supported by current credentials and training. This paper describes an effort to address skill gaps of certification auditors, a critical factor to ensure that ISO 50001 implementations are robust and result in continued energy performance improvement. A collaboration of governments through the Energy Management Working Group (EMWG), formerly under Global Superior Energy Performance (GSEP), has formed to build workforce capacity for ISO 50001 certification audits. The EMWG is leading the development of an internationally-relevant certification scheme for ISO 50001 Lead Auditor that meets requirements for ISO/IEC 17024 accreditation and ISO 50003 for defining ISO 50001 Lead Auditor competency. Wider availability of competent ISO 50001 Lead Auditors will ultimately increase the impact and market value of ISO 50001 certification and improve consistency of ISO 50001 certification outcomes by establishing a standardized and high level of knowledge and skills globally.« less

[Maternal discharge: conditions and organization for mothers and newborns returning home. The French National Authority for Health recommendations update].

PubMed

Hascoët, J-M; Petitprez, K

2014-09-01

In light of changes in both medical practices and the organization of medical care, the French National Authority for Health (Haute Autorité de santé, HAS) proposed new recommendations on the discharge of mothers and newborns, updating its 2004 recommendations on early discharge of mothers and newborns. This decision in turn made it necessary to define optimal discharge conditions and accompanying measures for mothers and infants returning home. The problem was approached by adopting the usual HAS methodology for drafting good practice recommendations. This involved establishing a working group bringing together representatives of all medical and care fields related to perinatology as well as patient representatives. This working group submitted draft recommendations, based on updated published references, to a committee. The committee then proposed amendments to the recommendations, which the working group was free to accept or reject. The updated recommendations that emerged from this process apply four essential principles : first, preparing for discharge as early as the prenatal period, ideally during the third trimester of pregnancy, in particular by providing expectant mothers with information on how the discharge will be organized and anticipating problems that might arise; second, ensuring care continuity between hospitalization, discharge to home, and follow-up; third, ensuring optimal conditions for discharge after a maternity stay of 72-96 h for normal delivery or 96-120 h in case of caesarean section (this hospital stay duration allows for neonatal screening); and fourth, defining how mothers and children are to be accompanied during the first postnatal month. In conclusion, these recommendations resulted in an increase in the duration of as well as an improvement in routine newborn surveillance, whether in hospital or after discharge, in what is a critical phase of infant development. They encourage ambulatory postnatal monitoring. The new recommendations ensure continuity of care while taking into account mothers' and couples' wish to take responsibility for organizing their own healthcare. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Unlocking information for coordination of care in Australia: a qualitative study of information continuity in four primary health care models

PubMed Central

2013-01-01

Background Coordination of care is considered a key component of patient-centered health care systems, but is rarely defined or operationalised in health care policy. Continuity, an aspect of coordination, is the patient’s experience of care over time, and is often described in terms of three dimensions: information, relational and management continuity. With the current health policy focus on both the use of information technology and care coordination, this study aimed to 1) explore how information continuity supports coordination and 2) investigate conditions required to support information continuity. Methods Four diverse Australian primary health care initiatives were purposively selected for inclusion in the study. Each has improved coordination as an aim or fundamental principle. Each organization was asked to identify practitioners, managers and decision makers who could provide insight into the use of information for care coordination to participate in the study. Using in-depth semi-structured interviews, we explored four questions covering the scope and use of information, the influence of governance, data ownership and confidentiality and the influence of financial incentives and quality improvement on information continuity and coordination. Data were thematically analyzed using NVivo 8. Results The overall picture that emerged across all four cases was that whilst accessibility and continuity of information underpin effective care, they are not sufficient for coordination of care for complex conditions. Shared information reduced unnecessary repetition and provided health professionals with the opportunity to access records of care from other providers, but participants described their role in coordination in terms of the active involvement of a person in care rather than the passive availability of information. Complex issues regarding data ownership and confidentiality often hampered information sharing. Successful coordination in each case was associated with responsiveness to local rather than system level factors. Conclusions The availability of information is not sufficient to ensure continuity for the patient or coordination from the systems perspective. Policy directed at information continuity must give consideration to the broader ‘fit’ with management and relational continuity and provide a broad base that allows for local responsiveness in order for coordination of care to be achieved. PMID:23497291

Unlocking information for coordination of care in Australia: a qualitative study of information continuity in four primary health care models.

PubMed

Banfield, Michelle; Gardner, Karen; McRae, Ian; Gillespie, James; Wells, Robert; Yen, Laurann

2013-03-13

Coordination of care is considered a key component of patient-centered health care systems, but is rarely defined or operationalised in health care policy. Continuity, an aspect of coordination, is the patient's experience of care over time, and is often described in terms of three dimensions: information, relational and management continuity. With the current health policy focus on both the use of information technology and care coordination, this study aimed to 1) explore how information continuity supports coordination and 2) investigate conditions required to support information continuity. Four diverse Australian primary health care initiatives were purposively selected for inclusion in the study. Each has improved coordination as an aim or fundamental principle. Each organization was asked to identify practitioners, managers and decision makers who could provide insight into the use of information for care coordination to participate in the study. Using in-depth semi-structured interviews, we explored four questions covering the scope and use of information, the influence of governance, data ownership and confidentiality and the influence of financial incentives and quality improvement on information continuity and coordination. Data were thematically analyzed using NVivo 8. The overall picture that emerged across all four cases was that whilst accessibility and continuity of information underpin effective care, they are not sufficient for coordination of care for complex conditions. Shared information reduced unnecessary repetition and provided health professionals with the opportunity to access records of care from other providers, but participants described their role in coordination in terms of the active involvement of a person in care rather than the passive availability of information. Complex issues regarding data ownership and confidentiality often hampered information sharing. Successful coordination in each case was associated with responsiveness to local rather than system level factors. The availability of information is not sufficient to ensure continuity for the patient or coordination from the systems perspective. Policy directed at information continuity must give consideration to the broader 'fit' with management and relational continuity and provide a broad base that allows for local responsiveness in order for coordination of care to be achieved.

Perceptions of registered nurses in four state health insititutions on continuing formal education.

PubMed

Richards, L; Potgieter, E

2010-06-01

This study investigated registered nurses in four selected state health institutions' perceptions with regard to continuing formal education. The relevance of continuing formal education is being emphasised globally by the increasing quest for quality assurance and quality management systems within an ethos of continuous improvement. According to Tlholoe (2006:5), it is important to be committed to continual learning, as people's knowledge become less relevant because skills gained early in a career are insufficient to avoid costly mistakes made through ignorance. Continuing formal education in nursing is a key element to the maintenance of quality in health care delivery. The study described: registered nurses' views on continuing formal education. Registered nurses' perceived barriers to continuing formal education. A quantitative descriptive survey design was chosen using a questionnaire for data collection. The sample consisted of 40 registered nurses working at four state health institutions in the Western Cape Province, South Africa. Convenience sampling was selected to include registered nurses who were on duty on the days during which the researcher visited the health institutions to distribute the questionnaires. The questionnaire contained mainly closed-ended and a few open-ended questions. Content validity of the instrument was ensured by doing a thorough literature review before construction of items and a pretest. Reliability was established by the pretest and providing the same information to all respondents before completion of the questionnaires. The ethical considerations of informed consent, anonymity and confidentiality were adhered to and consent to conduct the study was obtained from relevant authorities. Descriptive statistics, based on calculations using the Microsoft (MS) Excel (for Windows 2000) programme, were used to summarise and describe the research results. The research results indicated that most registered nurses perceive continuing formal education as beneficial to their personal and professional growth and that it could lead towards improving the quality of patient/client care, but barriers exist which prevent or deter them from undertaking continuing formal education programmes. The main structural barriers included lack of funding and lack of coherent staff development planning and physical barriers including job and family responsibilities.

Legislation should support optimal breastfeeding practices and access to low-cost, high-quality complementary foods: Indonesia provides a case study.

PubMed

Soekarjo, Damayanti; Zehner, Elizabeth

2011-10-01

It is important to support women to exclusively breastfeed for 6 months and continue breastfeeding for 24 months and beyond. It is also necessary to provide the poor with access to affordable ways to improve the quality of complementary foods. Currently, many countries do not have the legal and policy environment necessary to support exclusive and continued breastfeeding. Legislative and policy changes are also necessary for introducing complementary food supplements, allowing them to be marketed to those who need them, and ensuring that marketing remains appropriate and in full compliance with the International Code of Marketing of Breastmilk Substitutes. This paper aims to illustrate the above with examples from Indonesia and to identify legislative requirements for supporting breastfeeding and enabling appropriate access to high-quality complementary food supplements for children 6-24 months of age. Requirements include improved information, training, monitoring and enforcement systems for the International Code of Marketing of Breastmilk Substitutes; implementation and monitoring of the Baby-Friendly Hospital Initiative; establishment of a registration category for complementary food supplements to enhance availability of high-quality, low-cost fortified products to help improve young child feeding; clear identification and marketing of these products as complementary food supplements for 6-24-month-olds so as to promote proper use and not interfere with breastfeeding. © 2011 Blackwell Publishing Ltd.

Continuing Education Records: Can They Withstand Scrutiny?

ERIC Educational Resources Information Center

Shimberg, Benjamin

The need for ensuring the educational quality of experiences pursued by practitioners to satisfy their continuing education requirements and the difficulties of evaluating the experiences are addressed. Because of financial constraints placed on state regulatory boards and state professional associations, neither is equipped to handle the…

14 CFR 35.4 - Instructions for Continued Airworthiness.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AIRCRAFT AIRWORTHINESS STANDARDS: PROPELLERS General § 35.4 Instructions for Continued Airworthiness. The... program exists to ensure their completion prior to delivery of the first aircraft with the propeller installed, or upon issuance of a standard certificate of airworthiness for an aircraft with the propeller...

14 CFR 35.4 - Instructions for Continued Airworthiness.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AIRCRAFT AIRWORTHINESS STANDARDS: PROPELLERS General § 35.4 Instructions for Continued Airworthiness. The... program exists to ensure their completion prior to delivery of the first aircraft with the propeller installed, or upon issuance of a standard certificate of airworthiness for an aircraft with the propeller...

14 CFR 35.4 - Instructions for Continued Airworthiness.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AIRCRAFT AIRWORTHINESS STANDARDS: PROPELLERS General § 35.4 Instructions for Continued Airworthiness. The... program exists to ensure their completion prior to delivery of the first aircraft with the propeller installed, or upon issuance of a standard certificate of airworthiness for an aircraft with the propeller...

14 CFR 35.4 - Instructions for Continued Airworthiness.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AIRCRAFT AIRWORTHINESS STANDARDS: PROPELLERS General § 35.4 Instructions for Continued Airworthiness. The... program exists to ensure their completion prior to delivery of the first aircraft with the propeller installed, or upon issuance of a standard certificate of airworthiness for an aircraft with the propeller...

14 CFR 35.4 - Instructions for Continued Airworthiness.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AIRCRAFT AIRWORTHINESS STANDARDS: PROPELLERS General § 35.4 Instructions for Continued Airworthiness. The... program exists to ensure their completion prior to delivery of the first aircraft with the propeller installed, or upon issuance of a standard certificate of airworthiness for an aircraft with the propeller...

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

Walters, William; Hyde, Embriette R.; Berg-Lyons, Donna

ABSTRACT Designing primers for PCR-based taxonomic surveys that amplify a broad range of phylotypes in varied community samples is a difficult challenge, and the comparability of data sets amplified with varied primers requires attention. Here, we examined the performance of modified 16S rRNA gene and internal transcribed spacer (ITS) primers for archaea/bacteria and fungi, respectively, with nonaquatic samples. We moved primer bar codes to the 5′ end, allowing for a range of different 3′ primer pairings, such as the 515f/926r primer pair, which amplifies variable regions 4 and 5 of the 16S rRNA gene. We additionally demonstrated that modifications tomore » the 515f/806r (variable region 4) 16S primer pair, which improves detection ofThaumarchaeotaand clade SAR11 in marine samples, do not degrade performance on taxa already amplified effectively by the original primer set. Alterations to the fungal ITS primers did result in differential but overall improved performance compared to the original primers. In both cases, the improved primers should be widely adopted for amplicon studies. ImportanceWe continue to uncover a wealth of information connecting microbes in important ways to human and environmental ecology. As our scientific knowledge and technical abilities improve, the tools used for microbiome surveys can be modified to improve the accuracy of our techniques, ensuring that we can continue to identify groundbreaking connections between microbes and the ecosystems they populate, from ice caps to the human body. It is important to confirm that modifications to these tools do not cause new, detrimental biases that would inhibit the field rather than continue to move it forward. We therefore demonstrated that two recently modified primer pairs that target taxonomically discriminatory regions of bacterial and fungal genomic DNA do not introduce new biases when used on a variety of sample types, from soil to human skin. This confirms the utility of these primers for maintaining currently recommended microbiome research techniques as the state of the art.« less

Ensuring quality: a key consideration in scaling-up HIV-related point-of-care testing programs

PubMed Central

Fonjungo, Peter N.; Osmanov, Saladin; Kuritsky, Joel; Ndihokubwayo, Jean Bosco; Bachanas, Pam; Peeling, Rosanna W.; Timperi, Ralph; Fine, Glenn; Stevens, Wendy; Habiyambere, Vincent; Nkengasong, John N.

2016-01-01

Objective: The objective of the WHO/US President's Emergency Plan for AIDS Relief consultation was to discuss innovative strategies, offer guidance, and develop a comprehensive policy framework for implementing quality-assured HIV-related point-of-care testing (POCT). Methods: The consultation was attended by representatives from international agencies (WHO, UNICEF, UNITAID, Clinton Health Access Initiative), United States Agency for International Development, Centers for Disease Control and Prevention/President's Emergency Plan for AIDS Relief Cooperative Agreement Partners, and experts from more than 25 countries, including policy makers, clinicians, laboratory experts, and program implementers. Main outcomes: There was strong consensus among all participants that ensuring access to quality of POCT represents one of the key challenges for the success of HIV prevention, treatment, and care programs. The following four strategies were recommended: implement a newly proposed concept of a sustainable quality assurance cycle that includes careful planning; definition of goals and targets; timely implementation; continuous monitoring; improvements and adjustments, where necessary; and a detailed evaluation; the importance of supporting a cadre of workers [e.g. volunteer quality corps (Q-Corps)] with the role to ensure that the quality assurance cycle is followed and sustained; implementation of the new strategy should be seen as a step-wise process, supported by development of appropriate policies and tools; and joint partnership under the leadership of the ministries of health to ensure sustainability of implementing novel approaches. Conclusion: The outcomes of this consultation have been well received by program implementers in the field. The recommendations also laid the groundwork for developing key policy and quality documents for the implementation of HIV-related POCT. PMID:26807969

The effect of various parameters of large scale radio propagation models on improving performance mobile communications

NASA Astrophysics Data System (ADS)

Pinem, M.; Fauzi, R.

2018-02-01

One technique for ensuring continuity of wireless communication services and keeping a smooth transition on mobile communication networks is the soft handover technique. In the Soft Handover (SHO) technique the inclusion and reduction of Base Station from the set of active sets is determined by initiation triggers. One of the initiation triggers is based on the strong reception signal. In this paper we observed the influence of parameters of large-scale radio propagation models to improve the performance of mobile communications. The observation parameters for characterizing the performance of the specified mobile system are Drop Call, Radio Link Degradation Rate and Average Size of Active Set (AS). The simulated results show that the increase in altitude of Base Station (BS) Antenna and Mobile Station (MS) Antenna contributes to the improvement of signal power reception level so as to improve Radio Link quality and increase the average size of Active Set and reduce the average Drop Call rate. It was also found that Hata’s propagation model contributed significantly to improvements in system performance parameters compared to Okumura’s propagation model and Lee’s propagation model.

40 CFR 94.211 - Emission-related maintenance instructions for purchasers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM MARINE COMPRESSION-IGNITION ENGINES..., replacement, or repair of the emission control devices and systems may be performed by any engine repair... and necessary to ensure the proper functioning of the engine's emission control systems. If the...

40 CFR 94.211 - Emission-related maintenance instructions for purchasers.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM MARINE COMPRESSION-IGNITION ENGINES..., replacement, or repair of the emission control devices and systems may be performed by any engine repair... and necessary to ensure the proper functioning of the engine's emission control systems. If the...

40 CFR 94.211 - Emission-related maintenance instructions for purchasers.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM MARINE COMPRESSION-IGNITION ENGINES..., replacement, or repair of the emission control devices and systems may be performed by any engine repair... and necessary to ensure the proper functioning of the engine's emission control systems. If the...

Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve.

PubMed

Boone, Brian A; Zenati, Mazen; Hogg, Melissa E; Steve, Jennifer; Moser, Arthur James; Bartlett, David L; Zeh, Herbert J; Zureikat, Amer H

2015-05-01

Quality assessment is an important instrument to ensure optimal surgical outcomes, particularly during the adoption of new surgical technology. The use of the robotic platform for complex pancreatic resections, such as the pancreaticoduodenectomy, requires close monitoring of outcomes during its implementation phase to ensure patient safety is maintained and the learning curve identified. To report the results of a quality analysis and learning curve during the implementation of robotic pancreaticoduodenectomy (RPD). A retrospective review of a prospectively maintained database of 200 consecutive patients who underwent RPD in a large academic center from October 3, 2008, through March 1, 2014, was evaluated for important metrics of quality. Patients were analyzed in groups of 20 to minimize demographic differences and optimize the ability to detect statistically meaningful changes in performance. Robotic pancreaticoduodenectomy. Optimization of perioperative outcome parameters. No statistical differences in mortality rates or major morbidity were noted during the study. Statistical improvements in estimated blood loss and conversions to open surgery occurred after 20 cases (600 mL vs 250 mL [P = .002] and 35.0% vs 3.3% [P < .001], respectively), incidence of pancreatic fistula after 40 cases (27.5% vs 14.4%; P = .04), and operative time after 80 cases (581 minutes vs 417 minutes [P < .001]). Complication rates, lengths of stay, and readmission rates showed continuous improvement that did not reach statistical significance. Outcomes for the last 120 cases (representing optimized metrics beyond the learning curve) included a mean operative time of 417 minutes, median estimated blood loss of 250 mL, a conversion rate of 3.3%, 90-day mortality of 3.3%, a clinically significant (grade B/C) pancreatic fistula rate of 6.9%, and a median length of stay of 9 days. Continuous assessment of quality metrics allows for safe implementation of RPD. We identified several inflexion points corresponding to optimization of performance metrics for RPD that can be used as benchmarks for surgeons who are adopting this technology.

[Mental health: an identification of new directions walking in Archie Cochrane footsteps].

PubMed

Tansella, Michele

2006-10-01

New borders and promising new directions in scientific fields are often difficult to identify and define. This paper attempts to it so in relation to recent developments and new research evidence in mental health, recognizing that this exercise may be biased by many factors, including: the author's own perspective, professional background and research training and the always present dialectic between the analysis of the past and the attraction of the future. A good starting point is the ground-breaking work by Sir Archibald Cochrane. He recommended to adopt a rigorous and continuous evaluation of clinical practice and protocols, promoting well designed clinical research and the use of scientific methods. This evidence-based approach should also be used in mental health. High quality research, continuous education and good clinical practice, incorporating the results of scientific experiments and observations, represent the approach that ensures an improvement in care provision and patient satisfaction. Currently, mental health care is still too "opinion oriented", due to the over emphasis placed on personal experience and traditional approaches by many psychiatrists. In this paper some of the most promising recent results in psychosocial research, psychopharmacological studies and genetics, as well as in neuroimaging studies, are briefly summarised. From a pragmatic point of view, it is possible to achieve a significant improvement in the quality of mental health care if the following procedure is followed: firstly, to start from solid evidence; secondly, to promote the wide implementation of evidence-based research into every day practice; thirdly, to ensure that administrators and policy makers incorporate the available scientific evidence in the planning and evaluating services and mental health systems of care. The integration between research, education and practice remains the hardest border to cross, yet the achievement of it holds the greatest promise for better mental health care in the future.

Emergency preparedness for genetics centers, laboratories, and patients: the Southeast Region Genetics Collaborative strategic plan.

PubMed

Andersson, Hans C; Perry, William; Bowdish, Bruce; Floyd-Browning, Phaidra

2011-10-01

Emergencies occur unpredictably and interrupt routine genetic care. The events after hurricanes Katrina and Rita have led to the recognition that a coherent plan is necessary to ensure continuity of operations for genetic centers and laboratories, including newborn screening. No geographic region is protected from the effects of a variety of potential emergencies. Regional and national efforts have begun to address the need for such preparedness, but a plan for ensuring continuity of operations by creating an emergency preparedness plan must be developed for each genetic center and laboratory, with attention to the interests of patients. This article describes the first steps in development of an emergency preparedness plan for individual centers.

Sports and recreational injuries in children and adolescents: prevention and education.

PubMed

Davis, Elaine K

2004-01-01

Youth and children's sports are becoming increasingly popular in America. Previous studies have shown that children and adolescents are not small adults in their responses to exercise and stress. As children around the world become involved in more competitive and organized sports activities, the frequency and severity of acute and overuse injuries continue to rise. Safety guidelines, protective equipment and prevention education are crucial to reducing pediatric recreational and sports injuries. Preventing injuries and ensuring safe athletic practices are necessary for children and adolescents to continue to receive benefits from organized sports and recreational activities. Efforts to minimize these injuries are warranted both to ensure the long-term health of children and to reduce medical costs.

Mineral supply for sustainable development requires resource governance.

PubMed

Ali, Saleem H; Giurco, Damien; Arndt, Nicholas; Nickless, Edmund; Brown, Graham; Demetriades, Alecos; Durrheim, Ray; Enriquez, Maria Amélia; Kinnaird, Judith; Littleboy, Anna; Meinert, Lawrence D; Oberhänsli, Roland; Salem, Janet; Schodde, Richard; Schneider, Gabi; Vidal, Olivier; Yakovleva, Natalia

2017-03-15

Successful delivery of the United Nations sustainable development goals and implementation of the Paris Agreement requires technologies that utilize a wide range of minerals in vast quantities. Metal recycling and technological change will contribute to sustaining supply, but mining must continue and grow for the foreseeable future to ensure that such minerals remain available to industry. New links are needed between existing institutional frameworks to oversee responsible sourcing of minerals, trajectories for mineral exploration, environmental practices, and consumer awareness of the effects of consumption. Here we present, through analysis of a comprehensive set of data and demand forecasts, an interdisciplinary perspective on how best to ensure ecologically viable continuity of global mineral supply over the coming decades.

Mineral supply for sustainable development requires resource governance

USGS Publications Warehouse

Ali, Saleem H.; Giurco, Damien; Arndt, Nicholas; Nickless, Edmund; Brown, Graham; Demetriades, Alecos; Durrheim, Ray; Enriquez, Maria Amélia; Kinnaird, Judith; Littleboy, Anna; Meinert, Lawrence D.; Oberhänsli, Roland; Salem, Janet; Schodde, Richard; Schneider, Gabi; Vidal, Olivier; Yakovleva, Natalia

2017-01-01

Successful delivery of the United Nations sustainable development goals and implementation of the Paris Agreement requires technologies that utilize a wide range of minerals in vast quantities. Metal recycling and technological change will contribute to sustaining supply, but mining must continue and grow for the foreseeable future to ensure that such minerals remain available to industry. New links are needed between existing institutional frameworks to oversee responsible sourcing of minerals, trajectories for mineral exploration, environmental practices, and consumer awareness of the effects of consumption. Here we present, through analysis of a comprehensive set of data and demand forecasts, an interdisciplinary perspective on how best to ensure ecologically viable continuity of global mineral supply over the coming decades.

Mineral supply for sustainable development requires resource governance

NASA Astrophysics Data System (ADS)

Ali, Saleem H.; Giurco, Damien; Arndt, Nicholas; Nickless, Edmund; Brown, Graham; Demetriades, Alecos; Durrheim, Ray; Enriquez, Maria Amélia; Kinnaird, Judith; Littleboy, Anna; Meinert, Lawrence D.; Oberhänsli, Roland; Salem, Janet; Schodde, Richard; Schneider, Gabi; Vidal, Olivier; Yakovleva, Natalia

2017-03-01

Successful delivery of the United Nations sustainable development goals and implementation of the Paris Agreement requires technologies that utilize a wide range of minerals in vast quantities. Metal recycling and technological change will contribute to sustaining supply, but mining must continue and grow for the foreseeable future to ensure that such minerals remain available to industry. New links are needed between existing institutional frameworks to oversee responsible sourcing of minerals, trajectories for mineral exploration, environmental practices, and consumer awareness of the effects of consumption. Here we present, through analysis of a comprehensive set of data and demand forecasts, an interdisciplinary perspective on how best to ensure ecologically viable continuity of global mineral supply over the coming decades.

Overdiagnosis in imaging.

PubMed

Díaz Candamio, M J; Jha, S; Martel Villagrán, J

2018-04-21

Overdiagnosis, more than an error regarding the diagnosis, is an error regarding the prognosis. We cannot know what consequences some lesions that we detect by imaging would have on our patients' lives if they were left untreated. As long as it is not possible for imaging techniques to differentiate between lesions that will have an indolent course from those that will have an aggressive course, there will be overdiagnosis. Advanced imaging techniques, radiomics, and radiogenomics, together with artificial intelligence, promise advances in this sense. In the meantime, it is important that radiologists be careful to ensure that only strictly necessary imaging tests are done. Moreover, we need to participate, together with patients, in making multidisciplinary decisions about diagnosis and clinical management. Finally, of course, we need to continue to contribute to the technological and scientific advance of our profession, so that we can continue to improve the diagnosis and early detection of abnormalities, especially those that require treatment. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues.

PubMed

Minear, Mollie A; Alessi, Stephanie; Allyse, Megan; Michie, Marsha; Chandrasekharan, Subhashini

2015-01-01

Noninvasive prenatal genetic testing (NIPT) for chromosomal aneuploidy involving the analysis of cell-free fetal DNA became commercially available in 2011. The low false-positive rate of NIPT, which reduces unnecessary prenatal invasive diagnostic procedures, has led to broad clinician and patient adoption. We discuss the ethical, legal, and social issues raised by rapid and global dissemination of NIPT. The number of women using NIPT is anticipated to expand, and the number of conditions being tested for will continue to increase as well, raising concerns about the routinization of testing and negative impacts on informed decision making. Ensuring that accurate and balanced information is available to all pregnant women and that access to NIPT is equitable will require policy guidance from regulators, professional societies, and payers. Empirical evidence about stakeholders' perspectives and experiences will continue to be essential in guiding policy development so that advances in NIPT can be used effectively and appropriately to improve prenatal care.

Postoperative pain control after arthroscopic rotator cuff repair.

PubMed

Uquillas, Carlos A; Capogna, Brian M; Rossy, William H; Mahure, Siddharth A; Rokito, Andrew S

2016-07-01

Arthroscopic rotator cuff repair (ARCR) can provide excellent clinical results for patients who fail to respond to conservative management of symptomatic rotator cuff tears. ARCR, however, can be associated with severe postoperative pain and discomfort that requires adequate analgesia. As ARCR continues to shift toward being performed as an outpatient procedure, it is incumbent on physicians and ambulatory surgical centers to provide appropriate pain relief with minimal side effects to ensure rapid recovery and safe discharge. Although intravenous and oral opioids are the cornerstone of pain management after orthopedic procedures, they are associated with drowsiness, nausea, vomiting, and increased length of hospital stay. As health care reimbursements continue to become more intimately focused on quality, patient satisfaction, and minimizing of complications, the need for adequate pain control with minimal complications will continue to be a principal focus for providers and institutions alike. We present a review of alternative modalities for pain relief after ARCR, including cryotherapy, intralesional anesthesia, nerve blockade, indwelling continuous nerve block catheters, and multimodal anesthesia. In choosing among these modalities, physicians should consider patient- and system-based factors to allow the efficient delivery of analgesia that optimizes recovery and improves patient satisfaction. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Continuing Professional Development: Lifelong Learning of Millions

ERIC Educational Resources Information Center

Friedman, Andrew L.

2011-01-01

Continuing Professional Development (CPD) is the means by which the professions across the world ensure that their knowledge and skills remain up to date and relevant to changing needs and environments. CPD significantly contributes to the quality and reputation of the professions and therefore to the quality of national and international social…

40 CFR 1065.309 - Continuous gas analyzer system-response and updating-recording verification-for gas analyzers...

Code of Federal Regulations, 2010 CFR

2010-07-01

... change the system response. (b) Measurement principles. This procedure verifies that the updating and... gas detectors used to generate a continuously combined/compensated concentration measurement signal... verifies that the measurement system meets a minimum response time. For this procedure, ensure that all...

32 CFR 635.24 - Updating the COPS MPRS.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 4 2011-07-01 2011-07-01 false Updating the COPS MPRS. 635.24 Section 635.24 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND... ensure that every founded offense is reported into the COPS MPRS. Timely and accurate reporting is...

32 CFR 635.24 - Updating the COPS MPRS.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Updating the COPS MPRS. 635.24 Section 635.24 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND... ensure that every founded offense is reported into the COPS MPRS. Timely and accurate reporting is...

7 CFR 170.11 - How are farmers and vendors selected for participation in the USDA Farmers Market?

Code of Federal Regulations, 2010 CFR

2010-01-01

... Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) MISCELLANEOUS MARKETING PRACTICES UNDER THE AGRICULTURAL MARKETING ACT... products to be sold. The selection of the participants is conducted by the market management to ensure a...

Continuous Professional Development of English Language Teachers: Perception and Practices

ERIC Educational Resources Information Center

Al Asmari, AbdulRahman

2016-01-01

Professional development is considered as an essential element in enhancing the teaching and learning process to ensure student learning. Professional development can also be deemed as a cornerstone of teacher professionalism and quality. The governments and educational institutions invest significantly in Continuous Professional Development (CPD)…

Ensuring and Improving Information Quality for Earth Science Data and Products Role of the ESIP Information Quality Cluster

NASA Technical Reports Server (NTRS)

Ramapriyan, H. K. (Rama); Peng, Ge; Moroni, David; Shie, Chung-Lin

2016-01-01

Quality of products is always of concern to users regardless of the type of products. The focus of this paper is on the quality of Earth science data products. There are four different aspects of quality scientific, product, stewardship and service. All these aspects taken together constitute Information Quality. With increasing requirement on ensuring and improving information quality, there has been considerable work related to information quality during the last several years. Given this rich background of prior work, the Information Quality Cluster (IQC), established within the Federation of Earth Science Information Partners (ESIP) has been active with membership from multiple organizations. Its objectives and activities, aimed at ensuring and improving information quality for Earth science data and products, are discussed briefly.

Ensuring and Improving Information Quality for Earth Science Data and Products: Role of the ESIP Information Quality Cluster

NASA Technical Reports Server (NTRS)

Ramapriyan, Hampapuram; Peng, Ge; Moroni, David; Shie, Chung-Lin

2016-01-01

Quality of products is always of concern to users regardless of the type of products. The focus of this paper is on the quality of Earth science data products. There are four different aspects of quality - scientific, product, stewardship and service. All these aspects taken together constitute Information Quality. With increasing requirement on ensuring and improving information quality, there has been considerable work related to information quality during the last several years. Given this rich background of prior work, the Information Quality Cluster (IQC), established within the Federation of Earth Science Information Partners (ESIP) has been active with membership from multiple organizations. Its objectives and activities, aimed at ensuring and improving information quality for Earth science data and products, are discussed briefly.

Interdisciplinary integration for quality improvement: the Cleveland Veterans Affairs Medical Center Firm System.

PubMed

Aucott, J N; Pelecanos, E; Bailey, A J; Shupe, T C; Romeo, J H; Ravdin, J I; Aron, D C

1995-04-01

Many of the characteristics of Firm Systems lend themselves to the application of principles of continuous quality improvement (CQI). A Firm System is defined as two or more parallel practices organized on the principle of continuity of relationships between patients and an interdisciplinary group of health care professionals and trainees. Firm Systems are organized around the care of the patient or customer and emphasize access, continuity, and quality of care. The Firm System was implemented at the Cleveland Veterans Affairs Medical Center (VAMC) not as a CQI initiative per se, but as an effort to coordinate the processes involved in the delivery of patient care. The primary goals of this implementation were to improve the quality of patient care, medical education, and health care research. The main strategy to deal with problems caused by uncoordinated care were to move from a departmental approach to an integrated interdisciplinary approach. This approach represented a paradigm shift within the organization that extended to planning, documentation, and the general work environment. Most important, the institution had leaders who were committed to the Firm System and willing to authorize resources to ensure its success. VA hospitals are ideal settings for Firm Systems because they provide longitudinal, comprehensive care with a centralized, prepaid payment mechanism, and they have well-developed information systems that allow the random assignment of patients to Firms. Recommendations to others interested in implementing Firm Systems include creation of a written plan that can gain general support; identification of resources needed for successful implementation; remembering that the patient is the most important customer, as well as that complex systems have many customers; monitoring of performance; and the importance of randomizing patients and providers.

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

PubMed Central

Wearne, Nicola; Kilonzo, Kajiru; Effa, Emmanuel; Davidson, Bianca; Nourse, Peter; Ekrikpo, Udeme; Okpechi, Ikechi G

2017-01-01

Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes. PMID:28115864

A corporate treasurer toolkit to ensure fund delivery in disaster zones.

PubMed

Parandeh, Sassan Cyrus

In a disaster situation, the corporate treasury department of an organisation is also responsible for ensuring business continuity. The treasury department's key role would be to ensure that vendors, suppliers and employees are adequately remunerated and that operations do not seize due to a lack of working capital. Treasury practitioners concerned with business continuity have traditionally focused on three mainstay aspects of the initiative: (1) creating virtual or remote treasury offices; (2) training key backup staff on emergency procedures; (3) maintaining power and telecommunication connectivity with their cash concentration bank to guarantee treasury is able to transmit funding instructions to them. This paper aims to take business continuity measures for corporate treasury departments to a higher level of preparedness by asking one critical question: 'What will happen if the cash concentration bank or the entire banking system of a country in which a company has operations collapses?' Rarely have treasury professionals contemplated such a cataclysmic scenario. This paper aims to (1) validate that banking system failures are common, (2) rationalise why treasury practitioners need to devise contingency funding strategies outside of the banking system and (3) offer some viable alternatives to commercial banks. In this regard the author will draw from the experience of international non-governmental organisations that routinely respond to and operate in cataclysmic emergencies.

Pharmacists' guide to the management of organ donors after brain death.

PubMed

Korte, Catherine; Garber, Jennifer L; Descourouez, Jillian L; Richards, Katelyn R; Hardinger, Karen

2016-11-15

This article reviews organ donor pathophysiology as it relates to medication use with the goal of maximizing the successful procurement and transplantation of donor organs. The number of patients requiring organ transplantation continues to grow, yet organ donation rates remain flat, making it critical to appropriately manage each organ donor in order to ensure viability of all transplantable organs. The care given to one organ donor is tantamount to the care of several transplant recipients. Aggressive donor management ensures that the largest number of organs can be successfully procured and improves the organs' overall quality. Hospital pharmacists are responsible for processing orders and preparing the medications outlined in donor management algorithms developed by their respective medical systems. It is important that pharmacists understand the details of the medications used in these protocols in order to critically evaluate each medication order and appropriately manage the donor. Typical medications used in organ donors after brain death include medications for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. It is essential to provide optimal pharmacotherapy for each organ donor to ensure organ recovery and donation. Typical medications used in organ donors include agents for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Historically Black Medical Schools: Addressing the Minority Health Professional Pipeline and the Public Mission of Care For Vulnerable Populations

PubMed Central

Norris, Keith C.; Baker, Richard S.; Taylor, Robert; Montgomery-Rice, Valerie; Higginbotham, Eve J.; Riley, Wayne J.; Maupin, John; Drew-Ivie, Sylvia; Reede, Joan Y.; Gibbons, Gary

2013-01-01

Substantial changes in not only access to care, cost, and quality of care, but also health professions education are needed to ensure effective national healthcare reform. Since the actionable determinants of health such as personal beliefs and behaviors, socioeconomic factors, and the environment disproportionately affect the poor (and often racial/ethnic minorities), many have suggested that focusing efforts on this population will both directly and indirectly improve the overall health of the nation. Key to the success of such strategies are the ongoing efforts by historically black medical schools (HBMSs) as well as other minority serving medical and health professional schools, who produce a disproportionate percentage of the high-quality and diverse health professionals that are dedicated to maintaining the health of an increasingly diverse nation. Despite their public mission, HBMSs receive limited public support threatening their ability to not only meet the increasing minority health workforce needs but to even sustain their existing contributions. Substantial changes in health education policy and funding are needed to ensure HBMSs as well as other minority-serving medical and health professional schools can continue to produce the diverse, high-quality health professional workforce necessary to maintain the health of an increasingly diverse nation. We explore several model initiatives including focused partnerships with legislative and business leaders that are urgently needed to ensure the ability of HBMSs to maintain their legacy of providing compassionate, quality care to the communities in greatest need. PMID:19806842

Space-ecology set covering problem for modeling Daiyun Mountain Reserve, China

NASA Astrophysics Data System (ADS)

Lin, Chih-Wei; Liu, Jinfu; Huang, Jiahang; Zhang, Huiguang; Lan, Siren; Hong, Wei; Li, Wenzhou

2018-02-01

Site selection is an important issue in designing the nature reserve that has been studied over the years. However, a well-balanced relationship between preservation of biodiversity and site selection is still challenging. Unlike the existing methods, we consider three critical components, the spatial continuity, spatial compactness and ecological information to address the problem of designing the reserve. In this paper, we propose a new mathematical model of set covering problem called Space-ecology Set Covering Problem (SeSCP) for designing a reserve network. First, we generate the ecological information by forest resource investigation. Then, we split the landscape into elementary cells and calculate the ecological score of each cell. Next, we associate the ecological information with the spatial properties to select a set of cells to form a nature reserve for improving the ability of protecting the biodiversity. Two spatial constraints, continuity and compactability, are given in SeSCP. The continuity is to ensure that any selected site has to be connected with adjacent sites and the compactability is to minimize the perimeter of the selected sites. In computational experiments, we take Daiyun Mountain as a study area to demonstrate the feasibility and effectiveness of the proposed model.

Retrieval of Aerosol Properties from MODIS Terra, MODIS Aqua, and VIIRS SNPP: Calibration Focus

NASA Technical Reports Server (NTRS)

Levy, Robert C.; Mattoo, Shana; Sawyer, Virginia; Kleidman, Richard; Patadia, Falguni; Zhou, Yaping; Gupta, Pawan; Shi, Yingxi; Remer, Lorraine; Holz, Robert

2016-01-01

MODIS-DT Collection 6 - Aqua/Terra level 2, 3; entire record processed - "Trending" issues reduced - Still a 15% or 0.02 Terra vs Aqua offset. - Terra/Aqua convergence improved with C6+, but bias remains. - Other calibration efforts yield mixed results. VIIRS-­-DT in development - VIIRS is similar, yet different then MODIS - With 50% wider swath, VIIRS has daily coverage - Ensures algorithm consistency with MODIS. - Currently: 20% NPP vs Aqua offset over ocean. - Only small bias (%) over land (2012-­-2016) - Can VIIRS/MODIS create aerosol CDR? Calibration for MODIS - VIIRS continues to fundamentally important. It's not just Terra, or just Aqua, or just NPP-­-VIIRS, I really want to push synergistic calibration.

The application of genomics and bioinformatics to accelerate crop improvement in a changing climate.

PubMed

Batley, Jacqueline; Edwards, David

2016-04-01

The changing climate and growing global population will increase pressure on our ability to produce sufficient food. The breeding of novel crops and the adaptation of current crops to the new environment are required to ensure continued food production. Advances in genomics offer the potential to accelerate the genomics based breeding of crop plants. However, relating genomic data to climate related agronomic traits for use in breeding remains a huge challenge, and one which will require coordination of diverse skills and expertise. Bioinformatics, when combined with genomics has the potential to help maintain food security in the face of climate change through the accelerated production of climate ready crops. Copyright © 2016 Elsevier Ltd. All rights reserved.

Aerosol Polarimetry Sensor (APS): Design Summary, Performance and Potential Modifications

NASA Technical Reports Server (NTRS)

Cairns, Brian

2014-01-01

APS is a mature design that has already been built and has a TRL of 7. Algorithmic and retrieval capabilities continue to improve and make better and more sophisticated used of the data. Adjoint solutions, both in one dimensional and three dimensional are computationally efficient and should be the preferred implementation for the calculation of Jacobians (one dimensional), or cost-function gradients (three dimensional). Adjoint solutions necessarily provide resolution of internal fields and simplify incorporation of active measurements in retrievals, which will be necessary for a future ACE mission. Its best to test these capabilities when you know the answer: OSSEs that are well constrained observationally provide the best place to test future multi-instrument platform capabilities and ensure capabilities will meet scientific needs.

Residency and specialties training in nutrition: a call for action1234

PubMed Central

Lenders, Carine M; Deen, Darwin D; Bistrian, Bruce; Edwards, Marilyn S; Seidner, Douglas L; McMahon, M Molly; Kohlmeier, Martin; Krebs, Nancy F

2014-01-01

Despite evidence that nutrition interventions reduce morbidity and mortality, malnutrition, including obesity, remains highly prevalent in hospitals and plays a major role in nearly every major chronic disease that afflicts patients. Physicians recognize that they lack the education and training in medical nutrition needed to counsel their patients and to ensure continuity of nutrition care in collaboration with other health care professionals. Nutrition education and training in specialty and subspecialty areas are inadequate, physician nutrition specialists are not recognized by the American Board of Medical Specialties, and nutrition care coverage by third payers remains woefully limited. This article focuses on residency and fellowship education and training in the United States and provides recommendations for improving medical nutrition education and practice. PMID:24646816

Refrigeration Showcases

NASA Technical Reports Server (NTRS)

1997-01-01

Through the Technology Affiliates Program at the Jet Propulsion Laboratory (JPL), valuable modifications were made to refrigerator displays built by Displaymor Manufacturing Company, Inc. By working with JPL, Displaymor could address stiffer requirements that ensure the freshness of foods. The application of the space technology meant that the small business would be able to continue to market its cases without incurring expenses that could threaten the viability of the business, and the future of several dozen jobs. Research and development improvements in air flow distribution and refrigeration coil technology contributed greatly to certifying Displaymor's showcases given the new federal regulations. These modifications resulted in a refrigerator case that will keep foods cooler, longer. Such changes maintained the openness of the display, critical to customer visibility and accessibility, impulse buying, and cross-merchandising.

Interprofessional Care and Role of Team Leaders.

PubMed

Kaini, B K

2015-01-01

Interprofessional care is an essential part of the health service delivery system. It helps to achieve improved care and to deliver the optimal and desired health outcomes by working together, sharing and learning skills. Health care organisation is a collective sum of many leaders and followers. Successful delivery of interprofessional care relies on the contribution of interprofessional care team leaders and health care professionals from all groups. The role of the interprofessional care team leader is vital to ensuring continuity and consistency of care and to mobilise and motivate health care professionals for the effective delivery of health services. Medical professionals usually lead interprofessional care teams. Interprofessional care leaders require various skills and competencies for the successful delivery of interprofessional care.

Commissioning a passive-scattering proton therapy nozzle for accurate SOBP delivery.

PubMed

Engelsman, M; Lu, H M; Herrup, D; Bussiere, M; Kooy, H M

2009-06-01

Proton radiotherapy centers that currently use passively scattered proton beams do field specific calibrations for a non-negligible fraction of treatment fields, which is time and resource consuming. Our improved understanding of the passive scattering mode of the IBA universal nozzle, especially of the current modulation function, allowed us to re-commission our treatment control system for accurate delivery of SOBPs of any range and modulation, and to predict the output for each of these fields. We moved away from individual field calibrations to a state where continued quality assurance of SOBP field delivery is ensured by limited system-wide measurements that only require one hour per week. This manuscript reports on a protocol for generation of desired SOBPs and prediction of dose output.

21 CFR 862.3350 - Diphenylhydantoin test system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Toxicology Test... monitoring levels of diphenylhydantoin to ensure appropriate therapy. (b) Classification. Class II. ...

Striving for Better Medical Education: the Simulation Approach.

PubMed

Sakakushev, Boris E; Marinov, Blagoi I; Stefanova, Penka P; Kostianev, Stefan St; Georgiou, Evangelos K

2017-06-01

Medical simulation is a rapidly expanding area within medical education due to advances in technology, significant reduction in training hours and increased procedural complexity. Simulation training aims to enhance patient safety through improved technical competency and eliminating human factors in a risk free environment. It is particularly applicable to a practical, procedure-orientated specialties. Simulation can be useful for novice trainees, experienced clinicians (e.g. for revalidation) and team building. It has become a cornerstone in the delivery of medical education, being a paradigm shift in how doctors are educated and trained. Simulation must take a proactive position in the development of metric-based simulation curriculum, adoption of proficiency benchmarking definitions, and should not depend on the simulation platforms used. Conversely, ingraining of poor practice may occur in the absence of adequate supervision, and equipment malfunction during the simulation can break the immersion and disrupt any learning that has occurred. Despite the presence of high technology, there is a substantial learning curve for both learners and facilitators. The technology of simulation continues to advance, offering devices capable of improved fidelity in virtual reality simulation, more sophisticated procedural practice and advanced patient simulators. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and ensured that the scope and impact of simulation will continue to broaden.

How PEPFAR's public-private partnerships achieved ambitious goals, from improving labs to strengthening supply chains.

PubMed

Sturchio, Jeffrey L; Cohen, Gary M

2012-07-01

The President's Emergency Plan for AIDS Relief (PEPFAR), established in 2003, is widely recognized as one of the most ambitious and successful bilateral programs ever implemented to address a single disease. Part of the program's success is attributable to the participation of the private sector, working in partnership with the US and local governments and implementing organizations to maximize the reach and effectiveness of every dollar spent. We examined key public-private partnerships that grew out of PEPFAR to identify features that have made them effective. For example, PEPFAR's Supply Chain Management System took advantage of private industry's best practices in logistics, and a partnership with the medical technology company BD (Becton, Dickinson and Company) improved laboratory systems throughout sub-Saharan Africa. We found that setting ambitious goals, enlisting both global and local partners, cultivating a culture of collaboration, careful planning, continuous monitoring and evaluation, and measuring outcomes systematically led to the most effective programs. The Office of the US Global AIDS Coordinator and PEPFAR should continue to strengthen their capacity for private-sector partnerships, learning from a decade of experience and identifying new ways to make smart investments that will make the most efficient use of taxpayer resources, expand proven interventions more rapidly, and help ensure the sustainability of key programs.

The Planetary Data System — Renewing Our Science Nodes in Order to Better Serve Our Science Community

NASA Astrophysics Data System (ADS)

Morgan, T. H.; McLaughlin, S.; Grayzeck, E. J.; Knopf, W.; McNutt, R. L., Jr.; Crichton, D. J.; New, M. H.

2015-12-01

In order to improve NASA's ability to provide an agile response to the needs of the Planetary Science Community, the Planetary Data System (PDS) is being transformed. NASA has used the highly successful virtual institute model (e.g., for NASA's Astrobiology Program) to re-compete the Science Nodes within the PDS Structure. We expect the new PDS will improve both archive searchability and product discoverability, continue the adaption of the new PDS4 Standard, and enhance our ability to work with other archive/curation activities within NASA and with the International community of space faring nations (through the International Planetary Data Alliance). PDS will continue to work with NASA missions from the initial Announcement of Opportunity through the end of mission to define, organize, and document the data. This process includes peer-review of data sets by members of the science community to ensure that the data sets are scientifically useful, effectively organized, and well documented. In this presentation we discuss recent changes in the PDS, and our future activities to build on these changes. Please visit our User Support Area at the meeting (Booth #446) if you have questions accessing our data sets or providing data to the PDS or about the new PDS structure.

The Galaxy platform for accessible, reproducible and collaborative biomedical analyses: 2018 update.

PubMed

Afgan, Enis; Baker, Dannon; Batut, Bérénice; van den Beek, Marius; Bouvier, Dave; Cech, Martin; Chilton, John; Clements, Dave; Coraor, Nate; Grüning, Björn A; Guerler, Aysam; Hillman-Jackson, Jennifer; Hiltemann, Saskia; Jalili, Vahid; Rasche, Helena; Soranzo, Nicola; Goecks, Jeremy; Taylor, James; Nekrutenko, Anton; Blankenberg, Daniel

2018-05-22

Galaxy (homepage: https://galaxyproject.org, main public server: https://usegalaxy.org) is a web-based scientific analysis platform used by tens of thousands of scientists across the world to analyze large biomedical datasets such as those found in genomics, proteomics, metabolomics and imaging. Started in 2005, Galaxy continues to focus on three key challenges of data-driven biomedical science: making analyses accessible to all researchers, ensuring analyses are completely reproducible, and making it simple to communicate analyses so that they can be reused and extended. During the last two years, the Galaxy team and the open-source community around Galaxy have made substantial improvements to Galaxy's core framework, user interface, tools, and training materials. Framework and user interface improvements now enable Galaxy to be used for analyzing tens of thousands of datasets, and >5500 tools are now available from the Galaxy ToolShed. The Galaxy community has led an effort to create numerous high-quality tutorials focused on common types of genomic analyses. The Galaxy developer and user communities continue to grow and be integral to Galaxy's development. The number of Galaxy public servers, developers contributing to the Galaxy framework and its tools, and users of the main Galaxy server have all increased substantially.

Proposal Improvements That Work

NASA Technical Reports Server (NTRS)

Dunn, F.

1998-01-01

Rocketdyne Propulsion and Power, an operating location of Boeing in Canoga Park, California is under contract with NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama for design, development, production, and mission support of Space Shuttle Main Engines (SSMEs). The contract was restructured in 1996 to emphasize a mission contracting environment under which Rocketdyne supports the Space Transportation System launch manifest of seven flights a year without the need for a detailed list of contract deliverables such as nozzles, turbopumps, and combustion devices. This contract structure is in line with the overall Space Shuttle program goals established by the NASA to fly safely, meet the flight manifest, and reduce cost. Rocketdyne's Contracts, Pricing, and Estimating team has worked for the past several years with representatives from MSFC, the local Defense Contract Management Command, and the DCAA to improve the quality of cost proposals to MSFC for contract changes on the SSME. The contract changes on the program result primarily from engineering change proposals for product enhancements to improve safety, maintainability, or operability in the space environment. This continuous improvement team effort has been successful in improving proposal quality, reducing cycle time, and reducing cost. Some of the principal lessons learned are highlighted here to show how proposal improvements can be implemented to enhance customer satisfaction and ensure cost proposals can be evaluated easily by external customers.

Architecture for Improving Terrestrial Logistics Based on the Web of Things

PubMed Central

Castro, Miguel; Jara, Antonio J.; Skarmeta, Antonio

2012-01-01

Technological advances for improving supply chain efficiency present three key challenges for managing goods: tracking, tracing and monitoring (TTM), in order to satisfy the requirements for products such as perishable goods where the European Legislations requires them to ship within a prescribed temperature range to ensure freshness and suitability for consumption. The proposed system integrates RFID for tracking and tracing through a distributed architecture developed for heavy goods vehicles, and the sensors embedded in the SunSPOT platform for monitoring the goods transported based on the concept of the Internet of Things. This paper presents how the Internet of Things is integrated for improving terrestrial logistics offering a comprehensive and flexible architecture, with high scalability, according to the specific needs for reaching an item-level continuous monitoring solution. The major contribution from this work is the optimization of the Embedded Web Services based on RESTful (Web of Things) for the access to TTM services at any time during the transportation of goods. Specifically, it has been extended the monitoring patterns such as observe and blockwise transfer for the requirements from the continuous conditional monitoring, and for the transfer of full inventories and partial ones based on conditional queries. In definitive, this work presents an evolution of the previous TTM solutions, which were limited to trailer identification and environment monitoring, to a solution which is able to provide an exhaustive item-level monitoring, required for several use cases. This exhaustive monitoring has required new communication capabilities through the Web of Things, which has been optimized with the use and improvement of a set of communications patterns. PMID:22778657

Architecture for improving terrestrial logistics based on the Web of Things.

PubMed

Castro, Miguel; Jara, Antonio J; Skarmeta, Antonio

2012-01-01

Technological advances for improving supply chain efficiency present three key challenges for managing goods: tracking, tracing and monitoring (TTM), in order to satisfy the requirements for products such as perishable goods where the European Legislations requires them to ship within a prescribed temperature range to ensure freshness and suitability for consumption. The proposed system integrates RFID for tracking and tracing through a distributed architecture developed for heavy goods vehicles, and the sensors embedded in the SunSPOT platform for monitoring the goods transported based on the concept of the Internet of Things. This paper presents how the Internet of Things is integrated for improving terrestrial logistics offering a comprehensive and flexible architecture, with high scalability, according to the specific needs for reaching an item-level continuous monitoring solution. The major contribution from this work is the optimization of the Embedded Web Services based on RESTful (Web of Things) for the access to TTM services at any time during the transportation of goods. Specifically, it has been extended the monitoring patterns such as observe and blockwise transfer for the requirements from the continuous conditional monitoring, and for the transfer of full inventories and partial ones based on conditional queries. In definitive, this work presents an evolution of the previous TTM solutions, which were limited to trailer identification and environment monitoring, to a solution which is able to provide an exhaustive item-level monitoring, required for several use cases. This exhaustive monitoring has required new communication capabilities through the Web of Things, which has been optimized with the use and improvement of a set of communications patterns.

Continuous quality improvement in the ambulatory endoscopy center.

PubMed

Johanson, John F

2002-04-01

What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit of improvement. Second, learning must be viewed as a process. A quality improvement plan that is successful in one setting may not be as favorable in another situation. Clinicians must be able to focus on their individual situations and adapt what others have implemented to their own practice. Third, the most important aspect of the quality improvement is the implementation step. It matters little if elegant studies of endoscopic complications or patient satisfaction are completed if the information is not used to improve the delivery of health care to every single patient. The delivery of medical care continues to evolve. Resources are becoming increasingly scarce and the progressive rise of health care expenditures suggests a need for control. In this zeal for cost constraint, quality must not be sacrificed. This new-found attention to quality must be extended to the level of the individual practitioner to ensure that individual patients' interests are protected and the best possible care is delivered regardless of the economic implications. As providers of health care, endoscopists need to take an active role in these efforts both in understanding and implementing the techniques of quality assessment into their practices. If physicians are not actively involved in data collection and measurement to improve the quality and value of their own work, someone else will undoubtedly assume this role.

The struggle of translating science into action: Foundational concepts of implementation science

PubMed Central

Clay‐Williams, Robyn; Churruca, Kate; Shih, Patti; Hogden, Anne; Braithwaite, Jeffrey

2017-01-01

Abstract Rationale, aims, and objectives “Implementation science,” the scientific study of methods translating research findings into practical, useful outcomes, is contested and complex, with unpredictable use of results from routine clinical practice and different levels of continuing assessment of implementable interventions. The authors aim to reveal how implementation science is presented and understood in health services research contexts and clarify the foundational concepts: diffusion, dissemination, implementation, adoption, and sustainability, to progress knowledge in the field. Method Implementation science models, theories, and frameworks are critiqued, and their value for laying the groundwork from which to implement a study's findings is emphasised. The paper highlights the challenges of turning research findings into practical outcomes that can be successfully implemented and the need for support from change agents, to ensure improvements to health care provision, health systems, and policy. The paper examines how researchers create implementation plans and what needs to be considered for study outputs to lead to sustainable interventions. This aspect needs clear planning, underpinned by appropriate theoretical paradigms that rigorously respond to a study's aims and objectives. Conclusion Researchers might benefit from a return to first principles in implementation science, whereby applications that result from research endeavours are both effective and readily disseminated and where interventions can be supported by appropriate health care personnel. These should be people specifically identified to promote change in service organisation, delivery, and policy that can be systematically evaluated over time, to ensure high‐quality, long‐term improvements to patients' health. PMID:28371050

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

PubMed

Verma, Pooja; Moran, John W

2014-01-01

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

Landsat 8: The plans, the reality, and the legacy

USGS Publications Warehouse

Loveland, Thomas R.; Irons, James R.

2016-01-01

Landsat 8, originally known as the Landsat Data Continuity Mission (LDCM), is a National Aeronautics and Space Administration (NASA)-U.S. Geological Survey (USGS) partnership that continues the legacy of continuous moderate resolution observations started in 1972. The conception of LDCM to the reality of Landsat 8 followed an arduous path extending over nearly 13 years, but the successful launch on February 11, 2013 ensures the continuity of the unparalleled Landsat record. The USGS took over mission operations on May 30, 2013 and renamed LCDM to Landsat 8. Access to Landsat 8 data was opened to users worldwide. Three years following launch we evaluate the science and applications impact of Landsat 8. With a mission objective to enable the detection and characterization of global land changes at a scale where differentiation between natural and human-induced causes of change is possible, LDCM promised incremental technical improvements in capabilities needed for Landsat scientific and applications investigations. Results show that with Landsat 8, we are acquiring more data than ever before, the radiometric and geometric quality of data are generally technically superior to data acquired by past Landsat missions, and the new measurements, e.g., the coastal aerosol and cirrus bands, are opening new opportunities. Collectively, these improvements are sparking the growth of science and applications opportunities. Equally important, with Landsat 7 still operational, we have returned to global imaging on an 8-day cycle, a capability that ended when Landsat 5 ceased operational Earth imaging in November 2011. As a result, the Landsat program is on secure footings and planning is underway to extend the record for another 20 or more years.

Landsat 8: The Plans, the Reality, and the Legacy

NASA Technical Reports Server (NTRS)

Loveland, Thomas R.; Irons, James R.

2016-01-01

Landsat 8, originally known as the Landsat Data Continuity Mission (LDCM), is a National Aeronautics and Space Administration (NASA)-U.S. Geological Survey (USGS) partnership that continues the legacy of continuous moderate resolution observations started in 1972. The conception of LDCM to the reality of Landsat 8 followed an arduous path extending over nearly 13 years, but the successful launch on February 11, 2013 ensures the continuity of the unparalleled Landsat record. The USGS took over mission operations on May 30, 2013 and renamed LCDM to Landsat 8. Access to Landsat 8 data was opened to users worldwide. Three years following launch we evaluate the science and applications impact of Landsat 8. With a mission objective to enable the detection and characterization of global land changes at a scale where differentiation between natural and human-induced causes of change is possible, LDCM promised incremental technical improvements in capabilities needed for Landsat scientific and applications investigations. Results show that with Landsat 8, we are acquiring more data than ever before, the radiometric and geometric quality of data are generally technically superior to data acquired by past Landsat missions, and the new measurements, e.g., the coastal aerosol and cirrus bands, are opening new opportunities. Collectively, these improvements are sparking the growth of science and applications opportunities. Equally important, with Landsat 7 still operational, we have returned to global imaging on an 8-day cycle, a capability that ended when Landsat 5 ceased operational Earth imaging in November 2011. As a result, the Landsat program is on secure footings and planning is underway to extend the record for another 20 or more years.

National Institutes of Health Pathways to Prevention Workshop: Methods for Evaluating Natural Experiments in Obesity.

PubMed

Emmons, Karen M; Doubeni, Chyke A; Fernandez, Maria E; Miglioretti, Diana L; Samet, Jonathan M

2018-06-05

On 5 and 6 December 2017, the National Institutes of Health (NIH) convened the Pathways to Prevention Workshop: Methods for Evaluating Natural Experiments in Obesity to identify the status of methods for assessing natural experiments to reduce obesity, areas in which these methods could be improved, and research needs for advancing the field. This article considers findings from a systematic evidence review on methods for evaluating natural experiments in obesity, workshop presentations by experts and stakeholders, and public comment. Research gaps are identified, and recommendations related to 4 key issues are provided. Recommendations on population-based data sources and data integration include maximizing use and sharing of existing surveillance and research databases and ensuring significant effort to integrate and link databases. Recommendations on measurement include use of standardized and validated measures of obesity-related outcomes and exposures, systematic measurement of co-benefits and unintended consequences, and expanded use of validated technologies for measurement. Study design recommendations include improving guidance, documentation, and communication about methods used; increasing use of designs that minimize bias in natural experiments; and more carefully selecting control groups. Cross-cutting recommendations target activities that the NIH and other funders might undertake to improve the rigor of natural experiments in obesity, including training and collaboration on modeling and causal inference, promoting the importance of community engagement in the conduct of natural experiments, ensuring maintenance of relevant surveillance systems, and supporting extended follow-up assessments for exemplar natural experiments. To combat the significant public health threat posed by obesity, researchers should continue to take advantage of natural experiments. The recommendations in this report aim to strengthen evidence from such studies.

On the use of INS to improve Feature Matching

NASA Astrophysics Data System (ADS)

Masiero, A.; Guarnieri, A.; Vettore, A.; Pirotti, F.

2014-11-01

The continuous technological improvement of mobile devices opens the frontiers of Mobile Mapping systems to very compact systems, i.e. a smartphone or a tablet. This motivates the development of efficient 3D reconstruction techniques based on the sensors typically embedded in such devices, i.e. imaging sensors, GPS and Inertial Navigation System (INS). Such methods usually exploits photogrammetry techniques (structure from motion) to provide an estimation of the geometry of the scene. Actually, 3D reconstruction techniques (e.g. structure from motion) rely on use of features properly matched in different images to compute the 3D positions of objects by means of triangulation. Hence, correct feature matching is of fundamental importance to ensure good quality 3D reconstructions. Matching methods are based on the appearance of features, that can change as a consequence of variations of camera position and orientation, and environment illumination. For this reason, several methods have been developed in recent years in order to provide feature descriptors robust (ideally invariant) to such variations, e.g. Scale-Invariant Feature Transform (SIFT), Affine SIFT, Hessian affine and Harris affine detectors, Maximally Stable Extremal Regions (MSER). This work deals with the integration of information provided by the INS in the feature matching procedure: a previously developed navigation algorithm is used to constantly estimate the device position and orientation. Then, such information is exploited to estimate the transformation of feature regions between two camera views. This allows to compare regions from different images but associated to the same feature as seen by the same point of view, hence significantly easing the comparison of feature characteristics and, consequently, improving matching. SIFT-like descriptors are used in order to ensure good matching results in presence of illumination variations and to compensate the approximations related to the estimation process.

Linking Fine-Scale Observations and Model Output with Imagery at Multiple Scales

NASA Astrophysics Data System (ADS)

Sadler, J.; Walthall, C. L.

2014-12-01

The development and implementation of a system for seasonal worldwide agricultural yield estimates is underway with the international Group on Earth Observations GeoGLAM project. GeoGLAM includes a research component to continually improve and validate its algorithms. There is a history of field measurement campaigns going back decades to draw upon for ways of linking surface measurements and model results with satellite observations. Ground-based, in-situ measurements collected by interdisciplinary teams include yields, model inputs and factors affecting scene radiation. Data that is comparable across space and time with careful attention to calibration is essential for the development and validation of agricultural applications of remote sensing. Data management to ensure stewardship, availability and accessibility of the data are best accomplished when considered an integral part of the research. The expense and logistical challenges of field measurement campaigns can be cost-prohibitive and because of short funding cycles for research, access to consistent, stable study sites can be lost. The use of a dedicated staff for baseline data needed by multiple investigators, and conducting measurement campaigns using existing measurement networks such as the USDA Long Term Agroecosystem Research network can fulfill these needs and ensure long-term access to study sites.

Bilingualism: A Pearl to Overcome Certain Perils of Cochlear Implants

PubMed Central

Humphries, Tom; Kushalnagar, Poorna; Mathur, Gaurav; Napoli, Donna Jo; Padden, Carol; Rathmann, Christian; Smith, Scott

2014-01-01

Cochlear implants (CI) have demonstrated success in improving young deaf children’s speech and low-level speech awareness across a range of auditory functions, but this success is highly variable, and how this success correlates to high-level language development is even more variable. Prevalence on the success rate of CI as an outcome for language development is difficult to obtain because studies vary widely in methodology and variables of interest, and because not all cochlear implant technology (which continues to evolve) is the same. Still, even if the notion of treatment failure is limited narrowly to those who gain no auditory benefit from CI in that they cannot discriminate among ambient noises, the reported treatment failure rate is high enough to call into question the current lack of consideration of alternative approaches to ensure young deaf children’s language development. Recent research has highlighted the risks of delaying language input during critical periods of brain development with concomitant consequences for cognitive and social skills. As a result, we propose that before, during, and after implantation deaf children learn a sign language along with a spoken language to ensure their maximal language development and optimal long-term developmental outcomes. PMID:25419095

Fenced and Fragmented: Conservation Value of Managed Metapopulations

PubMed Central

Miller, Susan M.; Harper, Cindy K.; Bloomer, Paulette; Hofmeyr, Jennifer; Funston, Paul J.

2015-01-01

Population fragmentation is threatening biodiversity worldwide. Species that once roamed vast areas are increasingly being conserved in small, isolated areas. Modern management approaches must adapt to ensure the continued survival and conservation value of these populations. In South Africa, a managed metapopulation approach has been adopted for several large carnivore species, all protected in isolated, relatively small, reserves that are fenced. As far as possible these approaches are based on natural metapopulation structures. In this network, over the past 25 years, African lions (Panthera leo) were reintroduced into 44 fenced reserves with little attention given to maintaining genetic diversity. To examine the situation, we investigated the current genetic provenance and diversity of these lions. We found that overall genetic diversity was similar to that in a large national park, and included a mixture of four different southern African evolutionarily significant units (ESUs). This mixing of ESUs, while not ideal, provides a unique opportunity to study the impact of mixing ESUs over the long term. We propose a strategic managed metapopulation plan to ensure the maintenance of genetic diversity and improve the long-term conservation value of these lions. This managed metapopulation approach could be applied to other species under similar ecological constraints around the globe. PMID:26699333

Dual-surface dielectric depth detector for holographic millimeter-wave security scanners

NASA Astrophysics Data System (ADS)

McMakin, Douglas L.; Keller, Paul E.; Sheen, David M.; Hall, Thomas E.

2009-05-01

The Transportation Security Administration (TSA) is presently deploying millimeter-wave whole body scanners at over 20 airports in the United States. Threats that may be concealed on a person are displayed to the security operator of this scanner. "Passenger privacy is ensured through the anonymity of the image. The officer attending the passenger cannot view the image, and the officer viewing the image is remotely located and cannot see the passenger. Additionally, the image cannot be stored, transmitted or printed and is deleted immediately after being viewed. Finally, the facial area of the image has been blurred to further ensure privacy." Pacific Northwest National Laboratory (PNNL) originated research into this novel security technology which has been independently commercialized by L-3 Communications, SafeView, Inc. PNNL continues to perform fundamental research into improved software techniques which are applicable to the field of holographic security screening technology. This includes performing significant research to remove human features from the imagery. Both physical and software imaging techniques have been employed. The physical imaging techniques include polarization diversity illumination and reception, dual frequency implementation, and high frequency imaging at 100 GHz. This paper will focus on a software privacy technique using a dual surface dielectric depth detector method.

The challenges of sustainable access to safe drinking water in rural areas of developing countries: case of Zawtar El-Charkieh, Southern Lebanon.

PubMed

Massoud, May A; Al-Abady, Abdolmonim; Jurdi, Mey; Nuwayhid, Iman

2010-06-01

Adequate and safe water is important for human health and well-being, economic production, and sustainable development. Failure to ensure the safety of drinking water may expose the community to the risk of outbreaks of waterborne and infectious diseases. Although drinking water is a basic human right, many people do not have access to safe and adequate drinking water or proper sanitation facilities. The authors conducted a study to assess the quantity, cost, continuity, coverage, and quality of drinking water in the village of Zawtar El-Charkieh, Lebanon. Their aim was to identify the challenges of sustainable access to safe drinking water in order to determine the short-term management actions and long-term strategies to improve water quality. Results revealed that contamination of the source, absence of any disinfection method or insufficient dose, poor maintenance operations, and aging of the networks are significant factors contributing to water contamination during the storage and distribution process. Establishing a comprehensive drinking water system that integrates water supply, quality, and management as well as associated educational programs in order to ensure the safety and sustainability of drinking water supplies is essential.

Geriatrics in family practice residency education: an unmet challenge.

PubMed

Gazewood, John D; Vanderhoff, Bruce; Ackermann, Richard; Cefalu, Charles

2003-01-01

The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline's interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill.

Using Technology in Undergraduate Admission: A Student Perspective

ERIC Educational Resources Information Center

Lindbeck, Robin; Fodrey, Brian

2010-01-01

The relationship that currently exists between undergraduate admission, technology and the Millennial generation continues to be an area of constant change. As technology trends come-and-go and resources continue to be limited, what are colleges and universities doing to ensure they are being as effective and efficient as possible when it comes to…

Electronic Continuous Professional Development (E-CPD) for Teachers: Bridging the Gap between Knowledge and Application

ERIC Educational Resources Information Center

Razak, Rafiza Abdul; Yusop, Farah Dina; Halili, Siti Hajar; Chukumaran, Sri Raman

2015-01-01

The continuing professional development (CPD) is a concerted effort to ensure the educational service officers equip themselves with professional knowledge, skill, values and practices of teachers through in-service training programs organized based on competency development, lifelong learning and career path. Nonetheless, educators do not only…

Planning for Continuing Education in the 70's.

ERIC Educational Resources Information Center

Nyquist, Ewald B.

Continuing education is not only an extension of the K-12 continuum but also the foundation for ensuring that childhood education is fully effective since children spend most of their first eighteen years under parental influence. Lifelong learning is necessary as new facts are discovered, society's needs and individual needs change, and some…

Ensuring Effective Impact of Continuing Professional Development: Saudi Science Teachers' Perspective

ERIC Educational Resources Information Center

Qablan, Ahmad; Mansour, Nassar; Alshamrani, Saeed; Aldahmash, Abdulwali; Sabbah, Saed

2015-01-01

Many researchers critique that continuing professional development programs in Saudi Arabia are neither well organized nor are systematic. This study came to assess the impact of CPD opportunities in the country to better suit the professional needs of Saudi science teachers and support them in implementing the reformed instructional practices.…

Transition from Long Day Care to Kindergarten: Continuity or Not?

ERIC Educational Resources Information Center

Barblett, Lennie; Barratt-Pugh, Caroline; Kilgallon, Pam; Maloney, Carmel

2011-01-01

Transition practices that ensure continuity between early childhood settings have been shown to be important in assisting children's short-term and long-term growth and development (Vogler, Cravello & Woodhead, 2008). In Western Australia many young children move from and between long day care (LDC) settings to kindergarten. In that state,…

Doctoral Education--Taking Salzburg Forward: Implementation and New Challenges

ERIC Educational Resources Information Center

European University Association, 2016

2016-01-01

The purpose of this document is to provide guidelines for the continued implementation of reforms in doctoral education building on the Salzburg Principles and Recommendations. It is directed at university leaders who want to continue and deepen the implementation of Salzburg at the strategic level, ensuring a consistent, institution-wide approach…

32 CFR 100.4 - Responsibility.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Departments shall ensure that: (a) Ready Reserve applicants understand their obligations for satisfactory... continue to understand their obligations for satisfactory participation in the Ready Reserve after their...

14 CFR 145.103 - Housing and facilities requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... TRANSPORTATION (CONTINUED) SCHOOLS AND OTHER CERTIFICATED AGENCIES REPAIR STATIONS Housing, Facilities, Equipment... temperature, humidity, and other climatic conditions sufficient to ensure personnel perform maintenance...

Health economics and outcomes research fellowship practices reviewed.

PubMed

Suh, Kangho; Gabriel, Susan; Adams, Michelle A; Arcona, Steve

2015-01-01

The guidelines for health economics and outcomes research (HEOR) fellowship training programs devised by the American College of Clinical Pharmacy (ACCP) and the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) suggest that continuous improvements are made to ensure that postgraduate training through didactic and professional experiences prepare fellows for HEOR research careers. The HEOR Fellowship Program at Novartis Pharmaceuticals Corporation was standardized to enhance the fellows' HEOR research understanding and align professional skill sets with the ACCP-ISPOR Fellowship Program Guidelines. Based on feedback from an internal task force comprised of HEOR employees and current and former fellows, the HEOR Fellowship Program was normatively and qualitatively assessed to evaluate the current curricular program. Fellowship program activities were instituted to ensure that the suggested minimum level requirements established by the guidelines were being met. Research opportunities enabling fellows to work hand-in-hand with other fellows and HEOR professionals were emphasized. Curricular enhancements in research methodology and professional training and development, and materials for a structured journal club focusing on specific methodological and HEOR research topics were developed. A seminar series (e.g., creating SMART Goals, StrengthsFinder 2.0) and professional courses (e.g., ISPOR short courses, statistics.com) were included to enhance the fellows' short- and long-term professional experience. Additional program attributes include an online reference library developed to enrich the current research facilities and a Statistical Analysis Software training program. Continuously assessing and updating HEOR fellowship programs keeps programs up-to-date in the latest HEOR concepts and approaches used to evaluate health care, both professionally and educationally. Copyright © 2015 Elsevier Inc. All rights reserved.

A survey of Canadian regulated complementary and alternative medicine schools about research, evidence-based health care and interprofessional training, as well as continuing education

PubMed Central

2013-01-01

Background While some effort has been made to integrate complementary and alternative medicine (CAM) information in conventional biomedical training, it is unclear whether regulated Canadian CAM schools’ students are exposed to research activities and continuing education, or whether topics such as evidence-based health care and interprofessional collaboration (IPC) are covered during their training. Since these areas are valued by the biomedical training field, this may help to bridge the attitudinal and communication gaps between these different practices. The aim of this study was to describe the training offered in these areas and gather the perceptions of curriculum/program directors in regulated Canadian CAM schools. Methods A two-phase study consisting of an electronic survey and subsequent semi-structured telephone interviews was conducted with curriculum/program (C/P) directors in regulated Canadian CAM schools. Questions assessed the extent of the research, evidence-based health care, IPC training and continuing education, as well as the C/P directors’ perceptions about the training. Descriptive statistics were used to describe the schools’, curriculum’s and the C/P directors’ characteristics. Content analysis was conducted on the interview material. Results Twenty-eight C/P directors replied to the electronic survey and 11 participated in the interviews, representing chiropractic, naturopathy, acupuncture and massage therapy schools. Canadian regulated CAM schools offered research and evidence-based health care training as well as opportunities for collaboration with biomedical peers and continuing education to a various extent (58% to 91%). Although directors were generally satisfied with the training offered at their school, they expressed a desire for improvements. They felt future CAM providers should understand research findings and be able to rely on high quality research and to communicate with conventional care providers as well as to engage in continuing education. Limited length of the curriculum was one of the barriers to such improvements. Conclusions These findings seem to reinforce the directors’ interest and the importance of integrating these topics in order to ensure best CAM practices and improve communication between CAM and conventional providers. PMID:24373181

The TOMS V9 Algorithm for OMPS Nadir Mapper Total Ozone: An Enhanced Design That Ensures Data Continuity

NASA Astrophysics Data System (ADS)

Haffner, D. P.; McPeters, R. D.; Bhartia, P. K.; Labow, G. J.

2015-12-01

The TOMS V9 total ozone algorithm will be applied to the OMPS Nadir Mapper instrument to supersede the exisiting V8.6 data product in operational processing and re-processing for public release. Becuase the quality of the V8.6 data is already quite high, enchancements in V9 are mainly with information provided by the retrieval and simplifcations to the algorithm. The design of the V9 algorithm has been influenced by improvements both in our knowledge of atmospheric effects, such as those of clouds made possible by studies with OMI, and also limitations in the V8 algorithms applied to both OMI and OMPS. But the namesake instruments of the TOMS algorithm are substantially more limited in their spectral and noise characterisitics, and a requirement of our algorithm is to also apply the algorithm to these discrete band spectrometers which date back to 1978. To achieve continuity for all these instruments, the TOMS V9 algorithm continues to use radiances in discrete bands, but now uses Rodgers optimal estimation to retrieve a coarse profile and provide uncertainties for each retrieval. The algorithm remains capable of achieving high accuracy results with a small number of discrete wavelengths, and in extreme cases, such as unusual profile shapes and high solar zenith angles, the quality of the retrievals is improved. Despite the intended design to use limited wavlenegths, the algorithm can also utilitze additional wavelengths from hyperspectral sensors like OMPS to augment the retreival's error detection and information content; for example SO2 detection and correction of Ring effect on atmospheric radiances. We discuss these and other aspects of the V9 algorithm as it will be applied to OMPS, and will mention potential improvements which aim to take advantage of a synergy with OMPS Limb Profiler and Nadir Mapper to further improve the quality of total ozone from the OMPS instrument.

A house officer-sponsored quality improvement initiative: leadership lessons and liabilities.

PubMed

Weingart, S N

1998-07-01

House officers play an important role in the care of hospitalized patients, yet they are infrequent participants in quality improvement (QI) activities. A grassroots QI initiative among medical house officers was implemented at Beth Israel Deaconess Medical Center's East Campus in Boston from 1995 through 1997. A group of house officer volunteers completed five of nine projects, including a survey that demonstrated frequent failures of cardiac monitor-defibrillators in the emergency room. Reaching out to key administrators produced several quick fixes. Developing effective, ongoing partnerships with clinical departments and QI professionals proved more problematic. Residency training programs that provide experience in QI give house officers a potentially valuable skill and an additional means to improve the quality of patient care. Yet many obstacles work against house officers' participation in QI initiatives, including long hours and the daily demands of patient care, rotating monthly assignments, and clinical leaders' assumption that they have little interest in QI. The organizers of the officer problem-solving group over-estimated the hospital resources at their disposal and failed to build mechanisms to ensure the initiative's continuation into its second year, when their own interest waned and no new group of leaders emerged to take their place. House officers represent an underused resource for QI. They are skilled at identifying problems but have difficulty executing sustained and complex QI initiatives. Peer leadership is a potent means to mobilize resident-physician participation but may require faculty or staff involvement and support to guarantee its continuity.

Integrating Quality Improvement and Continuing Professional Development: A Model From the Mental Health Care System.

PubMed

Sockalingam, Sanjeev; Tehrani, Hedieh; Lin, Elizabeth; Lieff, Susan; Harris, Ilene; Soklaridis, Sophie

2016-04-01

To explore the perspectives of leaders in psychiatry and continuing professional development (CPD) regarding the relationship, opportunities, and challenges in integrating quality improvement (QI) and CPD. In 2013-2014, the authors interviewed 18 participants in Canada: 10 psychiatrists-in-chief, 6 CPD leaders in psychiatry, and 2 individuals with experience integrating these domains in psychiatry who were identified through snowball sampling. Questions were designed to identify participants' perspectives about the definition, relationship, and integration of QI and CPD in psychiatry. Interviews were recorded and transcribed. An iterative, inductive method was used to thematically analyze the transcripts. To ensure the rigor of the analysis, the authors performed member checking and sampling until theoretical saturation was achieved. Participants defined QI as a concept measured at the individual, hospital, and health care system levels and CPD as a concept measured predominantly at the individual and hospital levels. Four themes related to the relationship between QI and CPD were identified: challenges with QI training, adoption of QI into the mental health care system, implementation of QI in CPD, and practice improvement outcomes. Despite participants describing QI and CPD as mutually beneficial, they expressed uncertainty about the appropriateness of aligning these domains within a mental health care context because of the identified challenges. This study identified challenges with aligning QI and CPD in psychiatry and yielded a framework to inform future integration efforts. Further research is needed to determine the generalizability of this framework to other specialties and health care professions.

Medicines optimisation: priorities and challenges.

PubMed

Kaufman, Gerri

2016-03-23

Medicines optimisation is promoted in a guideline published in 2015 by the National Institute for Health and Care Excellence. Four guiding principles underpin medicines optimisation: aim to understand the patient's experience; ensure evidence-based choice of medicines; ensure medicines use is as safe as possible; and make medicines optimisation part of routine practice. Understanding the patient experience is important to improve adherence to medication regimens. This involves communication, shared decision making and respect for patient preferences. Evidence-based choice of medicines is important for clinical and cost effectiveness. Systems and processes for the reporting of medicines-related safety incidents have to be improved if medicines use is to be as safe as possible. Ensuring safe practice in medicines use when patients are transferred between organisations, and managing the complexities of polypharmacy are imperative. A medicines use review can help to ensure that medicines optimisation forms part of routine practice.

Business Continuity Planning for Nursing Schools: Preparation for Potential Disasters.

PubMed

Zerwic, Julie J; Rosen, Denise

2016-01-01

Nursing schools are vulnerable to disasters, ranging from pandemics to weather emergencies, fires, and acts of terrorism. To ensure minimal disruptions to teaching, provision of care, research, and other critical missions, nursing faculty and administrative leaders should develop a business continuity plan. The business continuity plan can help faculty, students, and administration identify critical functions and alternative plans if an emergency occurs. We offer our experience as a guide for other nursing schools.

Introduction of a quality improvement program in a children's hospital in Tehran: design, implementation, evaluation and lessons learned.

PubMed

Mohammadi, S Mehrdad; Mohammadi, S Farzad; Hedges, Jerris R; Zohrabi, Morteza; Ameli, Omid

2007-08-01

Reports addressing continuous quality improvement (CQI) methods in developing countries are scant and there are questions about the applicability of quality improvement methods in such settings. The structure and output of a formal quality improvement program implemented in a teaching hospital affiliated with the Tehran University of Medical Sciences is presented. OBJECTIVE METHOD: During a nine-month period, a multi-stage quality improvement program was implemented. It comprised: (i) training workshops; (ii) a steering committee; (iii) weekly consultation and facilitation of improvement projects; and (iv) a day-long demonstration and recognition meeting. Four cycles of workshops were held in which 132 employees were trained in the basics of CQI. Thirty improvement projects were initiated. Twenty-five of the projects were completed. In an evaluation survey more than 70% of respondents assessed a 'positive impact' on organizational culture, work efficiency and quality of services. More than 90% believed that the changes were sustained, and more than 60% reported that they have implemented additional improvement projects. Our quality improvement package supported rapid implementation of multiple projects. The underlying 'change structure' comprised the improvement teams, top management and the university's quality improvement office; it integrated project management, support and facilitation functions by the respective participant. Organization-wide change was more limited than anticipated. To institutionalize the program and ensure sustainability, a local structure for change should be organized, management coaching should be sustained, local facilitators should be developed, incentives should be established and physician involvement should be emphasized.

Performance of a community-based health and nutrition-education intervention in the management of diarrhoea in a slum of Delhi, India.

PubMed

Pahwa, Smriti; Kumar, Geeta Trilok; Toteja, G S

2010-12-01

Diarrhoeal infections are the fifth leading cause of death worldwide and continue to take a high toll on child health. Mushrooming of slums due to continuous urbanization has made diarrhoea one of the biggest public-health challenges in metropolitan cities in India. The objective of the study was to carry out a community-based health and nutrition-education intervention, focusing on several factors influencing child health with special emphasis on diarrhoea, in a slum of Delhi, India. Mothers (n=370) of children, aged >12-71 months, identified by a door-to-door survey from a large urban slum, were enrolled in the study in two groups, i.e. control and intervention. To ensure minimal group interaction, enrollment for the control and intervention groups was done purposively from two extreme ends of the slum cluster. Baseline assessment of knowledge, attitudes, and practices on diarrhoea-related issues, such as oral rehydration therapy (ORT), oral rehydration salt (ORS), and continuation of breastfeeding during diarrhoea, was carried out using a pretested questionnaire. Thereafter, mothers (n=195) from the intervention area were provided health and nutrition education through fortnightly contacts achieved by two approaches developed for the study--'personal discussion sessions' and 'lane approach'. The mothers (n=175) from the control area were not contacted. After the intervention, there was a significant (p=0.000) improvement in acquaintance to the term 'ORS' (65-98%), along with its method of reconstitution from packets (13-69%); preparation of home-made sugar-salt solution (10-74%); role of both in the prevention of dehydration (30-74%) and importance of their daily preparation (74-96%); and continuation of breastfeeding during diarrhoea (47-90%) in the intervention area. Sensitivity about age-specific feeding of ORS also improved significantly (p=0.000) from 13% to 88%. The reported usage of ORS packets and sugar-salt solution improved significantly from 12% to 65% (p=0.000) and 12% to 75% (p=0.005) respectively. The results showed that health and nutrition-education intervention improved the knowledge and attitudes of mothers. The results indicate a need for intensive programmes, especially directed towards urban slums to further improve the usage of oral rehydration therapy.

Research on construction technology for orthotropic steel deck pavement of Haihe River Chunyi Bridge

NASA Astrophysics Data System (ADS)

Xue, Y. C.; Qian, Z. D.; Zhang, M.

2017-01-01

In order to ensure the good service quality of orthotropic steel deck pavement of Haihe River Chunyi Bridge in Tianjin, and to reduce the occurrence of pavement diseases like lateral and longitudinal cracks, the key working procedures such as steel deck cleaning, anticorrosive coating, bonding layer spraying, seam cutting, epoxy asphalt concrete’s mixing, transportation, paving and compaction were studied. The study was based on the main features of epoxy asphalt concrete which is the pavement materials of Haihe River Chunyi Bridge, and combined with the basic characteristics and construction conditions of Haihe River Chunyi Bridge. Furthermore, some processing measures like controlling time and temperature, continuous paving with two pavers, lateral feeding, and improving the compaction method were proposed. The project example shows that the processing measures can effectively solve the technical difficulties in the construction of orthotropic steel deck pavement of Haihe River Chunyi Bridge, can greatly improve the construction speed and quality, and can provide reference for the same kinds of orthotropic steel deck pavement construction.

Risk factors for mortality in the Bangladesh cyclone of 1991.

PubMed

Bern, C; Sniezek, J; Mathbor, G M; Siddiqi, M S; Ronsmans, C; Chowdhury, A M; Choudhury, A E; Islam, K; Bennish, M; Noji, E

1993-01-01

Cyclones continue to pose a dangerous threat to the coastal populations of Bangladesh, despite improvements in disaster control procedures. After 138,000 persons died in the April 1991 cyclone, we carried out a rapid epidemiological assessment to determine factors associated with cyclone-related mortality and to identify prevention strategies. A nonrandom survey of 45 housing clusters comprising 1123 persons showed that mortality was greatest among under-10-year-olds (26%) and women older than 40 years (31%). Nearly 22% of persons who did not reach a concrete or brick structure died, whereas all persons who sought refuge in such structures survived. Future cyclone-associated mortality in Bangladesh could be prevented by more effective warnings leading to an earlier response, better access to designated cyclone shelters, and improved preparedness in high-risk communities. In particular, deaths among women and under-10-year-olds could be reduced by ensuring that they are given special attention by families, neighbours, local authorities, and especially those in charge of early warnings and emergency evacuation.

Mediation analysis of severity of needs, service performance and outcomes for patients with mental disorders.

PubMed

Roux, Paul; Passerieux, Christine; Fleury, Marie-Josée

2016-12-01

Needs and service performance assessment are key components in improving recovery among individuals with mental disorders. To test the role of service performance as a mediating factor between severity of patients' needs and outcomes. A total of 339 adults with mental disorders were interviewed. A mediation analysis between severity of needs, service performance (adequacy of help, continuity of care and recovery orientation of services) and outcomes (personal recovery and quality of life) was carried out using structural equation modelling. The structural equation model provided a good fit with the data. An increase in needs was associated with lower service performance and worse outcomes, whereas higher service performance was associated with better outcomes. Service performance partially mediated the effect of patient needs on outcomes. Poorer service performance has a negative impact on outcomes for patients with the highest needs. Ensuring more efficient services for patients with high needs may help improve their recovery and quality of life. © The Royal College of Psychiatrists 2016.

The United States Naval Nuclear Propulsion Program - Over 151 Million Miles Safely Steamed on Nuclear Power

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

None, None

NNSA’s third mission pillar is supporting the U.S. Navy’s ability to protect and defend American interests across the globe. The Naval Reactors Program remains at the forefront of technological developments in naval nuclear propulsion and ensures a commanding edge in warfighting capabilities by advancing new technologies and improvements in naval reactor performance and reliability. In 2015, the Naval Nuclear Propulsion Program pioneered advances in nuclear reactor and warship design – such as increasing reactor lifetimes, improving submarine operational effectiveness, and reducing propulsion plant crewing. The Naval Reactors Program continued its record of operational excellence by providing the technical expertise requiredmore » to resolve emergent issues in the Nation’s nuclear-powered fleet, enabling the Fleet to safely steam more than two million miles. Naval Reactors safely maintains, operates, and oversees the reactors on the Navy’s 82 nuclear-powered warships, constituting more than 45 percent of the Navy’s major combatants.« less

The 1992 Langley Aerospace Research Summer Scholars (LARSS) program

NASA Technical Reports Server (NTRS)

1993-01-01

The overwhelming majority of the LARSS participants rated their overall summer research experience as good or excellent. Even though the 1992 LARSS Program has met its goals, all areas of the program need to be considered for continuous improvement. Of the various recommendations provided by the participants, the following will be implemented in the 1993 LARSS Program: (1) LARSS participants will be housed in two or three apartment complexes; (2) mentors will be encouraged to contact their student before the beginning of the LARSS Program; (3) LARSS participants will be notified of a tentative payroll schedule before the Program begins; (4) LARSS participants will be strongly encouraged to give an oral presentation on their research project in their respective Divisions; and (5) a Career Conference, in conjunction with a forum where the participants can share their individual research projects will be held. The participant recommendations made in the 1992 LARSS Student Exit Survey will ensure a more successful and improved LARSS Program in 1993.

A Data Services Upgrade for Advanced Composition Explorer (ACE) Data

NASA Astrophysics Data System (ADS)

Davis, A. J.; Hamell, G.

2008-12-01

Since early in 1998, NASA's Advanced Composition Explorer (ACE) spacecraft has provided continuous measurements of solar wind, interplanetary magnetic field, and energetic particle activity from L1, located approximately 0.01 AU sunward of Earth. The spacecraft has enough fuel to stay in orbit about L1 until ~2024. The ACE Science Center (ASC) provides access to ACE data, and performs level 1 and browse data processing for the science instruments. Thanks to a NASA Data Services Upgrade grant, we have recently retooled our legacy web interface to ACE data, enhancing data subsetting capabilities and improving online plotting options. We have also integrated a new application programming interface (API) and we are working to ensure that it will be compatible with emerging Virtual Observatory (VO) data services standards. The new API makes extensive use of metadata created using the Space Physics Archive Search and Extract (SPASE) data model. We describe these recent improvements to the ACE Science Center data services, and our plans for integrating these services into the VO system.

Medical Readiness of the Reserve Component.

PubMed

Brauner, Marygail K; Jackson, Timothy; Gayton, Elizabeth

2012-01-01

The reserve components (RCs) of the U.S. military must ensure that reservists are not only properly equipped and trained, but also medically ready to serve. Medical readiness means that service members are free from health-related conditions, including dental conditions, that could limit their ability to carry out their duties. Medically ready reservists require less medical and dental support in theater and fewer medical evacuations from theater, both of which save money and free assets for other purposes. This article identifies existing medical readiness requirements, quantifies the current status of RC medical readiness, identifies obstacles to achieving compliance, and suggests options for improving medical readiness in a cost-effective manner. The authors find that time and expense are the major barriers to the RCs achieving their overall goals for medical readiness. Recommendations include standardizing medical readiness criteria across services, improving data reporting and archiving processes, providing incentives to individuals and units to achieve medical readiness, and continuing to extend TRICARE coverage to reservists prior to deployment.

Harmonization of anti-doping rules in a global context (World Anti-Doping Agency-laboratory accreditation perspective).

PubMed

Ivanova, Victoria; Miller, John H M; Rabin, Olivier; Squirrell, Alan; Westwood, Steven

2012-07-01

This article provides a review of the leading role of the World Anti-Doping Agency (WADA) in the context of the global fight against doping in sport and the harmonization of anti-doping rules worldwide through the implementation of the World Anti-Doping Program. Particular emphasis is given to the WADA-laboratory accreditation program, which is coordinated by the Science Department of WADA in conjunction with the Laboratory Expert Group, and the cooperation with the international accreditation community through International Laboratory Accreditation Cooperation and other organizations, all of which contribute to constant improvement of laboratory performance in the global fight against doping in sport. A perspective is provided of the means to refine the existing anti-doping rules and programs to ensure continuous improvement in order to face growing sophisticated challenges. A viewpoint on WADA's desire to embrace cooperation with other international organizations whose knowledge can contribute to the fight against doping in sport is acknowledged.

Innovations in cardiac transplantation.

PubMed

Hasan, Reema; Ela, Ashraf Abou El; Goldstein, Daniel

2017-03-16

As the number of people living with heart failure continues to grow, future treatments will focus on efficient donor organ donation and ensuring safe and durable outcomes. This review will focus on organ procurement, graft surveillance and emerging therapies. Preliminary studies into donation after cardiac death have indicated that this may be an effective means to increase the donor pool. Novel preservation techniques that include ex-vivo perfusion to improve donor metabolic stabilization prior to implantation may also expand the donor pool. Biomarkers, including circulating-free DNA, are emerging that could replace the endomyocardial biopsy for acute graft rejection, but we lack a risk predictive biomarker in heart transplantation. Novel immune suppressants are being investigated. Emerging therapeutics to reduce the development of chronic allograft vasculopathy are yet to be found. This review highlights the most recent studies and future possible therapies that will improve outcomes in cardiac transplantation. Larger clinical trials are currently taking place and will be needed in the future to develop and sustain current trends toward better survival rates with cardiac transplantation.

Promoting Good Clinical Laboratory Practices and Laboratory Accreditation to Support Clinical Trials in Sub-Saharan Africa

PubMed Central

Shott, Joseph P.; Saye, Renion; Diakité, Moussa L.; Sanogo, Sintry; Dembele, Moussa B.; Keita, Sekouba; Nagel, Mary C.; Ellis, Ruth D.; Aebig, Joan A.; Diallo, Dapa A.; Doumbo, Ogobara K.

2012-01-01

Laboratory capacity in the developing world frequently lacks quality management systems (QMS) such as good clinical laboratory practices, proper safety precautions, and adequate facilities; impacting the ability to conduct biomedical research where it is needed most. As the regulatory climate changes globally, higher quality laboratory support is needed to protect study volunteers and to accurately assess biological parameters. The University of Bamako and its partners have undertaken a comprehensive QMS plan to improve quality and productivity using the Clinical and Laboratory Standards Institute standards and guidelines. The clinical laboratory passed the College of American Pathologists inspection in April 2010, and received full accreditation in June 2010. Our efforts to implement high-quality standards have been valuable for evaluating safety and immunogenicity of malaria vaccine candidates in Mali. Other disease-specific research groups in resource-limited settings may benefit by incorporating similar training initiatives, QMS methods, and continual improvement practices to ensure best practices. PMID:22492138

A relational leadership perspective on unit-level safety climate.

PubMed

Thompson, Debra N; Hoffman, Leslie A; Sereika, Susan M; Lorenz, Holly L; Wolf, Gail A; Burns, Helen K; Minnier, Tamra E; Ramanujam, Rangaraj

2011-11-01

This study compared nursing staff perceptions of safety climate in clinical units characterized by high and low ratings of leader-member exchange (LMX) and explored characteristics that might account for differences. Frontline nursing leaders' actions are critical to ensure patient safety. Specific leadership behaviors to achieve this goal are underexamined. The LMX perspective has shown promise in nonhealthcare settings as a means to explain safety climate perceptions. Cross-sectional survey of staff (n = 711) and unit directors from 34 inpatient units in an academic medical center was conducted. Significant differences were found between high and low LMX scoring units on supervisor safety expectations, organizational learning-continuous improvement, total communication, feedback and communication about errors, and nonpunitive response to errors. The LMX perspective can be used to identify differences in perceptions of safety climate among nursing staff. Future studies are needed to identify strategies to improve staff safety attitudes and behaviors. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

The role of organizational culture and leadership in water safety plan implementation for improved risk management.

PubMed

Summerill, Corinna; Pollard, Simon J T; Smith, Jennifer A

2010-09-15

Appropriate implementation of WSPs offers an important opportunity to engage in and promote preventative risk management within water utilities. To ensure success, the whole organization, especially executive management, need to be advocates. Illustrated by two case studies, we discuss the influence of organizational culture on buy-in and commitment to public health protection and WSPs. Despite an internal desire to undertake risk management, some aspects of organizational culture prevented these from reaching full potential. Enabling cultural features included: camaraderie; competition; proactive, involved leaders; community focus; customer service mentality; transparency; accountability; competent workforce; empowerment; appreciation of successes, and a continual improvement culture. Blocking features included: poor communication; inflexibility; complacency; lack of awareness, interest or reward and coercion. We urge water utilities to consider the influence of organizational culture on the success and sustainability of WSP adoption, and better understand how effective leadership can mould culture to support implementation. Copyright 2010 Elsevier B.V. All rights reserved.

Team-based learning in therapeutics workshop sessions.

PubMed

Beatty, Stuart J; Kelley, Katherine A; Metzger, Anne H; Bellebaum, Katherine L; McAuley, James W

2009-10-01

To implement team-based learning in the workshop portion of a pathophysiology and therapeutics sequence of courses to promote integration of concepts across the pharmacy curriculum, provide a consistent problem-solving approach to patient care, and determine the impact on student perceptions of professionalism and teamwork. Team-based learning was incorporated into the workshop portion of 3 of 6 pathophysiology and therapeutics courses. Assignments that promoted team-building and application of key concepts were created. Readiness assurance tests were used to assess individual and team understanding of course materials. Students consistently scored 20% higher on team assessments compared with individual assessments. Mean professionalism and teamwork scores were significantly higher after implementation of team-based learning; however, this improvement was not considered educationally significant. Approximately 91% of students felt team-based learning improved understanding of course materials and 93% of students felt teamwork should continue in workshops. Team-based learning is an effective teaching method to ensure a consistent approach to problem-solving and curriculum integration in workshop sessions for a pathophysiology and therapeutics course sequence.

Modeling the prediction of business intelligence system effectiveness.

PubMed

Weng, Sung-Shun; Yang, Ming-Hsien; Koo, Tian-Lih; Hsiao, Pei-I

2016-01-01

Although business intelligence (BI) technologies are continually evolving, the capability to apply BI technologies has become an indispensable resource for enterprises running in today's complex, uncertain and dynamic business environment. This study performed pioneering work by constructing models and rules for the prediction of business intelligence system effectiveness (BISE) in relation to the implementation of BI solutions. For enterprises, effectively managing critical attributes that determine BISE to develop prediction models with a set of rules for self-evaluation of the effectiveness of BI solutions is necessary to improve BI implementation and ensure its success. The main study findings identified the critical prediction indicators of BISE that are important to forecasting BI performance and highlighted five classification and prediction rules of BISE derived from decision tree structures, as well as a refined regression prediction model with four critical prediction indicators constructed by logistic regression analysis that can enable enterprises to improve BISE while effectively managing BI solution implementation and catering to academics to whom theory is important.

Death certification: an audit of practice entering the 21st century

PubMed Central

Swift, B; West, K

2002-01-01

Aims: Death certification, a legal duty of doctors, continues to be poorly performed despite Royal College recommendations and increased education at an undergraduate level. Therefore, the current performance of certifying doctors was audited within a large teaching hospital entering the new century. Methods: A total of 1000 completed certificate counterfoils were examined retrospectively for appropriateness of completion and the ability to construct a logical cause of death cascade. Results: Only 55% of certificates were completed to a minimally accepted standard, and many of these failed to provide relevant information to allow adequate ICD-10 coding. Nearly 10% were completed to a poor standard, being illogical or inappropriately completed. Conclusions: The results show no improvement in the state of certification. Possible interventions to improve outcomes are discussed; however, in light of a recent high profile legal case a current Home Office review of death certification may suggest the passing of statutory law to ensure accurate completion. PMID:11919211

Understanding Evaluation of Learning Support in Mathematics and Statistics

ERIC Educational Resources Information Center

MacGillivray, Helen; Croft, Tony

2011-01-01

With rapid and continuing growth of learning support initiatives in mathematics and statistics found in many parts of the world, and with the likelihood that this trend will continue, there is a need to ensure that robust and coherent measures are in place to evaluate the effectiveness of these initiatives. The nature of learning support brings…

Adult and Continuing Education in Kenya: The Need for Transformative Leadership

ERIC Educational Resources Information Center

Nyatuka, Benard O.; Ndiku, Judah M.

2015-01-01

As a multidisciplinary process, Adult and Continuing Education (ACE) is meant to foster efficient lifelong learning throughout life. To achieve this, it should be geared towards providing knowledge, skills as well as attitudes that ensure equal opportunities to life, meeting the needs of individuals of all ages so as to understand the world and…

ESSA Offers Changes That Can Continue Learning Gains

ERIC Educational Resources Information Center

Chenoweth, Karin

2016-01-01

The Every Student Succeeds Act (ESSA) gives educators a fresh opportunity to think through how to ensure that all students achieve at high levels, especially kids from low-income families and kids of color. The new law continues with four principles that had been in earlier iterations, all of which have important implications for students from…

Perceived Effectiveness of Clinical E-Learning for Georgia Midwives

ERIC Educational Resources Information Center

Hunter, Adrienne

2014-01-01

In the state of Georgia, approximately nine out of every 1,000 babies die during birth and approximately 18.6 out of every 1,000 women die from a pregnancy-related cause (Georgia Department of Public Health, 2011). Continuing to build capacities for the continuing education of midwives--specifically Certified Nurse Midwives (CNMs)--can ensure they…

Will your plans survive a crisis? Principles for ensuring an effective recovery.

PubMed

Jones, Brendan

2017-01-01

Guided by international standards, internal governance and government policy, most businesses and organisations will have continuity plans. There is, however, a significant difference between a having a plan and providing an effective response and recovery to a crisis event. This paper will explore six principles that will ensure an organisation can provide an effective response to significant business disruptions. Two real-life case studies provide practical examples of these principles at work.

Maintaining Vitality: Pharmacists’ Continuing Professional Education Decision-Making in the Upper Midwest

PubMed Central

Henkel, Paul Jacob

2018-01-01

Continuing professional education (CPE) plays an important role in continuing professional development of pharmacists for providing quality pharmaceutical care but also to maintain professional and organizational vitality and meet changing community/population needs. The study objective was to describe and understand factors of importance in selection of CPE credit hours among Upper Midwest pharmacists. A cross-sectional study of licensed pharmacists (n = 1239) in Iowa, Minnesota, Nebraska, North Dakota, and South Dakota included completion of a questionnaire on demographics and CPE decision-making. Factor analysis, t-test, and multivariate analyses were performed using Stata 10.1. Pharmacists placed greatest importance on maintaining licensure (mean = 2.72/3.00), personal interest (mean = 2.57), and self-improvement (mean = 2.42). Community/population need (mean = 1.83) was rated as slightly more important (p < 0.01) by retail/community pharmacists, females, and those with a Doctor of Pharmacy degree or pharmacy residency while business growth/development (mean = 1.33) was rated slightly more important (p < 0.01) by retail/community pharmacists. Despite findings that neither community/population need nor business development were among the most important factors in pharmacists’ CPE selection, there exists significant potential for pharmacists to utilize CPE to maintain professional and organizational vitality in the labor market, but more importantly to ensure continued provision of quality pharmaceutical care and patient education. PMID:29389850

Maintaining Vitality: Pharmacists' Continuing Professional Education Decision-Making in the Upper Midwest.

PubMed

Henkel, Paul Jacob; Marvanova, Marketa

2018-02-01

Continuing professional education (CPE) plays an important role in continuing professional development of pharmacists for providing quality pharmaceutical care but also to maintain professional and organizational vitality and meet changing community/population needs. The study objective was to describe and understand factors of importance in selection of CPE credit hours among Upper Midwest pharmacists. A cross-sectional study of licensed pharmacists ( n = 1239) in Iowa, Minnesota, Nebraska, North Dakota, and South Dakota included completion of a questionnaire on demographics and CPE decision-making. Factor analysis, t -test, and multivariate analyses were performed using Stata 10.1. Pharmacists placed greatest importance on maintaining licensure (mean = 2.72/3.00), personal interest (mean = 2.57), and self-improvement (mean = 2.42). Community/population need (mean = 1.83) was rated as slightly more important ( p < 0.01) by retail/community pharmacists, females, and those with a Doctor of Pharmacy degree or pharmacy residency while business growth/development (mean = 1.33) was rated slightly more important ( p < 0.01) by retail/community pharmacists. Despite findings that neither community/population need nor business development were among the most important factors in pharmacists' CPE selection, there exists significant potential for pharmacists to utilize CPE to maintain professional and organizational vitality in the labor market, but more importantly to ensure continued provision of quality pharmaceutical care and patient education.

Aperiodic Robust Model Predictive Control for Constrained Continuous-Time Nonlinear Systems: An Event-Triggered Approach.

PubMed

Liu, Changxin; Gao, Jian; Li, Huiping; Xu, Demin

2018-05-01

The event-triggered control is a promising solution to cyber-physical systems, such as networked control systems, multiagent systems, and large-scale intelligent systems. In this paper, we propose an event-triggered model predictive control (MPC) scheme for constrained continuous-time nonlinear systems with bounded disturbances. First, a time-varying tightened state constraint is computed to achieve robust constraint satisfaction, and an event-triggered scheduling strategy is designed in the framework of dual-mode MPC. Second, the sufficient conditions for ensuring feasibility and closed-loop robust stability are developed, respectively. We show that robust stability can be ensured and communication load can be reduced with the proposed MPC algorithm. Finally, numerical simulations and comparison studies are performed to verify the theoretical results.

Quality-improvement analytics for intravenous infusion pumps.

PubMed

Skledar, Susan J; Niccolai, Cynthia S; Schilling, Dennis; Costello, Susan; Mininni, Nicolette; Ervin, Kelly; Urban, Alana

2013-04-15

The implementation of a smart-pump continuous quality-improvement (CQI) program across a large health system is described, with an emphasis on key metrics for outcomes analyses and program refinement. Three years ago, the University of Pittsburgh Medical Center health system launched a CQI initiative to help ensure the safe use of 6000 smart pumps in its 14 inpatient facilities. A centralized team led by pharmacists is responsible for the retrieval and interpretation of smart-pump data, which is continuously transmitted to a main server. CQI findings are regularly posted on the health system's interdisciplinary intranet. Monitored metrics include rates of compliance with preprogrammed infusion limits, the top 20 drugs involved in alerts, drugs associated with alert-override rates of ≥90%, numbers of alerts by infusion type, nurse responses to alerts, and alert rate per drug library update. Based on the collected CQI data and site-specific requests, four systemwide updates of the smart-pump drug library were performed during the first 18 months of the program, reducing "nuisance alerts" by about 10% per update cycle and enabling targeted interventions to reduce rapid-infusion errors, other adverse drug events (ADEs), and pump-programming workarounds. Over one 12-month period, bedside alerts prompted nurses to reprogram or cancel continuous infusions an average of 400 times per month, potentially averting i.v. medication ADEs. A smart-pump CQI program is an effective tool for enhancing the safety of i.v. medication administration. The ongoing refinement of the drug library through the development and implementation of key interventions promotes the growth and sustainability of the smart-pump initiative systemwide.

U.S. Department of Energy, Office of Legacy Management Program Update, April-June 2009

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

None

2009-04-01

Welcome to the April-June 2009 issue of the U.S. Department of Energy (DOE) Office of Legacy Management (LM) Program Update. This publication is designed to provide a status of activities within LM. The Legacy Management goals are: (1) Protect human health and the environment through effective and efficient long-term surveillance and maintenance - This goal highlights DOE's responsibility to ensure long-term protection of people, the environment, and the integrity of engineered remedies and monitoring systems. (2) Preserve, protect, and make accessible legacy records and information - This goal recognizes LM's commitment to successfully manage records, information, and archives of legacymore » sites under its authority. (3) Support an effective and efficient work force structured to accomplish Departmental missions and assure continuity of contractor worker pension and medical benefits - This goal recognizes DOE's commitment to its contracted work force and the consistent management of pension and health benefits. As sites continue to close, DOE faces the challenges of managing pension plan and health benefits liability. (4) Manage legacy land and assets, emphasizing protective real and personal property reuse and disposition - This goal recognizes a DOE need for local collaborative management of legacy assets, including coordinating land use planning, personal property disposition to community reuse organizations, and protecting heritage resources (natural, cultural, and historical). (5) Improve program effectiveness through sound management - This goal recognizes that LM's goals cannot be attained efficiently unless the federal and contractor work force is motivated to meet requirements and work toward continuous performance improvement.« less

Pneumatic Muscle Actuated Equipment for Continuous Passive Motion

NASA Astrophysics Data System (ADS)

Deaconescu, Tudor T.; Deaconescu, Andrea I.

2009-10-01

Applying continuous passive rehabilitation movements as part of the recovery programme of patients with post-traumatic disabilities of the bearing joints of the inferior limbs requires the development of new high performance equipment. This chapter discusses a study of the kinematics and performance of such a new, continuous passive motion based rehabilitation system actuated by pneumatic muscles. The utilized energy source is compressed air ensuring complete absorption of the end of stroke shocks, thus minimizing user discomfort.

The good CPD guide: A practical guide to managed continuing professional development in medicine Janet Grant The good CPD guide: A practical guide to managed continuing professional development in medicine Radcliffe Publishing 190pp £29.99 9781846195709 1846195705 [Formula: see text].

PubMed

2012-02-10

DURING HARD times, when education budgets decrease, the purpose of continuing professional development (CPD) programmes must be made clear to practitioners and services. Clarity is crucial in ensuring that CPD programmes receive adequate funding, and that enough time and professional effort are devoted to them.

Teamwork for Oversight of Processes and Systems (TOPS). Implementation guide for TOPS version 2.0, 10 August 1992

NASA Technical Reports Server (NTRS)

Strand, Albert A.; Jackson, Darryl J.

1992-01-01

As the nation redefines priorities to deal with a rapidly changing world order, both government and industry require new approaches for oversight of management systems, particularly for high technology products. Declining defense budgets will lead to significant reductions in government contract management personnel. Concurrently, defense contractors are reducing administrative and overhead staffing to control costs. These combined pressures require bold approaches for the oversight of management systems. In the Spring of 1991, the DPRO and TRW created a Process Action Team (PAT) to jointly prepare a Performance Based Management (PBM) system titled Teamwork for Oversight of Processes and Systems (TOPS). The primary goal is implementation of a performance based management system based on objective data to review critical TRW processes with an emphasis on continuous improvement. The processes are: Finance and Business Systems, Engineering and Manufacturing Systems, Quality Assurance, and Software Systems. The team established a number of goals: delivery of quality products to contractual terms and conditions; ensure that TRW management systems meet government guidance and good business practices; use of objective data to measure critical processes; elimination of wasteful/duplicative reviews and audits; emphasis on teamwork--all efforts must be perceived to add value by both sides and decisions are made by consensus; and synergy and the creation of a strong working trust between TRW and the DPRO. TOPS permits the adjustment of oversight resources when conditions change or when TRW systems performance indicate either an increase or decrease in surveillance is appropriate. Monthly Contractor Performance Assessments (CPA) are derived from a summary of supporting system level and process-level ratings obtained from objective process-level data. Tiered, objective, data-driven metrics are highly successful in achieving a cooperative and effective method of measuring performance. The teamwork-based culture developed by TOPS proved an unequaled success in removing adversarial relationships and creating an atmosphere of continuous improvement in quality processes at TRW. The new working relationship does not decrease the responsibility or authority of the DPRO to ensure contract compliance and it permits both parties to work more effectively to improve total quality and reduce cost. By emphasizing teamwork in developing a stronger approach to efficient management of the defense industrial base TOPS is a singular success.

Teamwork for Oversight of Processes and Systems (TOPS). Implementation guide for TOPS version 2.0, 10 August 1992

NASA Astrophysics Data System (ADS)

Strand, Albert A.; Jackson, Darryl J.

As the nation redefines priorities to deal with a rapidly changing world order, both government and industry require new approaches for oversight of management systems, particularly for high technology products. Declining defense budgets will lead to significant reductions in government contract management personnel. Concurrently, defense contractors are reducing administrative and overhead staffing to control costs. These combined pressures require bold approaches for the oversight of management systems. In the Spring of 1991, the DPRO and TRW created a Process Action Team (PAT) to jointly prepare a Performance Based Management (PBM) system titled Teamwork for Oversight of Processes and Systems (TOPS). The primary goal is implementation of a performance based management system based on objective data to review critical TRW processes with an emphasis on continuous improvement. The processes are: Finance and Business Systems, Engineering and Manufacturing Systems, Quality Assurance, and Software Systems. The team established a number of goals: delivery of quality products to contractual terms and conditions; ensure that TRW management systems meet government guidance and good business practices; use of objective data to measure critical processes; elimination of wasteful/duplicative reviews and audits; emphasis on teamwork--all efforts must be perceived to add value by both sides and decisions are made by consensus; and synergy and the creation of a strong working trust between TRW and the DPRO. TOPS permits the adjustment of oversight resources when conditions change or when TRW systems performance indicate either an increase or decrease in surveillance is appropriate. Monthly Contractor Performance Assessments (CPA) are derived from a summary of supporting system level and process-level ratings obtained from objective process-level data. Tiered, objective, data-driven metrics are highly successful in achieving a cooperative and effective method of measuring performance. The teamwork-based culture developed by TOPS proved an unequaled success in removing adversarial relationships and creating an atmosphere of continuous improvement in quality processes at TRW. The new working relationship does not decrease the responsibility or authority of the DPRO to ensure contract compliance and it permits both parties to work more effectively to improve total quality and reduce cost. By emphasizing teamwork in developing a stronger approach to efficient management of the defense industrial base TOPS is a singular success.

Model-based color halftoning using direct binary search.

PubMed

Agar, A Ufuk; Allebach, Jan P

2005-12-01

In this paper, we develop a model-based color halftoning method using the direct binary search (DBS) algorithm. Our method strives to minimize the perceived error between the continuous tone original color image and the color halftone image. We exploit the differences in how the human viewers respond to luminance and chrominance information and use the total squared error in a luminance/chrominance based space as our metric. Starting with an initial halftone, we minimize this error metric using the DBS algorithm. Our method also incorporates a measurement based color printer dot interaction model to prevent the artifacts due to dot overlap and to improve color texture quality. We calibrate our halftoning algorithm to ensure accurate colorant distributions in resulting halftones. We present the color halftones which demonstrate the efficacy of our method.

Study on perception and control layer of mine CPS with mixed logic dynamic approach

NASA Astrophysics Data System (ADS)

Li, Jingzhao; Ren, Ping; Yang, Dayu

2017-01-01

Mine inclined roadway transportation system of mine cyber physical system is a hybrid system consisting of a continuous-time system and a discrete-time system, which can be divided into inclined roadway signal subsystem, error-proofing channel subsystems, anti-car subsystems, and frequency control subsystems. First, to ensure stable operation, improve efficiency and production safety, this hybrid system model with n inputs and m outputs is constructed and analyzed in detail, then its steady schedule state to be solved. Second, on the basis of the formal modeling for real-time systems, we use hybrid toolbox for system security verification. Third, the practical application of mine cyber physical system shows that the method for real-time simulation of mine cyber physical system is effective.

LANL Institutional Decision Support By Process Modeling and Analysis Group (AET-2)

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

Booth, Steven Richard

2016-04-04

AET-2 has expertise in process modeling, economics, business case analysis, risk assessment, Lean/Six Sigma tools, and decision analysis to provide timely decision support to LANS leading to continuous improvement. This capability is critical during the current tight budgetary environment as LANS pushes to identify potential areas of cost savings and efficiencies. An important arena is business systems and operations, where processes can impact most or all laboratory employees. Lab-wide efforts are needed to identify and eliminate inefficiencies to accomplish Director McMillan’s charge of “doing more with less.” LANS faces many critical and potentially expensive choices that require sound decision supportmore » to ensure success. AET-2 is available to provide this analysis support to expedite the decisions at hand.« less

Preparing health care organizations for successful case management programs.

PubMed

Bonvissuto, C A; Kastens, J M; Atwell, S R

1997-01-01

This article reports the results of a study of four hospital-based providers in varying stages of implementing case management programs. Three of the providers had most of the necessary elements in place to ensure success, such as a mix of reimbursement sources, an effective and integrated information management system, a full range of clinical services, and continuous quality improvement programs. The authors make several suggestions for key activities that must be pursued by any health care organization seeking to implement a case management program in an era of managed care, tightening reimbursement, and consumer demand for quality care. These include the need to (a) organize essential case management functions under a centralized structure; (b) set realistic, quantifiable targets, and (c) design a communications plan for the program.

Casemix and rehabilitation: evaluation of an early discharge scheme.

PubMed

Brandis, S

2000-01-01

This paper presents a case study of an early discharge scheme funded by casemix incentives and discusses limitations of a casemix model of funding whereby hospital inpatient care is funded separately from care in other settings. The POSITIVE Rehabilitation program received 151 patients discharged early from hospital in a twelve-month period. Program evaluation demonstrates a 40.9% drop in the average length of stay of rehabilitation patients and a 42.6% drop in average length of stay for patients with stroke. Other benefits of the program include a high level of patient satisfaction, improved carer support and increased continuity of care. The challenge under the Australian interpretation of a casemix model of funding is ensuring the viability of services that extend across acute hospital, non-acute care, and community and home settings.

Improving your genetic literacy in epilepsy-A new series.

PubMed

Tan, Nigel C K; Lowenstein, Daniel H

2015-11-01

Advances in epilepsy genetics have been rapid, and it is challenging for clinicians on the ground to keep pace with these advances. The International League Against Epilepsy (ILAE) Genetics Commission has thus crafted a new Genetic Literacy series targeted at busy clinicians. Our goal is to help provide a concise, accessible resource on epilepsy genetics for the busy, on-the-ground clinician so that he/she can apply that knowledge at point-of-care to help patients. This new series is grounded in educational theories and evidence to ensure that learning is effective and efficient. We hope that by promoting and encouraging continuing medical education in epilepsy genetics, this eventually translates to better patient management and therefore better patient health outcomes. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Parameter Identification of Static Friction Based on An Optimal Exciting Trajectory

NASA Astrophysics Data System (ADS)

Tu, X.; Zhao, P.; Zhou, Y. F.

2017-12-01

In this paper, we focus on how to improve the identification efficiency of friction parameters in a robot joint. First, the static friction model that has only linear dependencies with respect to their parameters is adopted so that the servomotor dynamics can be linearized. In this case, the traditional exciting trajectory based on Fourier series is modified by replacing the constant term with quintic polynomial to ensure the boundary continuity of speed and acceleration. Then, the Fourier-related parameters are optimized by genetic algorithm(GA) in which the condition number of regression matrix is set as the fitness function. At last, compared with the constant-velocity tracking experiment, the friction parameters from the exciting trajectory experiment has the similar result with the advantage of time reduction.