Reflotron cholesterol measurement in general practice: accuracy and detection of errors.

PubMed

Ball, M J; Robertson, I K; Woods, M

1994-11-01

Comparison of cholesterol determinations by nurses using a Reflotron analyser in a general practice setting showed a good correlation with plasma cholesterol determinations by wet chemistry in a clinical biochemistry laboratory. A limited number of comparisons did, however, give a much lower result on the Reflotron. In an experimental situation, small sample volumes (which could result from poor technique) were shown to produce falsely low readings. A simple method which may immediately detect falsely low Reflotron readings is discussed.

The Coast Artillery Journal. Volume 72, Number 5, May 1930

DTIC Science & Technology

1930-05-01

the JOURNAL’Swelfare. ’rVeare pleased to learn that it is increasing its goodwill at Barrancas. Let us hope that the arts of alchemy ,vill be practiced...R. MILLER, C. A. C Business Manager Yolume 72 May, 1930 CONTENTS Number 5 MAJOR GENERAL JOHN W. GULICK. Frontispiece GREETINGS OF CHIEF OF COAST...ARTILLERY TO CORPS 381 MAJOR GENERAL JOHN W. GULICK, CHIEF OF COAST ARTILLERY 382 COMMENTS ON REVISION OF TR 535..55, COAST ARTILLERY TAR- GET PRACTICE

Effectiveness and Student Success: Transforming Community Colleges for the 1990's. Proceedings from the Conference (Chicago, Illinois, June 25-27, 1989).

ERIC Educational Resources Information Center

Walleri, Dan, Ed.; And Others

The eight general session, exemplary practice, and roundtable papers contained in this conference proceedings report focus on various aspects of institutional effectiveness and student outcomes. The volume includes: (1) "Effectiveness and Student Success in Community Colleges: Practices, Realities, and Imperatives," by Peter Ewell; (2) "Rhetoric…

Forcible Rape. A National Survey of the Response by Prosecutors. Prosecutors' Volume 1.

ERIC Educational Resources Information Center

Battelle Memorial Inst., Seattle, WA. Law and Justice Study Center.

This report presents the results of a nationwide survey of current law enforcement practices in response to the crime of forcible rape. A total of 150 prosecutor agencies were sampled. Respondents were asked to provide information regarding their agencies' general policies and specific practices in the following areas: classification methods;…

[The shutdown point and the output volume limit (OVL) in the present situation of healthcare in Hungary (or a little economics for practicing physicians)].

PubMed

Gresz, Miklós

2008-09-07

In the present situation of health care, financing has become so complicated that the treating doctor has to know not only his profession but also has to consider the different regulations, laws and book of rules. The work of the physician cannot be carried out only through the fact that he is a master of his art, that is healing. All healing practice, diagnostic abilities, intuition, empathy and other things are in vain: if he is not familiar with the basics of financing he can lead his institution to insolvency. This article tries to give a view of a small part of financing, the output volume limit (OVL) from another aspect. According to the basics of economy and general rules of leadership it tries to show up the practical difficulties of the output volume limit. The study enlightens that by defining the output volume limit one has to consider the shutdown point of the hospital and knowing this, the actual output volume limit should be defined in the way that it does not make the proper activity of the hospital completely impossible.

The feasibility of introducing advanced minimally invasive surgery into surgical practice

PubMed Central

Birch, Daniel W.; Misra, Monali; Farrokhyar, Forough

2007-01-01

Background This study investigates the feasibility of performing advanced minimally invasive surgery (MIS) in a nonspecialized practice environment. Methods We conducted a cross-sectional survey of all community general surgeons currently practising in Ontario. Results Few community surgeons perform a high volume (> 10 procedures per yr) of advanced MIS. Most (70%) believe it is important to acquire additional skills in advanced MIS. The most appropriate methods for learning advanced MIS are believed to be expert mentoring (79.7%), courses (77.2%) and a colleague mentor (63.9%). A total of 57.6% of respondents have attended a course in MIS while in practice, and most have access to a reasonable variety of instrumentation. Respondents believe that 57.6% of assistants, 54.8% of nurses and 43.4% of anaesthetists are relatively inexperienced with advanced MIS. Barriers to establishing advanced MIS include limited operating room access (50%), resources or equipment (45.2%) and limited expert mentoring (43.6%). Surgeons with less than 10 years of practice found lack of trained nursing staff (7.9% v. 4.2%, p = 0.01) and experienced assistants (12% v. 6.2%, p = 0.008) to be more important barriers than did those with over 10 years of practice, respectively. Conclusion Most general surgeons working in Ontario are self-taught with respect to MIS skills, and few perform a high volume of advanced MIS. Only one-half of all respondents have access to skilled MIS operating room nurses, surgical assistants or anesthesiology. Despite this, general surgeons perceive the greatest barriers to introducing advanced MIS procedures to be limited access to operating rooms, resources or equipment and limited mentoring. This study has shown that the role of the surgical team in advanced MIS may be underestimated by many general surgeons. These data have important implications in training general surgeons and in incorporating additional advanced MIS procedures into the armamentarium of general surgeons. PMID:17897513

Impact of acute care surgery to departmental productivity.

PubMed

Barnes, Stephen L; Cooper, Christopher J; Coughenour, Jeffrey P; MacIntyre, Allan D; Kessel, James W

2011-10-01

The face of trauma surgery is rapidly evolving with a paradigm shift toward acute care surgery (ACS). The formal development of ACS has been viewed by some general surgeons as a threat to their practice. We sought to evaluate the impact of a new division of ACS to both departmental productivity and provider satisfaction at a University Level I Trauma Center. Two-year retrospective analysis of annual work relative value unit (wRVU) productivity, operative volume, and FTEs before and after establishment of an ACS division at a University Level I trauma center. Provider satisfaction was measured using a 10-point scale. Analysis completed using Microsoft Excel with a p value less than 0.05 significant. The change to an ACS model resulted in a 94% increase in total wRVU production (78% evaluation and management, 122% operative; p<0.05) for ACS, whereas general surgery wRVU production increased 8% (-15% evaluation and management, 14% operative; p<0.05). Operative productivity was substantial after transition to ACS, with 129% and 44% increases (p<0.05) in operative and elective case load, respectively. Decline in overall general surgery operative volume was attributed to reduction in emergent cases. Establishment of the ACS model necessitated one additional FTE. Job satisfaction substantially improved with the ACS model while allowing general surgery a more focused practice. The ACS practice model significantly enhances provider productivity and job satisfaction when compared with trauma alone. Fears of a productivity impact to the nontrauma general surgeon were not realized.

Detailed model for practical pulverized coal furnaces and gasifiers

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

Smith, P.J.; Smoot, L.D.

1989-08-01

This study has been supported by a consortium of nine industrial and governmental sponsors. Work was initiated on May 1, 1985 and completed August 31, 1989. The central objective of this work was to develop, evaluate and apply a practical combustion model for utility boilers, industrial furnaces and gasifiers. Key accomplishments have included: Development of an advanced first-generation, computer model for combustion in three dimensional furnaces; development of a new first generation fouling and slagging submodel; detailed evaluation of an existing NO{sub x} submodel; development and evaluation of an improved radiation submodel; preparation and distribution of a three-volume final report:more » (a) Volume 1: General Technical Report; (b) Volume 2: PCGC-3 User's Manual; (c) Volume 3: Data Book for Evaluation of Three-Dimensional Combustion Models; and organization of a user's workshop on the three-dimensional code. The furnace computer model developed under this study requires further development before it can be applied generally to all applications; however, it can be used now by specialists for many specific applications, including non-combusting systems and combusting geseous systems. A new combustion center was organized and work was initiated to continue the important research effort initiated by this study. 212 refs., 72 figs., 38 tabs.« less

Research in dental practice: a 'SWOT' analysis.

PubMed

Burke, F J T; Crisp, R J; McCord, J F

2002-03-01

Most dental treatment, in most countries, is carried out in general dental practice. There is therefore a potential wealth of research material, although clinical evaluations have generally been carried out on hospital-based patients. Many types of research, such as clinical evaluations and assessments of new materials, may be appropriate to dental practice. Principal problems are that dental practices are established to treat patients efficiently and to provide an income for the staff of the practice. Time spent on research therefore cannot be used for patient treatment, so there are cost implications. Critics of practice-based research have commented on the lack of calibration of operative diagnoses and other variables; however, this variability is the stuff of dental practice, the real-world situation. Many of the difficulties in carrying out research in dental practice may be overcome. For the enlightened, it may be possible to turn observations based on the volume of treatment carried out in practice into robust, clinically related and relevant research projects based in the real world of dental practice.

Why are patients prescribed proton pump inhibitors? Retrospective analysis of link between morbidity and prescribing in the General Practice Research Database

PubMed Central

Bashford, James N R; Norwood, Jeff; Chapman, Stephen R

1998-01-01

Objectives: To establish the relation between new prescriptions for proton pump inhibitors and recorded upper gastrointestinal morbidity within a large computerised general practitioner database. Design: Retrospective survey of morbidity and prescribing data linked to new prescriptions for proton pump inhibitors and comparison with licensed indications between 1991 and 1995. Setting: General Practice Research Database and prescribing analysis and cost (PACT) data for the former West Midlands region. Subjects: Information for 612 700 patients in the General Practice Research Database. Anonymous PACT data for all general practitioners in West Midlands region. Main outcome measures: Diagnostic codes linked to the first prescriptions issued for proton pump inhibitors; relation between new prescriptions and licensed indications; yearly change in ratio of new to repeat prescriptions and prescribing volumes measured as defined daily doses. Results: Oesophagitis was the commonest recorded indication in 1991, accounting for 31% of new prescriptions, but was third in 1995 (14%). During the study new prescriptions increased substantially, especially for duodenal disease (780%) and non-ulcer dyspepsia (690%). In 1995 non-specific morbidity accounted for 46% of new prescriptions. The total volume of prescribing rose 10-fold between 1991 and 1995, when repeat prescribing accounted for 77% of the total. Conclusions: Changes in recorded morbidity associated with new prescriptions of proton pump inhibitors did not necessarily reflect changes in licensed indications. Although general practitioners seemed to respond to changes in licensing, particularly for duodenal and gastric disease, prescribing for unlicensed indications non-ulcer dyspepsia and non-specific abdominal pain increased. Key messages There has been much speculation about the reasons behind the substantial rise in prescribing of proton pump inhibitors, especially their use for minor symptoms. We used the General Practitioner Research Database for the former West Midlands region to show that the volume of proton pump inhibitor prescribing rose 10-fold between 1992 and 1995 and repeat prescribing had risen to 77% of the volume by 1995 Prescribing for uncomplicated dyspepsia and non-specific abdominal symptoms, which were outside the licensed indications, accounted for 46% of new prescribing by 1995 The proportion of prescribing for the licensed indication of oesophagitis fell during the study, but that for duodenal ulceration increased in line with the expansion of licensed indications Analysis of PACT data showed similar prescribing trends to those found with the General Practitioner Research Database PMID:9703528

Stormwater management criteria for on-site pollution control: a comparative assessment of international practices.

PubMed

Sage, Jérémie; Berthier, Emmanuel; Gromaire, Marie-Christine

2015-07-01

Over the last decade, a growing interest has been shown toward innovative stormwater management practices, breaking away from conventional "end of pipe" approaches (based on conveying water offsite to centralized detention facilities). Innovative strategies, referred to as sustainable urban drainage systems, low impact development (LID) or green infrastructures, advocating for management of runoff as close to its origin as possible, have therefore gained a lot of popularity among practitioners and public authorities. However, while the need for pollution control is generally well accepted, there is no wide agreement about management criteria to be given to developers. This article hence aims to compare these criteria through literature analysis of different state or local stormwater management manuals or guidelines, investigating both their suitability for pollution control and their influence on best management practices selection and design. Four categories of criteria were identified: flow-rate limitations, "water quality volumes" (to be treated), volume reduction (through infiltration or evapotranspiration), and non-hydrologic criteria (such as loads reduction targets or maximum effluent concentrations). This study suggests that hydrologic criteria based on volume reduction (rather than treatment) might generally be preferable for on-site control of diffuse stormwater pollution. Nonetheless, determination of an appropriate management approach for a specific site is generally not straightforward and presents a variety of challenges for site designers seeking to satisfy local requirements in addressing stormwater quantity and quality issues. The adoption of efficient LID solution may therefore strongly depend on the guidance given to practitioners to account for these management criteria.

Stormwater Management Criteria for On-Site Pollution Control: A Comparative Assessment of International Practices

NASA Astrophysics Data System (ADS)

Sage, Jérémie; Berthier, Emmanuel; Gromaire, Marie-Christine

2015-07-01

Over the last decade, a growing interest has been shown toward innovative stormwater management practices, breaking away from conventional "end of pipe" approaches (based on conveying water offsite to centralized detention facilities). Innovative strategies, referred to as sustainable urban drainage systems, low impact development (LID) or green infrastructures, advocating for management of runoff as close to its origin as possible, have therefore gained a lot of popularity among practitioners and public authorities. However, while the need for pollution control is generally well accepted, there is no wide agreement about management criteria to be given to developers. This article hence aims to compare these criteria through literature analysis of different state or local stormwater management manuals or guidelines, investigating both their suitability for pollution control and their influence on best management practices selection and design. Four categories of criteria were identified: flow-rate limitations, "water quality volumes" (to be treated), volume reduction (through infiltration or evapotranspiration), and non-hydrologic criteria (such as loads reduction targets or maximum effluent concentrations). This study suggests that hydrologic criteria based on volume reduction (rather than treatment) might generally be preferable for on-site control of diffuse stormwater pollution. Nonetheless, determination of an appropriate management approach for a specific site is generally not straightforward and presents a variety of challenges for site designers seeking to satisfy local requirements in addressing stormwater quantity and quality issues. The adoption of efficient LID solution may therefore strongly depend on the guidance given to practitioners to account for these management criteria.

Industrial Training Practices.

ERIC Educational Resources Information Center

Beverstock, A.G.

Based primarily on British conditions, this volume concentrates on methods of industrial training for production workers, craftsmen and technicians, office personnel, technicians and technologists, supervisors, marketing and sales personnel, and the junior, middle, and senior or executive levels of management. General principles and fundamental…

Practical optimal flight control system design for helicopter aircraft. Volume 1: Technical Report

NASA Technical Reports Server (NTRS)

Hofmann, L. G.; Riedel, S. A.; Mcruer, D.

1980-01-01

A method by which modern and classical theory techniques may be integrated in a synergistic fashion and used in the design of practical flight control systems is presented. A general procedure is developed, and several illustrative examples are included. Emphasis is placed not only on the synthesis of the design, but on the assessment of the results as well.

Current Practices and Barriers to the Integration of Oncoplastic Breast Surgery: A Canadian Perspective.

PubMed

Maxwell, Jessica; Roberts, Amanda; Cil, Tulin; Somogyi, Ron; Osman, Fahima

2016-10-01

Despite the safety and popularity of oncoplastic surgery, there is limited data examining utilization and barriers associated with its incorporation into practice. This study examines the use of oncoplastic techniques in breast conserving surgery and determines the barriers associated with their implementation. A 13-item survey was mailed to all registered general surgeons in Ontario, Canada. The survey assessed surgeon demographics, utilization of specific oncoplastic techniques, and perceived barriers. A total of 234 survey responses were received, representing a response rate of 32.2 % (234 of 725). Of the respondents, 166 surgeons (70.9 %) reported a practice volume of at least 25 % breast surgery. Comparison was made between general surgeons performing oncoplastic breast surgery (N = 79) and those who did not use these techniques (N = 87). Surgeon gender, years in practice, fellowship training, and access to plastic surgery were similar across groups. Both groups rated the importance of breast cosmesis similarly. General surgeons with a practice volume involving >50 % breast surgery were more likely to use oncoplastic techniques (OR 8.82, p < .001) and involve plastic surgeons in breast conserving surgery (OR 2.21, p = .02). For surgeons not performing oncoplastic surgery, a lack of training and access to plastic surgeons were identified as significant barriers. For those using oncoplastic techniques, the absence of specific billing codes was identified as a limiting factor. Lack of training, access to plastic surgeons, and absence of appropriate reimbursement for these cases are significant barriers to the adoption of oncoplastic techniques.

Geology of Wisconsin: Survey of 1873-1879, Volume I

USGS Publications Warehouse

Chamberlin, T.C.

1883-01-01

The leading purpose df this volume was determined by the following enactment, being section 1, chapter 121, of the Laws of 1876. "The people of the State of Wisconsin, represented in Senate and Assembly, do enact as follows: Section 1. That in the preparation of his final report, the chief geologist be, and he is hereby authorized to collate the general geology and the leading facts and principles relating to the material resources of the State, together with practical suggestions as to the methods of detecting and utilizing the same, so as to constitute the material for a volume suited to the wants of explorers, miners, land owners, and manufacturers, who use crude native products, and to the needs of the schools of the State, and the masses of intelligent people who are not familiar with the principles of geology; said volume to be written in clear, plain language, with explanations of technical terms, and to be properly illustrated with maps and diagrams, and to be so arranged as to constitute a key to the more perfect understanding of the whole report." To subserve the purposes thus legally defined, the volume will be found to consist of three distinct portions; Part I, embracing the General Geology of the State, with explanatory matter; Part II, consisting of lists of the minerals, rocks and life-products of the State, with descriptions and auxiliary discussions; and Part III, embracing industrial descriptions and practical suggestions with reference to the leading natural resources of the State.

[Research of bleeding volume and method in blood-letting acupuncture therapy based on data mining].

PubMed

Liu, Xin; Jia, Chun-Sheng; Wang, Jian-Ling; Du, Yu-Zhu; Zhang, Xiao-Xu; Shi, Jing; Li, Xiao-Feng; Sun, Yan-Hui; Zhang, Shen; Zhang, Xuan-Ping; Gang, Wei-Juan

2014-03-01

Through computer-based technology and data mining method, with treatment in cases of bloodletting acupuncture therapy in collected literature as sample data, the association rule in data mining was applied. According to self-built database platform, the data was input, arranged and summarized, and eventually required data was acquired to perform the data mining of bleeding volume and method in blood-letting acupuncture therapy, which summarized its application rules and clinical values to provide better guide for clinical practice. There were 9 kinds of blood-letting tools in the literature, in which the frequency of three-edge needle was the highest, accounting for 84.4% (1239/1468). The bleeding volume was classified into six levels, in which less volume (less than 0.1 mL) had the highest frequency (401 times). According to the results of the data mining, blood-letting acupuncture therapy was widely applied in clinical practice of acupuncture, in which use of three-edge needle and less volume (less than 0.1 mL) of blood were the most common, however, there was no central tendency in general.

An Exploratory Study of Women in the Health Professions Schools. Volume X: Bibliography and Annotated Bibliography.

ERIC Educational Resources Information Center

Urban and Rural Systems Associates, San Francisco, CA.

The bibliography is part of an extensive study of the barriers to women's success in the schools and practice of eight health professions. It divides resources into 14 segments: one covers the health professions in general; one treats women and careers in general; one is devoted to each of eight health professions (medicine, osteopathic medicine,…

Proceedings of the Annual Meeting of the North American Chapter of the International Group for the Psychology of Mathematics Education (19th, Bloomington-Normal, IL, October 18-21, 1997). Volume 2.

ERIC Educational Resources Information Center

Dossey, John A., Ed.; Swafford, Jane O., Ed.; Parmantie, Marilyn, Ed.; Dossey, Anne E., Ed.

The conference proceedings volume for PME-NA-XIX contains a total of 72 reports: 34 research reports; 20 short oral reports; 11 poster session reports; and 7 discussion group reports. Only the research reports are full reports; the others are generally one-page abstracts. The full reports include: (1) "Equity, Teaching Practices, and Reform:…

Does general surgery residency prepare surgeons for community practice in British Columbia?

PubMed Central

Hwang, Hamish

2009-01-01

Background Preparing surgeons for clinical practice is a challenging task for postgraduate training programs across Canada. The purpose of this study was to examine whether a single surgeon entering practice was adequately prepared by comparing the type and volume of surgical procedures experienced in the last 3 years of training with that in the first year of clinical practice. Methods During the last 3 years of general surgery training, I logged all procedures. In practice, the Medical Services Plan (MSP) of British Columbia tracks all procedures. Using MSP remittance reports, I compiled the procedures performed in my first year of practice. I totaled the number of procedures and broke them down into categories (general, colorectal, laparoscopic, endoscopic, hepatobiliary, oncologic, pediatric, thoracic, vascular and other). I then compared residency training with community practice. Results I logged a total of 1170 procedures in the last 3 years of residency. Of these, 452 were performed during community rotations. The procedures during residency could be broken down as follows: 392 general, 18 colorectal, 242 laparoscopic, 103 endoscopic, 85 hepatobiliary, 142 oncologic, 1 pediatric, 78 thoracic, 92 vascular and 17 other. I performed a total of 1440 procedures in the first year of practice. In practice the break down was 398 general, 15 colorectal, 101 laparoscopic, 654 endoscopic, 2 hepatobiliary, 77 oncologic, 10 pediatric, 0 thoracic, 70 vascular and 113 other. Conclusion On the whole, residency provided excellent preparation for clinical practice based on my experience. Areas of potential improvement included endoscopy, pediatric surgery and “other,” which comprised mostly hand surgery. PMID:19503663

Surgical specialty procedures in rural surgery practices: implications for rural surgery training.

PubMed

Sticca, Robert P; Mullin, Brady C; Harris, Joel D; Hosford, Clint C

2012-12-01

Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training. Current Procedural Terminology codes for all surgical procedures for 81% of North Dakota and South Dakota rural surgeons were entered into the Dakota Database for Rural Surgery. Specialty procedures were analyzed and compared with the Surgical Council on Resident Education curriculum to determine whether general surgery training is adequate preparation for rural surgery practice. The Dakota Database for Rural Surgery included 46,052 procedures, of which 5,666 (12.3%) were specialty procedures. Highest volume specialty categories included vascular, obstetrics and gynecology, orthopedics, cardiothoracic, urology, and otolaryngology. Common procedures in cardiothoracic and vascular surgery are taught in general surgical residency, while common procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology are usually not taught in general surgery training. Optimal training for rural surgery practice should include experience in specialty procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology. Copyright © 2012 Elsevier Inc. All rights reserved.

Focus on Basics, 1999.

ERIC Educational Resources Information Center

Focus on Basics, 1999

1999-01-01

This volume consists of four issues that present best practices, current research on adult learning and literacy, and how research is used. Issue 1(A) on adult multiple intelligences has seven articles: "MI (Multiple Intelligences), the GED (General Educational Development), and Me (Martha Jean); "Understanding Multiple Intelligences: The Theory…

Aeromedical Evacuation: Validating Civil Reserve Air Fleet

DTIC Science & Technology

2009-02-25

flight nurses and three medical technicians) is added for AE missions. The aeromedical evacuation crew (AEC) may be pared and tailored as required in... Biosecurity and Bioterrorism: Biodefense Strategy, Practice and Science, Volume 5, Number 4, 2007: 319-325. 34 IAT.R 0554 General Accounting Office

Between demarcation and discretion: The medical-administrative boundary as a locus of safety in high-volume organisational routines.

PubMed

Grant, Suzanne; Guthrie, Bruce

2018-04-01

Patient safety is an increasing concern for health systems internationally. The majority of administrative work in UK general practice takes place in the context of organisational routines such as repeat prescribing and test results handling, where high workloads and increased clinician dependency on administrative staff have been identified as an emerging safety issue. Despite this trend, most research to date has focused on the redistribution of the clinical workload between doctors, nurses and allied health professionals within individual care settings. Drawing on Strauss's negotiated order perspective, we examine ethnographically the achievement of safety across the medical-administrative boundary in key high-volume routines in UK general practice. We focus on two main issues. First, GPs engaged in strategies of demarcation by defining receptionist work as routine, unspecialised and dependent upon GP clinical knowledge and oversight as the safety net to deal with complexity and risk. Receptionists consented to this 'social closure' when describing their role, thus reinforcing the underlying inter-occupational relationship of medical domination. Second, in everyday practice, GPs and receptionists engaged in informal boundary-blurring to safely accommodate the complexity of everyday high-volume routine work. This comprised additional informal discretionary spaces for receptionist decision-making and action that went beyond the routine safety work formally assigned to them. New restratified intra-occupational hierarchies were also being created between receptionists based on the complexity of the safety work that they were authorised to do at practice level, with specialised roles constituting a new form of administrative 'professional project'. The article advances negotiated order theory by providing an in-depth examination of the ways in which medical-administrative boundary-making and boundary-blurring constitute distinct modes of safety in high-volume routines. It also provides the basis for further research and safety improvement to maximise team-level understandings of the pivotal role of medical-administrative negotiations in achieving safety and mitigating risk. Copyright © 2018 Elsevier Ltd. All rights reserved.

Training our Future Endocrine Surgeons: A Look at the Endocrine Surgery Operative Experience of U.S. Surgical Residents

PubMed Central

Zarebczan, Barbara; Rajamanickam, Victoria; Leverson, Glen; Chen, Herbert; Sippel, Rebecca S

2010-01-01

Background Over the last 10 years the number of endocrine procedures performed in the US has increased significantly. We sought to determine if this has translated into an increase in operative volume for general surgery and otolaryngology residents. Method We evaluated records from the Resident Statistic Summaries of the RRC for US general surgery and otolaryngology residents for the years 2004-2008, specifically examining data on thyroidectomies and parathyroidectomies. Results Between 2004 and 2008, the average endocrine case volume of US general surgery and otolaryngology residents increased by approximately 15%, but otolaryngology residents performed over twice as many operations as US general surgery residents. The growth in case volume was mostly due to increases in the number of thyroidectomies performed by US general surgery and otolaryngology residents (17.9 to 21.8, p=0.007 and 46.5 to 54.4, p=0.04). Overall, otolaryngology residents also performed more parathyroidectomies than their general surgery counterparts (11.6 vs. 8.8, p=0.007). Conclusion Although there has been an increase in the number of endocrine cases performed by graduating US general surgery residents, this is significantly smaller than that of otolaryngology residents. In order to remain competitive, general surgery residents wishing to practice endocrine surgery may need to pursue additional fellowship training. PMID:21134536

Training our future endocrine surgeons: a look at the endocrine surgery operative experience of U.S. surgical residents.

PubMed

Zarebczan, Barbara; McDonald, Robert; Rajamanickam, Victoria; Leverson, Glen; Chen, Herbert; Sippel, Rebecca S

2010-12-01

During the last 10 years, the number of endocrine procedures performed in the United States has increased significantly. We sought to determine whether this has translated into an increase in operative volume for general surgery and otolaryngology residents. We evaluated records from the Resident Statistic Summaries of the Residency Review Committee (RRC) for U.S. general surgery and otolaryngology residents for the years 2004-2008, specifically examining data on thyroidectomies and parathyroidectomies. Between 2004 and 2008, the average endocrine case volume of U.S. general surgery and otolaryngology residents increased by approximately 15%, but otolaryngology residents performed more than twice as many operations as U.S. general surgery residents. The growth in case volume was mostly from increases in the number of thyroidectomies performed by U.S. general surgery and otolaryngology residents (17.9 to 21.8, P = .007 and 46.5 to 54.4, P = .04). Overall, otolaryngology residents also performed more parathyroidectomies than their general surgery counterparts (11.6 vs 8.8, P = .007). Although there has been an increase in the number of endocrine cases performed by graduating U.S. general surgery residents, this is significantly smaller than that of otolaryngology residents. To remain competitive, general surgery residents wishing to practice endocrine surgery may need to pursue additional fellowship training. Copyright © 2010 Mosby, Inc. All rights reserved.

43 CFR 5422.1 - Cruise sales.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Cruise sales. 5422.1 Section 5422.1 Public... OF THE INTERIOR FOREST MANAGEMENT (5000) PREPARATION FOR SALE Volume Measurements § 5422.1 Cruise sales. As the general practice, the Bureau will sell timber on a tree cruise basis. ...

43 CFR 5422.1 - Cruise sales.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Cruise sales. 5422.1 Section 5422.1 Public... OF THE INTERIOR FOREST MANAGEMENT (5000) PREPARATION FOR SALE Volume Measurements § 5422.1 Cruise sales. As the general practice, the Bureau will sell timber on a tree cruise basis. ...

43 CFR 5422.1 - Cruise sales.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Cruise sales. 5422.1 Section 5422.1 Public... OF THE INTERIOR FOREST MANAGEMENT (5000) PREPARATION FOR SALE Volume Measurements § 5422.1 Cruise sales. As the general practice, the Bureau will sell timber on a tree cruise basis. ...

43 CFR 5422.1 - Cruise sales.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Cruise sales. 5422.1 Section 5422.1 Public... OF THE INTERIOR FOREST MANAGEMENT (5000) PREPARATION FOR SALE Volume Measurements § 5422.1 Cruise sales. As the general practice, the Bureau will sell timber on a tree cruise basis. ...

Endobronchial Valves for Endoscopic Lung Volume Reduction: Best Practice Recommendations from Expert Panel on Endoscopic Lung Volume Reduction.

PubMed

Slebos, Dirk-Jan; Shah, Pallav L; Herth, Felix J F; Valipour, Arschang

2017-01-01

Endoscopic lung volume reduction (ELVR) is being adopted as a treatment option for carefully selected patients suffering from severe emphysema. ELVR with the one-way endobronchial Zephyr valves (EBV) has been demonstrated to improve pulmonary function, exercise capacity, and quality of life in patients with both heterogeneous and homogenous emphysema without collateral ventilation. In this "expert best practices" review, we will highlight the practical aspects of this therapy. Key selection criteria for ELVR are hyperinflation with a residual volume >175% of predicted, forced expiratory volume <50% of predicted, and a 6-min walking distance >100 m. Patients with repeated infectious complications, severe bronchiectasis, and those with unstable cardiovascular comorbidities should be excluded from EBV treatment. The procedure may be performed with either conscious sedation or general anesthesia and positive pressure mechanical ventilation using a flexible endotracheal tube or a rigid bronchoscope. Chartis and EBV placement should be performed in 1 procedure when possible. The sequence of valve placement should be orchestrated to avoid obstruction and delivery of subsequent valves. If atelectasis has not occurred by 1 month after procedure, evaluate valve position on CT and consider replacing the valves that are not optimally positioned. Pneumothorax is a common complication and typically occurs in the first 2 days following treatment. A management algorithm for pneumothorax has been previously published. Long-term sequelae from EBV therapy do occur but are easily manageable. © 2016 The Author(s) Published by S. Karger AG, Basel.

42 CFR 495.306 - Establishing patient volume.

Code of Federal Regulations, 2010 CFR

2010-10-01

... calculate patient volume at the group practice/clinic level, but only in accordance with all of the following limitations: (1) The clinic or group practice's patient volume is appropriate as a patient volume... practice's patient volume determination. (3) All EPs in the group practice or clinic must use the same...

International training course on nuclear materials accountability for safeguards purposes

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

Not Available

1980-12-01

The two volumes of this report incorporate all lectures and presentations at the International Training Course on Nuclear Materials Accountability and Control for Safeguards Purposes, held May 27-June 6, 1980, at the Bishop's Lodge near Santa Fe, New Mexico. The course, authorized by the US Nuclear Non-Proliferation Act and sponsored by the US Department of Energy in cooperation with the International Atomic Energy Agency, was developed to provide practical training in the design, implementation, and operation of a National system of nuclear materials accountability and control that satisfies both National and IAEA International safeguards objectives. Volume I, covering the firstmore » week of the course, presents the background, requirements, and general features of material accounting and control in modern safeguard systems. Volume II, covering the second week of the course, provides more detailed information on measurement methods and instruments, practical experience at power reactor and research reactor facilities, and examples of operating state systems of accountability and control.« less

A comparison of three methods of setting prescribing budgets, using data derived from defined daily dose analyses of historic patterns of use.

PubMed Central

Maxwell, M; Howie, J G; Pryde, C J

1998-01-01

BACKGROUND: Prescribing matters (particularly budget setting and research into prescribing variation between doctors) have been handicapped by the absence of credible measures of the volume of drugs prescribed. AIM: To use the defined daily dose (DDD) method to study variation in the volume and cost of drugs prescribed across the seven main British National Formulary (BNF) chapters with a view to comparing different methods of setting prescribing budgets. METHOD: Study of one year of prescribing statistics from all 129 general practices in Lothian, covering 808,059 patients: analyses of prescribing statistics for 1995 to define volume and cost/volume of prescribing for one year for 10 groups of practices defined by the age and deprivation status of their patients, for seven BNF chapters; creation of prescribing budgets for 1996 for each individual practice based on the use of target volume and cost statistics; comparison of 1996 DDD-based budgets with those set using the conventional historical approach; and comparison of DDD-based budgets with budgets set using a capitation-based formula derived from local cost/patient information. RESULTS: The volume of drugs prescribed was affected by the age structure of the practices in BNF Chapters 1 (gastrointestinal), 2 (cardiovascular), and 6 (endocrine), and by deprivation structure for BNF Chapters 3 (respiratory) and 4 (central nervous system). Costs per DDD in the major BNF chapters were largely independent of age, deprivation structure, or fundholding status. Capitation and DDD-based budgets were similar to each other, but both differed substantially from historic budgets. One practice in seven gained or lost more than 100,000 Pounds per annum using DDD or capitation budgets compared with historic budgets. The DDD-based budget, but not the capitation-based budget, can be used to set volume-specific prescribing targets. CONCLUSIONS: DDD-based and capitation-based prescribing budgets can be set using a simple explanatory model and generalizable methods. In this study, both differed substantially from historic budgets. DDD budgets could be created to accommodate new prescribing strategies and raised or lowered to reflect local intentions to alter overall prescribing volume or cost targets. We recommend that future work on setting budgets and researching prescribing variations should be based on DDD statistics. PMID:10024703

Competitive Employment for Persons with Mental Retardation: From Research to Practice. Volume I.

ERIC Educational Resources Information Center

Wehman, Paul, Ed.; Hill, Janet W., Ed.

Twenty-one papers address issues related to competitive employment of persons with mental retardation. The papers are grouped into four distinct sections having the following headings: general papers, transition from school to work, parent involvement, and behavioral training strategies. The individual papers are as follows: "Critical Values in…

Cultural practices for restoring and maintaining ecosystem function

Treesearch

David H. Van Lear; Tricia L. Wurtz

2005-01-01

Forest restoration, in a general sense, suggests a transition from a degraded state to some "natural" condition, presumably devoid of human influence (Stanturf, this volume). Yet, because nearly all temperate and boreal forests have been influenced to varying and unknown degrees by aborigional man, as well as being subject to continually changing climate and...

Language, Ethnography, and Education: Bridging New Literacy Studies and Bourdieu

ERIC Educational Resources Information Center

Grenfell, Michael; Bloome, David; Hardy, Cheryl; Pahl, Kate; Rowsell, Jennifer; Street, Brian V.

2011-01-01

This frontline volume contributes to the social study of education in general and literacy in particular by bringing together in a new way the traditions of language, ethnography, and education. Integrating New Literacy Studies and Bourdieusian sociology with ethnographic approaches to the study of classroom practice, it offers an original and…

Russian Basic Course: Military Situations, Exercises 1-35.

ERIC Educational Resources Information Center

Defense Language Inst., Washington, DC.

Thirty-five military situations treated in this volume provide exercises in the use of practical military terminology received from the United States Army General School. Each exercise is devoted to a specific topic, and in each case lists of new words and idioms together with their English equivalents are provided. Lessons consist primarily of…

THE USE OF ARCHITECTURAL ACOUSTICAL MATERIALS, THEORY AND PRACTICE. SECOND EDITION.

ERIC Educational Resources Information Center

Acoustical Materials Association, New York, NY.

THIS DISCUSSION OF THE BASIC FUNCTION OF ACOUSTICAL MATERIALS--THE CONTROL OF SOUND BY SOUND ABSORPTION--IS BASED ON THE WAVE AND ENERGY PROPERTIES OF SOUND. IT IS STATED THAT, IN GENERAL, A MUCH LARGER VOLUME OF ACOUSTICAL MATERIALS IS NEEDED TO REMOVE DISTRACTING NOISE FROM CLASSROOMS AND OFFICES, FOR EXAMPLE, THAN FROM AUDITORIUMS, WHERE A…

Quick-Guides to Inclusion: Ideas for Educating Students with Disabilities, Second Edition

ERIC Educational Resources Information Center

Giangreco, Michael F., Ed.; Doyle, Mary Beth, Ed.

2007-01-01

Now for the first time ever, the bestselling, teacher-trusted "Quick-Guides to Inclusion" are available in a single updated and revised volume -- complete with seven all-new Quick-Guides. A resource for busy K-12 teachers who need fast, friendly, and practical guidance on including students with disabilities in general education classrooms, this…

Improving the Preparation of Professional Personnel for Vocational Education in Metropolitan Areas. Volume VII, Final Report.

ERIC Educational Resources Information Center

Righthand, Herbert

This institute was designed to study the needs and problems of vocational teaching in metropolitan areas and to recommend model teacher preparation practices. A total of 60 participants, representing 23 states, Washington, D.C., and the Virgin Islands, took part in this program, which consisted of general sessions, homogeneous and heterogeneous…

Study of overlength on red oak lumber drying quality and rough mill yield

Treesearch

Brian Bond; Janice Wiedenbeck

2006-01-01

Lumber stacking practices can directly affect drying defects, drying rate, and moisture content uniformity. The effect of overlength on drying is generally thought to be detrimental, yet large volumes of overlength lumber are used by secondary manufacturers. Managers of secondary manufacturing facilities need quantitative information to assist them in determining if...

Performance of new automated transthoracic three-dimensional echocardiographic software for left ventricular volumes and function assessment in routine clinical practice: Comparison with 3 Tesla cardiac magnetic resonance.

PubMed

Levy, Franck; Dan Schouver, Elie; Iacuzio, Laura; Civaia, Filippo; Rusek, Stephane; Dommerc, Carinne; Marechaux, Sylvestre; Dor, Vincent; Tribouilloy, Christophe; Dreyfus, Gilles

2017-11-01

Three-dimensional (3D) transthoracic echocardiography (TTE) is superior to two-dimensional Simpson's method for assessment of left ventricular (LV) volumes and LV ejection fraction (LVEF). Nevertheless, 3D TTE is not incorporated into everyday practice, as current LV chamber quantification software products are time-consuming. To evaluate the feasibility, accuracy and reproducibility of new fully automated fast 3D TTE software (HeartModel A.I. ; Philips Healthcare, Andover, MA, USA) for quantification of LV volumes and LVEF in routine practice; to compare the 3D LV volumes and LVEF obtained with a cardiac magnetic resonance (CMR) reference; and to optimize automated default border settings with CMR as reference. Sixty-three consecutive patients, who had comprehensive 3D TTE and CMR examinations within 24hours, were eligible for inclusion. Nine patients (14%) were excluded because of insufficient echogenicity in the 3D TTE. Thus, 54 patients (40 men; mean age 63±13 years) were prospectively included into the study. The inter- and intraobserver reproducibilities of 3D TTE were excellent (coefficient of variation<10%) for end-diastolic volume (EDV), end-systolic volume (ESV) and LVEF. Despite a slight underestimation of EDV using 3D TTE compared with CMR (bias=-22±34mL; P<0.0001), a significant correlation was found between the two measurements (r=0.93; P=0.0001). Enlarging default border detection settings leads to frequent volume overestimation in the general population, but improved agreement with CMR in patients with LVEF≤50%. Correlations between 3D TTE and CMR for ESV and LVEF were excellent (r=0.93 and r=0.91, respectively; P<0.0001). 3D TTE using new-generation fully automated software is a feasible, fast, reproducible and accurate imaging modality for LV volumetric quantification in routine practice. Optimization of border detection settings may increase agreement with CMR for EDV assessment in dilated ventricles. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Is Annual Volume Enough? The Role of Experience and Specialization on Inpatient Mortality After Hepatectomy.

PubMed

Hashimoto, Daniel A; Bababekov, Yanik J; Mehtsun, Winta T; Stapleton, Sahael M; Warshaw, Andrew L; Lillemoe, Keith D; Chang, David C; Vagefi, Parsia A

2017-10-01

To investigate the effect of subspecialty practice and experience on the relationship between annual volume and inpatient mortality after hepatic resection. The impact of annual surgical volume on postoperative outcomes has been extensively examined. However, the impact of cumulative surgeon experience and specialty training on this relationship warrants investigation. The New York Statewide Planning and Research Cooperative System inpatient database was queried for patients' ≥18 years who underwent wedge hepatectomy or lobectomy from 2000 to 2014. Primary exposures included annual surgeon volume, surgeon experience (early vs late career), and surgical specialization-categorized as general surgery (GS), surgical oncology (SO), and transplant (TS). Primary endpoint was inpatient mortality. Hierarchical logistic regression was performed accounting for correlation at the level of the surgeon and the hospital, and adjusting for patient demographics, comorbidities, presence of cirrhosis, and annual surgical hospital volume. A total of 13,467 cases were analyzed. Overall inpatient mortality was 2.35%. On unadjusted analysis, late career surgeons had a mortality rate of 2.62% versus 1.97% for early career surgeons. GS had a mortality rate of 2.98% compared with 1.68% for SO and 2.67% for TS. Once risk-adjusted, annual volume was associated with reduced mortality only among early-career surgeons (odds ratio 0.82, P = 0.001) and general surgeons (odds ratio 0.65, P = 0.002). No volume effect was seen among late-career or specialty-trained surgeons. Annual volume alone likely contributes only a partial assessment of the volume-outcome relationship. In patients undergoing hepatic resection, increased annual volume did not confer a mortality benefit on subspecialty surgeons or late career surgeons.

The British Association of Urological Surgeons (BAUS) radical prostatectomy audit 2014/2015 - an update on current practice and outcomes by centre and surgeon case-volume.

PubMed

Khadhouri, Sinan; Miller, Catherine; Fowler, Sarah; Hounsome, Luke; McNeill, Alan; Adshead, Jim; McGrath, John S

2018-02-01

To describe contemporary radical prostatectomy (RP) practice using the British Association of Urological Surgeons (BAUS) data and audit project and to observe differences in practice in relation to surgeon or centre case-volume. Data on 13 920 RP procedures performed by 179 surgeons across 86 centres were recorded on the BAUS data and audit platform between 1 January 2014 and 31 December 2015. This equates to ~95% of total RPs performed over this period when compared to Hospital Episode Statistics (HES) data. Centre case-volumes were categorised as 'high' (>200), 'medium' (100-200) and 'low' (<100); surgeon case-volumes were categorised as 'high' (>100) and 'low' (<100). Differences in surgical practice and selected outcome measures were observed between groups. All data and volume categories were for the combined 2-year period. The median number of RPs performed over the 2-year period was 63.5 per surgeon and 164 per centre. Overall, surgical approach was robot-assisted laparoscopic RP (RALP) in 65%, laparoscopic RP (LRP) in 23%, and open RP (ORP) in 12%. The dominant approach in high-case-volume centres and by high-case-volume surgeons was RALP (74.3% and 69.2%, respectively). There was a greater percentage of ORPs reported by low-volume surgeons and centres when compared to higher volume equivalents. In all, 51.6% of all patients in this series underwent RP in high-case-volume centres using robot-assisted surgery (RAS). High-case-volume surgeons performed nerve-sparing (NS) procedures on 57.3% of their cases; low-volume surgeons performing NS on 48.2%. Overall, lymph node dissection (LND) rates were very similar across the groups. An 'extended' LND was more commonly performed in high-volume centres (22.1%). The median length of stay (LOS) was lowest in patients undergoing RALP at high-volume centres (1 day) and highest in ORP across all volume categories (3-4 days). Reported pT2 positive surgical margin (PSM) rate varied by technique, centre volume, and surgeon volume. In general, observed PSM rates were lower when RALP was the surgical approach (14.4%) and when high-volume surgeons were compared to low-volume surgeons (13.6% vs 17.7%). Transfusion rates were highest in ORP across all centres and surgeons (2.96-4.49%) compared to techniques using a minimally-invasive approach (0.25-2.41%). Training cases ranged from 0.5% in low-volume centres to 6.0% in high-volume centres. Compliance with data registration for centres and surgeons performing RP is high in the present series. Most RPs were performed in high-case-volume centres and by high-case-volume surgeons, with the most common approaches being minimally invasive and specifically RAS. High-case-volume centres and surgeons reported higher rates of extended LND and training cases. Higher-case-volume surgeons reported lower pT2 PSM rates, whilst the most marked differences in transfusion rates and LOS were seen when ORP was compared to minimally invasive approaches. Caution must be applied when interpreting these differences on the basis of this being registry data - causality cannot be assumed. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Social Networking in Schools: Benefits and Risks; Review of the Research; Policy Considerations; and Current Practices. Information Capsule. Volume 1109

ERIC Educational Resources Information Center

Blazer, Christie

2012-01-01

The role that social media should play in education is being hotly debated in school districts across the country. The adoption of social networking for educational purposes lags behind the public's general usage because educators fear that students will be exposed to inappropriate online content, unwanted adult interactions, and bullying from…

Au Courant: Teaching French Vocabulary and Culture Using the Mass Media. Language in Education: Theory and Practice 65.

ERIC Educational Resources Information Center

Berwald, Jean-Pierre

This volume outlines potential uses of many of the topics associated with daily newspapers, music, film, theater, and sports for vocabulary development and grammar review in French language instruction. The emphasis is on the advantage of using authentic, current materials prepared for the general public but somewhat familiar to students. The…

STORMWATER BEST MANAGEMENT PRACTICES DESIGN GUIDE VOLUME 2 - VEGETATIVE BIOFILTERS

EPA Science Inventory

This document is Volume 2 of a three volume document that provides guidance on the selection and design of stormwater management Best Management Practices (BMPs). This second volume provides specific design guidance for a group of onsite BMP control practices that are referred t...

Accuracy Analysis for Finite-Volume Discretization Schemes on Irregular Grids

NASA Technical Reports Server (NTRS)

Diskin, Boris; Thomas, James L.

2010-01-01

A new computational analysis tool, downscaling test, is introduced and applied for studying the convergence rates of truncation and discretization errors of nite-volume discretization schemes on general irregular (e.g., unstructured) grids. The study shows that the design-order convergence of discretization errors can be achieved even when truncation errors exhibit a lower-order convergence or, in some cases, do not converge at all. The downscaling test is a general, efficient, accurate, and practical tool, enabling straightforward extension of verification and validation to general unstructured grid formulations. It also allows separate analysis of the interior, boundaries, and singularities that could be useful even in structured-grid settings. There are several new findings arising from the use of the downscaling test analysis. It is shown that the discretization accuracy of a common node-centered nite-volume scheme, known to be second-order accurate for inviscid equations on triangular grids, degenerates to first order for mixed grids. Alternative node-centered schemes are presented and demonstrated to provide second and third order accuracies on general mixed grids. The local accuracy deterioration at intersections of tangency and in flow/outflow boundaries is demonstrated using the DS tests tailored to examining the local behavior of the boundary conditions. The discretization-error order reduction within inviscid stagnation regions is demonstrated. The accuracy deterioration is local, affecting mainly the velocity components, but applies to any order scheme.

Retaining the general practitioner workforce in England: what matters to GPs? A cross-sectional study.

PubMed

Dale, Jeremy; Potter, Rachel; Owen, Katherine; Parsons, Nicholas; Realpe, Alba; Leach, Jonathan

2015-10-16

The general practice (GP) workforce in England is in crisis, reflected in increasing rates of early retirement and intentions to reduce hours of working. This study aimed to investigate underlying factors and how these might be mitigated. GPs in central England were invited to participate in an on-line survey exploring career plans and views and experiences of work-related pressures. Quantitative data were analysed using logistic regression analysis and principal components analysis. Qualitative data were analysed using a thematic framework approach. Of 1,192 GPs who participated, 978 (82.0 %) stated that they intend to leave general practice, take a career break and/or reduce clinical hours of work within the next five years. This included 488 (41.9 %) who intend to leave practice, and almost a quarter (279; 23.2 %) intending to take a career break. Only 67 (5.6 %) planned to increase their hours of clinical work. For participants planning to leave practice, the issues that most influenced intentions were volume and intensity of workload, time spent on "unimportant tasks", introduction of seven-day working and lack of job satisfaction. Four hundred fifty five participants responded to open questions (39128 words in total). The main themes were the cumulative impact of work-related pressures, the changing and growing nature of the workload, and the consequent stress. Reducing workload intensity, workload volume, administrative activities, with increased time for patient care, no out-of-hour commitments, more flexible working conditions and greater clinical autonomy were identified as the most important requirements to address the workforce crisis. In addition, incentive payments, increased pay and protected time for education and training were also rated as important. New models of professionalism and organisational arrangements may be needed to address the issues described here. Without urgent action, the GP workforce crisis in England seems set to worsen.

Advances in diagnostic ultrasonography.

PubMed

Reef, V B

1991-08-01

A wide variety of ultrasonographic equipment currently is available for use in equine practice, but no one machine is optimal for every type of imaging. Image quality is the most important factor in equipment selection once the needs of the practitioner are ascertained. The transducer frequencies available, transducer footprints, depth of field displayed, frame rate, gray scale, simultaneous electrocardiography, Doppler, and functions to modify the image are all important considerations. The ability to make measurements off of videocassette recorder playback and future upgradability should be evaluated. Linear array and sector technology are the backbone of equine ultrasonography today. Linear array technology is most useful for a high-volume broodmare practice, whereas sector technology is ideal for a more general equine practice. The curved or convex linear scanner has more applications than the standard linear array and is equipped with the linear array rectal probe, which provides the equine practitioner with a more versatile unit for equine ultrasonographic evaluations. The annular array and phased array systems have improved image quality, but each has its own limitations. The new sector scanners still provide the most versatile affordable equipment for equine general practice.

Effects of practice and experience on the arcuate fasciculus: comparing singers, instrumentalists, and non-musicians.

PubMed

Halwani, Gus F; Loui, Psyche; Rüber, Theodor; Schlaug, Gottfried

2011-01-01

Structure and function of the human brain are affected by training in both linguistic and musical domains. Individuals with intensive vocal musical training provide a useful model for investigating neural adaptations of learning in the vocal-motor domain and can be compared with learning in a more general musical domain. Here we confirm general differences in macrostructure (tract volume) and microstructure (fractional anisotropy, FA) of the arcuate fasciculus (AF), a prominent white-matter tract connecting temporal and frontal brain regions, between singers, instrumentalists, and non-musicians. Both groups of musicians differed from non-musicians in having larger tract volume and higher FA values of the right and left AF. The AF was then subdivided in a dorsal (superior) branch connecting the superior temporal gyrus and the inferior frontal gyrus (STG ↔ IFG), and ventral (inferior) branch connecting the middle temporal gyrus and the inferior frontal gyrus (MTG ↔ IFG). Relative to instrumental musicians, singers had a larger tract volume but lower FA values in the left dorsal AF (STG ↔ IFG), and a similar trend in the left ventral AF (MTG ↔ IFG). This between-group comparison controls for the general effects of musical training, although FA was still higher in singers compared to non-musicians. Both musician groups had higher tract volumes in the right dorsal and ventral tracts compared to non-musicians, but did not show a significant difference between each other. Furthermore, in the singers' group, FA in the left dorsal branch of the AF was inversely correlated with the number of years of participants' vocal training. Our findings suggest that long-term vocal-motor training might lead to an increase in volume and microstructural complexity of specific white-matter tracts connecting regions that are fundamental to sound perception, production, and its feedforward and feedback control which can be differentiated from a more general musician effect.

Biennial Survey of Education in the United States, 1928-1930. Bulletin, 1931, No. 20. Volume I. Chapter VIII: Art Education

ERIC Educational Resources Information Center

Farnum, Royal Bailey

1931-01-01

Art education in the United States has never been on a firmer footing than at the present time. It faces a future secure in the knowledge that during the past 10 years its social, economic, and educational values have been demonstrated and acknowledged and generally put into practice. Educational leaders no longer ignore it; rather one finds an…

What Does PK-3 Instructional Alignment Mean for Policy and Practice? Social Policy Report Brief. Volume 30, Issue 2

ERIC Educational Resources Information Center

Bridgman, Anne

2017-01-01

With most 4 year olds in the United States now in center-based early care, the need for aligning instruction from preschool through the early grades (PK-3) has become more pressing. Yet so far there has been little guidance on how to create alignment. Research on PK-3 alignment seeks to provide general principles for creating instructional…

Bronchoscopic Thermal Vapor Ablation: Best Practice Recommendations from an Expert Panel on Endoscopic Lung Volume Reduction.

PubMed

Gompelmann, Daniela; Shah, Pallav L; Valipour, Arschang; Herth, Felix J F

2018-06-12

Bronchoscopic thermal vapor ablation (BTVA) represents one of the endoscopic lung volume reduction (ELVR) techniques that aims at hyperinflation reduction in patients with advanced emphysema to improve respiratory mechanics. By targeted segmental vapor ablation, an inflammatory response leads to tissue and volume reduction of the most diseased emphysematous segments. So far, BTVA has been demonstrated in several single-arm trials and 1 multinational randomized controlled trial to improve lung function, exercise capacity, and quality of life in patients with upper lobe-predominant emphysema irrespective of the collateral ventilation. In this review, we emphasize the practical aspects of this ELVR method. Patients with upper lobe-predominant emphysema, forced expiratory volume in 1 second (FEV1) between 20 and 45% of predicted, residual volume (RV) > 175% of predicted, and carbon monoxide diffusing capacity (DLCO) ≥20% of predicted can be considered for BTVA treatment. Prior to the procedure, a special software assists in identifying the target segments with the highest emphysema index, volume and the highest heterogeneity index to the untreated ipsilateral lung lobes. The procedure may be performed under deep sedation or preferably under general anesthesia. After positioning of the BTVA catheter and occlusion of the target segment by the occlusion balloon, heated water vapor is delivered in a predetermined specified time according to the vapor dose. After the procedure, patients should be strictly monitored to proactively detect symptoms of localized inflammatory reaction that may temporarily worsen the clinical status of the patient and to detect complications. As the data are still very limited, BTVA should be performed within clinical trials or comprehensive registries where the product is commercially available. © 2018 S. Karger AG, Basel.

Economic impact of converting an interventional pain medicine physician office-based practice into a provider-based ambulatory pain practice.

PubMed

Grider, Jay S; Findley, Kelley A; Higdon, Courtney; Curtright, Jonathan; Clark, Don P

2014-01-01

One consequence of the shifting economic health care landscape is the growing trend of physician employment and practice acquisition by hospitals. These acquired practices are often converted into hospital- or provider-based clinics. This designation brings the increased services of the hospital, the accreditation of the hospital, and a new billing structure verses the private clinic (the combination of the facility and professional fee billing). One potential concern with moving to a provider-based designation is that this new structure might make the practice less competitive in a marketplace that may still be dominated by private physician office-based practices. The aim of the current study was to evaluate the impact of the provider-based/hospital fee structure on clinical volume. Determine the effect of transition to a hospital- or provider-based practice setting (with concomitant cost implications) on patient volume in the current practice milieu.   Community hospital-based academic interventional pain medicine practice. Economic analysis of effect of change in price structure on clinical volumes. The current study evaluates the effect of a change in designation with price implications on the demand for clinical services that accompany the transition to a hospital-based practice setting from a physician office setting in an academic community hospital. Clinical volumes of both procedures and clinic volumes increased in a mature practice setting following transition to a provider-based designation and the accompanying facility and professional fee structure. Following transition to a provider-based designation clinic visits were increased 24% while procedural volume demand did not change. Single practice entity and single geographic location in southeastern United States. The conversion to a hospital- or provider-based setting does not negatively impact clinical volume and referrals to community-based pain medicine practice. These results imply that factors other than price are a driver of patient choice.  

Command History. 1969. Volume 3. Sanitized

DTIC Science & Technology

1969-01-01

ground antiairc raft defenses. 11. Tactical specifics, such as altitudes, course, speeds, or angle of attack. (General de - scriptions such as "low and fast...correspondents, the MACV portion of the Daily Press Briefing was revised to consist of brief comment on more significant de - velopments, late additions, and a...focused attention on the fact that the US was attempting to de -escalate, negative , * publicity asserted the men had to stand and practice in the hot

Connecting Research, Policy, and Practice. Review of Adult Learning and Literacy, Volume 7

ERIC Educational Resources Information Center

Comings, John, Ed.; Garner, Barbara, Ed.; Smith, Christine, Ed.

2007-01-01

"Review of Adult Learning and Literacy: Connecting Research, Policy, and Practice, Volume 7" is the newest volume in a series of annual publications of the National Center for the Study of Adult Learning and Literacy (NCSALL) that address major issues, the latest research, and the best practices in the field of adult literacy and…

Handbook of Parenting. Volume 5: Practical Issues in Parenting. Second Edition.

ERIC Educational Resources Information Center

Bornstein, Marc H., Ed.

Concerned with practical aspects of meeting children's needs, this volume, the fifth of five on parenting, describes the nuts and bolts of parenting as well as the promotion of positive parenting practices. The volume consists of the following 19 chapters: (1) "The Ethics of Parenting" (Diana Baumrind and Ross A. Thompson; (2) "Parenting and…

Block Volume Estimation from the Discontinuity Spacing Measurements of Mesozoic Limestone Quarries, Karaburun Peninsula, Turkey

PubMed Central

Elci, Hakan; Turk, Necdet

2014-01-01

Block volumes are generally estimated by analyzing the discontinuity spacing measurements obtained either from the scan lines placed over the rock exposures or the borehole cores. Discontinuity spacing measurements made at the Mesozoic limestone quarries in Karaburun Peninsula were used to estimate the average block volumes that could be produced from them using the suggested methods in the literature. The Block Quality Designation (BQD) ratio method proposed by the authors has been found to have given in the same order of the rock block volume to the volumetric joint count (J v) method. Moreover, dimensions of the 2378 blocks produced between the years of 2009 and 2011 in the working quarries have been recorded. Assuming, that each block surfaces is a discontinuity, the mean block volume (V b), the mean volumetric joint count (J vb) and the mean block shape factor of the blocks are determined and compared with the estimated mean in situ block volumes (V in) and volumetric joint count (J vi) values estimated from the in situ discontinuity measurements. The established relations are presented as a chart to be used in practice for estimating the mean volume of blocks that can be obtained from a quarry site by analyzing the rock mass discontinuity spacing measurements. PMID:24696642

Block volume estimation from the discontinuity spacing measurements of mesozoic limestone quarries, Karaburun Peninsula, Turkey.

PubMed

Elci, Hakan; Turk, Necdet

2014-01-01

Block volumes are generally estimated by analyzing the discontinuity spacing measurements obtained either from the scan lines placed over the rock exposures or the borehole cores. Discontinuity spacing measurements made at the Mesozoic limestone quarries in Karaburun Peninsula were used to estimate the average block volumes that could be produced from them using the suggested methods in the literature. The Block Quality Designation (BQD) ratio method proposed by the authors has been found to have given in the same order of the rock block volume to the volumetric joint count (J(v)) method. Moreover, dimensions of the 2378 blocks produced between the years of 2009 and 2011 in the working quarries have been recorded. Assuming, that each block surfaces is a discontinuity, the mean block volume (V(b)), the mean volumetric joint count (J(vb)) and the mean block shape factor of the blocks are determined and compared with the estimated mean in situ block volumes (V(in)) and volumetric joint count (J(vi)) values estimated from the in situ discontinuity measurements. The established relations are presented as a chart to be used in practice for estimating the mean volume of blocks that can be obtained from a quarry site by analyzing the rock mass discontinuity spacing measurements.

Report of the Plasma Physics and Environmental Perturbation Laboratory (PPEPL) working groups. Volume 3: Magnetospheric experiments working group

NASA Technical Reports Server (NTRS)

1974-01-01

A number of general studies that were proposed for the PPEPL-SHUTTLE program are considered in qualitative detail from both the theoretical and practical points of view. The selection of experimental programs was restricted to those which may be considered active as opposed to refinements of the passive observational programs done previously. It is concluded that, while these new studies were scientifically worthwhile and could be performed in principle, in most cases insufficient attention was paid to the practical details of the experiments. Several specific areas of study, stressing in particular the practical feasibility of the proposed experiments, are recommended. In addition, recommendations are made for further theoretical study, where appropriate. For Vol. 1, see N74-28169; for Vol. 2, see N74-28170.

Brain Trauma Foundation Guideline Compliance: Results of a Multidisciplinary, International Survey.

PubMed

Hirschi, Ryan; Rommel, Casey; Letsinger, Joshua; Nirula, Raminder; Hawryluk, Gregory W J

2018-05-09

Brain Trauma Foundation (BTF) guidelines reflect evidence-based best practices in management of traumatic brain injury. The aim of this study was to examine self-reported physician compliance and predictors of compliance related to BTF guidelines. We conducted an international, multidisciplinary survey examining self-reported adherence to BTF guidelines and multiple factors potentially affecting adherence. We also surveyed intracranial pressure monitoring practices. Of 154 physician respondents, 15.9% reported their institutions "always" follow BTF guidelines and 72.2% reported that they follow them "most of the time." Personal volume of traumatic brain injury cases and years in practice were not significantly related to adherence. Reported adherence varied significantly in association with respondent's institutional trauma level (P = 0.0010): 17.3% of practitioners at level I, 13.0% at level II, and 0% at level III trauma centers reported "always" following guidelines. Reported adherence to guidelines also varied significantly in association with provider specialty (P = 0.015) and institutional volume of severe traumatic brain injury cases (P = 0.008). Regarding intracranial pressure monitoring practices, 52% of respondents used external ventricular drains, 21% used intraparenchymal monitors, and 27% had no preference (P < 0.001). Of respondents not routinely using external ventricular drains, 36% claimed to "always" follow guidelines. There was no apparent association between type of intracranial pressure monitoring used and reported guideline adherence. Few respondents reported their institutions "always" follow BTF guidelines. General surgeons and providers at high-volume level I trauma centers were more likely to comply with guidelines. Differences in survey responses based on provider and institutional characteristics may help target educational efforts. Copyright © 2018 Elsevier Inc. All rights reserved.

The effect of physician practice organization on efficient utilization of hospital resources.

PubMed

Burns, L R; Chilingerian, J A; Wholey, D R

1994-12-01

This study examines variations in the efficient use of hospital resources across individual physicians. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior.

The effect of physician practice organization on efficient utilization of hospital resources.

PubMed Central

Burns, L R; Chilingerian, J A; Wholey, D R

1994-01-01

OBJECTIVE. This study examines variations in the efficient use of hospital resources across individual physicians. DATA SOURCES AND SETTING. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. STUDY DESIGN. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. PRINCIPAL FINDINGS. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. CONCLUSIONS. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior. PMID:8002351

Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements.

PubMed

Heneghan, Steven J; Bordley, James; Dietz, Patrick A; Gold, Michael S; Jenkins, Paul L; Zuckerman, Randall J

2005-11-01

The purpose of this study is to determine the differences between rural and urban surgeons with regard to practice patterns, factors in choosing a practice location, and educational needs. A list of surgeons obtained from the American Medical Association was examined using the Office of Management and Budget definition of rural. Seventeen hundred rural surgeons were mailed surveys; 421 responded. One hundred fourteen urban surgeons were contacted by telephone. Questions were designed to measure job and community satisfaction, factors influencing their decision to practice in their current location, spectrum and volume of cases, and their perceived educational needs. Age distribution did not differ markedly between urban and rural surgeons. Motivation to practice in their current location varied considerably between urban and rural surgeons. Both groups equally rated quality of life as the leading factor influencing their current practice location. Urban surgeons rated other factors, such as income, practice growth, hospital facilities, and proximity to family, higher than rural surgeons. Practice patterns and educational needs also varied between the two groups. Rural surgeons performed more procedures per year with more variety in procedure type. Both groups felt that additional training in advanced laparoscopic techniques would be helpful, and rural surgeons felt that additional training in the surgical subspecialty areas was important. Although rural and urban surgeons do not differ in age or the importance of lifestyle in deciding career location, different factors do impact their choice of location. Practice pattern and educational needs varied markedly between rural and urban general surgeons.

Bilingual Preschools. Volume 2: Best Practices

ERIC Educational Resources Information Center

Kersten, Kristin, Ed.; Rohde, Andreas, Ed.; Schelletter, Christina, Ed.; Steinlen, Anja K., Ed.

2010-01-01

Drawing on data from eleven preschools in four European countries (Germany, Belgium, Sweden, and the UK), this edited volume explores the progress of preschool children learning English over a period of two years. This edited volume (Volume II) gives details on best practices in bilingual preschools as well as background and training on topics…

Snow and Ice Control Materials for Texas Roads; VOLUME 1: Literature and Best Practices Review; VOLUME 2: Field Trials and Laboratory Study

DOT National Transportation Integrated Search

2017-03-01

This report provides findings from a four-year research study of snow and ice control materials for winter weather roadway maintenance applications in Texas. The report is presented in two volumes. Volume 1 is a literature review and best practices r...

Caudal anesthesia in pediatric surgical practice.

PubMed

Rahman, S; Siddiqui, M A; Haque, M; Majumder, S K; Ali, M S; Majid, M A; Hasan, M R

2006-07-01

Prospective study was carried out on 100 patients since May 2005 in my private practice and in the department of pediatric surgery of MMCH. Under caudal anesthesia along with or without ketaminie induction and gas inhalation all the patients underwent different surgical procedure namely anorectal surgery (eg. anoplasty, rectal polyp), urogenital surgery (Circumcision, hypospadias, meatotomy), groin surgery (hernia, hydrocele) and foot & leg surgery. Calculated dose schedule of drugs used in anesthesia and volume were maintained. Time of giving anesthesia and time of starting analgesia were recorded. Per-operative and postoperative analgesia were evaluated. Every parent was explained regarding the merit of caudal anesthesia calculated and compared with that of general anesthesia. Application of caudal anesthesia with or without ketamine & diazepam induction can be used safely and cost effectively and may be put into protocol in many of the pediatric surgical practice both in institute and also in private practice.

Moving NSDC's Staff Development Standards into Practice: Innovation Configurations, Volume II. [CD-ROMs

ERIC Educational Resources Information Center

National Staff Development Council, 2005

2005-01-01

The second volume of "Moving NSDC's Staff Development Standards into Practice: Innovation Configurations" builds on the work that began with the first volume published in 2003. An Innovation Configuration map is a device that identifies and describes the major components of a new practice such as the standards and details of how it would look in…

Platelet-rich preparations to improve healing. Part I: workable options for every size practice.

PubMed

Davis, Vicki L; Abukabda, Alaeddin B; Radio, Nicholas M; Witt-Enderby, Paula A; Clafshenkel, William P; Cairone, J Vito; Rutkowski, James L

2014-08-01

Numerous studies have demonstrated that platelet-rich preparations applied to surgical sites, injuries, or wounds are a safe and effective way to promote soft tissue healing and bone growth. Various protocols have been developed for preparing platelet-rich preparations, with subtle but important differences between them. Unfortunately, only a minority of clinicians use platelet-rich preparations, such as platelet-rich plasma and platelet-rich fibrin, in their practice, possibly due to confusion about the different methods and their advantages and disadvantages. Therefore, the different types of preparations are described to help guide the selection of the best method for any size practice. Classic methods generally require large volumes of blood and can be expensive, complicated, and time-intensive. Simpler protocols have been developed recently, which require relatively inexpensive equipment and small blood volumes and, thus, may be more applicable for small clinical practices. Platelet-rich preparations accelerate healing at earlier time points to reduce discomfort and the potential for adverse outcomes, including infection, poor wound closure, and delays in forming strong bone for subsequent procedures (such as implants). However, platelet-rich preparations may also improve long-term outcomes in patients expected to have impaired healing, such as with lifestyle choices (eg, smoking), medications (eg, steroids), diseases (eg, diabetes, osteoporosis, atherosclerosis), and aging, by supplementing the deficient wound environment to restore proper healing. Therefore, both large and small clinical practices would benefit from utilizing platelet-rich preparations to enhance healing in their patients.

Including internal mammary lymph nodes in radiation therapy for synchronous bilateral breast cancer: an international survey of treatment technique and clinical priorities.

PubMed

Roumeliotis, M; Long, K; Phan, T; Graham, D; Quirk, S

2018-06-05

The aim of this study was to understand the international standard practice for radiation therapy treatment techniques and clinical priorities for institutions including the internal mammary lymph nodes (IMLNs) in the target volume for patients with synchronous bilateral breast cancer. An international survey was developed to include questions that would provide awareness of favored treatment techniques, treatment planning and delivery resource requirements, and the clinical priorities that may lead to the utilization of preferred treatment techniques. Of the 135 respondents, 82 indicated that IMLNs are regularly included in the target volume for radiation therapy (IMLN-inclusion) when the patient is otherwise generally indicated for regional nodal irradiation. Of the 82 respondents that regularly include IMLNs, five were removed as those respondents do not treat this population synchronously. Of the 77 respondents, institutional standard of care varied significantly, though VMAT (34%) and combined static photon and electron fields (21%) were the most commonly utilized techniques. Respondents did preferentially select target volume coverage (70%) as the most important clinical priority, followed by normal tissue sparing (25%). The results of the survey indicate that the IMLN-inclusion for radiation therapy has not yet been comprehensively adopted. As well, no consensus on best practice for radiation therapy treatment techniques has been reached.

Adequacy in voided urine cytology specimens: The role of volume and a repeat void upon predictive values for high-grade urothelial carcinoma.

PubMed

VandenBussche, Christopher J; Rosenthal, Dorothy L; Olson, Matthew T

2016-03-01

Adequacy assessment is one of the most controversial and overlooked components in the daily practice of cytopathology, because it is generally determined from limited samples. Because voided urine varies widely in terms of its volume and cellularity, there is little consensus about the proper role for these variables in assessing specimen adequacy. In this study, the authors explored the role of volume in voided urine specimens to determine whether it plays a role in determining adequacy for the detection of high-grade urothelial carcinoma. Voided urine specimens received at the authors' laboratory over the 9.5 years since the introduction of the Johns Hopkins Template for Reporting Urinary Cytopathology were analyzed for correlations between volume, specimen adequacy, and the diagnosis of high-grade malignancy. The same data set also was queried to determine whether a patient who provided a voided low-volume specimen could yield a higher volume specimen and thereby increase adequacy. In total, 15,731 voided urine specimens with a cumulative volume of 891 liters originating from 8594 individual patients were analyzed. Specimen adequacy increased linearly for each increment of volume submitted to the laboratory up to 30 mL, after which the correlation was nonlinear. Low-volume specimens below this cutoff also had lower fractions of specimens that were diagnosed as malignant or suspicious. Volume is an important component in the evaluation of adequacy for voided urine cytology specimens. © 2015 American Cancer Society.

Studies in Course Design. Volume 1. Case Study I: One Year Postgraduate Course in Teaching for Biology Graduates. Case Study II: A Course for Teachers in General Medical Practice.

ERIC Educational Resources Information Center

Dallas, Dorothy; And Others

A collection of working papers from the course design process of two education courses is presented with attention focused on the category systems employed to set out course objectives and methods. The two studies illustrate the use of a grid to establish the relationships between various course objectives. The first collection of papers is based…

Civil Engineering Corrosion Control. Volume 3. Cathodic Protection Design

DTIC Science & Technology

1975-02-01

coatings, test stations bonds, and insulation. It is certainly not a "cure-all Its economics and feasibility mus’ always be carefully studied .. An in...General Description of Cathodic Protection. Cath- odic protection, as the name signifies, is the process by which an entire surface is transformed into a...The National Asaoeiation of Corrosion Enguler "I i ,.I-11 Standard RP-Ol-69, "Recommended Practice Por ront.ol ol." Ex - ternal Corrosion on

Volume Fraction Determination in Cast Superalloys and DS Eutectic Alloys by a New Practice for Manual Point Counting

NASA Technical Reports Server (NTRS)

Andrews, C. W.

1976-01-01

Volume fraction of a constituent or phase was estimated in six specimens of conventional and DS-eutectic superalloys, using ASTM E562-76, a new standard recommended practice for determining volume fraction by systematic manual point count. Volume fractions determined ranged from 0.086 to 0.36, and with one exception, the 95 percent relative confidence limits were approximately 10 percent of the determined volume fractions. Since the confidence-limit goal of 10 percent, which had been arbitrarily chosen previously, was achieved in all but one case, this application of the new practice was considered successful.

A model for a career in a specialty of general surgery: One surgeon's opinion.

PubMed

Ko, Bona; McHenry, Christopher R

2018-01-01

The integration of general and endocrine surgery was studied as a potential career model for fellowship trained general surgeons. Case logs collected from 1991-2016 and academic milestones were examined for a single general surgeon with a focused interest in endocrine surgery. Operations were categorized using CPT codes and the 2017 ACGME "Major Case Categories" and there frequencies were determined. 10,324 operations were performed on 8209 patients. 412.9 ± 84.9 operations were performed yearly including 279.3 ± 42.7 general and 133.7 ± 65.5 endocrine operations. A high-volume endocrine surgery practice and a rank of tenured professor were achieved by years 11 and 13, respectively. At year 25, the frequency of endocrine operations exceeded general surgery operations. Maintaining a foundation in broad-based general surgery with a specialty focus is a sustainable career model. Residents and fellows can use the model to help plan their careers with realistic expectations. Copyright © 2017. Published by Elsevier Inc.

Four-dimensional multislice computed tomography for determination of respiratory lung tumor motion in conformal radiotherapy

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

Leter, Edward M.; Cademartiri, Filippo; Levendag, Peter C.

2005-07-01

Purpose: We used four-dimensional multislice spiral computed tomography (MSCT) to determine respiratory lung-tumor motion and compared this strategy to common clinical practice in conformal radiotherapy treatment-planning imaging. Methods and Materials: The entire lung volume of 10 consecutive patients with 14 lung metastases were scanned by a 16-slice MSCT. During the scans, patients were instructed to breathe through a spirometer that was connected to a laptop computer. For each patient, 10 stacks of 1.5-mm slices, equally distributed throughout the respiratory cycle, were reconstructed from the acquired MSCT data. The lung tumors were manually contoured in each data set. For each patient,more » the tumor-volume contours of all data sets were copied to 1 data set, which allowed determination of the volume that encompassed all 10 lung-tumor positions (i.e., the tumor-traversed volume [TTV]) during the respiratory cycle. The TTV was compared with the 10 tumor volumes contoured for each patient, to which an empiric respiratory-motion margin was added. The latter target volumes were designated internal-motion included tumor volume (IMITV). Results: The TTV measurements were significantly smaller than the reference IMITV measurements (5.2 {+-} 10.2 cm{sup 3} and 10.1 {+-} 13.7 cm{sup 3}, respectively). All 10 IMITVs for 2 of the 4 tumors in 1 subject completely encompassed the TTV. All 10 IMITVs for 3 tumors in 2 patients did not show overlap with up to 35% of the corresponding TTV. The 10 IMITVs for the remaining tumors either completely encompassed the corresponding TTV or did not show overlap with up to 26% of the corresponding TTV. Conclusions: We found that individualized determination of respiratory lung-tumor motion by four-dimensional respiratory-gated MSCT represents a better and simple strategy to incorporate periodic physiologic motion compared with a generalized approach. The former strategy can, therefore, improve common and state-of-the-art clinical practice in conformal radiotherapy.« less

The cost of implementation of the Clinical Laboratory Improvement Amendments of 1988--the example of pediatric office-based cholesterol screening.

PubMed

Tershakovec, A M; Brannon, S D; Bennett, M J; Shannon, B M

1995-08-01

To measure the additional costs of office-based laboratory testing due to the implementation of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88), using cholesterol screening for children as an example. Four- to ten-year-old children who received their well child care at one of seven participating pediatric practices were screened for hypercholesterolemia. The average number of analyses per day and days per month were derived from the volume of testing completed by the practices. Nurses and technicians time in the screening process were measured and personnel costs were calculated based on salary and fringe benefit rates. Costs of supplies, analyzing control samples, instrument calibration, and instrument depreciation were included. Costs estimates of screening were then completed. CLIA '88 implementation costs were derived from appropriate proficiency testing and laboratory inspection programs. In six practices completing a low volume of testing, 2807 children (5 to 6 children per week) were screened during the observation period, while 414 (about 25 children per week) were screened in one high-volume practice implementing universal screening over a 4-month period. For the six low-volume practices, the cost of screening was $10.60 per child. This decreased to $5.47 for the high-volume practice. Estimated costs of CLIA '88 implementation, including additional proficiency testing and laboratory inspection, added $3.20 per test for the low-volume practices, and $0.71 per test for the high-volume testing. Implementation of CLIA adds significantly to the cost of office-based chemistry laboratory screening. Despite these additional expenses, the cost of testing is still within a reasonable charge for laboratory testing, and is highly sensitive to the volume of tests completed.

Abortion training at multiple sites: an unexpected curriculum for teaching systems-based practice.

PubMed

Herbitter, Cara; Kumar, Vanita; Karasz, Alison; Gold, Marji

2010-04-01

In 1999, the Accreditation Council for Graduate Medical Education endorsed systems-based practice as one of six general competencies. The objective is to explore the paradigm of teaching residents systems-based practice during a women's health rotation that included abortion training in multiple settings. During a routine women's health rotation, residents from two urban family medicine residency programs received early abortion training at a high-volume abortion clinic and their continuity clinic. Thirty-min semistructured interviews were conducted with all 26 residents who rotated between July 2005 and August 2006. Transcripts were analyzed using thematic codes. Through exposure to different healthcare delivery systems, residents learned about systems-based practice, including understanding the failure of the larger system to meet patients' reproductive healthcare needs, differences between two systems, and potential systems barriers they might face as providers. Abortion training in multiple settings may serve as a paradigm for teaching systems-based practice during other rotations that include training in multiple sites.

Nonlinear bivariate dependency of price-volume relationships in agricultural commodity futures markets: A perspective from Multifractal Detrended Cross-Correlation Analysis

NASA Astrophysics Data System (ADS)

He, Ling-Yun; Chen, Shu-Peng

2011-01-01

Nonlinear dependency between characteristic financial and commodity market quantities (variables) is crucially important, especially between trading volume and market price. Studies on nonlinear dependency between price and volume can provide practical insights into market trading characteristics, as well as the theoretical understanding of market dynamics. Actually, nonlinear dependency and its underlying dynamical mechanisms between price and volume can help researchers and technical analysts in understanding the market dynamics by integrating the market variables, instead of investigating them in the current literature. Therefore, for investigating nonlinear dependency of price-volume relationships in agricultural commodity futures markets in China and the US, we perform a new statistical test to detect cross-correlations and apply a new methodology called Multifractal Detrended Cross-Correlation Analysis (MF-DCCA), which is an efficient algorithm to analyze two spatially or temporally correlated time series. We discuss theoretically the relationship between the bivariate cross-correlation exponent and the generalized Hurst exponents for time series of respective variables. We also perform an empirical study and find that there exists a power-law cross-correlation between them, and that multifractal features are significant in all the analyzed agricultural commodity futures markets.

In vitro platelet quality in storage containers used for pediatric transfusions.

PubMed

Weiss, Sandra; Scammell, Kenneth; Levin, Elena; Culibrk, Brankica; Zolfaghari, Sima; Gyöngyössy-Issa, Maria I C; Acker, Jason P

2012-08-01

The in vitro quality of small-volume platelet (PLT) aliquots for pediatric transfusions was assessed to determine the best practice approach. Small volumes (50 mL) of single apheresis PLT components (APCs), collected on either CaridianBCT Trima or Haemonetics MCS+ instruments, were aliquoted on Days 2, 3, 4, and 5 postcollection into Fenwal PL1240 or 4R2014 bags or 60-mL polypropylene syringes. Samples were tested for in vitro quality at their recommended expiry times (4 hr for 4R2014 bags and syringes or Day 5 for PL1240 bags). Assays included pH, CD62P expression, and metabolic measures. CD62P expression increased throughout storage in all containers. Among the small-volume containers, pH, pCO(2) , lactate, and bicarbonate varied considerably. Regardless of the day of aliquoting, pCO(2) was significantly higher and pO(2) was significantly lower in gas-impermeable syringes than other containers. No bacterial growth was detected in any sample. The quality of APCs aliquoted into small-volume containers meets regulatory requirements and is generally equivalent to that of full-volume APCs at expiry. © 2012 American Association of Blood Banks.

Volumic visual perception: principally novel concept

NASA Astrophysics Data System (ADS)

Petrov, Valery

1996-01-01

The general concept of volumic view (VV) as a universal property of space is introduced. VV exists in every point of the universe where electromagnetic (EM) waves can reach and a point or a quasi-point receiver (detector) of EM waves can be placed. Classification of receivers is given for the first time. They are classified into three main categories: biological, man-made non-biological, and mathematically specified hypothetical receivers. The principally novel concept of volumic perception is introduced. It differs chiefly from the traditional concept which traces back to Euclid and pre-Euclidean times and much later to Leonardo da Vinci and Giovanni Battista della Porta's discoveries and practical stereoscopy as introduced by C. Wheatstone. The basic idea of novel concept is that humans and animals acquire volumic visual data flows in series rather than in parallel. In this case the brain is free from extremely sophisticated real time parallel processing of two volumic visual data flows in order to combine them. Such procedure seems hardly probable even for humans who are unable to combine two primitive static stereoscopic images in one quicker than in a few seconds. Some people are unable to perform this procedure at all.

Critical reading and critical thinking--study design and methodology: a personal approach on how to read the clinical literature.

PubMed

Lipman, Timothy O

2013-04-01

The volume of medical literature grows exponentially. Yet we are faced with the necessity to make clinical decisions based on the availability and quality of scientific information. The general strength (reliability, robustness) of any interpretation that guides us in clinical decision making is dependent on how information was obtained. All information and medical studies and, consequently, all conclusions are not created equal. It is incumbent upon us to be able to assess the quality of the information that guides us in the care of our patients. Being able to assess medical literature critically requires use of critical reading and critical thinking skills. To achieve these skills, to be able to analyze medical literature critically, takes a combination of education and practice, practice, and more practice.

Research Informing Practice--Practice Informing Research: Innovative Teaching Methologies for World Language Teachers. Research in Second Language Learning

ERIC Educational Resources Information Center

Schwarzer, David, Ed.; Petron, Mary, Ed.; Luke, Christopher, Ed.

2011-01-01

"Research Informing Practice--Practice Informing Research: Innovative Teaching Methodologies for World Language Educators" is an edited volume that focuses on innovative, nontraditional methods of teaching and learning world languages. Using teacher-research projects, each author in the volume guides readers through their own personal…

Improved Design of Tunnel Supports : Volume 4 : Tunneling Practices in Austria and Germany

DOT National Transportation Integrated Search

1980-06-01

Volume 4 documents and evaluates extensive information gathered on tunnel construction practices in Austria and Germany, identifies differences compared to U.S. practices, and describes new developments. The objective was to assemble all available in...

Characteristics and Energy Use of Volume Servers in the United States

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

Fuchs, H.; Shehabi, A.; Ganeshalingam, M.

Servers’ field energy use remains poorly understood, given heterogeneous computing loads, configurable hardware and software, and operation over a wide range of management practices. This paper explores various characteristics of 1- and 2-socket volume servers that affect energy consumption, and quantifies the difference in power demand between higher-performing SPEC and ENERGY STAR servers and our best understanding of a typical server operating today. We first establish general characteristics of the U.S. installed base of volume servers from existing IDC data and the literature, before presenting information on server hardware configurations from data collection events at a major online retail website.more » We then compare cumulative distribution functions of server idle power across three separate datasets and explain the differences between them via examination of the hardware characteristics to which power draw is most sensitive. We find that idle server power demand is significantly higher than ENERGY STAR benchmarks and the industry-released energy use documented in SPEC, and that SPEC server configurations—and likely the associated power-scaling trends—are atypical of volume servers. Next, we examine recent trends in server power draw among high-performing servers across their full load range to consider how representative these trends are of all volume servers before inputting weighted average idle power load values into a recently published model of national server energy use. Finally, we present results from two surveys of IT managers (n=216) and IT vendors (n=178) that illustrate the prevalence of more-efficient equipment and operational practices in server rooms and closets; these findings highlight opportunities to improve the energy efficiency of the U.S. server stock.« less

Impact of Resource-Based Practice Expenses on the Medicare Physician Volume

PubMed Central

Maxwell, Stephanie; Zuckerman, Stephen

2007-01-01

In 1999, Medicare implemented a resource-based relative value unit (RVU) system for physician practice expense payments, and increased the number of services for which practice expense payments differ by site. Using 1998-2004 data, we examined RVU growth and decomposed that growth into resource-based RVUs, site of service, and service quantity and mix. We found that the number services with site of service differentials doubled, and that shifts in site of service and introduction of resource-based practice expenses (RBPE) were important sources of change in practice expense RVU volume. Service quantity and mix remained the largest source of growth in total RVU volume. PMID:18435224

The Coast Artillery Journal. Volume 71, Number 4, October 1929

DTIC Science & Technology

1929-10-01

34ad .. justed" in 1927 with the number" adjusted" in 1928 it was necessary to re-examine all 1927 reports and apply the same rule for determination of...should be made in TR 435-55. The rules goveming target practice for the year 1929were in the hands of the printer prior to the receipt of the...means, with the camera obscura of accurately tracking a plane through the heavens. General rules could simulate the actual flight of a bomber and provide

The Guardian: The Source for Antiterrorism Information. Volume 9, Number 1, April 2007

DTIC Science & Technology

2007-04-01

the fuel in these research reactors is generally not highly radioactive . Unlike the fuel rods in a nuclear power plant, these fuel elements would...NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND...practices and lessons learned. In addition, we will include Service and issue-specific breakout sessions that will focus on critical AT program elements

Review of Adult Learning and Literacy, Volume 5. Connecting Research, Policy, and Practice: A Project of the National Center for the Study of Adult Learning and Literacy

ERIC Educational Resources Information Center

Comings, John, Ed.; Garner, Barbara, Ed.; Smith, Cristine, Ed.

2005-01-01

"The Review of Adult Learning and Literacy: Connecting Research, Policy, and Practice, Volume 5" is a volume in a series of annual publications of the National Center for the Study of Adult Learning and Literacy (NCSALL) that address major issues, the latest research, and the best practices in the field of adult literacy and learning.…

System analysis of a piston steam engine employing the uniflow principle, a study in optimized performance

NASA Technical Reports Server (NTRS)

Peoples, J. A.

1975-01-01

Results are reported which were obtained from a mathematical model of a generalized piston steam engine configuration employing the uniflow principal. The model accounted for the effects of clearance volume, compression work, and release volume. A simple solution is presented which characterizes optimum performance of the steam engine, based on miles per gallon. Development of the mathematical model is presented. The relationship between efficiency and miles per gallon is developed. An approach to steam car analysis and design is presented which has purpose rather than lucky hopefulness. A practical engine design is proposed which correlates to the definition of the type engine used. This engine integrates several system components into the engine structure. All conclusions relate to the classical Rankine Cycle.

Benchmarking the Wilmer general eye services clinics: baseline metrics for surgical and outpatient clinic volume in an educational environment.

PubMed

Singman, Eric; Srikumaran, Divya; Hackett, Kathy; Kaplan, Brian; Jun, Albert; Preece, Derek; Ramulu, Pradeep

2016-01-27

The Wilmer General Eye Services (GES) at the Johns Hopkins Hospital is the clinic where residents provide supervised comprehensive medical and surgical care to ophthalmology patients. The clinic schedule and supervision structure allows for a progressive increase in trainee responsibility, with graduated autonomy and longitudinal continuity of care over the three years of ophthalmology residency training. This study sought to determine the number of cases the GES contributes to the resident surgical experiences. In addition, it was intended to create benchmarks for patient volumes, cataract surgery yield and room utilization as part of an educational initiative to introduce residents to metrics important for practice management. The electronic surgical posting system database was explored to determine the numbers of cases scheduled for patients seen by residents in the GES. In addition, aggregated residents' self-reported Accreditation Council for Graduate Medical Education (ACGME) surgical logs were collected for comparison. Finally transactional databases were queried to determine clinic volumes of new and established patients. The proportion of resident surgeries (1(st) surgeon and assistant) provided by GES patients, cataract surgery yield and new patient rates were calculated. Data was collected from July 1(st), 2014 until March 31(st), 2015 for all 16 residents (6 third year, 5 second year and 5 first year). The percentage of cataract, oculoplastics, cornea and glaucoma surgeries in which a resident was 1(st) surgeon and the patient came from the GES was 91.3, 76.1, 65.6, and 93.9 respectively. The new patient rate was 28.1% and room utilization was 50.4%. Cataract surgery yield was 29.2 DISCUSSION: The GES provides a significant proportion of primary surgeon opportunities for the residents, and in some instances, the majority of cases. Compared to benchmarks available for private practices, the new patient rate is high while the cataract surgery yield is low. The room utilization is lower than the 85% preferred by the hospital system. These are the first benchmarks of this type for an academic resident ophthalmology practice in the United States. Our study suggests that resident-hosted clinics can provide the majority of surgical opportunities for ophthalmology trainees, particulary with regard to cataract cases. However, because our study is the first academic resident practice to publish metrics of the type used in private practices, it is impossible to determine where our clinic stands compared to other training programs. Therefore, the authors strongly encourage ophthalmology training programs to explore and publish practice metrics. This will permit the creation of a benchmarking program that could be used to quantify efforts at enhancing ophthalmic resident education.

Physician's working hours and patients seen before and after national health insurance: "free" medical care and medical practice.

PubMed

Enterline, P E; McDonald, J C; McDonald, A D; Henderson, V

1975-02-01

Surveys were made of a sample of physicians before and after the introduction of a national health insurance plan in Montreal, Canada. Although the number of physicians in active practice seemed unaffected by the plan, their average working day was reduced 1.5 hours. Declines ranged from 0.3 hours for general internists to 2.7 hours for general surgeons. The average daily volume of services by physicians in the area also declined because of a decline in telephone consultations, and home and hospital visits. Office visits increased sharply. Changes in the type of services were clearly related to the fee schedule adopted by the government, with large declines in services for which payment was probably inadequate in relation to physician's time required. If the fee schedule reflected actual collections prior to the health insurance plan, then gross physician income increased as the result of redirecting services to better paying activities.

[Re-organization of internal medicine wing in hospitals: a last-ditch effort or the beginning of reform?].

PubMed

Sharabi, Yehonatan

2014-01-01

Over the last decade numerous publications have dealt with ongoing changes in the traditional practice of internal medicine. In general, in-hospital medicine has evolved into ambulatory or specialized care. In this volume of Harefuah, Yinon et al. discuss trends at Shaare-Zedek Medical Center, focusing on the challenge of attracting residents to general internal medicine. Their model addresses local problems, but they have laid the groundwork for a more radical change. They present an evolutionary process that would transform hospital practice to become both more patient-centered and integrative, with an interdisciplinary team that translates the strengths of in-hospital (in- and out-patient care) vs. ambulatory or over-specialized care. Such reform should also include changes in clinical medical education, coupled with research and academic activities that can only take place in hospitals. The health care system is waiting for the next academic medical center that will take the lead in accepting this challenge and spearhead much needed reform.

Safety analysis of urban signalized intersections under mixed traffic.

PubMed

S, Anjana; M V L R, Anjaneyulu

2015-02-01

This study examined the crash causative factors of signalized intersections under mixed traffic using advanced statistical models. Hierarchical Poisson regression and logistic regression models were developed to predict the crash frequency and severity of signalized intersection approaches. The prediction models helped to develop general safety countermeasures for signalized intersections. The study shows that exclusive left turn lanes and countdown timers are beneficial for improving the safety of signalized intersections. Safety is also influenced by the presence of a surveillance camera, green time, median width, traffic volume, and proportion of two wheelers in the traffic stream. The factors that influence the severity of crashes were also identified in this study. As a practical application, the safe values of deviation of green time provided from design green time, with varying traffic volume, is presented in this study. This is a useful tool for setting the appropriate green time for a signalized intersection approach with variations in the traffic volume. Copyright © 2014 Elsevier Ltd. All rights reserved.

An Immersed Boundary method with divergence-free velocity interpolation and force spreading

NASA Astrophysics Data System (ADS)

Bao, Yuanxun; Donev, Aleksandar; Griffith, Boyce E.; McQueen, David M.; Peskin, Charles S.

2017-10-01

The Immersed Boundary (IB) method is a mathematical framework for constructing robust numerical methods to study fluid-structure interaction in problems involving an elastic structure immersed in a viscous fluid. The IB formulation uses an Eulerian representation of the fluid and a Lagrangian representation of the structure. The Lagrangian and Eulerian frames are coupled by integral transforms with delta function kernels. The discretized IB equations use approximations to these transforms with regularized delta function kernels to interpolate the fluid velocity to the structure, and to spread structural forces to the fluid. It is well-known that the conventional IB method can suffer from poor volume conservation since the interpolated Lagrangian velocity field is not generally divergence-free, and so this can cause spurious volume changes. In practice, the lack of volume conservation is especially pronounced for cases where there are large pressure differences across thin structural boundaries. The aim of this paper is to greatly reduce the volume error of the IB method by introducing velocity-interpolation and force-spreading schemes with the properties that the interpolated velocity field in which the structure moves is at least C1 and satisfies a continuous divergence-free condition, and that the force-spreading operator is the adjoint of the velocity-interpolation operator. We confirm through numerical experiments in two and three spatial dimensions that this new IB method is able to achieve substantial improvement in volume conservation compared to other existing IB methods, at the expense of a modest increase in the computational cost. Further, the new method provides smoother Lagrangian forces (tractions) than traditional IB methods. The method presented here is restricted to periodic computational domains. Its generalization to non-periodic domains is important future work.

30 CFR 250.456 - What safe practices must the drilling fluid program follow?

Code of Federal Regulations, 2012 CFR

2012-07-01

... circulate a volume of drilling fluid equal to the annular volume with the drill pipe just off-bottom. You... volume needed to fill the hole. Both sets of numbers must be posted near the driller's station. You must... industry-accepted practices and include density, viscosity, and gel strength; hydrogenion concentration...

30 CFR 250.456 - What safe practices must the drilling fluid program follow?

Code of Federal Regulations, 2014 CFR

2014-07-01

... circulate a volume of drilling fluid equal to the annular volume with the drill pipe just off-bottom. You... volume needed to fill the hole. Both sets of numbers must be posted near the driller's station. You must... industry-accepted practices and include density, viscosity, and gel strength; hydrogenion concentration...

30 CFR 250.456 - What safe practices must the drilling fluid program follow?

Code of Federal Regulations, 2013 CFR

2013-07-01

... circulate a volume of drilling fluid equal to the annular volume with the drill pipe just off-bottom. You... volume needed to fill the hole. Both sets of numbers must be posted near the driller's station. You must... industry-accepted practices and include density, viscosity, and gel strength; hydrogenion concentration...

Trends and variation in prescribing of low-priority treatments identified by NHS England: a cross-sectional study and interactive data tool in English primary care.

PubMed

Walker, Alex J; Curtis, Helen J; Bacon, Seb; Croker, Richard; Goldacre, Ben

2018-06-01

Objectives NHS England recently announced a consultation seeking to discourage the use of treatments it considers to be low-value. We set out to produce an interactive data resource to show savings in each NHS general practice and to assess the current use of these treatments, their change in use over time, and the extent and reasons for variation in such prescribing. Design Cross-sectional analysis. Setting English primary care. Participants English general practices. Main outcome measures We determined the cost per 1000 patients for prescribing of each of 18 treatments identified by NHS England for each month from July 2012 to June 2017, and also aggregated over the most recent year to assess total cost and variation among practices. We used mixed effects linear regression to determine factors associated with cost of prescribing. Results Spend on low-value treatments was £153.5 m in the last year, across 5.8 m prescriptions (mean, £26 per prescription). Among individual treatments, liothyronine had the highest prescribing cost at £29.6 m, followed by trimipramine (£20.2 m). Over time, the overall total number of low-value prescriptions decreased, but the cost increased, although this varied greatly between treatments. Three treatment areas increased in cost and two increased in volume, all others reduced in cost and volume. Annual practice level spending varied widely (median, £2262 per thousand patients; interquartile range £1439 to £3298). Proportion of patients over 65 was strongly associated with low-value prescribing, as was Clinical Commissioning Group. Our interactive data tool was deployed to OpenPrescribing.net where monthly updated figures and graphs can be viewed. Conclusions Prescribing of low-value treatments is extensive but varies widely by treatment, geographic area and individual practice. Despite a fall in prescription numbers, the overall cost of prescribing for low-value items has risen. Prescribing behaviour is clustered by Clinical Commissioning Group, which may represent variation in the optimisation efficiency of medicines, or in some cases access inequality.

Effect of variable rates of daily sampling of fly larvae on decomposition and carrion insect community assembly: implications for forensic entomology field study protocols.

PubMed

Michaud, Jean-Philippe; Moreau, Gaétan

2013-07-01

Experimental protocols in forensic entomology successional field studies generally involve daily sampling of insects to document temporal changes in species composition on animal carcasses. One challenge with that method has been to adjust the sampling intensity to obtain the best representation of the community present without affecting the said community. To this date, little is known about how such investigator perturbations affect decomposition-related processes. Here, we investigated how different levels of daily sampling of fly eggs and fly larvae affected, over time, carcass decomposition rate and the carrion insect community. Results indicated that a daily sampling of <5% of the egg and larvae volumes present on a carcass, a sampling intensity believed to be consistent with current accepted practices in successional field studies, had little effect overall. Higher sampling intensities, however, slowed down carcass decomposition, affected the abundance of certain carrion insects, and caused an increase in the volume of eggs laid by dipterans. This study suggests that the carrion insect community not only has a limited resilience to recurrent perturbations but that a daily sampling intensity equal to or <5% of the egg and larvae volumes appears adequate to ensure that the system is representative of unsampled conditions. Hence we propose that this threshold be accepted as best practice in future forensic entomology successional field studies.

Patient-Physician Web Messaging

PubMed Central

Liederman, Eric M; Lee, Jerry C; Baquero, Victor H; Seites, Paul G

2005-01-01

BACKGROUND Patients want electronic access to providers. Providers fear being overwhelmed by unreimbursed messages. OBJECTIVE Measure the effects of patient-physician web messaging on primary care practices. DESIGN/SETTING Retrospective analysis of 6 case and 9 control internal medicine (IM) and family practice (FP) physicians' message volume, and a survey of 5,971 patients' web messaging with 267 providers and staff in 16 community primary care clinics in the Sacramento, CA region. MEASUREMENTS AND MAIN RESULTS Case telephone volume was 18.2% lower (P =.002) and fell 6.50 times faster than control. Case total telephone plus web message volume was 13.7% lower (P =.025) and fell 5.84 times faster than control. Surveys were responded to by 40.3% (1,743/4,320) of patients and 61.4% (164/267) of providers and staff. Patients were overwhelmingly satisfied and providers and staff were generally satisfied; both found the system easy to use. Patient satisfaction correlated strongly with provider response time (Γ=0.557), and provider/staff satisfaction with computer skills (Γ=0.626) (Goodman-Kruskal Gamma [Γ] measure of ordinal association). CONCLUSIONS Secure web messaging improves on e-mail with encryption, access controls, message templates, customized message and prescription routing, knowledge content, and reimbursement. Further study is needed to determine whether reducing telephone traffic through the use of web messaging decreases provider interruptions and increases clinical efficiency during the workday. Satisfaction with web messaging may increase patient retention. PMID:15693928

Accounting for medical variation: the case of prescribing activity in a New Zealand general practice sample.

PubMed

Davis, P B; Yee, R L; Millar, J

1994-08-01

Medical practice variation is extensive and well documented, particularly for surgical interventions, and raises important questions for health policy. To date, however, little work has been carried out on interpractitioner variation in prescribing activity in the primary care setting. An analytical model of medical variation is derived from the literature and relevant indicators are identified from a study of New Zealand general practice. The data are based on nearly 9,500 completed patient encounter records drawn from over a hundred practitioners in the Waikato region of the North Island, New Zealand. The data set represents a 1% sample of all weekday general practice office encounters in the Hamilton Health District recorded over a 12-month period. Overall levels of prescribing, and the distribution of drug mentions across diagnostic groupings, are broadly comparable to results drawn from international benchmark data. A multivariate analysis is carried out on seven measures of activity in the areas of prescribing volume, script detail, and therapeutic choice. The analysis indicates that patient, practitioner and practice attributes exert little systematic influence on the prescribing task. The principal influences are diagnosis, followed by practitioner identity. The pattern of findings suggests also that the prescribing task cannot be viewed as an undifferentiated activity. It is more usefully considered as a process of decision-making in which 'core' judgements--such as the decision to prescribe and the choice of drug--are highly predictable and strongly influenced by diagnosis, while 'peripheral' features of the task--such as choosing a combination drug or prescribing generically--are less determinate and more subject to the exercise of clinical discretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2).

PubMed

White, S M; Moppett, I K; Griffiths, R; Johansen, A; Wakeman, R; Boulton, C; Plant, F; Williams, A; Pappenheim, K; Majeed, A; Currie, C T; Grocott, M P W

2016-05-01

We re-analysed prospective data collected by anaesthetists in the Anaesthesia Sprint Audit of Practice (ASAP-1) to describe associations with linked outcome data. Mortality was 165/11,085 (1.5%) 5 days and 563/11,085 (5.1%) 30 days after surgery and was not associated with anaesthetic technique (general vs. spinal, with or without peripheral nerve blockade). The risk of death increased as blood pressure fell: the odds ratio (95% CI) for mortality within five days after surgery was 0.983 (0.973-0.994) for each 5 mmHg intra-operative increment in systolic blood pressure, p = 0.0016, and 0.980 (0.967-0.993) for each mmHg increment in mean pressure, p = 0.0039. The equivalent odds ratios (95% CI) for 30-day mortality were 0.968 (0.951-0.985), p = 0.0003 and 0.976 (0.964-0.988), p = 0.0001, respectively. The lowest systolic blood pressure after intrathecal local anaesthetic relative to before induction was weakly correlated with a higher volume of subarachnoid bupivacaine: r(2) -0.10 and -0.16 for hyperbaric and isobaric bupivacaine, respectively. A mean 20% relative fall in systolic blood pressure correlated with an administered volume of 1.44 ml hyperbaric bupivacaine. Future research should focus on refining standardised anaesthesia towards administering lower doses of spinal (and general) anaesthesia and maintaining normotension. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

Operational effectiveness and quality assurance mechanisms with stochastic demand of blood supply: blood bank case study.

PubMed

Smith, Alan D

2011-01-01

A general overview of various blood products operational effectiveness and related strategies that can be utilised by service providers (in particular, healthcare providers) is presented in the present study. In terms of the massive volumes of blood products, the North American blood centres collect more than eight million units of whole blood, which represents appropriately 50% of the US and Quebec, Canada?s volunteer donor blood supply. A case study of the quality inspection and inventory control concerns of the Central Blood Bank, located in the metropolitan area of Pittsburgh, PA, is presented. Initially, brief introduction to its general operating environment is followed by sections describing its general situation, quality-service initiatives, and followed by a fairly detailed discussion of the practical applications of lessons learned from the case study.

Major depressive episodes over the course of 7 years and hippocampal subfield volumes at 7 tesla MRI: the PREDICT-MR study.

PubMed

Wisse, L E M; Biessels, G J; Stegenga, B T; Kooistra, M; van der Veen, P H; Zwanenburg, J J M; van der Graaf, Y; Geerlings, M I

2015-04-01

Smaller hippocampal volumes have been associated with major depressive disorder (MDD). The hippocampus consists of several subfields that may be differentially related to MDD. We investigated the association of occurrence of major depressive episodes (MDEs), assessed five times over seven years, with hippocampal subfield and entorhinal cortex volumes at 7 tesla MRI. In this prospective study of randomly selected general practice attendees, MDEs according to DSM-IV-R criteria were assessed at baseline and after 6, 12, 39 and 84 months follow-up. At the last follow-up, a T2 (0.7 mm(3)) 7 tesla MRI scan was obtained in 47 participants (60±10 years). The subiculum, cornu ammonis (CA) 1 to 3, dentate gyrus&CA4 and entorhinal cortex volumes were manually segmented according a published protocol. Of the 47 participants, 13 had one MDE and 5 had multiple MDEs. ANCOVAs, adjusted for age, sex, education and intracranial volume, revealed no significant differences in hippocampal subfield or entorhinal cortex volumes between participants with and without an MDE in the preceding 84 months. Multiple episodes were associated with smaller subiculum volumes (B=-0.03 mL/episode; 95% CI -0.06; -0.003), but not with the other hippocampal subfield volumes, entorhinal cortex, or total hippocampal volume. A limitation of this study is the small sample size which makes replication necessary. In this exploratory study, we found that an increasing number of major depressive episodes was associated with smaller subiculum volumes in middle-aged and older persons, but not with smaller volumes in other hippocampal subfields or the entorhinal cortex. Copyright © 2014 Elsevier B.V. All rights reserved.

Gray matter volume is associated with rate of subsequent skill learning after a long term training intervention

PubMed Central

Sampaio-Baptista, Cassandra; Scholz, Jan; Jenkinson, Mark; Thomas, Adam G.; Filippini, Nicola; Smit, Gabrielle; Douaud, Gwenaëlle; Johansen-Berg, Heidi

2014-01-01

The ability to predict learning performance from brain imaging data has implications for selecting individuals for training or rehabilitation interventions. Here, we used structural MRI to test whether baseline variations in gray matter (GM) volume correlated with subsequent performance after a long-term training of a complex whole-body task. 44 naïve participants were scanned before undertaking daily juggling practice for 6 weeks, following either a high intensity or a low intensity training regime. To assess performance across the training period participants' practice sessions were filmed. Greater GM volume in medial occipito-parietal areas at baseline correlated with steeper learning slopes. We also tested whether practice time or performance outcomes modulated the degree of structural brain change detected between the baseline scan and additional scans performed immediately after training and following a further 4 weeks without training. Participants with better performance had higher increases in GM volume during the period following training (i.e., between scans 2 and 3) in dorsal parietal cortex and M1. When contrasting brain changes between the practice intensity groups, we did not find any straightforward effects of practice time though practice modulated the relationship between performance and GM volume change in dorsolateral prefrontal cortex. These results suggest that practice time and performance modulate the degree of structural brain change evoked by long-term training regimes. PMID:24680712

Evaluation of a controlled drinking minimal intervention for problem drinkers in general practice (the DRAMS scheme)

PubMed Central

Heather, Nick; Campion, Peter D.; Neville, Ronald G.; Maccabe, David

1987-01-01

Sixteen general practitioners participated in a controlled trial of the Scottish Health Education Group's DRAMS (drinking reasonably and moderately with self-control) scheme. The scheme was evaluated by randomly assigning 104 heavy or problem drinkers to three groups – a group participating in the DRAMS scheme (n = 34), a group given simple advice only (n = 32) and a non-intervention control group (n = 38). Six month follow-up information was obtained for 91 subjects (87.5% of initial sample). There were no significant differences between the groups in reduction in alcohol consumption, but patients in the DRAMS group showed a significantly greater reduction in a logarithmic measure of serum gamma-glutamyl-transpeptidase than patients in the group receiving advice only. Only 14 patients in the DRAMS group completed the full DRAMS procedure. For the sample as a whole, there was a significant reduction in alcohol consumption, a significant improvement on a measure of physical health and well-being, and significant reductions in the logarithmic measure of serum gamma-glutamyl transpeptidase and in mean corpuscular volume. The implications of these findings for future research into controlled drinking minimal interventions in general practice are discussed. PMID:3448228

High-Performance Home Technologies: Solar Thermal & Photovoltaic Systems

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

Baechler, M.; Gilbride, T.; Ruiz, K.

This document is the sixth volume of the Building America Best Practices Series. It presents information that is useful throughout the United States for enhancing the energy efficiency practices in the specific climate zones that are presented in the first five Best Practices volumes. It provides an introduction to current photovoltaic and solar thermal building practices. Information about window selection and shading is included.

30 CFR 250.456 - What safe practices must the drilling fluid program follow?

Code of Federal Regulations, 2011 CFR

2011-07-01

... fluid. You must circulate a volume of drilling fluid equal to the annular volume with the drill pipe... fluid volume needed to fill the hole. Both sets of numbers must be posted near the driller's station... warrant. Your tests must conform to industry-accepted practices and include density, viscosity, and gel...

Validity of peak expiratory flow measurement in assessing reversibility of airflow obstruction.

PubMed Central

Dekker, F W; Schrier, A C; Sterk, P J; Dijkman, J H

1992-01-01

BACKGROUND: Assessing the reversibility of airflow obstruction by peak expiratory (PEF) measurements would be practicable in general practice, but its usefulness has not been investigated. METHODS: PEF measurements were performed (miniWright peak flow meter) in 73 general practice patients (aged 40 to 84) with a history of asthma or chronic obstructive lung disease before and after 400 micrograms inhaled sulbutamol. The change in PEF was compared with the change in forced expiratory volume in one second (FEV1). Reversible airflow obstruction was analysed in two ways according to previous criteria. When defined as a 9% or greater increase in FEV1 expressed as a percentage of predicted values reversibility was observed in 42% of patients. Relative operating characteristic analysis showed that an absolute improvement in PEF of 60 l/min or more gave optimal discrimination between patients with reversible and irreversible airflow obstruction (the sensitivity and specificity of an increase of 60 l/min in detecting a 9% or more increase in FEV1 as a percentage of predicted values were 68% and 93% respectively, with a positive predictive value of 87%). When defined as an increase of 190 ml or more in FEV1, reversible airflow obstruction was observed in 53% of patients. Again an absolute improvement in PEF of 60 l/min or more gave optimal discrimination between patients with reversible and irreversible airflow obstruction (sensitivity 56%, specificity 94%, and positive predictive value 92%). CONCLUSION: Absolute changes in PEF can be used as a simple technique to diagnose reversible airflow obstruction in patients from general practice. PMID:1519192

Predicting oropharyngeal tumor volume throughout the course of radiation therapy from pretreatment computed tomography data using general linear models.

PubMed

Yock, Adam D; Rao, Arvind; Dong, Lei; Beadle, Beth M; Garden, Adam S; Kudchadker, Rajat J; Court, Laurence E

2014-05-01

The purpose of this work was to develop and evaluate the accuracy of several predictive models of variation in tumor volume throughout the course of radiation therapy. Nineteen patients with oropharyngeal cancers were imaged daily with CT-on-rails for image-guided alignment per an institutional protocol. The daily volumes of 35 tumors in these 19 patients were determined and used to generate (1) a linear model in which tumor volume changed at a constant rate, (2) a general linear model that utilized the power fit relationship between the daily and initial tumor volumes, and (3) a functional general linear model that identified and exploited the primary modes of variation between time series describing the changing tumor volumes. Primary and nodal tumor volumes were examined separately. The accuracy of these models in predicting daily tumor volumes were compared with those of static and linear reference models using leave-one-out cross-validation. In predicting the daily volume of primary tumors, the general linear model and the functional general linear model were more accurate than the static reference model by 9.9% (range: -11.6%-23.8%) and 14.6% (range: -7.3%-27.5%), respectively, and were more accurate than the linear reference model by 14.2% (range: -6.8%-40.3%) and 13.1% (range: -1.5%-52.5%), respectively. In predicting the daily volume of nodal tumors, only the 14.4% (range: -11.1%-20.5%) improvement in accuracy of the functional general linear model compared to the static reference model was statistically significant. A general linear model and a functional general linear model trained on data from a small population of patients can predict the primary tumor volume throughout the course of radiation therapy with greater accuracy than standard reference models. These more accurate models may increase the prognostic value of information about the tumor garnered from pretreatment computed tomography images and facilitate improved treatment management.

Patients of doctors further from medical school graduation have poorer outcomes.

PubMed

Norcini, John J; Boulet, John R; Opalek, Amy; Dauphinee, W Dale

2017-05-01

There is an apparent contradiction between the findings of studies indicating that patient outcomes are better when physicians have a greater volume of practice and those that find outcomes to be worse with increased time since training, which implies greater volume. This study was designed to estimate the adjusted relationships between physicians' characteristics, including recent practice volume and time since medical school graduation, and patient outcomes. This is a retrospective observational study based on all Pennsylvania hospitalisations over 7 years for acute myocardial infarction, congestive heart failure, gastrointestinal haemorrhage, hip fracture and pneumonia. It refers to 694 020 hospitalisations in 184 hospitals attended by 5280 internists and family physicians. Patient severity of illness at admission and in-hospital mortality, hospital location and volume, and the physician's recent practice volume, time since medical school graduation, board certification, and citizenship or medical school location were analysed. After adjustment, recent practice volume did not have a statistically significant association with in-hospital mortality for all of the conditions combined. By contrast, each decade since graduation from medical school was associated with a 4.5% increase in relative risk for patient mortality. Recent practice volume does not mitigate the increase in patient mortality associated with physicians' time since medical school graduation. These findings underscore the need to finds ways to support and encourage learning. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Generality and specificity in cognitive aging: a volumetric brain analysis.

PubMed

Staff, Roger T; Murray, Alison D; Deary, Ian J; Whalley, Lawrence J

2006-05-01

To investigate whether, in old age, brain volume differences are associated with age-related change in general mental ability and/or specific cognitive abilities. The authors investigate the association between brain volumes and current cognitive function in a well-characterized sample of healthy old people (aged 79-80) whose intelligence was recorded at age 11. This allowed estimation of intellectual change over the life span. After accounting for childhood intelligence, associations were found between specific cognitive measures and brain volumes. An association was also found between volumes and the general intelligence factor g. After removing the influence of g from each of the specific cognitive measures, no remaining significant associations were found between brain volumes and the specific part of each test. Generalized cognitive aging is associated with brain volume differences, but there is no evidence in this sample that specific components of cognitive aging are associated with differences in brain volume.

[Specialized training in geriatric psychiatry during residency in France].

PubMed

Lepetit, Alexis; Lavigne, Benjamin; Legros, Emilie; Herrmann, Mathieu; Sebbane, Déborah

2014-09-01

Aging of the population is a growing concern in developed countries. Therefore, geriatric psychiatry has gradually emerged from general psychiatry. Many names have been proposed to term this sub-specialty: old age psychiatry (OAP), psychogeriatrics, geropsychiatry. A working group of the French federation of psychiatric trainees (AFFEP) set up an inventory of the theoretical instruction and clinical practice of OAP during the training of psychiatrists in France. Methods. A survey of both academic teaching and practical training for OAP was carried out in the 28 local AFFEP representatives of every French medical residency district, including overseas. We assessed the supply of general courses and seminars devoted to OAP during the training of French residents in psychiatry, and the offer of university or inter-university degrees as well as the possibility of specialized internship in every residency district. Results. 96% of French medical residency districts offered general courses of OAP with a mean volume of 11.5 hours along the four years of psychiatric training in France. Fifty percent of medical residency districts proposed at least one seminar devoted to OAP. Half of medical residency districts also offer a specialized university or inter-university degree. Concerning clinical practice, 86% of medical residency districts had one internship dedicated to OAP, in 39% of cases in teaching hospitals. Conclusion. Nationwide, there is an overall effort to make OAP available to French psychiatric residents by general courses and internship, but some disparity appeared in academic teaching (i.e. offering seminars and university/inter-university degrees) according to various residency districts.

The U.S. Twin Delivery Volume and Association with Cesarean Delivery Rates: A Hospital-Level Analysis.

PubMed

Easter, Sarah Rae; Robinson, Julian N; Carusi, Daniela; Little, Sarah E

2018-03-01

 The objective of this study was to test whether hospitals experienced in twin delivery have lower rates of cesarean delivery for twins.  We divided obstetric hospitals in the 2011 National Inpatient Sample by quartile of annual twin deliveries and compared twin cesarean delivery rates between hospitals with weighted linear regression. We used Pearson's coefficients to correlate a hospital's twin cesarean delivery rate to its overall cesarean delivery and vaginal birth after cesarean (VBAC) rates.  Annual twin delivery volume ranged from 1 to 506 across the 547 analyzed hospitals with a median of 10 and mode of 3. Adjusted rates of cesarean delivery were independent of delivery volume with a rate of 75.5 versus 74.8% in the lowest and highest volume hospitals ( p  = 0.09 across quartiles). A hospital's cesarean delivery rate for twins moderately correlated with the overall cesarean rate ( r  = 0.52, p  < 0.01) and inversely correlated with VBAC rate ( r  =  - 0.42, p  < 0.01).  Most U.S. obstetrical units perform a low volume of twin deliveries with no decrease in cesarean delivery rates at higher volume hospitals. Twin cesarean delivery rates correlate with other obstetric parameters such as singleton cesarean delivery and VBAC rates suggesting twin cesarean delivery rate is more closely related to a hospital's general obstetric practice than its twin delivery volume. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Planning for the Rheumatologist Workforce: Factors Associated With Work Hours and Volumes.

PubMed

Barber, Claire E H; Nasr, Mina; Barnabe, Cheryl; Badley, Elizabeth M; Lacaille, Diane; Pope, Janet; Cividino, Alfred; Yacyshyn, Elaine; Baillie, Cory; Mosher, Dianne; Thomson, John G; Charnock, Christine; Thorne, J Carter; Zummer, Michel; Brophy, Julie; Ruban, Thanu Nadarajah; Ahluwalia, Vandana; McDougall, Robert; Marshall, Deborah A

2018-05-25

The aim of this study was to evaluate factors associated with rheumatologists' clinical work hours and patient volumes based on a national workforce survey in rheumatology. Adult rheumatologists who participated in a 2015 workforce survey were included (n = 255). Univariate analysis evaluated the relationship between demographics (sex, age, academic vs. community practice, billing fee for service vs. other plan, years in practice, retirement plans) and workload (total hours and number of ½-day clinics per week) or patient volumes (number of new and follow-up consults per week). Multiple linear regression models were used to evaluate the relationship between practice type, sex, age, and working hours or clinical volumes. Male rheumatologists had more ½-day clinics (P = 0.05) and saw more new patients per week (P = 0.001) compared with females. Community rheumatologists had more ½-day clinics and new and follow-up visits per week (all P < 0.01). Fee-for-service rheumatologists reported more ½-day clinics per week (P < 0.001) and follow-ups (P = 0.04). Workload did not vary by age, years in practice, or retirement plans. In multivariate analysis, community practice remained independently associated with higher patient volumes and more clinics per week. Female rheumatologists reported fewer clinics and fewer follow-up patients per week than males, but this did not affect the duration of working hours or new consultations. Age was not associated with work volumes or hours. Practice type and rheumatologist sex should be considered when evaluating rheumatologist workforce needs, as the proportion of female rheumatologists has increased over time and alternative billing practices have been introduced in many centers.

Probing the space of toric quiver theories

NASA Astrophysics Data System (ADS)

Hewlett, Joseph; He, Yang-Hui

2010-03-01

We demonstrate a practical and efficient method for generating toric Calabi-Yau quiver theories, applicable to both D3 and M2 brane world-volume physics. A new analytic method is presented at low order parametres and an algorithm for the general case is developed which has polynomial complexity in the number of edges in the quiver. Using this algorithm, carefully implemented, we classify the quiver diagram and assign possible superpotentials for various small values of the number of edges and nodes. We examine some preliminary statistics on this space of toric quiver theories.

Choice for All: Proceedings of the International Conference of the Association for the Advancement of Rehabilitation Technology = Choix pour tous: Conference internationale pour le developpement de la technologie en readaptation (3rd, Montreal, Quebec, Canada, June 25-30, 1988). ICAART Volume III.

ERIC Educational Resources Information Center

RESNA: Association for the Advancement of Rehabilitation Technology, Washington, DC.

These proceedings were composed of 290 papers, submitted by 700 authors from 15 countries, in the field of rehabilitation engineering and technology. Of the 290 papers, 13 are written in French. Papers are generally two to four pages in length, and are organized within the following areas of rehabilitation technology: service delivery practice (15…

Proceedings of the Image Understanding Workshop (18th) Held in Cambridge, Massachusetts on 6-8 April 1988. Volume 2

DTIC Science & Technology

1988-04-01

solution to a information. There is thus a biological motivation for investi- specific problem, e.g., solving the visual obstacle avoidance gating the...narticular practically motivated aspect of the image, known as the optical flow, does not necessarily the general problem. correspond to the 2-D motion...on (Z Z * "inexact" vision jThom8fi] The obvious motivation stems from a = X tancosa b - Z tan3sina; (1) the fact that an obstacle in relative motion

Proceedings of the European ISTVS Conference (6th) , OVK Symposium (4th), On ’Off Road Vehicles in Theory and Practice’ , Held at Vienna, Austria on 28-30 September 1994 in Vienna, Austria. Volume 1.

DTIC Science & Technology

1994-09-30

The Commander-in-Chief of the British troops, General Sir Peter de la Billiere, reported that each vehicle of the Tenth Transport Regiment covered 400...Simulation des Reifenprofileinflusses fuir die Gelaindebeweglichkeit von Fahrzeugen C. W. FERVERS IKK-University of German Armed Forces Hamburg, Germany...of the Process) 731 Experimentelle und theoretische Analyse kohaisiven Erdreichs beim Verschiebevorgang (Optimierung des Vorganges) A. JARZEBOWSKI, J

Documentation of the GLAS fourth order general circulation model. Volume 1: Model documentation

NASA Technical Reports Server (NTRS)

Kalnay, E.; Balgovind, R.; Chao, W.; Edelmann, J.; Pfaendtner, J.; Takacs, L.; Takano, K.

1983-01-01

The volume 1, of a 3 volume technical memoranda which contains a documentation of the GLAS Fourth Order General Circulation Model is presented. Volume 1 contains the documentation, description of the stratospheric/tropospheric extension, user's guide, climatological boundary data, and some climate simulation studies.

Antimicrobial Use and Indication-based Prescribing Among General Practitioners in Eastern Croatia: Comparison with Data from the European Surveillance of Antimicrobial Consumption Project

PubMed Central

Vojvodić, Željko

2010-01-01

Aim To investigate antibiotic consumption in a sample of physicians from Osijek-Baranja county in Eastern Croatia and to determine the volume of prescribed antimicrobials and assess the appropriateness of prescribing practices. Methods Analysis of routine prescribing data was carried out in 30 primary care practices in both urban and rural communities of eastern Croatia, corresponding to a total population of 48 000 patients. Prescribing practices were studied over a period of 3 years, from 2003 to 2005. Both the quantity of antimicrobials and differences and similarities between individual practitioners were analyzed. Results Urban and rural practices did not significantly differ in regard to the volume of antimicrobials prescribed. However, significant differences were found between individual physicians. Total consumption was 17.73 defined daily doses per 1000 inhabitants per day or 6456.85 defined daily doses per 1000 inhabitants per year. The 10 most frequently used antimicrobials (93.70% of the total quantity) were amoxicillin, co-amoxiclav, co-trimoxazole, cephalexin, norfloxacin, penicillin V, azithromycin, cefuroxime, doxycycline, and nitrofurantoin. Sore throat was the most frequent reason for prescribing antibiotics. Conclusion Prescription of medicines in Osijek-Baranja county was characterized by high consumption of broad-spectrum penicillins, combined penicillins, combined sulfonamides and long-acting macrolides (azithromycin), together with disproportionately low use of doxycycline and erythromycin. The use of combined sulfonamides and azithromycin in this part of Croatia was among the highest in Europe. Great differences between prescribers in regard to indication-based prescribing have been found, and future studies should examine the factors behind these heterogeneous practices. PMID:21162165

Correction of Age-Related Midface Volume Loss With Low-Volume Hyaluronic Acid Filler.

PubMed

Wilson, Monique Vanaman; Fabi, Sabrina Guillen; Greene, Ryan

2017-03-01

The pivotal approval trial for a smooth, highly cohesive, viscous, 20-mg/mL hyaluronic acid filler demonstrated sustained aesthetic improvement, with a mean injection volume of 6.65 mL. In daily practice, however, it is not often practical or necessary to use large injection volumes to achieve the desired cosmetic outcome. To assess the efficacy, longevity, and patient satisfaction associated with correction of age-related midface volume loss using the low volumes of hyaluronic acid filler more commonly used in day-to-day practice. A 2-center, retrospective cohort study examined medical records of 61 healthy patients who underwent treatment for facial volume loss with hyaluronic acid filler from November 1, 2013, through April 31, 2014. Follow-up visits were conducted at 1, 3, 6, and 12 months after the procedure. Data were pooled from a private facial plastic surgery practice in Weston, Florida, and a private cosmetic dermatology practice in San Diego, California. Patients were treated with hyaluronic acid filler according to the investigator's usual practices. The main outcome measure was patient-graded Global Aesthetic Improvement Scale scores at 1, 3, 6, and 12 months after treatment. Scores range from 1 to 5; 1 indicates very much improved and 5, worse. A total of 61 consecutive, healthy adult patients (mean [SD] age, 57.4 [12.8] years) with mild to severe facial volume loss were enrolled in the study. A total of 46 patients (75%) were white, 3 (5%) were black/African American, 9 (15%) were Hispanic/Latino, 1 (2%) was Asian/Pacific Islander, and 2 (3%) were other. Three patients (5%) were male, and 58 (95%) were female. Mean initial treatment volume was 1.6 mL. At follow-up, 29 patients (48%) elected to have a touch-up treatment; mean total touch-up volume was 1.4 mL. The patient-graded Global Aesthetic Improvement Scale scores at 1, 3, 6, and 12 months after treatment demonstrated that 73% (41 of 56) to 89% (24 of 27) of the study patients reported being very much or moderately improved. Most patients were rated by investigators on the Global Aesthetic Improvement Scale as very much or moderately improved at the 12-month follow-up. At 12 months after the procedure, 43 of 51 patients (84%) reported satisfaction with their outcome. At all time points, most patients would elect to undergo the procedure again (range, 17 [68%] to 61 [100%]). Adverse events were mild, and all resolved spontaneously within 14 days. At the 2-year follow-up, there were no reports of delayed adverse events. Midface volumization using the low volumes of hyaluronic acid filler more commonly used in daily clinical practice is effective and well tolerated. 3.

[Research on spatial differentiation of urban stormwater runoff quality by source area monitoring].

PubMed

Li, Li-Qing; Zhu, Ren-Xiao; Guo, Shu-Gang; Yin, Cheng-Qing

2010-12-01

Runoff samples were collected from 14 source areas in Hanyang district during four rain events in an attempt to investigate the spatial differentiation and influencing factors of urban stormwater runoff quality. The outcomes are expected to offer practical guidance in sources control of urban runoff pollution. The results revealed that particle-bound proportion of chemical oxygen demand (COD), total nitrogen (TN), and total phosphorus (TP) in stormwater runoff were 58% +/- 17%, 65% +/- 13% and 92% +/- 6%, respectively. The fractions of ammonia, nitrate and dissolved organic nitrogen were homogeneous in dissolved nitrogen composition. Urban surface function, traffic volume, land use, population density, and street sweeping practice are the main factors determining spatial differentiation of urban surface runoff quality. The highest magnitude of urban stormwater runoff pollution was expected in the old urban residential area, followed by general residential with restaurants, commercial and transport area, new developments and green land. In addition, the magnitude of road stormwater runoff pollution is positively correlated to traffic volume, in the following order: the first trunk road > the second trunk road > minor road. Street sweeping and critical source areas controls should be implemented to mitigate the adverse effects of urban stormwater runoff on receive waters.

Expanded Guidance for NASA Systems Engineering. Volume 1: Systems Engineering Practices

NASA Technical Reports Server (NTRS)

Hirshorn, Steven R.

2016-01-01

This document is intended to provide general guidance and information on systems engineering that will be useful to the NASA community. It provides a generic description of Systems Engineering (SE) as it should be applied throughout NASA. A goal of the expanded guidance is to increase awareness and consistency across the Agency and advance the practice of SE. This guidance provides perspectives relevant to NASA and data particular to NASA. This expanded guidance should be used as a companion for implementing NPR 7123.1, Systems Engineering Processes and Requirements, the Rev 2 version of SP-6105, and the Center-specific handbooks and directives developed for implementing systems engineering at NASA. It provides a companion reference book for the various systems engineering-related training being offered under NASA's auspices.

Attitudes and barriers to evidence-based practice in optometry educators.

PubMed

Suttle, Catherine M; Challinor, Kirsten L; Thompson, Rachel E; Pesudovs, Konrad; Togher, Leanne; Chiavaroli, Neville; Lee, Adrian; Junghans, Barbara; Stapleton, Fiona; Watt, Kathleen; Jalbert, Isabelle

2015-04-01

Evidence-based practice (EBP) is an essential component of good quality, patient-centered health care. This requires practitioners to acquire EBP skills and knowledge during undergraduate and continuing education. Evidence-based practice education exists in a range of health care disciplines, including optometry. Evidence-based practice education, however, depends on relevant skills and knowledge in educators. Courses and workshops exist for the development of EBP teaching skills in some areas of health care but not in optometry. Here, we describe a pilot workshop designed to enhance the teaching of EBP and to investigate the perspectives of optometric educators on EBP including their attitudes and perceived barriers to EBP and its teaching. Twenty-seven optometric educators including 8 facilitators participated. Of these, 14 were academics (including the 8 facilitators) and 13 were practitioners. Evidence-based practice attitudes were assessed using the Evidence-Based Practice Attitude Scale-50 with appropriate modifications for optometry. Workshop design incorporated strategies to trigger discussion among participants. A nominal group technique was used to identify, prioritize, and reach consensus on barriers to EBP. Although some participants expressed reservations about EBP, a common understanding of the contemporary definition of EBP emerged in educators. Thirty-five barriers to EBP were identified; "time" was selected in the top five barriers by most participants and attracted the highest total score, well above any other barrier (negative attitude to EBP, volume of evidence, integration with clinical practice, and lack of lifelong learning mind-set). Attitudes toward EBP were generally positive and negatively correlated with age and time since graduation, respectively. A group of optometrists and academics new to implementing education in EBP displayed positive attitudes to EBP but considered that its application and teaching could be significantly hindered by a lack of time to access and appraise the large volume of available research evidence in the field of eye care.

A simple and clinically relevant combination of neuroimaging and functional indexes for the identification of those at highest risk of Alzheimer's disease.

PubMed

Tabatabaei-Jafari, Hossein; Walsh, Erin; Shaw, Marnie E; Cherbuin, Nicolas

2018-06-01

The current challenge in clinical practice is to identify those with mild cognitive impairment (MCI), who are at greater risk of Alzheimer's disease (AD) conversion in the near future. The aim of this study was to assess a clinically practical new hippocampal index-hippocampal volume normalized by cerebellar volume (hippocampus to cerebellum volume ratio) used alone or in combination with scores on the Mini-Mental State Examination, as a predictor of conversion from MCI to AD. The predictive value of the HCCR was also contrasted to that of the hippocampal volume to intracranial volume ratio. The findings revealed that the performance of the combination of measures was significantly better than that of each measure used individually. The combination of Mini-Mental State Examination and hippocampal volume, normalized by the cerebellum or by intracranial volume, accurately discriminated individuals with MCI who progress to AD within 5 years from other MCI types (stable, reverters) and those with intact cognition (area under receiver operating curve of 0.88 and 0.89, respectively). Normalization by cerebellar volume was as accurate as normalization by intracranial volume with the advantage of being more practical, particularly for serial assessments. Copyright © 2018 Elsevier Inc. All rights reserved.

Pre-Employment Laboratory Training. General Agricultural Mechanics Volume I. Instructional Materials.

ERIC Educational Resources Information Center

Texas A and M Univ., College Station. Vocational Instructional Services.

This course outline, the first volume of a two-volume set, consists of lesson plans for pre-employment laboratory training in general agricultural mechanics. Covered in the 12 lessons included in this volume are selecting tractors and engines, diagnosing engine conditions, servicing electrical systems, servicing cooling systems, servicing fuel and…

Pre-Employment Laboratory Training. General Agricultural Mechanics Volume II. Instructional Materials.

ERIC Educational Resources Information Center

Texas A and M Univ., College Station. Vocational Instructional Services.

This course outline, the second volume of a two-volume set, consists of lesson plans for pre-employment laboratory training in general agricultural mechanics. Covered in the eight lessons included in this volume are cold metal work, soldering, agricultural safety programs, farm shops, farm structures, farm and ranch electrification, soil and water…

General Revenue Sharing Data Study: Executive Summary. Volume I.

ERIC Educational Resources Information Center

Wilson, Reese C.; Bowditch, E. Francis, Jr.

The results of the General Revenue Sharing Data Study carried out by Stanford Research Institute for the Office of Revenue Sharing are reported in four volumes. This volume, Executive Summary, presents highlights excerpted from Volumes II, III, and IV. Emphasis is placed on those findings, conclusions, and recommendations that deserve special…

Pollution Prevention Benefits Manual: Phase II. Volume 1: The Manual and Volume 2: Appendices (1989)

EPA Pesticide Factsheets

Manual is intended to help polluters evaluate the economic feasibility of pollution prevention or waste minimization alternatives to current practices, helping polluters evaluate how much a pollution prevention alternative will cost vs. current practices.

Prostate Brachytherapy Case Volumes by Academic and Nonacademic Practices: Implications for Future Residency Training

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

Orio, Peter F., E-mail: PORIO@lroc.harvard.edu; Harvard Medical School, Boston, Massachusetts; Nguyen, Paul L.

Purpose: The use of prostate brachytherapy has continued to decline in the United States. We examined the national practice patterns of both academic and nonacademic practices performing prostate brachytherapy by case volume per year to further characterize the decline and postulate the effect this trend might have on training the next generation of residents. Methods and Materials: Men diagnosed with prostate cancer who had undergone radiation therapy in 2004 to 2012 were identified. The annual brachytherapy case volume at each facility was determined and further categorized into ≤12 cases per year (ie, an average of ≤1 cases per month), 13more » to 52 cases per year, and ≥53 cases per year (ie, an average of ≥1 cases per week) in academic practices versus nonacademic practices. Results: In 2004 to 2012, academic practices performing an average of ≤1 brachytherapy cases per month increased from 56.4% to 73.7%. In nonacademic practices, this percentage increased from 60.2% to 77.4% (P<.0001 for both). Practices performing an average of ≥1 cases per week decreased among both academic practices (from 6.7% to 1.5%) and nonacademic practices (from 4.5% to 2.7%). Conclusions: Both academic and nonacademic radiation oncology practices have demonstrated a significant reduction in the use of prostate brachytherapy from 2004 to 2012. With the case volume continuing to decline, it is unclear whether we are prepared to train the next generation of residents in this critical modality.« less

Optimization of the convection volume in online post-dilution haemodiafiltration: practical and technical issues

PubMed Central

Chapdelaine, Isabelle; de Roij van Zuijdewijn, Camiel L.M.; Mostovaya, Ira M.; Lévesque, Renée; Davenport, Andrew; Blankestijn, Peter J.; Wanner, Christoph; Nubé, Menso J.; Grooteman, Muriel P.C.

2015-01-01

In post-dilution online haemodiafiltration (ol-HDF), a relationship has been demonstrated between the magnitude of the convection volume and survival. However, to achieve high convection volumes (>22 L per session) detailed notion of its determining factors is highly desirable. This manuscript summarizes practical problems and pitfalls that were encountered during the quest for high convection volumes. Specifically, it addresses issues such as type of vascular access, needles, blood flow rate, recirculation, filtration fraction, anticoagulation and dialysers. Finally, five of the main HDF systems in Europe are briefly described as far as HDF prescription and optimization of the convection volume is concerned. PMID:25815176

Flame Retardant Exposure among Collegiate U.S. Gymnasts

PubMed Central

Carignan, Courtney C.; Heiger-Bernays, Wendy; McClean, Michael D.; Roberts, Simon C.; Stapleton, Heather M.; Sjödin, Andreas; Webster, Thomas F.

2013-01-01

Gymnastics training facilities contain large volumes of polyurethane foam, a material that often contains additive flame retardants such as PentaBDE. While investigations of human exposure to flame retardants have focused on the general population, potentially higher than background exposures may occur in gymnasts and certain occupational groups. Our objectives were to compare PentaBDE body burden among gymnasts to the general U.S. population and characterize flame retardants levels in gym equipment, air and dust. We recruited 11 collegiate female gymnasts (ages 18–22) from one gym in the Eastern U.S. The geometric mean (GM) concentration of BDE-153 in gymnast sera (32.5 ng/g lipid) was 4–6.5 times higher than general U.S. population groups. Median concentrations of PentaBDE, TBB and TBPH in paired handwipe samples were 2–3 times higher after practice compared to before, indicating the gymnasts contacted these flame retardants during practice. GM concentrations of PentaBDE, TBB and TBPH were 1-3 orders of magnitude higher in gym air and dust than in residences. Our findings suggest that these collegiate gymnasts experienced higher exposures to PentaBDE flame retardants compared to the general U.S. population and that gymnasts may also have increased exposure to other additive flame retardants used in polyurethane foam such as TBB and TBPH. PMID:24195753

Plutonium shipments - a supplement

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

Kwiatkowska, B.; Soons, A.

1994-10-01

By means of a supplement to the stimulating analysis found in the comprehensive article by Professor Jon Van Dyke on `Sea Shipment of Japanese Plutonium under International Law`, published in Volume 24 of this journal, we feel that the following clarifications and additions are appropriate. Radioactive wastes are not covered by the 1989 Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and Their Disposal. Fir this reason, the Basel Conference adopted on March 22, 1989, along with the convention, Resolution 5 on Harmonization of Procedures of the Basel Convention and the Code of Practice for International Transactionsmore » Involving Nuclear Wastes. In accordance with Resolution 5, the provisions of the Basel Convention were taken into full account during the elaboration of the IAEA code, which ultimately was adopted by Resolution GC(XXXIV)/530 of the General Conference on Code of Practice on the International Transboundary Movement of Radioactive Waste (TMRW) of September 21, 1990. The IAEA code of practice and the respective regional instruments affirm, with respect to TMRW, the general principles of the Basel Convention, including the critical regime of prior notification and prior informed consent (PIC) that extend the scope of duties of notification, environmental impact assessment, and consultation with respect to transboundary interference as the duties have evolved under existing customary law.« less

Interdisciplinary periodontics: the multidisciplinary approach to the planning and treatment of complex cases.

PubMed

Lyons, Karl M; Darby, Ivan

2017-06-01

Periodontics cannot be practiced in isolation as frequently many patients have multiple dental needs or medical health issues requiring management. In addition, pathology may manifest in the periodontal tissues, and the onset and progression of periodontitis can be affected by systemic conditions, such as diabetes, and vice versa. The focus of this volume of Periodontology 2000 is interdisciplinary periodontics, and the articles included discuss the interactions and the interrelationshipbetween periodontal tissues/periodontal diseases and endodontics, fixed prosthodontics, implant dentistry, esthetics, gerodontology, radiology, orthodontics, pediatric dentistry, oral and maxillofacial surgery, oral pathology, special needs dentistry and general medicine. Previous volumes of Periodontology 2000 have covered some of the interactions between periodontal diseases and other dental disciplines, especially implant dentistry, 'and the interaction between periodontal disease and systemic disease', but there has not been a volume on interdisciplinary periodontics. The intention therefore is to show how and why periodontics should be interdisciplinary, as well as the benefits of an interdisciplinary approach; in addition, the potential consequences of using a discipline in isolation are discussed. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Documentation of the GLAS fourth order general circulation model. Volume 2: Scalar code

NASA Technical Reports Server (NTRS)

Kalnay, E.; Balgovind, R.; Chao, W.; Edelmann, D.; Pfaendtner, J.; Takacs, L.; Takano, K.

1983-01-01

Volume 2, of a 3 volume technical memoranda contains a detailed documentation of the GLAS fourth order general circulation model. Volume 2 contains the CYBER 205 scalar and vector codes of the model, list of variables, and cross references. A variable name dictionary for the scalar code, and code listings are outlined.

On the theory of thermometric titration.

PubMed

Piloyan, G O; Dolinina, Y V

1974-09-01

The general equation defining the change in solution temperature DeltaT during a thermometric titration is DeltaT = T - T(0) = - AV 1 + BV where A and B are constants, V is the volume of titrant used to produce temperature T, and T(0) is the initial temperature. There is a linear relation between the inverse values of DeltaT and V: 1 Delta T = - a V - b where a = 1/A and b = B/A, both a and b being constants. A linear relation between DeltaT and V is usually a special case of this general relation, and is valid only over a narrow range of V. Graphs of 1/DeltaTvs. 1/V are more suitable for practical calculations than the usual graphs of DeltaTvs. V.

A tour of inequality

NASA Astrophysics Data System (ADS)

Eliazar, Iddo

2018-02-01

This paper presents a concise and up-to-date tour to the realm of inequality indices. Originally devised for socioeconomic applications, inequality indices gauge the divergence of wealth distributions in human societies from the socioeconomic 'ground state' of perfect equality, i.e. pure communism. Inequality indices are quantitative scores that take values in the unit interval, with the zero score characterizing perfect equality. In effect, inequality indices are applicable in the context of general distributions of sizes - non-negative quantities such as count, length, area, volume, mass, energy, and duration. For general size distributions, which are omnipresent in science and engineering, inequality indices provide multi-dimensional and infinite-dimensional quantifications of the inherent inequality - i.e., the statistical heterogeneity, the non-determinism, the randomness. This paper compactly describes the insights and the practical implementation of inequality indices.

Standard software for automated testing of infrared imagers, IRWindows, in practical applications

NASA Astrophysics Data System (ADS)

Irwin, Alan; Nicklin, Robert L.

1998-08-01

In the past, ad-hoc and manual testing of infrared images hasn't been a deterrent to the characterization of these systems due to the low volume of production and high ratio of skilled personnel to the quantity of units under test. However, with higher volume production, increasing numbers of development labs in emerging markets, and the push towards less expensive, faster development cycles, there is a strong need for standardized testing that is quickly configurable by test engineers, which can be run by less experienced test technicians, and which produce repeatable, accurate results. The IRWindowsTM system addresses these needs using a standard computing platform and existing automated IR test equipment. This paper looks at the general capabilities of the IRWindowsTM system, and then examines the specific results from its application in the PalmIR and Automotive IR production environments.

Increased Grey Matter Associated with Long-Term Sahaja Yoga Meditation: A Voxel-Based Morphometry Study.

PubMed

Hernández, Sergio Elías; Suero, José; Barros, Alfonso; González-Mora, José Luis; Rubia, Katya

2016-01-01

To investigate regional differences in grey matter volume associated with the practice of Sahaja Yoga Meditation. Twenty three experienced practitioners of Sahaja Yoga Meditation and twenty three non-meditators matched on age, gender and education level, were scanned using structural Magnetic Resonance Imaging and their grey matter volume were compared using Voxel-Based Morphometry. Grey matter volume was larger in meditators relative to non-meditators across the whole brain. In addition, grey matter volume was larger in several predominantly right hemispheric regions: in insula, ventromedial orbitofrontal cortex, inferior temporal and parietal cortices as well as in left ventrolateral prefrontal cortex and left insula. No areas with larger grey matter volume were found in non-meditators relative to meditators. The study shows that long-term practice of Sahaja Yoga Meditation is associated with larger grey matter volume overall, and with regional enlargement in several right hemispheric cortical and subcortical brain regions that are associated with sustained attention, self-control, compassion and interoceptive perception. The increased grey matter volume in these attention and self-control mediating regions suggests use-dependent enlargement with regular practice of this meditation.

Increased Grey Matter Associated with Long-Term Sahaja Yoga Meditation: A Voxel-Based Morphometry Study

PubMed Central

Hernández, Sergio Elías; Suero, José; Barros, Alfonso; González-Mora, José Luis; Rubia, Katya

2016-01-01

Objectives To investigate regional differences in grey matter volume associated with the practice of Sahaja Yoga Meditation. Design Twenty three experienced practitioners of Sahaja Yoga Meditation and twenty three non-meditators matched on age, gender and education level, were scanned using structural Magnetic Resonance Imaging and their grey matter volume were compared using Voxel-Based Morphometry. Results Grey matter volume was larger in meditators relative to non-meditators across the whole brain. In addition, grey matter volume was larger in several predominantly right hemispheric regions: in insula, ventromedial orbitofrontal cortex, inferior temporal and parietal cortices as well as in left ventrolateral prefrontal cortex and left insula. No areas with larger grey matter volume were found in non-meditators relative to meditators. Conclusions The study shows that long-term practice of Sahaja Yoga Meditation is associated with larger grey matter volume overall, and with regional enlargement in several right hemispheric cortical and subcortical brain regions that are associated with sustained attention, self-control, compassion and interoceptive perception. The increased grey matter volume in these attention and self-control mediating regions suggests use-dependent enlargement with regular practice of this meditation. PMID:26938433

Automobile Engine Control Parameters Study : Volume 1. Summary and Status of Domestic Engine Control Practice

DOT National Transportation Integrated Search

1977-02-01

This report contains the results of a study to evaluate automobile engine control parameters and their effects on vehicle fuel economy and emissions. Volume I presents detailed technical information on the engine control practices used by selected do...

Acquisition Regulations and Offshore Software Development: Implications for Cybersecurity of DOD Networks

DTIC Science & Technology

2013-02-14

Kessler, “Protection and Protectionism: The Practicalities of Offshore Software Devleopment in Government Procurement,” Public Contract Law Journal, Volume...Protection and Protectionism: The Practicalities of Offshore Software Development In Government Procurement,” Public Contract Law Journal, Volume 38, No. 1

Annual Proceedings of Selected Papers on the Practice of Educational Communications and Technology Presented at the Annual Convention of the Association for Educational Communications and Technology (33rd, Anaheim, California, 2010). Volume 2

ERIC Educational Resources Information Center

Simonson, Michael, Ed.

2010-01-01

For the thirty-third year, the Research and Theory Division of the Association for Educational Communications and Technology (AECT) is sponsoring the publication of these Proceedings. This is Volume #2 of the 33rd "Annual Proceedings of Selected Papers on the Practice of Educational Communications and Technology." This volume includes…

High Performing Colleges. The Malcolm Baldrige National Quality Award as a Framework for Improving Higher Education. Volume I: Theory and Concepts [and] Volume II: Case and Practice.

ERIC Educational Resources Information Center

Seymour, Daniel, Ed.; And Others

This publication provides research-based discussion in 20 chapters of possible extension of the Malcolm Baldrige National Quality Award to honor high performing colleges. Chapters are organized into two volumes, the first exploring a broad range of issues from a scholarly point of view and the second emphasizing the practical application of a…

An Independent Scientific Assessment of Well Stimulation in California Volume I

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

Jane C.S. Long; Laura C. Feinstein; Birkholzer, Jens

In 2013, the California Legislature passed Senate Bill 4 (SB 4), setting the framework for regulation of well stimulation technologies in California, including hydraulic fracturing. SB 4 also requires the California Natural Resources Agency to conduct an independent scientific study of well stimulation technologies in California to assess current and potential future practices, including the likelihood that well stimulation technologies could enable extensive new petroleum production in the state, evaluate the impacts of well stimulation technologies and the gaps in data that preclude this understanding, identify risks associated with current practices, and identify alternative practices which might limit these risks.more » The study is issued in three volumes. This document, Volume I, provides the factual basis describing well stimulation technologies, how and where operators deploy these technologies for oil and gas production in California, and where they might enable production in the future. Volume II discusses how well stimulation affects water, the atmosphere, seismic activity, wildlife and vegetation, traffic, light and noise levels; it will also explore human health hazards, and identify data gaps and alternative practices. Volume III presents case studies to assess environmental issues and qualitative« less

The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice

PubMed Central

Phillips, Robert L.; Petterson, Stephen M.; Bazemore, Andrew W.; Wingrove, Peter; Puffer, James C.

2017-01-01

PURPOSE Medicare beneficiary spending patterns reflect those of the 306 Hospital Referral Regions where physicians train, but whether this holds true for smaller areas or for quality is uncertain. This study assesses whether cost and quality imprinting can be detected within the 3,436 Hospital Service Areas (HSAs), 82.4 percent of which have only 1 teaching hospital, and whether sponsoring institution characteristics are associated. METHODS We conducted a secondary, multi-level, multivariable analysis of 2011 Medicare claims and American Medical Association Masterfile data for a random, nationally representative sample of family physicians and general internists who completed residency between 1992 and 2010 and had more than 40 Medicare patients (3,075 physicians providing care to 503,109 beneficiaries). Practice and training locations were matched with Dartmouth Atlas HSAs and categorized into low-, average-, and high-cost spending groups. Practice and training HSAs were assessed for differences in 4 diabetes quality measures. Institutional characteristics included training volume and percentage of graduates in rural practice and primary care. RESULTS The unadjusted, annual, per-beneficiary spending difference between physicians trained in high- and low-cost HSAs was $1,644 (95% CI, $1,253–$2,034), and the difference remained significant after controlling for patient and physician characteristics. No significant relationship was found for diabetes quality measures. General internists were significantly more likely than family physicians to train in high-cost HSAs. Institutions with more graduates in rural practice and primary care produced lower-spending physicians. CONCLUSIONS The “imprint” of training spending patterns on physicians is strong and enduring, without discernible quality effects, and, along with identified institutional features, supports measures and policy options for improved graduate medical education outcomes. PMID:28289113

A recursively formulated first-order semianalytic artificial satellite theory based on the generalized method of averaging. Volume 1: The generalized method of averaging applied to the artificial satellite problem

NASA Technical Reports Server (NTRS)

Mcclain, W. D.

1977-01-01

A recursively formulated, first-order, semianalytic artificial satellite theory, based on the generalized method of averaging is presented in two volumes. Volume I comprehensively discusses the theory of the generalized method of averaging applied to the artificial satellite problem. Volume II presents the explicit development in the nonsingular equinoctial elements of the first-order average equations of motion. The recursive algorithms used to evaluate the first-order averaged equations of motion are also presented in Volume II. This semianalytic theory is, in principle, valid for a term of arbitrary degree in the expansion of the third-body disturbing function (nonresonant cases only) and for a term of arbitrary degree and order in the expansion of the nonspherical gravitational potential function.

Molecular representation of molar domain (volume), evolution equations, and linear constitutive relations for volume transport.

PubMed

Eu, Byung Chan

2008-09-07

In the traditional theories of irreversible thermodynamics and fluid mechanics, the specific volume and molar volume have been interchangeably used for pure fluids, but in this work we show that they should be distinguished from each other and given distinctive statistical mechanical representations. In this paper, we present a general formula for the statistical mechanical representation of molecular domain (volume or space) by using the Voronoi volume and its mean value that may be regarded as molar domain (volume) and also the statistical mechanical representation of volume flux. By using their statistical mechanical formulas, the evolution equations of volume transport are derived from the generalized Boltzmann equation of fluids. Approximate solutions of the evolution equations of volume transport provides kinetic theory formulas for the molecular domain, the constitutive equations for molar domain (volume) and volume flux, and the dissipation of energy associated with volume transport. Together with the constitutive equation for the mean velocity of the fluid obtained in a previous paper, the evolution equations for volume transport not only shed a fresh light on, and insight into, irreversible phenomena in fluids but also can be applied to study fluid flow problems in a manner hitherto unavailable in fluid dynamics and irreversible thermodynamics. Their roles in the generalized hydrodynamics will be considered in the sequel.

Language Teacher Research in Asia

ERIC Educational Resources Information Center

Farrell, Thomas S. C., Ed.

2006-01-01

The Language Teacher Research Series aims to connect research and practice by highlighting the insights that teachers themselves describe after examining their own practices. This first volume of the five-volume series presents research conducted by language teachers at all levels, from high school English teachers to English language teacher…

ELM Meets Urban Big Data Analysis: Case Studies

PubMed Central

Chen, Huajun; Chen, Jiaoyan

2016-01-01

In the latest years, the rapid progress of urban computing has engendered big issues, which creates both opportunities and challenges. The heterogeneous and big volume of data and the big difference between physical and virtual worlds have resulted in lots of problems in quickly solving practical problems in urban computing. In this paper, we propose a general application framework of ELM for urban computing. We present several real case studies of the framework like smog-related health hazard prediction and optimal retain store placement. Experiments involving urban data in China show the efficiency, accuracy, and flexibility of our proposed framework. PMID:27656203

Increasing the speed of medical image processing in MatLab®

PubMed Central

Bister, M; Yap, CS; Ng, KH; Tok, CH

2007-01-01

MatLab® has often been considered an excellent environment for fast algorithm development but is generally perceived as slow and hence not fit for routine medical image processing, where large data sets are now available e.g., high-resolution CT image sets with typically hundreds of 512x512 slices. Yet, with proper programming practices – vectorization, pre-allocation and specialization – applications in MatLab® can run as fast as in C language. In this article, this point is illustrated with fast implementations of bilinear interpolation, watershed segmentation and volume rendering. PMID:21614269

Sector-specific issues and reporting methodologies supporting the General Guidelines for the voluntary reporting of greenhouse gases under Section 1605(b) of the Energy Policy Act of 1992. Volume 2: Part 4, Transportation sector; Part 5, Forestry sector; Part 6, Agricultural sector

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

Not Available

This volume, the second of two such volumes, contains sector-specific guidance in support of the General Guidelines for the voluntary reporting of greenhouse gas emissions and carbon sequestration. This voluntary reporting program was authorized by Congress in Section 1605(b) of the Energy Policy Act of 1992. The General Guidelines, bound separately from this volume, provide the overall rationale for the program, discuss in general how to analyze emissions and emission reduction/carbon sequestration projects, and address programmatic issues such as minimum reporting requirements, time parameters, international projects, confidentiality, and certification. Together, the General Guidelines and the guidance in these supporting documentsmore » will provide concepts and approaches needed to prepare the reporting forms. This second volume of sector-specific guidance covers the transportation sector, the forestry sector, and the agricultural sector.« less

1970 MLA International Bibliography of Books and Articles on the Modern Languages and Literatures, Volume I: General, English, American, Medieval and Neo-Latin, Celtic Literatures; and Folklore.

ERIC Educational Resources Information Center

Meserole, Harrison T., Comp.

Volume 1 of the four-volume, international bibliography contains over 11,140 entries referring to books, Festschriften, analyzed collections, and articles which focus on General, English, American, medieval and neo-Latin, and Celtic literatures. A section of folklore is also included. The section on general literature includes: (1) aesthetics, (2)…

Practical Nursing, Volume I. Health Occupations Education.

ERIC Educational Resources Information Center

Rogers, Helen W.; And Others

This curriculum guide provides teachers with up-to-date information and skill-related applications needed by the practical nurse. The volume contains three sections and 24 instructional units: Personal Vocational Relationships (6 units), Nutrition (3 units), and Basic Nursing Principles and Applied Skills (15 units covering such topics as…

Retrofitting LID Practices into Existing Neighborhoods: Is It Worth It?

NASA Astrophysics Data System (ADS)

Wright, Timothy J.; Liu, Yaoze; Carroll, Natalie J.; Ahiablame, Laurent M.; Engel, Bernard A.

2016-04-01

Low-impact development (LID) practices are gaining popularity as an approach to manage stormwater close to the source. LID practices reduce infrastructure requirements and help maintain hydrologic processes similar to predevelopment conditions. Studies have shown LID practices to be effective in reducing runoff and improving water quality. However, little has been done to aid decision makers in selecting the most effective practices for their needs and budgets. The long-term hydrologic impact assessment LID model was applied to four neighborhoods in Lafayette, Indiana using readily available data sources to compare LID practices by analyzing runoff volumes, implementation cost, and the approximate period needed to achieve payback on the investment. Depending on the LID practice and adoption level, 10-70 % reductions in runoff volumes could be achieved. The cost per cubic meter of runoff reduction was highly variable depending on the LID practice and the land use to which it was applied, ranging from around 3 to almost 600. In some cases the savings from reduced runoff volumes paid back the LID practice cost with interest in less than 3 years, while in other cases it was not possible to generate a payback. Decision makers need this information to establish realistic goals and make informed decisions regarding LID practices before moving into detailed designs, thereby saving time and resources.

Installation Restoration Program (IRP) Site Investigation Report for IRP Site Number 4. Volume 3. Appendices D-I. 128th Air Refueling Wing, Wisconsin Air National Guard, General Billy Mitchell Field Air National Guard Base, Milwaukee, Wisconsin.

DTIC Science & Technology

1996-03-01

NATIONAL GUARD GENERAL BILLY MITCHELL FIELD AIR NATIONAL GUARD BASE MILWAUKEE, WISCONSIN MARCH 1996 ______ 19960509 134 HQ ANG/CEVR ANDREWS AFB...Report for IRP Site No. 4, Wisconsin Air National Guard, 128th Air Refueling Wing, General Billy Mitchell Field, Milwaukee, Wisconsin - Volume III...Wisconsin Air National Guard, 128th Air Refueling Wing, General Billy Mitchell Field, Milwaukee, Wisconsin, Volume III - Appendices D-I. This is the

The 'fixed cost effect' on practice management.

PubMed

Tipton, E F; Finley, J B

1999-01-01

To obtain a better understanding of the behavior of "non-professional" costs in a medical practice, the authors analyzed the expenses of a 19-doctor practice. The analysis revealed that 80 percent of these expenses were fixed costs. Fixed costs, as opposed to variable costs, remain static in total but vary on a per unit basis as volume changes. Organizations with high fixed cost must maximize capacity to achieve profitability. Thus, the relationship among volume, capacity, cost and profit must be understood by medical practices negotiating rates for service units.

Review of Adult Learning and Literacy, Volume 4. Connecting Research, Policy, and Practice: A Project of the National Center for the Study of Adult Learning and Literacy

ERIC Educational Resources Information Center

Comings, John, Ed.; Garner, Barbara, Ed.; Smith, Cristine, Ed.

2004-01-01

"The Review of Adult Learning and Literacy: Connecting Research Policy, and Practice, Volume 4" is an addition to a series of annual publications of the National Center for the Study of Adult Learning and Literacy (NCSALL) that address major issues, the latest research, and the best practices in the field of adult literacy and learning.…

Practice arrangement and medicare physician payment in otolaryngology.

PubMed

Cracchiolo, Jennifer; Ridge, John A; Egleston, Brian; Lango, Miriam

2015-06-01

Medicare Part B physician payment indicates a cost to Medicare beneficiaries for a physician service and connotes physician clinical productivity. The objective of this study was to determine whether there was an association between practice arrangement and Medicare physician payment. Cross-sectional study. Medicare provider utilization and payment data. Otolaryngologists from 1 metropolitan area were included as part of a pilot study. A generalized linear model was used to determine the effect of practice-specific variables including patient volumes on physician payment. Of 67 otolaryngologists included, 23 (34%) provided services through an independent practice, while others were employed by 1 of 3 local academic centers. Median payment was $58,895 per physician for the year, although some physicians received substantially higher payments. Reimbursements to faculty at 1 academic department were higher than to those at other institutions or to independent practitioners. After adjustments were made for patient volumes, physician subspecialty, and gender, payments to each faculty at Hospital C were 2 times higher than to those at Hospital A (relative ratio [RR] 2.03; 95% CI, 1.27-3.27; P = .003); 2 times higher than to faculty at Hospital B (RR 2.04; 95% CI, 1.4-2.7; P = .0001); and 1.6 times higher than to independent practitioners (RR 1.6; 95% CI, 1.04-2.7; P = .03). Payments to physicians in the other groups were not significantly different. Differences in reimbursement corresponded to an emphasis on procedures over office visits but not Medicare case mix adjustments for patient discharges from associated institutions. Variation in the cost of academic otolaryngology care may be subject in part to institutional factors. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Impact of Provider Characteristics on Outcomes of Carotid Endarterectomy for Asymptomatic Carotid Stenosis in New York State.

PubMed

Meltzer, Andrew J; Agrusa, Christopher; Connolly, Peter H; Schneider, Darren B; Sedrakyan, Art

2017-11-01

The purpose of this study is to explore the impact of surgeon characteristics (including annual volume, specialty, and years in practice) on outcomes of carotid endarterectomy (CEA) for asymptomatic carotid atherosclerosis in New York State. The New York Statewide Planning and Cooperation System database was utilized to identify patients undergoing CEA from 2004 to 2011. Provider characteristics were determined by linkage to the New York Office of Professions and National Provider Identification databases. Provider-level factors were characterized by defining 5 quintiles of equal size for each factor. Hierarchical logistic regression models were created to evaluate the impact of provider characteristics on outcome. In total, 36,495 patients underwent CEA for asymptomatic disease performed by vascular (75.7%), general (16.1%), cardiac (6%), and neuro (2.1%) surgeons. Outcomes of interest included in-hospital mortality (0.26%), stroke (0.45%), and the composite end point of mortality, stroke, or cardiac complication (2.2%). Unadjusted outcomes improved with increasing surgeon annual CEA volume. Mid-career surgeons had lower mortality and stroke rates than early or late-career surgeons. Odds of mortality were increased when surgery was performed by the lowest volume providers (quintile 1; 0-11 CEA/year) (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.3-5.28) or a nonspecialty trained (general) surgeon (OR 1.64, 95% 1.01-2.67). After adjustment for all patient-level factors, provider volume remained an independent predictor of outcome, with significantly increased odds of mortality for volume quintile 1 (OR 2.57, 95% CI 1.27-5.23) and quintile 2 (12-22 CEA/year) (0.30%; OR 2.07, 95% CI 1-4.27) surgeons. Adverse events after CEA for asymptomatic disease are comparatively rare. However, surgeon characteristics impact outcome, with the best results offered by high-volume, mid-career, specialty-trained surgeons. Efforts to define the optimal treatment of asymptomatic carotid atherosclerosis must account for the impact of surgeon characteristics on patient outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Safe Sleep Practices of Kansas Birthing Hospitals

PubMed Central

Ahlers-Schmidt, Carolyn R.; Schunn, Christy; Sage, Cherie; Engel, Matthew; Benton, Mary

2018-01-01

Background Sleep-related death is tied with congenital anomalies as the leading cause of infant mortality in Kansas, and external risk factors are present in 83% of these deaths. Hospitals can impact caregiver intentions to follow risk-reduction strategies. This project assessed the current practices and policies of Kansas hospitals with regard to safe sleep. Methods A cross-sectional survey of existing safe sleep practices and policies in Kansas hospitals was performed. Hospitals were categorized based on reported delivery volume and data were compared across hospital sizes. Results Thirty-one of 73 (42%) contacted hospitals responded. Individual survey respondents represented various hospital departments including newborn/well-baby (68%), neonatal intensive care unit (3%) and other non-nursery departments or administration (29%). Fifty-eight percent of respondents reported staff were trained on infant safe sleep; 44% of these held trainings annually. High volume hospitals tended to have more annual training than low or mid volume birth hospitals. Thirty-nine percent reported a safe sleep policy, though most of these (67%) reported never auditing compliance. The top barrier to safe sleep education, regardless of delivery volume, was conflicting patient and family member beliefs. Conclusions Hospital promotion of infant safe sleep is being conducted in Kansas to varying degrees. High and mid volume birth hospitals may need to work more on formal auditing of safe sleep practices, while low volume hospitals may need more staff training. Low volume hospitals also may benefit from access to additional caregiver education materials. Finally, it is important to note hospitals should not be solely responsible for safe sleep education. PMID:29844848

Mitigating mechanical failure of crystalline silicon electrodes for lithium batteries by morphological design [Morphological design of silicon electrode with anisotropic interface reaction rate for lithium ion batteries

DOE PAGES

An, Yonghao; Wood, Brandon C.; Ye, Jianchao; ...

2015-06-08

Although crystalline silicon (c-Si) anodes promise very high energy densities in Li-ion batteries, their practical use is complicated by amorphization, large volume expansion and severe plastic deformation upon lithium insertion. Recent experiments have revealed the existence of a sharp interface between crystalline Si (c-Si) and the amorphous Li xSi alloy during lithiation, which propagates with a velocity that is orientation dependent; the resulting anisotropic swelling generates substantial strain concentrations that initiate cracks even in nanostructured Si. Here we describe a novel strategy to mitigate lithiation-induced fracture by using pristine c-Si structures with engineered anisometric morphologies that are deliberately designed tomore » counteract the anisotropy in the crystalline/amorphous interface velocity. This produces a much more uniform volume expansion, significantly reducing strain concentration. Based on a new, validated methodology that improves previous models of anisotropic swelling of c-Si, we propose optimal morphological designs for c-Si pillars and particles. The advantages of the new morphologies are clearly demonstrated by mesoscale simulations and verified by experiments on engineered c-Si micropillars. The results of this study illustrate that morphological design is effective in improving the fracture resistance of micron-sized Si electrodes, which will facilitate their practical application in next-generation Li-ion batteries. In conclusion, the model and design approach present in this paper also have general implications for the study and mitigation of mechanical failure of electrode materials that undergo large anisotropic volume change upon ion insertion and extraction.« less

Medical review practices for driver licensing volume 2: case studies of medical referrals and licensing outcomes in Maine, Ohio, Oregon, Texas, Washington, and Wisconsin.

DOT National Transportation Integrated Search

2017-03-01

This is the second of three reports examining driver medical review practices in the United States and how : they fulfill the basic functions of identifying, assessing, and rendering licensing decisions on medically at-risk : drivers. This volume pre...

User's Guide: Innovation Configurations for NSDC's Standards for Staff Development

ERIC Educational Resources Information Center

Roy, Patricia

2007-01-01

This 75-page guidebook is a companion to "Moving NSDC's Staff Development Standards into Practice: Innovation Configurations" Volumes I (ED522734) and II (ED522581). Innovation Configurations are a tool that helps educators better understand what the standards look like in practice. Roy, who co-authored the original volumes, introduces a process…

Mathematics: A Practical View. Volume I, Teacher Edition. Applied Basic Curriculum Series.

ERIC Educational Resources Information Center

Evaluation, Dissemination and Assessment Center, Dallas.

The activities in this volume of practical mathematics are intended for the intermediate grades. The manual contains three components which can be structured in different combinations according to different student needs. Built around a review of selected objectives in the mathematics basic curriculum, the material is intended to stimulate…

Dynamics of vascular volume and hemodilution of lactated Ringer’s solution in patients during induction of general and epidural anesthesia*

PubMed Central

Li, Yu-hong; Lou, Xian-feng; Bao, Fang-ping

2006-01-01

Objective: To investigate the dynamics of vascular volume and the plasma dilution of lactated Ringer’s solution in patients during the induction of general and epidural anesthesia. Methods: The hemodilution of i.v. infusion of 1000 ml of lactated Ringer’s solution over 60 min was studied in patients undergoing general (n=31) and epidural (n=22) anesthesia. Heart rate, arterial blood pressure and hemoglobin (Hb) concentration were measured every 5 min during the study. Surgery was not started until the study period had been completed. Results: General anesthesia caused the greater decrease of mean arterial blood pressure (MAP) (mean 15% versus 9%; P<0.01) and thereby followed by a more pronounced plasma dilution, blood volume expansion (VE) and blood volume expansion efficiency (VEE). A strong linear correlation between hemodilution and the reduction in MAP (r=−0.50; P<0.01) was found. At the end of infusion, patients undergoing general anesthesia retained 47% (SD 19%) of the infused fluid in the circulation, while epidural anesthesia retained 29% (SD 13%) (P<0.001). Correspondingly, a fewer urine output (mean 89 ml versus 156 ml; P<0.05) and extravascular expansion (454 ml versus 551 ml; P<0.05) were found during general anesthesia. Conclusion: We concluded that the induction of general anesthesia caused more hemodilution, volume expansion and volume expansion efficiency than epidural anesthesia, which was triggered only by the lower MAP. PMID:16909476

High Performance Schools Best Practices Manual. Volume I: Planning [and] Volume II: Design [and] Volume III: Criteria.

ERIC Educational Resources Information Center

Eley, Charles, Ed.

This three-volume manual, focusing on California's K-12 public schools, presents guidelines for establishing schools that are healthy, comfortable, energy efficient, resource efficient, water efficient, secure, adaptable, and easy to operate and maintain. The first volume describes why high performance schools are important, what components are…

Extending unbiased stereology of brain ultrastructure to three-dimensional volumes

NASA Technical Reports Server (NTRS)

Fiala, J. C.; Harris, K. M.; Koslow, S. H. (Principal Investigator)

2001-01-01

OBJECTIVE: Analysis of brain ultrastructure is needed to reveal how neurons communicate with one another via synapses and how disease processes alter this communication. In the past, such analyses have usually been based on single or paired sections obtained by electron microscopy. Reconstruction from multiple serial sections provides a much needed, richer representation of the three-dimensional organization of the brain. This paper introduces a new reconstruction system and new methods for analyzing in three dimensions the location and ultrastructure of neuronal components, such as synapses, which are distributed non-randomly throughout the brain. DESIGN AND MEASUREMENTS: Volumes are reconstructed by defining transformations that align the entire area of adjacent sections. Whole-field alignment requires rotation, translation, skew, scaling, and second-order nonlinear deformations. Such transformations are implemented by a linear combination of bivariate polynomials. Computer software for generating transformations based on user input is described. Stereological techniques for assessing structural distributions in reconstructed volumes are the unbiased bricking, disector, unbiased ratio, and per-length counting techniques. A new general method, the fractional counter, is also described. This unbiased technique relies on the counting of fractions of objects contained in a test volume. A volume of brain tissue from stratum radiatum of hippocampal area CA1 is reconstructed and analyzed for synaptic density to demonstrate and compare the techniques. RESULTS AND CONCLUSIONS: Reconstruction makes practicable volume-oriented analysis of ultrastructure using such techniques as the unbiased bricking and fractional counter methods. These analysis methods are less sensitive to the section-to-section variations in counts and section thickness, factors that contribute to the inaccuracy of other stereological methods. In addition, volume reconstruction facilitates visualization and modeling of structures and analysis of three-dimensional relationships such as synaptic connectivity.

Coverage-based constraints for IMRT optimization

NASA Astrophysics Data System (ADS)

Mescher, H.; Ulrich, S.; Bangert, M.

2017-09-01

Radiation therapy treatment planning requires an incorporation of uncertainties in order to guarantee an adequate irradiation of the tumor volumes. In current clinical practice, uncertainties are accounted for implicitly with an expansion of the target volume according to generic margin recipes. Alternatively, it is possible to account for uncertainties by explicit minimization of objectives that describe worst-case treatment scenarios, the expectation value of the treatment or the coverage probability of the target volumes during treatment planning. In this note we show that approaches relying on objectives to induce a specific coverage of the clinical target volumes are inevitably sensitive to variation of the relative weighting of the objectives. To address this issue, we introduce coverage-based constraints for intensity-modulated radiation therapy (IMRT) treatment planning. Our implementation follows the concept of coverage-optimized planning that considers explicit error scenarios to calculate and optimize patient-specific probabilities q(\\hat{d}, \\hat{v}) of covering a specific target volume fraction \\hat{v} with a certain dose \\hat{d} . Using a constraint-based reformulation of coverage-based objectives we eliminate the trade-off between coverage and competing objectives during treatment planning. In-depth convergence tests including 324 treatment plan optimizations demonstrate the reliability of coverage-based constraints for varying levels of probability, dose and volume. General clinical applicability of coverage-based constraints is demonstrated for two cases. A sensitivity analysis regarding penalty variations within this planing study based on IMRT treatment planning using (1) coverage-based constraints, (2) coverage-based objectives, (3) probabilistic optimization, (4) robust optimization and (5) conventional margins illustrates the potential benefit of coverage-based constraints that do not require tedious adjustment of target volume objectives.

47 CFR 0.411 - General reference materials.

Code of Federal Regulations, 2011 CFR

2011-10-01

... they need subchapter A, containing the general rules, and one of the other volumes, depending upon their area of interest. These four volumes are revised annually to reflect changes in the rules. See... single volume, Radio Laws of the United States (1962 ed.). See §§ 0.405 and 0.414. (b) Regulatory...

Runoff and water-quality characteristics of three Discovery Farms in North Dakota, 2008–16

USGS Publications Warehouse

Galloway, Joel M.; Nustad, Rochelle A.

2017-12-21

Agricultural producers in North Dakota are aware of concerns about degrading water quality, and many of the producers are interested in implementing conservation practices to reduce the export of nutrients from their farms. Producers often implement conservation practices without knowledge of the water quality of the runoff from their farm or if conservation practices they may implement have any effect on water quality. In response to this lack of information, the U.S. Geological Survey, in cooperation with North Dakota State University Extension Service and in coordination with an advisory group consisting of State agencies, agricultural producers, and commodity groups, implemented a monitoring study as part of a Discovery Farms program in North Dakota in 2007. Three data-collection sites were established at each of three farms near Underwood, Embden, and Dazey, North Dakota. The purpose of this report is to describe runoff and water-quality characteristics using data collected at the three Discovery Farms during 2008–16. Runoff and water-quality data were used to help describe the implications of agricultural conservation practices on runoff and water-quality patterns.Runoff characteristics of monitoring sites at the three farms were determined by measuring flow volume and precipitation. Runoff at the Underwood farm monitoring sites generally was controlled by precipitation in the area, antecedent soil moisture conditions, and, after 2012, possibly by the diversion ditch constructed by the producer. Most of the annual runoff was in March and April each year during spring snowmelt. Runoff characteristics at the Embden farm are complex because of the mix of surface runoff and flow through two separate drainage tile systems. Annual flow volumes for the drainage tiles sites (sites E2 and E3) were several orders of magnitude greater than measured at the surface water site E1. Site E1 generally only had runoff briefly in March and April during spring snowmelt and during only a few large rain events throughout 2009–16. Flow was somewhat continuous at sites E2 and E3 throughout the year during years of increased precipitation, such as in 2010 and 2011. At Dazey farm, annual flow volumes at the most downstream site D3 for 2010–15 ranged from 88 acre-feet (2012) to 12,060 acre-feet (2010). The largest monthly runoff volumes at D1 (most upstream site; combination of data from site D1a [original site] and site D1b [relocated site]) and D3 were in March and April during spring snowmelt runoff and rain events.At Underwood farm, total ammonia and total phosphorus had the highest concentrations at the most upstream site (U1) and decreased sequentially at sites U2 and U3 downstream. Total ammonia and total phosphorus concentrations at the sites for Underwood farm also generally were higher than measured at sites for the Dazey and Embden farms. At Embden farm, nitrate plus nitrite concentrations were lowest at site E1 (surface-water site) and highest at sites E2 and E3 (drainage tile sites). Nitrate plus nitrite concentrations at sites E2 and E3 also were the highest among all the sites at all three farms. Median total nitrate plus nitrite concentrations for sites E1, E2, and E3 were 0.22, 13, and 10 milligrams per liter as nitrogen, respectively. Nutrient concentrations generally were greater at site D1 (most upstream site) compared to site D3 (most downstream site) at Dazey farm. Higher concentrations at site D1, which is farther upstream and closer to potential sources of nutrients, compared to lower concentrations at site D3, which is farther downstream and receives more runoff, indicates that dilution may be the reason concentrations decrease downstream.Annual loads for chloride at all three Underwood sites were the greatest in 2011 and the least in 2012, which coincided with years of the greatest and least annual flow volume, respectively. Total ammonia had a similar pattern at the three sites. Nitrate plus nitrite loads displayed a different pattern than chloride and total ammonia, indicating possible different sources. Chloride, total ammonia, total phosphorus, and suspended sediment were transported past site U1 mostly in March and the least from July through October. Monthly nitrate plus nitrite loads had a different pattern than the other constituents, indicating other possible sources such as fertilizer application in the surrounding cropland.Annual loads for Embden farm were considerably greater at sites E2 and E3 compared to site E1. Annual yields for all constituents also were substantially greater at sites E2 and E3 compared to site E1, mainly because of a combination of higher flow volumes and small contributing drainage areas at sites E2 and E3 compared to site E1.The greatest annual loads at Dazey farm site D3 for chloride, nitrate plus nitrite, and suspended sediment were in 2010 and 2011, and zero loads were estimated for 2012 because no flow was measured at the site. Mean monthly loads generally were greatest for most constituents in March and April at sites D1 and D3 except for suspended sediment that had the greatest monthly loads in May.To mitigate runoff and water-quality effects of their operations, the producers implemented various agricultural conservation practices before and during the Discovery Farms monitoring. Even though it was difficult to quantify the effects of the agricultural conservation practices implemented at the farms, the data collected from the Discovery Farms program provided a better understanding of some of the variables that affect runoff and water quality.

1969 MLA International Bibliography of Books and Articles on the Modern Languages and Literatures. Volume I: General, English, American, Medieval and Neo-Latin, and Celtic Literatures.

ERIC Educational Resources Information Center

Meserole, Harrison T., Comp.

Volume 1 of the 4-volume, international bibliography contains some 9,000 entries referring to books and articles which focus on general, English, American, medieval and neo-Latin, and Celtic literatures. The master list of the nearly 1,500 periodicals from which entries are derived is furnished at the beginning of the volume with a table of…

Management Practices Used in Agricultural Drainage Ditches to Reduce Gulf of Mexico Hypoxia.

PubMed

Faust, Derek R; Kröger, Robert; Moore, Matthew T; Rush, Scott A

2018-01-01

Agricultural non-point sources of nutrients and sediments have caused eutrophication and other water quality issues in aquatic and marine ecosystems, such as the annual occurrence of hypoxia in the Gulf of Mexico. Management practices have been implemented adjacent to and in agricultural drainage ditches to promote their wetland characteristics and functions, including reduction of nitrogen, phosphorus, and sediment losses downstream. This review: (1) summarized studies examining changes in nutrient and total suspended solid concentrations and loads associated with management practices in drainage ditches (i.e., riser and slotted pipes, two-stage ditches, vegetated ditches, low-grade weirs, and organic carbon amendments) with emphasis on the Lower Mississippi Alluvial Valley, (2) quantified management system effects on nutrient and total suspended solid concentrations and loads and, (3) identified information gaps regarding water quality associated with these management practices and research needs in this area. In general, management practices used in drainage ditches at times reduced losses of total suspended solids, N, and P. However, management practices were often ineffective during storm events that were uncommon and intense in duration and volume, although these types of events could increase in frequency and intensity with climate change. Studies on combined effects of management practices on drainage ditch water quality, along with research towards improved nutrient and sediment reduction efficiency during intense storm events are urgently needed.

Association of Very Low-Volume Practice With Vascular Surgery Outcomes in New York.

PubMed

Mao, Jialin; Goodney, Philip; Cronenwett, Jack; Sedrakyan, Art

2017-08-01

Little research has focused on very low-volume surgery, especially in the context of decreasing vascular surgery volume with the adoption of endovascular procedures. To investigate the existence and outcomes of open abdominal aortic aneurysm repair (OAR) and carotid endarterectomy (CEA) performed by very low-volume surgeons in New York. This cohort study examined inpatient data of patients undergoing elective OAR or CEA from 2000 to 2014 from all New York hospitals. Surgeons who performed 1 or less designated procedure per year on average were considered very low volume, as opposed to higher-volume surgeons. Temporal trends of the existence of very low-volume practice were evaluated. Hierarchical logistic regression was used to compare in-hospital outcomes and health care resource use between patients treated by very low-volume surgeons and higher-volume surgeons for both OAR and CEA, adjusting for patient, surgeon, and hospital characteristics. There were 8781 OAR procedures and 68 896 CEA procedures included in the study. The mean (SD) patient age was 71.7 (8.4) years for OAR and 71.5 (9.1) years for CEA. A total of 614 surgeons performed OAR and 1071 performed CEA in New York during the study period. Of these, 318 (51.8%) and 512 (47.8%), respectively, were very low-volume surgeons. Very low-volume surgeons were less likely to be vascular surgeons. The number and proportion of very low-volume surgeons decreased over years. Compared with patients treated by higher-volume surgeons, those treated by very low-volume surgeons were more likely to have higher in-hospital mortality (odds ratio [OR], 2.09; 95% CI, 1.41-3.08) following OAR and higher risks of postoperative myocardial infarction (OR, 1.83; 95% CI, 1.03-3.26) and stroke (OR, 1.78; 95% CI, 1.21-2.62) following CEA. Patients treated by very low-volume surgeons also had greater health care resource use following both surgeries, including prolonged length of stay (OR, 1.37; 95% CI, 1.11-1.70) following OAR as well as higher charges (OR, 1.28; 95% CI, 1.01-1.62) and increased 30-day readmission (OR, 1.30; 95% CI 1.04-1.62) following CEA. The OAR and CEA procedures performed by very low-volume surgeons resulted in worse postoperative outcomes and greater lengths of stay. Although the percentage of very low-volume surgeons declined from 2000 to 2014, it remains concerning, given ready access to higher-volume surgeons. Future research is needed to understand the existence of this practice pattern in other surgical fields. Efforts to eliminate this practice pattern are warranted to ensure high-quality care for all patients.

Implementing Educational Language Policy in Arizona: Legal, Historical and Current Practices in SEI

ERIC Educational Resources Information Center

Arias, M. Beatriz, Ed.; Faltis, Christian, Ed.

2012-01-01

This volume is a unique contribution to the study of language policy and education for English Learners because it focuses on the decade long implementation of "English Only" in Arizona. How this policy influences teacher preparation and classroom practice is the central topic of this volume. Scholars and researchers present their latest…

Drugs given by a syringe driver: a prospective multicentre survey of palliative care services in the UK.

PubMed

Wilcock, Andrew; Jacob, Jayin K; Charlesworth, Sarah; Harris, Elayne; Gibbs, Margaret; Allsop, Helen

2006-10-01

The use of a syringe driver to administer drugs by continuous subcutaneous infusion is common practice in the UK. Over time, drug combinations used in a syringe driver are likely to change and the aim of this survey was to obtain a more recent snapshot of practice. On four separate days, at two-week intervals, a questionnaire was completed for every syringe driver in use by 15 palliative care services. Of 336 syringe drivers, the majority contained either two or three drugs, but one-fifth contained only one drug. The median (range) volume of the infusions was 15 (9.5-48) mL, and duration of infusion was generally 24 hours. Only one combination was reported as visually incompatible, and there were 13 site reactions (4% of total). Laboratory physical and chemical compatibility data are available for less than half of the most frequently used combinations.

An approximate Kalman filter for ocean data assimilation: An example with an idealized Gulf Stream model

NASA Technical Reports Server (NTRS)

Fukumori, Ichiro; Malanotte-Rizzoli, Paola

1995-01-01

A practical method of data assimilation for use with large, nonlinear, ocean general circulation models is explored. A Kalman filter based on approximation of the state error covariance matrix is presented, employing a reduction of the effective model dimension, the error's asymptotic steady state limit, and a time-invariant linearization of the dynamic model for the error integration. The approximations lead to dramatic computational savings in applying estimation theory to large complex systems. We examine the utility of the approximate filter in assimilating different measurement types using a twin experiment of an idealized Gulf Stream. A nonlinear primitive equation model of an unstable east-west jet is studied with a state dimension exceeding 170,000 elements. Assimilation of various pseudomeasurements are examined, including velocity, density, and volume transport at localized arrays and realistic distributions of satellite altimetry and acoustic tomography observations. Results are compared in terms of their effects on the accuracies of the estimation. The approximate filter is shown to outperform an empirical nudging scheme used in a previous study. The examples demonstrate that useful approximate estimation errors can be computed in a practical manner for general circulation models.

An approximate Kalman filter for ocean data assimilation: An example with an idealized Gulf Stream model

NASA Astrophysics Data System (ADS)

Fukumori, Ichiro; Malanotte-Rizzoli, Paola

1995-04-01

A practical method of data assimilation for use with large, nonlinear, ocean general circulation models is explored. A Kaiman filter based on approximations of the state error covariance matrix is presented, employing a reduction of the effective model dimension, the error's asymptotic steady state limit, and a time-invariant linearization of the dynamic model for the error integration. The approximations lead to dramatic computational savings in applying estimation theory to large complex systems. We examine the utility of the approximate filter in assimilating different measurement types using a twin experiment of an idealized Gulf Stream. A nonlinear primitive equation model of an unstable east-west jet is studied with a state dimension exceeding 170,000 elements. Assimilation of various pseudomeasurements are examined, including velocity, density, and volume transport at localized arrays and realistic distributions of satellite altimetry and acoustic tomography observations. Results are compared in terms of their effects on the accuracies of the estimation. The approximate filter is shown to outperform an empirical nudging scheme used in a previous study. The examples demonstrate that useful approximate estimation errors can be computed in a practical manner for general circulation models.

Geometry modeling and grid generation using 3D NURBS control volume

NASA Technical Reports Server (NTRS)

Yu, Tzu-Yi; Soni, Bharat K.; Shih, Ming-Hsin

1995-01-01

The algorithms for volume grid generation using NURBS geometric representation are presented. The parameterization algorithm is enhanced to yield a desired physical distribution on the curve, surface and volume. This approach bridges the gap between CAD surface/volume definition and surface/volume grid generation. Computational examples associated with practical configurations have shown the utilization of these algorithms.

A general method for assessing the effects of uncertainty in individual-tree volume model predictions on large-area volume estimates with a subtropical forest illustration

Treesearch

Ronald E. McRoberts; Paolo Moser; Laio Zimermann Oliveira; Alexander C. Vibrans

2015-01-01

Forest inventory estimates of tree volume for large areas are typically calculated by adding the model predictions of volumes for individual trees at the plot level, calculating the mean over plots, and expressing the result on a per unit area basis. The uncertainty in the model predictions is generally ignored, with the result that the precision of the large-area...

Strategies for the prevention of MP3-induced hearing loss among adolescents: expert opinions from a Delphi study.

PubMed

Vogel, Ineke; Brug, Johannes; van der Ploeg, Catharina P B; Raat, Hein

2009-05-01

To identify parties involved in the prevention of MP3-induced hearing loss among adolescents and potentially effective prevention strategies and interventions. Thirty experts in fields such as scientific research, medical practice, community health professions, education, youth work, music entertainment, and enforcement authorities participated in a qualitative, electronic, 3-round, Web-based Delphi study. Multiple parties involved in the prevention of MP3-induced hearing loss among adolescents were identified; the most relevant are the adolescents themselves, their parents, manufacturers of MP3 players and earphones, and the authorities. The experts did not expect that adolescents in general would perform the necessary protective behaviors to prevent MP3-induced hearing loss. Two environmental health protection measures were identified as both relevant and feasible to be implemented (ie, authorities encourage manufacturers to produce safer products, and public health campaigns will be held to improve knowledge of the risks of high-volume music, possible protective measures, and consequences of hearing loss). Authorities, the music industry in general, and especially manufacturers of MP3 players and earphones should recognize their responsibility and create a safer MP3-listening environment by taking measures to protect today's youth from the dangers of listening to high-volume music on MP3 players.

National Trends in Prostate Biopsy and Radical Prostatectomy Volumes Following the US Preventive Services Task Force Guidelines Against Prostate-Specific Antigen Screening.

PubMed

Halpern, Joshua A; Shoag, Jonathan E; Artis, Amanda S; Ballman, Karla V; Sedrakyan, Art; Hershman, Dawn L; Wright, Jason D; Shih, Ya Chen Tina; Hu, Jim C

2017-02-01

Studies demonstrate that use of prostate-specific antigen screening decreased significantly following the US Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen screening in 2012. To determine downstream effects on practice patterns in prostate cancer diagnosis and treatment following the 2012 USPSTF recommendation. Procedural volumes of certifying and recertifying urologists from 2009 through 2016 were evaluated for variation in prostate biopsy and radical prostatectomy (RP) volume. Trends were confirmed using the New York Statewide Planning and Research Cooperative System and Nationwide Inpatient Sample. The study included a representative sample of urologists across practice settings and nationally representative sample of all RP discharges. We obtained operative case logs from the American Board of Urology and identified urologists performing at least 1 prostate biopsy (n = 5173) or RP (n = 3748), respectively. The 2012 USPSTF recommendation against routine population-wide prostate-specific antigen screening. Change in median biopsy and RP volume per urologist and national procedural volume. Following the USPSTF recommendation, median biopsy volume per urologist decreased from 29 to 21 (interquartile range [IQR}, 12-34; P < .001). After adjusting for physician and practice characteristics, biopsy volume decreased by 28.7% following 2012 (parameter estimate, -0.25; SE, 0.03; P < .001). Similarly, following the USPSTF recommendation, median RP volume per urologist decreased from 7 (IQR, 3-15) to 6 (IQR, 2-12) (P < .001), and in adjusted analyses, RP volume decreased 16.2% (parameter estimate, -0.15; SE, 0.05; P = .003). Following the 2012 USPSTF recommendation, prostate biopsy and RP volumes decreased significantly. A panoramic vantage point is needed to evaluate the long-term consequences of the 2012 USPSTF recommendation.

Hypersonics. Volume 1 - Defining the hypersonic environment; Proceedings of the First Joint Europe/U.S. Short Course on Hypersonics, Paris, France, Dec. 7-11, 1987

NASA Astrophysics Data System (ADS)

Bertin, John J.; Glowinski, Roland; Periaux, Jacques

1989-05-01

The present work discusses the general characterization of hypersonic flows, the hypersonic phenomena to be encountered by the Hermes spacecraft, industrial methodologies for the design of hypersonic vehicles, the definition of aerodynamic methodology, and hypersonic airbreathing-propulsion vehicle design practices applicable to the U.S. National Aerospace Plane. Also discussed are real gas effects in the hypersonic regime, the influence of thermochemistry and of nonequilibrium and surface catalysis on hypersonic vehicle design, the modelling of nonequilibrium effects in high speed flows, air-dissociation thermochemistry, and rarefied gas dynamics effects for spacecraft.

[Our profession--as much an art as a science--Tidsskriftet 1881 - 1906].

PubMed

Schiøtz, Aina

2006-01-05

The Norwegian journal entitled The Journal of Practical Medicine: (Tidsskrift for praktisk Medicin) was established in 1881. From the eighth volume and onwards, publishing responsibility was taken over by the Norwegian Medical Association. In 1890, the name of the journal was changed to the Journal of The Norwegian Medical Association (Tidsskrift For Den norske laegeforening):, which this year celebrates its 125th anniversary. Why did a new medical journal emerge in the 1880s and why did it survive? How was the journal influenced by its time and how did it itself influence time, profession and field? Investigating the 25 first years of the history of the journal might give us some answers to these questions. The journal was more or less established as a protest against the strong theorisation of medicine and the dominant role of the natural sciences. The aim of the "founding fathers" was, through practical examples, to strengthen the art and practice of medicine. Practical experience is, the editors proclaimed, an essential source of medical knowledge and understanding. Under the auspices of the Medical Association, a new editorial line was established. From now on hygiene and social medicine were highlighted as key issues within medicine. In this the journal reflected dominant traits within society in general. Around 1900 there was an increasing demand for the competence of the professions in solving general problems. Steadily more areas were politicised and theorised. The journal reflected these traits and played an important role in the process of professionalisation and education in citizenship--in raising doctors' attention and responsibility towards societal issues.

A Review of Online Evidence-based Practice Point-of-Care Information Summary Providers

PubMed Central

Liberati, Alessandro; Moschetti, Ivan; Tagliabue, Ludovica; Moja, Lorenzo

2010-01-01

Background Busy clinicians need easy access to evidence-based information to inform their clinical practice. Publishers and organizations have designed specific tools to meet doctors’ needs at the point of care. Objective The aim of this study was to describe online point-of-care summaries and evaluate their breadth, content development, and editorial policy against their claims of being “evidence-based.” Methods We searched Medline, Google, librarian association websites, and information conference proceedings from January to December 2008. We included English Web-based point-of-care summaries designed to deliver predigested, rapidly accessible, comprehensive, periodically updated, evidence-based information to clinicians. Two investigators independently extracted data on the general characteristics and content presentation of summaries. We assessed and ranked point-of-care products according to: (1) coverage (volume) of medical conditions, (2) editorial quality, and (3) evidence-based methodology. We explored how these factors were associated. Results We retrieved 30 eligible summaries. Of these products, 18 met our inclusion criteria and were qualitatively described, and 16 provided sufficient data for quantitative evaluation. The median volume of medical conditions covered was 80.6% (interquartile range, 68.9% - 84.2%) and varied for the different products. Similarly, differences emerged for editorial policy (median 8.0, interquartile range 5.8 - 10.3) and evidence-based methodology scores (median 10.0, interquartile range 1.0 - 12.8) on a 15-point scale. None of these dimensions turned out to be significantly associated with the other dimensions (editorial quality and volume, Spearman rank correlation r = -0.001, P = .99; evidence-based methodology and volume, r = -0.19, P = .48; editorial and evidence-based methodology, r = 0.43, P =.09). Conclusions Publishers are moving to develop point-of-care summary products. Some of these have better profiles than others, and there is room for improved reporting of the strengths and weaknesses of these products. PMID:20610379

Teledermatology in the United States: An Update in a Dynamic Era.

PubMed

Yim, Kaitlyn M; Florek, Aleksandra G; Oh, Dennis H; McKoy, Karen; Armstrong, April W

2018-01-22

Teledermatology is rapidly advancing in the United States. The last comprehensive survey of U.S. teledermatology programs was conducted in 2011. This article provides an update regarding the state of teledermatology programs in the United States. Active programs were identified and surveyed from November 2014 to January 2017. Findings regarding practice settings, consult volumes, payment methods, and delivery modalities were compared to those from the 2011 survey. Findings from the Veterans Affairs (VA) were reported as an aggregate. There were 40 active nongovernmental programs, amounting to a 48% increase and 30% discontinuation rate over five years. Academia remained the most common practice setting (50%). Median annual consultation volume was comparable with 263 consultations, but maximum annual consultation volume increased (range: 20-20,000). The most frequent payment method was self-pay (53%). Store-and-forward continued to be the most common delivery modality. In Fiscal Year 2016, the VA System consisted of 62 consultation sites and performed a total of 101,507 consultations. The limitations of this study were that consult volume and payment methods were not available from all programs. U.S. teledermatology programs have increased in number and annual consultation volume. Academia is the most prevalent practice setting, and self-pay is the dominant accepted payment method. Innovative platforms and the provision of direct-to-patient care are changing the practice of teledermatology.

Validation of MIL-F-9490D. General Specification for Flight Control System for Piloted Military Aircraft. Volume III. C-5A Heavy Logistics Transport Validation

DTIC Science & Technology

1977-04-01

U* AFFDL-TR-77-7 0 VOLUME III " 󈧦 VALIDATION OF MIL-F-9490D - GENERAL SPECIFICATION FOR FLIGHT CONTROL SYSTEM "FOR PILOTED MILITARY AIRCRAFT VOLUME...ý A1O 1 C I\\.FFBL Ti(-77-7. Vol. III f Validatio~n of UL-P-9-490D#,*. General Spacificatior "~inal 1’l -_t e for Flight ContrsA Zyn’om for Piloted...cation MIL-F-9490D (USAF), "Flight Control Systems - Design, Installation and Test of Piloted Aircraft, General Specifications for," dated 6 June 1975, by

A cross sectional study of surgical training among United Kingdom general practitioners with specialist interests in surgery.

PubMed

Ferguson, H J M; Fitzgerald, J E F; Reilly, J; Beamish, A J; Gokani, V J

2015-04-08

Increasing numbers of minor surgical procedures are being performed in the community. In the UK, general practitioners (family medicine physicians) with a specialist interest (GPwSI) in surgery frequently undertake them. This shift has caused decreases in available cases for junior surgeons to gain and consolidate operative skills. This study evaluated GPwSI's case-load, procedural training and perceptions of offering formalised operative training experience to surgical trainees. Prospective, questionnaire-based cross-sectional study. A novel, 13-item, self-administered questionnaire was distributed to members of the Association of Surgeons in Primary Care (ASPC). A total 113 of 120 ASPC members completed the questionnaire, representing a 94% response rate. Respondents were general practitioners practising or intending to practice surgery in the community. Respondents performed a mean of 38 (range 5-150) surgical procedures per month in primary care. 37% (42/113) of respondents had previously been awarded Membership or Fellowship of a Surgical Royal College; 22% (25/113) had completed a surgical certificate or diploma or undertaken a course of less than 1 year duration. 41% (46/113) had no formal British surgical qualifications. All respondents believed that surgical training in primary care could be valuable for surgical trainees, and the majority (71/113, 63%) felt that both general practice and surgical trainees could benefit equally from such training. There is a significant volume of surgical procedures being undertaken in the community by general practitioners, with the capacity and appetite for training of prospective surgeons in this setting, providing appropriate standards are achieved and maintained, commensurate with current standards in secondary care. Surgical experience and training of GPwSI's in surgery is highly varied, and does not yet benefit from the quality assurance secondary care surgical training in the UK undergoes. The Royal Colleges of Surgery and General Practice are well placed to invest in such infrastructure to provide long-term, high-quality service and training in the community. 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.

Changes in the Hiring Process: New Actors, New Practices, and New Challenges. Final Report. Volume I: Findings and Implications [and] Volume II: Appendices.

ERIC Educational Resources Information Center

Kogan, Deborah; And Others

Trends in the recruitment and hiring practices of U.S. private sector firms were examined by analyzing data from the following: a literature review; telephone discussions with representatives of 13 key national labor market intermediaries (outplacement, career management, job search, screening, and staffing service firms); telephone discussions…

Decolonisation, Globalisation: Language-in-Education Policy and Practice. New Perspectives on Language and Education

ERIC Educational Resources Information Center

Lin, Angel M. Y., Ed.; Martin, Peter W., Ed.

2005-01-01

This volume brings together scholars from around the world to juxtapose the voices of classroom participants alongside the voices of ruling elites with the aim of critically linking language policy issues with classroom practice in a range of contexts. The volume is suitable for postgraduate students, researchers and educators in a range of areas.…

An investigation of the self-heating phenomenon in viscoelastic materials subjected to cyclic loadings accounting for prestress

NASA Astrophysics Data System (ADS)

de Lima, A. M. G.; Rade, D. A.; Lacerda, H. B.; Araújo, C. A.

2015-06-01

It has been demonstrated by many authors that the internal damping mechanism of the viscoelastic materials offers many possibilities for practical engineering applications. However, in traditional procedures of analysis and design of viscoelastic dampers subjected to cyclic loadings, uniform, constant temperature is generally assumed and do not take into account the self-heating phenomenon. Moreover, for viscoelastic materials subjected to dynamic loadings superimposed on static preloads, such as engine mounts, these procedures can lead to poor designs or even severe failures since the energy dissipated within the volume of the material leads to temperature rises. In this paper, a hybrid numerical-experimental investigation of effects of the static preloads on the self-heating phenomenon in viscoelastic dampers subjected to harmonic loadings is reported. After presenting the theoretical foundations, the numerical and experimental results obtained in terms of the temperature evolutions at different points within the volume of the viscoelastic material for various static preloads are compared, and the main features of the methodology are discussed.

Intraoperative mechanical ventilation for the pediatric patient.

PubMed

Kneyber, Martin C J

2015-09-01

Invasive mechanical ventilation is required when children undergo general anesthesia for any procedure. It is remarkable that one of the most practiced interventions such as pediatric mechanical ventilation is hardly supported by any scientific evidence but rather based on personal experience and data from adults, especially as ventilation itself is increasingly recognized as a harmful intervention that causes ventilator-induced lung injury. The use of low tidal volume and higher levels of positive end-expiratory pressure became an integral part of lung-protective ventilation following the outcomes of clinical trials in critically ill adults. This approach has been readily adopted in pediatric ventilation. However, a clear association between tidal volume and mortality has not been ascertained in pediatrics. In fact, experimental studies have suggested that young children might be less susceptible to ventilator-induced lung injury. As such, no recommendations on optimal lung-protective ventilation strategy in children with or without lung injury can be made. Copyright © 2015 Elsevier Ltd. All rights reserved.

High order finite volume WENO schemes for the Euler equations under gravitational fields

NASA Astrophysics Data System (ADS)

Li, Gang; Xing, Yulong

2016-07-01

Euler equations with gravitational source terms are used to model many astrophysical and atmospheric phenomena. This system admits hydrostatic balance where the flux produced by the pressure is exactly canceled by the gravitational source term, and two commonly seen equilibria are the isothermal and polytropic hydrostatic solutions. Exact preservation of these equilibria is desirable as many practical problems are small perturbations of such balance. High order finite difference weighted essentially non-oscillatory (WENO) schemes have been proposed in [22], but only for the isothermal equilibrium state. In this paper, we design high order well-balanced finite volume WENO schemes, which can preserve not only the isothermal equilibrium but also the polytropic hydrostatic balance state exactly, and maintain genuine high order accuracy for general solutions. The well-balanced property is obtained by novel source term reformulation and discretization, combined with well-balanced numerical fluxes. Extensive one- and two-dimensional simulations are performed to verify well-balanced property, high order accuracy, as well as good resolution for smooth and discontinuous solutions.

Pros and cons of practice-owned and office-based ambulatory surgery centers.

PubMed

Bert, J M

2000-01-01

A detailed feasibility analysis is imperative to ensure the success of a practice-owned ASC. Analysis of the payer mix and the market relating to surgical volume that can be performed at the ASC is imperative. If overbuilding, overequipping, and overstaffing are avoided and the group has adequate volume that can be managed at the ASC, the facility should be a success. Building a practice-owned ASC without an accurate and detailed financial feasibility and payer study can place the endeavor at risk. A well-planned, economically constructed and properly managed ASC will result in an efficient and successful ancillary service for the orthopedic group practice.

Practical optimal flight control system design for helicopter aircraft. Volume 2: Software user's guide

NASA Technical Reports Server (NTRS)

Riedel, S. A.

1979-01-01

A method by which modern and classical control theory techniques may be integrated in a synergistic fashion and used in the design of practical flight control systems is presented. A general procedure is developed, and several illustrative examples are included. Emphasis is placed not only on the synthesis of the design, but on the assessment of the results as well. The first step is to establish the differences, distinguishing characteristics and connections between the modern and classical control theory approaches. Ultimately, this uncovers a relationship between bandwidth goals familiar in classical control and cost function weights in the equivalent optimal system. In order to obtain a practical optimal solution, it is also necessary to formulate the problem very carefully, and each choice of state, measurement and output variable must be judiciously considered. Once design goals are established and problem formulation completed, the control system is synthesized in a straightforward manner. Three steps are involved: filter-observer solution, regulator solution, and the combination of those two into the controller. Assessment of the controller permits and examination and expansion of the synthesis results.

Physicians in private practice: reasons for being a social franchise member.

PubMed

Huntington, Dale; Mundy, Gary; Hom, Nang Mo; Li, Qingfeng; Aung, Tin

2012-08-01

Evidence is emerging on the cost-effectiveness, quality and health coverage of social franchises. But little is known about the motivations of providers to join or remain within a social franchise network, or the impact that franchise membership has on client volumes or revenue earnings. (i) Uncontrolled facility based of a random sample of 230 franchise members to assess self-reported motivations; (ii) A 24 month prospective cohort study of 3 cohorts of physicians who had been in the franchise for 4 years, 2 years and new members to track monthly case load and revenue generated. The most common reasons for joining the franchise were access to high quality and cheap drugs (96.1%) and feelings of social responsibility, (95.2%). The effects of joining the franchise on the volume of family planning services is shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician during their first 2 years in the franchise, (p<0.01). These gains are sustained during the 3rd and 4th year of franchise membership, as the 2007 cohort reported increases of monthly average family planning service volume from 71.2 per physician to 102.8 per physician (p<0.01). The net income of cohort 2009 increased significantly (p=0.024) during their first two years in the franchise. The results for cohorts 2007 and 2005 also show a generalized trend in increasing income. The findings show how franchise membership impacts the volume of franchise and non-franchised services. The increases in client volumes translated directly into increases in earnings among the franchise members, an unanticipated effect for providers who joined in order to better serve the poor. This finding has implications for the social franchise business model that relies upon subsidized medical products to reduce financial barriers for the poor. The increases in out of pocket payments for health care services that were not price controlled by the franchise is a concern. As the field of social franchises continues to mature its business models towards more sustainable and cost recovery management practices, attention should be given towards avoiding commercialization of services.

Physicians in private practice: reasons for being a social franchise member

PubMed Central

2012-01-01

Background Evidence is emerging on the cost-effectiveness, quality and health coverage of social franchises. But little is known about the motivations of providers to join or remain within a social franchise network, or the impact that franchise membership has on client volumes or revenue earnings. Methods (i) Uncontrolled facility based of a random sample of 230 franchise members to assess self-reported motivations; (ii) A 24 month prospective cohort study of 3 cohorts of physicians who had been in the franchise for 4 years, 2 years and new members to track monthly case load and revenue generated. Results The most common reasons for joining the franchise were access to high quality and cheap drugs (96.1%) and feelings of social responsibility, (95.2%). The effects of joining the franchise on the volume of family planning services is shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician during their first 2 years in the franchise, (p<0.01). These gains are sustained during the 3rd and 4th year of franchise membership, as the 2007 cohort reported increases of monthly average family planning service volume from 71.2 per physician to 102.8 per physician (p<0.01). The net income of cohort 2009 increased significantly (p=0.024) during their first two years in the franchise. The results for cohorts 2007 and 2005 also show a generalized trend in increasing income. Conclusions The findings show how franchise membership impacts the volume of franchise and non-franchised services. The increases in client volumes translated directly into increases in earnings among the franchise members, an unanticipated effect for providers who joined in order to better serve the poor. This finding has implications for the social franchise business model that relies upon subsidized medical products to reduce financial barriers for the poor. The increases in out of pocket payments for health care services that were not price controlled by the franchise is a concern. As the field of social franchises continues to mature its business models towards more sustainable and cost recovery management practices, attention should be given towards avoiding commercialization of services. PMID:22849434

Bilingualism tunes the anterior cingulate cortex for conflict monitoring.

PubMed

Abutalebi, Jubin; Della Rosa, Pasquale Anthony; Green, David W; Hernandez, Mireia; Scifo, Paola; Keim, Roland; Cappa, Stefano F; Costa, Albert

2012-09-01

Monitoring and controlling 2 language systems is fundamental to language use in bilinguals. Here, we reveal in a combined functional (event-related functional magnetic resonance imaging) and structural neuroimaging (voxel-based morphometry) study that dorsal anterior cingulate cortex (ACC), a structure tightly bound to domain-general executive control functions, is a common locus for language control and resolving nonverbal conflict. We also show an experience-dependent effect in the same region: Bilinguals use this structure more efficiently than monolinguals to monitor nonlinguistic cognitive conflicts. They adapted better to conflicting situations showing less ACC activity while outperforming monolinguals. Importantly, for bilinguals, brain activity in the ACC, as well as behavioral measures, also correlated positively with local gray matter volume. These results suggest that early learning and lifelong practice of 2 languages exert a strong impact upon human neocortical development. The bilingual brain adapts better to resolve cognitive conflicts in domain-general cognitive tasks.

Acute care surgery: now that we have built it, will they come?

PubMed

Coleman, Jamie J; Esposito, Thomas J; Rozycki, Grace S; Feliciano, David V

2013-02-01

Concern over lack of resident interest caused by the nonoperative nature and compromised lifestyle associated with a career as a "trauma surgeon" has led to the emergence of a new acute care surgery (ACS) specialty. This study examined the opinions of current general surgical residents about training and careers in this new field. A 36-item online anonymous survey regarding ACS was sent to the program directors of 55 randomly selected general surgery (GS) training programs for distribution to their categorical residents. The national sample consisted of 1,515 PGY 1 to 5 trainees. Response rate was 45%. More than 90% of residents had an appropriate understanding of the components of ACS as generally described (trauma, surgical critical care, and emergency GS). Nearly half (46%) of all respondents have considered ACS as a career. Overall, ACS ranked as the second most appealing career ahead of surgical critical care and trauma but behind GS. Most residents believed that ACS offers better or equivalent case complexity (88%), scope of practice (84%), case volume (75%), and level of reimbursement (69%) compared with GS alone. Respondents who answered ACS had a better scope of practice (61% vs. 36%), lifestyle as an attending surgeon (77% vs. 34%), or level of reimbursement (83% vs. 38%) compared with GS were twice as likely (p < 0.0001) to have considered ACS as a career. Overall, 40% of the residents believed that ACS offers a worse lifestyle in comparison with GS. These results suggest that there is notable interest in the emerging specialty of ACS. The level of resident interest in ACS as a fellowship and career may be increased by marketing those aspects of practice, which are viewed positively and addressing negative perceptions related to lifestyle. It may be appealing to add an elective GS component to certain ACS practice options.

A single-institution experience: the integrated vascular surgery residency's effect on fellowship and general surgery resident case volume and diversity.

PubMed

Carroll, Megan I; Downes, Kathryne; Miladinovic, Branko; Illig, Karl A; Armstrong, Paul A; Back, Martin R; Johnson, Brad L; Shames, Murray L

2014-01-01

To determine whether the formation of an integrated vascular surgery residency (0 + 5) has negatively impacted the case volume and diversity of the vascular surgery fellows (5 + 2) and chief general surgeons at the same institution. Operative data from the vascular integrated (0 + 5), independent (5 + 2), and general surgery residencies at a single institution were retrospectively reviewed and analyzed to determine vascular surgery case volumes from 2006-2012. National operative data (Residency Review Committee) were used for comparison of diversity and volume. Standard statistical methods were applied. During this period, the 5 + 2 fellows at our institution performed on average 741 (range, 554-1002) primary cases and 1091 (range, 844-1479) combined primary and secondary cases for the 2-year fellowship. Our integrated residency began in July 2007. Our fellows' primary case volumes remained relatively stable between 2006 and 2011, with a 4% increase in the number of cases, although their total (primary and secondary) case volumes fell 15%; by comparison, the equivalent national 50th percentile rates rose 16% during this time frame. Our institution's general surgery residents performed an average of 116 (range, 56-221) vascular cases individually during their 5-year residency from 2005-2011. From 2006-2011, the total case volume fell only 5%, while the national 50th percentile rate fell 24%. Across all years, however, resident and fellow volumes both continue to be above Accreditation Council for Graduate Medical Education minimum requirements, and the major vascular case volume at our institution in all groups studied remained statistically greater than or equal to the national 50th percentile of cases. Our first integrated resident to graduate finished in June 2012 with 931 total vascular cases and 249 general surgery cases for a total operative experience of 1180 cases during the 5-year residency. Finally, after an 8-year period (2003-2010) in which none of our general surgery residents pursued vascular training, 1 resident in each of the 2011, 2012, and 2013 graduating years has now done so. At our institution, the introduction of a 0 + 5 vascular residency has correlated with a modest drop (15%) in overall case volume for the 5 + 2 fellows, but the number of primary cases have actually increased slightly and they continue to meet or exceed Accreditation Council for Graduate Medical Education requirements and national 50th percentile rates. General surgery residents' vascular volumes, by contrast, have remained stable, and interest in vascular surgery by residents has increased. Our integrated vascular residents are projected to exceed the fellows' 50th percentile case volume and diversity targets during their residency experience. Copyright © 2014 Elsevier Inc. All rights reserved.

GP Networks as enablers of quality of care: implementing a practice engagement framework in a General Practice Network.

PubMed

Pearce, Christopher; Shearer, Marianne; Gardner, Karina; Kelly, Jill; Xu, Tony Baixian

2012-01-01

This paper describes how the Melbourne East General Practice Network supports general practice to enable quality of care, it describes the challenges and enablers of change, and the evidence of practice capacity building and improved quality of care. Primary care is well known as a place where quality, relatively inexpensive medical care occurs. General practice is made up of multiple small sites with fragmented systems and a funding system that challenges a whole-of-practice approach to clinical care. General Practice Networks support GPs to synthesise complexity and crystallise solutions that enhance general practice beyond current capacity. Through a culture of change management, GP Networks create the link between the practice and the big picture of the whole health system and reduce the isolation of general practice. They distribute information (evidence-based learning and resources) and provide individualised support, responding to practice need and capacity.

Standardized anatomic space for abdominal fat quantification

NASA Astrophysics Data System (ADS)

Tong, Yubing; Udupa, Jayaram K.; Torigian, Drew A.

2014-03-01

The ability to accurately measure subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) from images is important for improved assessment and management of patients with various conditions such as obesity, diabetes mellitus, obstructive sleep apnea, cardiovascular disease, kidney disease, and degenerative disease. Although imaging and analysis methods to measure the volume of these tissue components have been developed [1, 2], in clinical practice, an estimate of the amount of fat is obtained from just one transverse abdominal CT slice typically acquired at the level of the L4-L5 vertebrae for various reasons including decreased radiation exposure and cost [3-5]. It is generally assumed that such an estimate reliably depicts the burden of fat in the body. This paper sets out to answer two questions related to this issue which have not been addressed in the literature. How does one ensure that the slices used for correlation calculation from different subjects are at the same anatomic location? At what anatomic location do the volumes of SAT and VAT correlate maximally with the corresponding single-slice area measures? To answer these questions, we propose two approaches for slice localization: linear mapping and non-linear mapping which is a novel learning based strategy for mapping slice locations to a standardized anatomic space so that same anatomic slice locations are identified in different subjects. We then study the volume-to-area correlations and determine where they become maximal. We demonstrate on 50 abdominal CT data sets that this mapping achieves significantly improved consistency of anatomic localization compared to current practice. Our results also indicate that maximum correlations are achieved at different anatomic locations for SAT and VAT which are both different from the L4-L5 junction commonly utilized.

An operator calculus for surface and volume modeling

NASA Technical Reports Server (NTRS)

Gordon, W. J.

1984-01-01

The mathematical techniques which form the foundation for most of the surface and volume modeling techniques used in practice are briefly described. An outline of what may be termed an operator calculus for the approximation and interpolation of functions of more than one independent variable is presented. By considering the linear operators associated with bivariate and multivariate interpolation/approximation schemes, it is shown how they can be compounded by operator multiplication and Boolean addition to obtain a distributive lattice of approximation operators. It is then demonstrated via specific examples how this operator calculus leads to practical techniques for sculptured surface and volume modeling.

Integrated care for asthma: a clinical, social, and economic evaluation. Grampian Asthma Study of Integrated Care (GRASSIC)

PubMed Central

1994-01-01

OBJECTIVES--To evaluate integrated care for asthma in clinical, social, and economic terms. DESIGN--Pragmatic randomised trial. SETTING--Hospital outpatient clinics and general practices throughout the north east of Scotland. PATIENTS--712 adults attending hospital outpatient clinics with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%. MAIN OUTCOME MEASURES--Use of bronchodilators and inhaled and oral steroids; number of general practice consultations and hospital admissions for asthma; sleep disturbance and other restrictions on normal activity; psychological aspects of health including perceived asthma control; patient satisfaction; and financial costs. RESULTS--After one year there were no significant overall differences between those patients receiving integrated asthma care and those receiving conventional outpatient care for any clinical or psychosocial outcome. For pulmonary function, forced expiratory volume was 76% of predicted for integrated care patients and 75% for conventional outpatients (95% confidence interval for difference -3.6% to 5.0%). Patients who had experienced integrated care were more likely to select it as their preferred course of future management (75% (251/333) v 62% (207/333) (6% to 20%)); they saved 39.52 pounds a year. This was largely because patients in conventional outpatient care consulted their general practitioner as many times as those in integrated care, who were not also visiting hospital. CONCLUSION--Integrated care for moderately severe asthma patients is clinically as effective as conventional outpatient care, cost effective, and an attractive management option for patients, general practitioners, and hospital consultants. PMID:8148678

Building generalized tree mass/volume component models for improved estimation of forest stocks and utilization potential

Treesearch

David W. MacFarlane

2015-01-01

Accurately assessing forest biomass potential is contingent upon having accurate tree biomass models to translate data from forest inventories. Building generality into these models is especially important when they are to be applied over large spatial domains, such as regional, national and international scales. Here, new, generalized whole-tree mass / volume...

Encyclopedia of software components

NASA Technical Reports Server (NTRS)

Vanwarren, Lloyd (Inventor); Beckman, Brian C. (Inventor)

1991-01-01

Intelligent browsing through a collection of reusable software components is facilitated with a computer having a video monitor and a user input interface such as a keyboard or a mouse for transmitting user selections, by presenting a picture of encyclopedia volumes with respective visible labels referring to types of software, in accordance with a metaphor in which each volume includes a page having a list of general topics under the software type of the volume and pages having lists of software components for each one of the generic topics, altering the picture to open one of the volumes in response to an initial user selection specifying the one volume to display on the monitor a picture of the page thereof having the list of general topics and altering the picture to display the page thereof having a list of software components under one of the general topics in response to a next user selection specifying the one general topic, and then presenting a picture of a set of different informative plates depicting different types of information about one of the software components in response to a further user selection specifying the one component.

Encyclopedia of Software Components

NASA Technical Reports Server (NTRS)

Warren, Lloyd V. (Inventor); Beckman, Brian C. (Inventor)

1997-01-01

Intelligent browsing through a collection of reusable software components is facilitated with a computer having a video monitor and a user input interface such as a keyboard or a mouse for transmitting user selections, by presenting a picture of encyclopedia volumes with respective visible labels referring to types of software, in accordance with a metaphor in which each volume includes a page having a list of general topics under the software type of the volume and pages having lists of software components for each one of the generic topics, altering the picture to open one of the volumes in response to an initial user selection specifying the one volume to display on the monitor a picture of the page thereof having the list of general topics and altering the picture to display the page thereof having a list of software components under one of the general topics in response to a next user selection specifying the one general topic, and then presenting a picture of a set of different informative plates depicting different types of information about one of the software components in response to a further user selection specifying the one component.

Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study

PubMed Central

Harding, Alex; Rosenthal, Joe; Al-Seaidy, Marwa; Gray, Denis Pereira; McKinley, Robert K

2015-01-01

Background Health care is increasingly provided in general practice. To meet this demand, the English Department of Health recommends that 50% of all medical students should train for general practice after qualification. Currently 19% of medical students express general practice as their first career choice. Undergraduate exposure to general practice positively influences future career choice. Appropriate undergraduate exposure to general practice is therefore highly relevant to workforce planning Aim This study seeks to quantify current exposure of medical students to general practice and compare it with past provision and also with postgraduate provision. Design and setting A cross-sectional questionnaire in the UK. Method A questionnaire regarding provision of undergraduate teaching was sent to the general practice teaching leads in all UK medical schools. Information was gathered on the amount of undergraduate teaching, how this was supported financially, and whether there was an integrated department of general practice. The data were then compared with results from previous studies of teaching provision. The provision of postgraduate teaching in general practice was also examined. Results General practice teaching for medical students increased from <1.0% of clinical teaching in 1968 to 13.0% by 2008; since then, the percentage has plateaued. The total amount of general practice teaching per student has fallen by 2 weeks since 2002. Medical schools providing financial data delivered 14.6% of the clinical curriculum and received 7.1% of clinical teaching funding. The number of departments of general practice has halved since 2002. Provision of postgraduate teaching has tripled since 2000. Conclusion Current levels of undergraduate teaching in general practice are too low to fulfil future workforce requirements and may be falling. Financial support for current teaching is disproportionately low and the mechanism counterproductive. Central intervention may be required to solve this. PMID:26009536

Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice

PubMed Central

Brangan, Emer; Wye, Lesley; Checkland, Kath; Lasserson, Daniel; Morris, Richard; Tammes, Peter; Purdy, Sarah

2017-01-01

Objectives To describe how processes of primary care access influence decisions to seek help at the emergency department (ED). Design Ethnographic case study combining non-participant observation, informal and formal interviewing. Setting Six general practitioner (GP) practices located in three commissioning organisations in England. Participants and methods Reception areas at each practice were observed over the course of a working week (73 hours in total). Practice documents were collected and clinical and non-clinical staff were interviewed (n=19). Patients with recent ED use, or a carer if aged 16 and under, were interviewed (n=29). Results Past experience of accessing GP care recursively informed patient decisions about where to seek urgent care, and difficulties with access were implicit in patient accounts of ED use. GP practices had complicated, changeable systems for appointments. This made navigating appointment booking difficult for patients and reception staff, and engendered a mistrust of the system. Increasingly, the telephone was the instrument of demand management, but there were unintended consequences for access. Some patient groups, such as those with English as an additional language, were particularly disadvantaged, and the varying patient and staff semantic of words like ‘urgent’ and ‘emergency’ was exacerbated during telephone interactions. Poor integration between in-hours and out-of-hours care and patient perceptions of the quality of care accessible at their GP practice also informed ED use. Conclusions This study provides important insight into the implicit role of primary care access on the use of ED. Discourses around ‘inappropriate’ patient demand neglect to recognise that decisions about where to seek urgent care are based on experiential knowledge. Simply speeding up access to primary care or increasing its volume is unlikely to alleviate rising ED use. Systems for accessing care need to be transparent, perceptibly fair and appropriate to the needs of diverse patient groups. PMID:28473509

Hospital management practices and availability of surgery in sub-Saharan Africa: a pilot study of three hospitals.

PubMed

Funk, Luke M; Conley, Dante M; Berry, William R; Gawande, Atul A

2013-11-01

Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality. We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital's management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic). The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p < .001). It is possible to meaningfully assess hospital management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.

Structural brain development between childhood and adulthood: Convergence across four longitudinal samples.

PubMed

Mills, Kathryn L; Goddings, Anne-Lise; Herting, Megan M; Meuwese, Rosa; Blakemore, Sarah-Jayne; Crone, Eveline A; Dahl, Ronald E; Güroğlu, Berna; Raznahan, Armin; Sowell, Elizabeth R; Tamnes, Christian K

2016-11-01

Longitudinal studies including brain measures acquired through magnetic resonance imaging (MRI) have enabled population models of human brain development, crucial for our understanding of typical development as well as neurodevelopmental disorders. Brain development in the first two decades generally involves early cortical grey matter volume (CGMV) increases followed by decreases, and monotonic increases in cerebral white matter volume (CWMV). However, inconsistencies regarding the precise developmental trajectories call into question the comparability of samples. This issue can be addressed by conducting a comprehensive study across multiple datasets from diverse populations. Here, we present replicable models for gross structural brain development between childhood and adulthood (ages 8-30years) by repeating analyses in four separate longitudinal samples (391 participants; 852 scans). In addition, we address how accounting for global measures of cranial/brain size affect these developmental trajectories. First, we found evidence for continued development of both intracranial volume (ICV) and whole brain volume (WBV) through adolescence, albeit following distinct trajectories. Second, our results indicate that CGMV is at its highest in childhood, decreasing steadily through the second decade with deceleration in the third decade, while CWMV increases until mid-to-late adolescence before decelerating. Importantly, we show that accounting for cranial/brain size affects models of regional brain development, particularly with respect to sex differences. Our results increase confidence in our knowledge of the pattern of brain changes during adolescence, reduce concerns about discrepancies across samples, and suggest some best practices for statistical control of cranial volume and brain size in future studies. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Education and Work. Proceedings of the International Conference Linking Research and Practice (Toronto, Ontario, March 4-6, 1993). Volumes 1-2.

ERIC Educational Resources Information Center

Corson, David, Ed.; Lawton, Stephen B., Ed.

These two volumes comprise the proceedings of a conference on links between education and work and the power relationships in the wider culture and in its social order. Each volume begins with a "Foreword" (Ronald C. Morrison), "Preface" (Arthur Kruger), "Introduction" (David Corson), and author notes. Volume I…

Reinforced soil structures. Volume II, Summary of research and systems information

DOT National Transportation Integrated Search

1989-11-01

Volume II was essentially prepared as an Appendix of supporting information for Volume I. This volume contains much of the supporting theory and a summary of the research used to verify the design approach contained in Volume I, as well as general in...

Differences in characteristics among new pediatric neurology patients: the effect of a newly established private pediatric neurology practice.

PubMed

Van Cleave, Jeanne; Woodruff, Brian; Freed, Gary L

2008-01-01

To investigate changes in volume and characteristics of new patients referred when a private pediatric neurology practice (PP) opened in 2004 in an area served primarily by an academic medical center's (AMC) pediatric neurology practice. Retrospective analysis of medical and billing records to examine changes in volume, diagnosis, and sociodemographic factors of new patients at the AMC from July 2004 to June 2005; the PP during the same period; and the AMC during the year before. One year after the PP opened, 40% more new pediatric neurology patients were seen in this area than the year before. Compared with the AMC, PP saw a greater proportion of seizures (34% vs 26%, P < .05) and headaches (32% vs 17%, P < .001), and a lesser proportion of developmental delay/musculoskeletal disorders (12% vs 19%, P < .001) and congenital/metabolic disorders (<1% vs 2%, P < .001). Fewer PP patients lived >20 miles from the practice (32% vs 64%, P < .001), and fewer had public insurance (4% vs 33%, P < .001). The establishment of the PP dramatically increased the volume of new pediatric neurology patients in this area. After the PP opened, the AMC continued to care for most patients with rare diseases and fewer financial resources. Future research should examine whether the increase in volume reflects relief of pent-up demand or increased referral rates due to eased access, and should elucidate how differences in patient populations at academic and private subspecialty practices relate to access to subspecialty care and financial well-being of academic practices.

Associations of farm management practices with annual milk sales on smallholder dairy farms in Kenya.

PubMed

Richards, Shauna; VanLeeuwen, John; Shepelo, Getrude; Gitau, George Karuoya; Kamunde, Collins; Uehlinger, Fabienne; Wichtel, Jeff

2015-01-01

Cows on smallholder dairy farms (SDF) in developing countries such as Kenya typically produce volumes of milk that are well below their genetic potential. An epidemiological study was conducted to determine reasons for this low milk production, including limited use of best management practices, such as suboptimal nutritional management. An observational cross-sectional study of 111 SDF was performed in Nyeri County, Kenya in June of 2013 determining the effect of cow factors, farmer demographics and farm management practices on the volume of milk sold per cow per year (kg milk sold/cow). In particular, the effect of feeding high protein fodder trees and other nutritional management practices were examined. Approximatly 38% of farmers fed fodder trees, but such feeding was not associated with volume of milk sold per cow, likely due to the low number of fodder trees per farm. Volume of milk sold per cow was positively associated with feeding dairy meal during the month prior to calving, feeding purchased hay during the past year, deworming cows every 4 or more months (as opposed to more regularly), and having dairy farming as the main source of family income. Volume of milk sold per cow was negatively associated with a household size of >5 people and feeding Napier grass at >2 meters in height during the dry season. An interaction between gender of the principal farmer and feed shortages was noted; volume of milk sold per cow was lower when female farmers experienced feed shortages whereas milk sold per cow was unaffected when male farmers experienced feed shortages. These demographic and management risk factors should be considered by smallholder dairy farmers and their advisors when developing strategies to improve income from milk sales and animal-source food availability for the farming families.

Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia.

PubMed

Li, Yuhong; He, Rui; Ying, Xiaojiang; Hahn, Robert G

2014-01-01

Fluid volume optimization guided by stroke volume measurements reduces complications of colorectal and high-risk surgeries. We studied whether dehydration or a strong hemodynamic response to general anesthesia increases the probability of fluid responsiveness before surgery begins. Cardiac output, stroke volume, central venous pressure and arterial pressures were measured in 111 patients before general anesthesia (baseline), after induction and stepwise after three bolus infusions of 3 ml/kg of 6% hydroxyethyl starch 130/0.4 (n=86) or Ringer's lactate (n=25). A subgroup of 30 patients who received starch were preloaded with 500 ml of Ringer's lactate. Blood volume changes were estimated from the hemoglobin concentration and dehydration was estimated from evidence of renal water conservation in urine samples. Induction of anesthesia decreased the stroke volume to 62% of baseline (mean); administration of fluids restored this value to 84% (starch) and 68% (Ringer's). The optimized stroke volume index was clustered around 35-40 ml/m2/beat. Additional fluid boluses increased the stroke volume by ≥10% (a sign of fluid responsiveness) in patients with dehydration, as suggested by a low cardiac index and central venous pressure at baseline and by high urinary osmolality, creatinine concentration and specific gravity. Preloading and the hemodynamic response to induction did not correlate with fluid responsiveness. The blood volume expanded 2.3 (starch) and 1.8 (Ringer's) times over the infused volume. Fluid volume optimization did not induce a hyperkinetic state but ameliorated the decrease in stroke volume caused by anesthesia. Dehydration, but not the hemodynamic response to the induction, was correlated with fluid responsiveness.

Cost-effective safety treatments for low-volume roads.

DOT National Transportation Integrated Search

2012-08-01

The majority of roadside safety guidance pertains to high-volume roads. Very little guidance exists to assist engineers in : treating common obstacles found alongside low-volume roads. In general, it is assumed that low traffic volumes can effectivel...

WestREN: a description of an Irish academic general practice research network

PubMed Central

2010-01-01

Background Primary care research networks have been established internationally since the 1960s to enable diverse practitioners to engage in and develop research and education and implement research evidence. The newly established Western Research and Education Network (WestREN) is one such network consisting of a collaboration between the Discipline of General Practice at NUI Galway and 71 West of Ireland general practices. In September 2009 all member practices were issued with a questionnaire with two objectives: to describe the structure and characteristics of the member practices and to compare the results to the national profile of Irish general practice. Methods A postal survey was used followed by one written and one email reminder. Results A response rate of 73% (52/71) was achieved after two reminders. Half of practices were in a rural location, one quarter located in an urban setting and another quarter in a mixed location. Ninety-four per cent of general practitioners practice from purpose-built or adapted premises with under 6% of practices being attached to the general practitioner's residence. Over 96% of general practitioners use appointment systems with 58% using appointment only. All practices surveyed were computerised, with 80% describing their practices as 'fully computerised'. Almost 60% of general practitioners are coding chronic diagnoses with 20% coding individual consultations. Twenty-five per cent of general practitioners were single-handed with the majority of practices having at least two general practitioners, and a mean number of general practitioners of 2.4. Ninety-two per cent of practices employed a practice nurse with 30% employing more than one nurse. Compared to the national profile, WestREN practices appear somewhat larger, and more likely to be purpose-built and in rural areas. National trends apparent between 1982 and 1992, such as increasing computerisation and practice nurse availability, appear to be continuing. Conclusions WestREN is a new university-affiliated general practice research network in Ireland. Survey of its initial membership confirms WestREN practices to be broadly representative of the national profile and has provided us with valuable information on the current and changing structure of Irish general practice. PMID:20925958

Even the Janitor Is White: Educating for Cultural Diversity in Small Colleges and Universities. Critical Education and Ethics. Volume 4

ERIC Educational Resources Information Center

Hickey, M. Gail, Ed.; Lanahan, Brian K., Ed.

2012-01-01

"Even the Janitor Is White" addresses challenges faced by teacher educators who are committed to diversity education. The chapters in this volume invite readers to reflect on their own practice as teacher educators as well as consider ways in which that practice might be improved. More than forty percent of students in U.S. schools are…

Portraits of the Changes, the Players, and the Contexts. A Study of Dissemination Efforts Supporting School Improvement. People, Policies, and Practices: Examining the Chain of School Improvement, Volume II.

ERIC Educational Resources Information Center

Loucks, Susan F.; And Others

Based on a local site sample of 146 school districts, this volume (the second in a series of 10) describes school improvement efforts supported by 4 different federal strategies and representative programs: interpersonal linkage of validated practices (National Diffusion Network), commercial distribution (Bureau of Education for the Handicapped…

Neuroprotective effects of yoga practice: age-, experience-, and frequency-dependent plasticity

PubMed Central

Villemure, Chantal; Čeko, Marta; Cotton, Valerie A.; Bushnell, M. Catherine

2015-01-01

Yoga combines postures, breathing, and meditation. Despite reported health benefits, yoga’s effects on the brain have received little study. We used magnetic resonance imaging to compare age-related gray matter (GM) decline in yogis and controls. We also examined the effect of increasing yoga experience and weekly practice on GM volume and assessed which aspects of weekly practice contributed most to brain size. Controls displayed the well documented age-related global brain GM decline while yogis did not, suggesting that yoga contributes to protect the brain against age-related decline. Years of yoga experience correlated mostly with GM volume differences in the left hemisphere (insula, frontal operculum, and orbitofrontal cortex) suggesting that yoga tunes the brain toward a parasympatically driven mode and positive states. The number of hours of weekly practice correlated with GM volume in the primary somatosensory cortex/superior parietal lobule (S1/SPL), precuneus/posterior cingulate cortex (PCC), hippocampus, and primary visual cortex (V1). Commonality analyses indicated that the combination of postures and meditation contributed the most to the size of the hippocampus, precuneus/PCC, and S1/SPL while the combination of meditation and breathing exercises contributed the most to V1 volume. Yoga’s potential neuroprotective effects may provide a neural basis for some of its beneficial effects. PMID:26029093

Economic Factors Affecting the Financing of Education. National Educational Finance Project, Volume 2.

ERIC Educational Resources Information Center

Johns, Roe L., Ed.; And Others

Eleven articles on various aspects of educational finance comprise this document, volume two of the NEFP series. Volume one of this series deals with educational needs, volume three with educational planning and finance, and volume four with the impact of educational finance programs. In general, the material in this volume treats education as a…

Magnus effect: An overview of its past and future practical applications, 1850-1985, volumes 1 and 2

NASA Astrophysics Data System (ADS)

Borg, J.

The report is in two volumes and is intended to present the known data and past and future applications of Magnus effect devices. (Magnus effect devices are very high lift devices which can be used in applications where airfoils are currently used.) This first volume includes the history of Magnus effect devices, theory and principles, a significant patent review, practical marine applications, formulas and experimental data, comparisons of Magnus effect and other state-of-the-art devices, identification of further testing needed, and a proposed test program. Appendices include rudder research and a literature critique. The second volume is a collection of the drawings for 39 magnus effect patents plus a critique of each patent evaluating its potential, especially for marine applications.

Gender and Education. An Encyclopedia. Volume II

ERIC Educational Resources Information Center

Bank, Barbara J., Ed.

2007-01-01

This book represents the second of two volumes in a two-volume set where educators explore the intersection of gender and education. Their entries deal with educational theories, research, curricula, practices, personnel, and policies, but also with variations in the gendering of education across historical and cultural contexts. The various…

Highway Safety Program Manual: Volume 13: Traffic Engineering Services.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

Volume 13 of the 19-volume Highway Safety Program Manual (which provides guidance to State and local governments on preferred highway safety practices) focuses on traffic engineering services. The introduction outlines the purposes and objectives of Highway Safety Program Standard 13 and the Highway Safety Program Manual. Program development and…

Enhance hospital performance from intellectual capital to business intelligence.

PubMed

Karami, Mahtab; Fatehi, Mansoor; Torabi, Mashallah; Langarizadeh, Mostafa; Rahimi, Azin; Safdari, Reza

2013-01-01

Business intelligence (BI) refers to technologies, tools, and practices for collecting, integrating, analyzing, and presenting large volumes of information to enable better decision making. The aim of this study is to provide a general overview of BI and its impacts on improving hospital performance. In this paper, literature is reviewed on the concept, classification, and structure of intellectual capital and BI. Research on the building of BI and its impact on the performance of hospitals are briefly summarized. Some areas in healthcare which can utilize BI benefits, including radiology, are also discussed. Used properly, BI is an effective communication tool that can enable hospitals to reach strategic goals and objectives and can also help eliminate information asymmetry.

The Interplay of Media Violence Effects and Behaviorally Disordered Children and Adolescents: Guidelines for Practitioners.

PubMed

Reich, Manuel D

2018-04-01

A robust body of scientific research explores the effects of violent media on youths. For practitioners, the volume of interdisciplinary research and controversial findings can be confusing and difficult to generalize for best practice. This article briefly reviews the literature and presents guidelines for parenting and treating youths exposed and enmeshed in violent media. Attention is given to at-risk populations and children presenting with aggressive, violent, and antisocial behavior. Guidelines assume a family based, cognitive-behavioral approach suitable for the eclectic practitioner, with a focus on the complex, developmental, and ecological factors that contribute to presenting symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.

DDM at Work. Reply to comments on "Dependency distance: A new perspective on syntactic patterns in natural languages"

NASA Astrophysics Data System (ADS)

Xu, Chunshan; Liang, Junying; Liu, Haitao

2017-07-01

We provide responses to the commentaries in this volume to evaluate, clarify and extend some of the arguments in Dependency distance: A new perspective on syntactic patterns in natural languages. Evidences show that DDM (dependency distance minimization) is an important linguistic universal, biologically or cognitively motivated, in shaping the language system. As a general tendency, DDM works quite well in theoretical argumentations as well as practical applications. However, this does not mean that DDM is the only linguistic universal that works: it is highly possible that other factors, which might be biologically, physically, socially or culturally motivated, work as well to jointly mold languages.

3D Viscous Free-Surface Flow around a Combatant Ship Hull

NASA Astrophysics Data System (ADS)

Pacuraru, Florin; Lungu, Adrian; Maria, Viorel

2009-09-01

The prediction of the total drag experienced by an advancing ship is a complicated problem which requires a thorough understanding of the hydrodynamic forces acting on the hull, the physical processes from which these forces arise and their mutual interaction. A general numerical method to predict the hydrodynamic performance of a twin-propeller combatant ship hull is presented in the paper. For practical reasons, the technique couples a body forces method and a RANS-based finite volume solver to account for the interactions between the hull and the appendages mounted on it: propellers, rudders, shaft lines, bossings and brackets. The chimera approach has been found the most versatile way for grid generation of hull and appendages.

Landfill taxes and Enhanced Waste Management: Combining valuable practices with respect to future waste streams.

PubMed

Hoogmartens, Rob; Eyckmans, Johan; Van Passel, Steven

2016-09-01

Both landfill taxes and Enhanced Waste Management (EWM) practices can mitigate the scarcity issue of landfill capacity by respectively reducing landfilled waste volumes and valorising future waste streams. However, high landfill taxes might erode incentives for EWM, even though EWM creates value by valorising waste. Concentrating on Flanders (Belgium), the paper applies dynamic optimisation modelling techniques to analyse how landfill taxation and EWM can reinforce each other and how taxation schemes can be adjusted in order to foster sustainable and welfare maximising ways of processing future waste streams. Based on the Flemish simulation results, insights are offered that are generally applicable in international waste and resource management policy. As shown, the optimal Flemish landfill tax that optimises welfare in the no EWM scenario is higher than the one in the EWM scenario (93 against €50/ton). This difference should create incentives for applying EWM and is driven by the positive external effects that are generated by EWM practices. In Flanders, as the current landfill tax is slightly lower than these optimal levels, the choice that can be made is to further increase taxation levels or show complete commitment to EWM. A first generally applicable insight that was found points to the fact that it is not necessarily the case that the higher the landfill tax, the more effective waste management improvements can be realised. Other insights are about providing sufficient incentives for applying EMW practices and formulating appropriate pleas in support of technological development. By these insights, this paper should provide relevant information that can assist in triggering the transition towards a resource-efficient, circular economy in Europe. Copyright © 2016 Elsevier Ltd. All rights reserved.

Driving Change in Community Colleges. Volume 1: Building Systems for Advancement to Self-Sufficiency; Volume 2: An Analysis of Change in Two Community Colleges.

ERIC Educational Resources Information Center

Liebowitz, Marty; Haynes, Leslie; Milley, Jane

This report contains two volumes: "Building Systems for Advancement to Self-Sufficiency," and "An Analysis of Change in Two Community Colleges." Volume 1 addresses the following topics: (1) the need and opportunity for change; (2) from promising practices toward systems for advancement; (3) institutional change strategies; (4) levers for…

A spatial analysis of the expanding roles of nurses in general practice.

PubMed

Pearce, Christopher; Hall, Sally; Phillips, Christine; Dwan, Kathryn; Yates, Rachael; Sibbald, Bonnie

2012-08-07

Changes to the workforce and organisation of general practice are occurring rapidly in response to the Australian health care reform agenda, and the changing nature of the medical profession. In particular, the last five years has seen the rapid introduction and expansion of a nursing workforce in Australian general practices. This potentially creates pressures on current infrastructure in general practice. This study used a mixed methods, 'rapid appraisal' approach involving observation, photographs, and interviews. Nurses utilise space differently to GPs, and this is part of the diversity they bring to the general practice environment. At the same time their roles are partly shaped by the ways space is constructed in general practices. The fluidity of nursing roles in general practice suggests that nurses require a versatile space in which to maximize their role and contribution to the general practice team.

Pricing and reimbursement of drugs in Denmark.

PubMed

Møller Pedersen, K

2003-01-01

The Danish health care system is decentralized and tax financed. Reimbursable drugs are financed by the national health insurance, which despite its official name, is a tax-funded system for paying for drugs,practicing physicians outside hospitals, dentists, etc. Most issues related to pricing and reimbursement of drugs are placed centrally, however, with the Danish Medicines Agency, and in contrast to most of the health care system reimbursement is thoroughly grounded in legislation. Pricing in principle is free. In the 1990s a number of agreements between industry and government in practice introduced regulated price competition. Generic substitution at the pharmacy level and the agreements between government and industry have led to a decline in the overall price level for drugs from 1995 and onwards. The still increasing drug expenditures hence must be attributed to increasing volume and the introduction of new drugs. Reimbursement is divided into two: general reimbursement meaning unconditional reimbursement for a given drug or single reimbursement based on an application from the patient's physician on behalf of individual patients. The criteria for granting general reimbursement are relatively clear. Economic evaluations on a voluntary basis can be used to support documentation of a reasonable relationship between price and therapeutic effects. Reimbursement is calculated on the basis of an average European price level.

An assessment of space shuttle flight software development processes

NASA Technical Reports Server (NTRS)

1993-01-01

In early 1991, the National Aeronautics and Space Administration's (NASA's) Office of Space Flight commissioned the Aeronautics and Space Engineering Board (ASEB) of the National Research Council (NRC) to investigate the adequacy of the current process by which NASA develops and verifies changes and updates to the Space Shuttle flight software. The Committee for Review of Oversight Mechanisms for Space Shuttle Flight Software Processes was convened in Jan. 1992 to accomplish the following tasks: (1) review the entire flight software development process from the initial requirements definition phase to final implementation, including object code build and final machine loading; (2) review and critique NASA's independent verification and validation process and mechanisms, including NASA's established software development and testing standards; (3) determine the acceptability and adequacy of the complete flight software development process, including the embedded validation and verification processes through comparison with (1) generally accepted industry practices, and (2) generally accepted Department of Defense and/or other government practices (comparing NASA's program with organizations and projects having similar volumes of software development, software maturity, complexity, criticality, lines of code, and national standards); (4) consider whether independent verification and validation should continue. An overview of the study, independent verification and validation of critical software, and the Space Shuttle flight software development process are addressed. Findings and recommendations are presented.

Experimental aspects of buoyancy correction in measuring reliable high-pressure excess adsorption isotherms using the gravimetric method

NASA Astrophysics Data System (ADS)

Nguyen, Huong Giang T.; Horn, Jarod C.; Thommes, Matthias; van Zee, Roger D.; Espinal, Laura

2017-12-01

Addressing reproducibility issues in adsorption measurements is critical to accelerating the path to discovery of new industrial adsorbents and to understanding adsorption processes. A National Institute of Standards and Technology Reference Material, RM 8852 (ammonium ZSM-5 zeolite), and two gravimetric instruments with asymmetric two-beam balances were used to measure high-pressure adsorption isotherms. This work demonstrates how common approaches to buoyancy correction, a key factor in obtaining the mass change due to surface excess gas uptake from the apparent mass change, can impact the adsorption isotherm data. Three different approaches to buoyancy correction were investigated and applied to the subcritical CO2 and supercritical N2 adsorption isotherms at 293 K. It was observed that measuring a collective volume for all balance components for the buoyancy correction (helium method) introduces an inherent bias in temperature partition when there is a temperature gradient (i.e. analysis temperature is not equal to instrument air bath temperature). We demonstrate that a blank subtraction is effective in mitigating the biases associated with temperature partitioning, instrument calibration, and the determined volumes of the balance components. In general, the manual and subtraction methods allow for better treatment of the temperature gradient during buoyancy correction. From the study, best practices specific to asymmetric two-beam balances and more general recommendations for measuring isotherms far from critical temperatures using gravimetric instruments are offered.

Experimental aspects of buoyancy correction in measuring reliable highpressure excess adsorption isotherms using the gravimetric method.

PubMed

Nguyen, Huong Giang T; Horn, Jarod C; Thommes, Matthias; van Zee, Roger D; Espinal, Laura

2017-12-01

Addressing reproducibility issues in adsorption measurements is critical to accelerating the path to discovery of new industrial adsorbents and to understanding adsorption processes. A National Institute of Standards and Technology Reference Material, RM 8852 (ammonium ZSM-5 zeolite), and two gravimetric instruments with asymmetric two-beam balances were used to measure high-pressure adsorption isotherms. This work demonstrates how common approaches to buoyancy correction, a key factor in obtaining the mass change due to surface excess gas uptake from the apparent mass change, can impact the adsorption isotherm data. Three different approaches to buoyancy correction were investigated and applied to the subcritical CO 2 and supercritical N 2 adsorption isotherms at 293 K. It was observed that measuring a collective volume for all balance components for the buoyancy correction (helium method) introduces an inherent bias in temperature partition when there is a temperature gradient (i.e. analysis temperature is not equal to instrument air bath temperature). We demonstrate that a blank subtraction is effective in mitigating the biases associated with temperature partitioning, instrument calibration, and the determined volumes of the balance components. In general, the manual and subtraction methods allow for better treatment of the temperature gradient during buoyancy correction. From the study, best practices specific to asymmetric two-beam balances and more general recommendations for measuring isotherms far from critical temperatures using gravimetric instruments are offered.

Wastewater reuse in the countries of the Gulf Cooperation Council (GCC): the lost opportunity.

PubMed

Aleisa, Esra; Al-Zubari, Waleed

2017-10-12

Reuse of treated wastewater is not only environmentally and financially sound, it is becoming indispensable for meeting the staggering water demand in certain regions, especially under conditions of alarming water scarcity. Reusing treated wastewater will help in reducing the pressure on expensive desalinated water production and depleting groundwater withdrawal, thereby reducing associated harmful environmental impacts. Reuse of wastewater in general and in the countries of the Gulf Cooperation Council (GCC) in particular has been a priority research area and has been in the media spotlight for some time, especially the use of tertiary quality water resources for agricultural purposes. However, reuse of treated wastewater is still in its primitive stage in terms of implementation in GCC. In addition, the overall volume of tertiary treated water that outflows unutilized to the sea is much greater than the volume reused. This paper provides a general review of and statistics on current practices of treatment of domestic wastewater in the GCC. The review highlights water resources, sanitation service coverage, wastewater treatment, effluent types, treated and reuse quantities, costs, and tariffs. The paper provides recommendations to improve wastewater treatment in the GCC to alleviate the stress on the scarce groundwater resources, provide a relatively inexpensive alternative to desalination, reduce the environmentally adverse impacts and externalities of desalination plants, and eliminate the discharge of untreated wastewater in coastal areas or terrestrial landfills.

Pharmaceutical management in ProCare Health Limited.

PubMed

Malcolm, L; Barry, M; MacLean, I

2001-06-22

To review pharmaceutical budget holding and management in ProCare Health Limited by; describing budget holding strategies implemented in 1995/6, identifying prescribing savings achieved, analysing variation in prescribing behaviour and comparing the findings with experience elsewhere. With 340 members, ProCare is one of the largest and most progressive of New Zealand's independent practitioner associations (IPAs). Data were obtained for the three years 1994 to 1996 to determine pharmaceutical expenditure against budget and against national trends, by member and general medical services (GMS) consultations. ProCare has established a classical, quality focussed pharmaceutical management strategy. Savings against the agreed budget was 9.5% comparing 1996 with 1995 but 5.7% compared, with national trends. Wide variation in per capita and per consultation costs was not reduced and was entirely explained by prescribing volumes not drug prices. The most important finding is that general practitioners (GPs), working collaboratively, can establish a strategy of clinical and corporate governance which may be exerting a wide ranging influence over clinical behaviour. Although there may be doubts about the actual levels of saving these appeared to be well in excess of the financial investment in the strategy. Greater savings appear possible with a focus on addressing the large and apparently inappropriate per capita prescribing volume variation between practices. Understanding and successfully addressing this variation will be one of the key issues facing the implementation of the government's primary health care strategy.

Operative volume in the new era: a comparison of resident operative volume before and after implementation of 80-hour work week restrictions.

PubMed

Bruce, Pamela J; Helmer, Stephen D; Osland, Jacqueline S; Ammar, Alex D

2010-01-01

To determine the effect of the 80-hour work week restrictions on general surgery resident operative volume in a large, community-based, university-affiliated, general surgery residency program. We performed a retrospective review of Accreditation Council for Graduate Medical Education (ACGME) operative logs of general surgery residents graduating from a single residency. The control group consisted of the residents graduating in the 3 years prior to the work-hour restriction implementation (2001, 2002, and 2003). Our comparison group consisted of those residents graduating in the first 2 classes whose entire residency was conducted after the implementation of the 80-hour work week (2008 and 2009). Comparisons were made between the control and the comparison groups in the 19 ACGME defined categories, total number of major cases, total number of chief cases, and total number of teaching assist cases. Operative volumes in 13 categories (skin/soft tissue/breast, alimentary tract, abdominal, liver, pancreas, vascular, endocrine, pediatrics, endoscopy, laparoscopic-complex, total chief cases, total major cases, and teaching cases) were not significantly affected by the implementation of the 80-hour work week. One of the 19 categories (laparoscopic-basic) showed a significant increase in operative volume (p < 0.0001). In 4 of the 19 categories (head/neck, operative-trauma, thoracic, and plastics), operative volume was significantly decreased in the post-80-hour work week era (p < 0.05). Nonoperative trauma could not be assessed, as the category did not exist before the work-hour restrictions. Resident operative volume at our institution's general surgery residency program largely has been unaffected by implementation of the 80-hour work week. Residencies in general surgery can be structured in a manner to allow for compliance with duty-hour regulations while maintaining the required operative volume outlined by the ACGME defined categories. Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

An Ultra-Sensitive Method for the Analysis of Perfluorinated ...

EPA Pesticide Factsheets

In epidemiological research, it has become increasingly important to assess subjects' exposure to different classes of chemicals in multiple environmental media. It is a common practice to aliquot limited volumes of samples into smaller quantities for specific trace level chemical analysis. A novel method was developed for the determination of 14 perfluorinated alkyl acids (PFAAs) in small volumes (10 mL) of drinking water using off-line solid phase extraction (SPE) pre-treatment followed by on-line pre-concentration on WAX column before analysis on column-switching high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). In general, large volumes (100 - 1000 mL) have been used for the analysis of PFAAs in drinking water. The current method requires approximately 10 mL of drinking water concentrated by using an SPE cartridge and eluted with methanol. A large volume injection of the extract was introduced on to a column-switching HPLC-MS/MS using a mix-mode SPE column for the trace level analysis of PFAAs in water. The recoveries for most of the analytes in the fortified laboratory blanks ranged from 73±14% to 128±5%. The lowest concentration minimum reporting levels (LCMRL) for the 14 PFAAs ranged from 0.59 to 3.4 ng/L. The optimized method was applied to a pilot-scale analysis of a subset of drinking water samples from an epidemiological study. These samples were collected directly from the taps in the households of Ohio and Nor

Non-invasive 3D time-of-flight imaging technique for tumour volume assessment in subcutaneous models.

PubMed

Delgado San Martin, J A; Worthington, P; Yates, J W T

2015-04-01

Subcutaneous tumour xenograft volumes are generally measured using callipers. This method is susceptible to inter- and intra-observer variability and systematic inaccuracies. Non-invasive 3D measurement using ultrasound and magnetic resonance imaging (MRI) have been considered, but require immobilization of the animal. An infrared-based 3D time-of-flight (3DToF) camera was used to acquire a depth map of tumour-bearing mice. A semi-automatic algorithm based on parametric surfaces was applied to estimate tumour volume. Four clay mouse models and 18 tumour-bearing mice were assessed using callipers (applying both prolate spheroid and ellipsoid models) and 3DToF methods, and validated using tumour weight. Inter-experimentalist variability could be up to 25% in the calliper method. Experimental results demonstrated good consistency and relatively low error rates for the 3DToF method, in contrast to biased overestimation using callipers. Accuracy is currently limited by camera performance; however, we anticipate the next generation 3DToF cameras will be able to support the development of a practical system. Here, we describe an initial proof of concept for a non-invasive, non-immobilized, morphology-independent, economical and potentially more precise tumour volume assessment technique. This affordable technique should maximize the datapoints per animal, by reducing the numbers required in experiments and reduce their distress. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

A multifractal approach to space-filling recovery for PET quantification.

PubMed

Willaime, Julien M Y; Aboagye, Eric O; Tsoumpas, Charalampos; Turkheimer, Federico E

2014-11-01

A new image-based methodology is developed for estimating the apparent space-filling properties of an object of interest in PET imaging without need for a robust segmentation step and used to recover accurate estimates of total lesion activity (TLA). A multifractal approach and the fractal dimension are proposed to recover the apparent space-filling index of a lesion (tumor volume, TV) embedded in nonzero background. A practical implementation is proposed, and the index is subsequently used with mean standardized uptake value (SUV mean) to correct TLA estimates obtained from approximate lesion contours. The methodology is illustrated on fractal and synthetic objects contaminated by partial volume effects (PVEs), validated on realistic (18)F-fluorodeoxyglucose PET simulations and tested for its robustness using a clinical (18)F-fluorothymidine PET test-retest dataset. TLA estimates were stable for a range of resolutions typical in PET oncology (4-6 mm). By contrast, the space-filling index and intensity estimates were resolution dependent. TLA was generally recovered within 15% of ground truth on postfiltered PET images affected by PVEs. Volumes were recovered within 15% variability in the repeatability study. Results indicated that TLA is a more robust index than other traditional metrics such as SUV mean or TV measurements across imaging protocols. The fractal procedure reported here is proposed as a simple and effective computational alternative to existing methodologies which require the incorporation of image preprocessing steps (i.e., partial volume correction and automatic segmentation) prior to quantification.

Survey of college students on iPod use and hearing health.

PubMed

Danhauer, Jeffrey L; Johnson, Carole E; Byrd, Anne; DeGood, Laura; Meuel, Caitlin; Pecile, Angela; Koch, Lindsey L

2009-01-01

The popularity of personal listening devices (PLDs) including iPods has increased dramatically over the past decade. PLDs allow users to listen to music uninterrupted for prolonged periods and at levels that may pose a risk for hearing loss in some listeners, particularly those using earbud earphones that fail to attenuate high ambient noise levels and necessitate increasing volume for acoustic enjoyment. Earlier studies have documented PLD use by teenagers and adults, but omitted college students, which represent a large segment of individuals who use these devices. This study surveyed college students' knowledge about, experiences with, attitudes toward, and practices and preferences for hearing health and use of iPods and/or other PLDs. The study was designed to help determine the need, content, and preferred format for educational outreach campaigns regarding safe iPod use to college students. An 83-item questionnaire was designed and used to survey college students' knowledge about, experiences with, attitudes toward, and practices/preferences for hearing health and PLD use. The questionnaire assessed Demographics and Knowledge of Hearing Health, iPod Users' Practices and Preferences, Attitudes toward iPod Use, and Reasons for iPod Use. Generally, most college students were knowledgeable about hearing health but could use information about signs of and how to prevent hearing loss. Two-thirds of these students used iPods, but not at levels or for durations that should pose excessive risks for hearing loss when listening in quiet environments. However, most iPod users could be at risk for hearing loss given a combination of common practices. Most of these college students should not be at great risk of hearing loss from their iPods when used conscientiously. Some concern is warranted for a small segment of these students who seemed to be most at risk because they listened to their iPods at high volume levels for long durations using earbuds, and reported that they may already have hearing loss due to their iPods.

Eating meals before wheel-running exercise attenuate high fat diet-driven obesity in mice under two meals per day schedule.

PubMed

Sasaki, Hiroyuki; Hattori, Yuta; Ikeda, Yuko; Kamagata, Mayo; Shibata, Shigenobu

2015-06-01

Mice that exercise after meals gain less body weight and visceral fat compared to those that exercised before meals under a one meal/exercise time per day schedule. Humans generally eat two or three meals per day, and rarely have only one meal. To extend our previous observations, we examined here whether a "two meals, two exercise sessions per day" schedule was optimal in terms of maintaining a healthy body weight. In this experiment, "morning" refers to the beginning of the active phase (the "morning" for nocturnal animals). We found that 2-h feeding before 2-h exercise in the morning and evening (F-Ex/F-Ex) resulted in greater attenuation of high fat diet (HFD)-induced weight gain compared to other combinations of feeding and exercise under two daily meals and two daily exercise periods. There were no significant differences in total food intake and total wheel counts, but feeding before exercise in the morning groups (F-Ex/F-Ex and F-Ex/Ex-F) increased the morning wheel counts. These results suggest that habitual exercise after feeding in the morning and evening is more effective for preventing HFD-induced weight gain. We also determined whether there were any correlations between food intake, wheel rotation, visceral fat volume and skeletal muscle volumes. We found positive associations between gastrocnemius muscle volumes and morning wheel counts, as well as negative associations between morning food intake volumes/body weight and morning wheel counts. These results suggest that morning exercise-induced increase of muscle volume may refer to anti-obesity. Evening exercise is negatively associated with fat volume increases, suggesting that this practice may counteract fat deposition. Our multifactorial analysis revealed that morning food intake helps to increase exercise, and that evening exercise reduced fat volumes. Thus, exercise in the morning or evening is important for preventing the onset of obesity.

Stakeholder experiences with general practice pharmacist services: a qualitative study.

PubMed

Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

2013-09-11

To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study. Qualitative study. Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period. Patients, practice staff and pharmacists. Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings. 34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory. This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of general practice pharmacist roles.

Pectus carinatum treatment in Canada: current practices.

PubMed

Emil, Sherif; Laberge, Jean-Martin; Sigalet, David; Baird, Robert

2012-05-01

Multiple treatment options currently exist for the correction of pectus carinatum (PC). We performed a survey of Canadian pediatric surgeons to define current practices. All active members of Canadian Association of Paediatric Surgeons were surveyed online during winter 2011 through the Canadian Association of Paediatric Surgeons Web site. The survey assessed multiple facets of PC evaluation and treatment, with particular emphasis on the practice of bracing. Forty-five active members (85%) responded, of whom 32 (71%) currently treat PC. Fifty-three percent of practices are low volume (<5 patients annually). In terms of preferred or most used treatment modality, 69% of surgeons used bracing, 25% performed Ravitch repairs, 3% performed open minimal cartilage resections, and 3% performed reverse Nuss procedures. Of 23 surgeons (72%) who used bracing, 83% used it for most or the patients. Fifty-seven percent judged their bracing results as good or excellent, and 74% felt that most or all patients braced were satisfied; 80% and 88% agreed or strongly agreed that bracing was generally preferable to surgical repair and that bracing should be first line treatment, respectively. Bracing is the preferred treatment for PC by most Canadian pediatric surgeons, despite lack of prospective outcome data. This presents an opportunity for a multicenter prospective study. Copyright © 2012 Elsevier Inc. All rights reserved.

Near patient testing in general practice: a review.

PubMed Central

Hilton, S

1990-01-01

Until recently, technological advances in general practice have generally been thought of as the applications of microcomputers in practice organization and record keeping. Advances in miniaturization and versatility of diagnostic technology will have a similarly large impact on the way general practitioners practice medicine in the next decade. This article reviews some of the newer tests that are already available to general practitioners, particularly in diagnostic biochemistry and microbiology. Preliminary evaluative work and research studies in general practice are also described. PMID:2107838

How common is multiple general practice attendance in Australia?

PubMed

Wright, Michael; Hall, Jane; van Gool, Kees; Haas, Marion

2018-05-01

Australians can seek general practice care from multiple general practitioners (GPs) in multiple locations. This provides high levels of patient choice but may reduce continuity of care. The aim of this study was to estimate the prevalence of attendance at multiple general practices in Australia, and identify patient characteristics associated with multiple practice attendances. A cross-sectional survey of 2477 Australian adults was conducted online in July 2013. Respondents reported whether they had attended more than one general practice in the past year, and whether they had a usual general practice and GP. Demographic information, health service use and practice characteristics were also obtained from the survey. Over one-quarter of the sample reported attending more than one practice in the previous year. Multiple practice attendance is less common with increasing age, and less likely for survey respondents from regional Australia, compared with respondents from metropolitan areas. Multiple practice attenders are just as likely as single practice attenders to have a usual GP. A significant proportion of general practice care is delivered away from usual practices. This may have implications for health policy, in terms of continuity and quality of primary care.

Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey

PubMed Central

Laverty, Anthony A; Harris, Matthew J; Watt, Hilary C; Greaves, Felix; Majeed, Azeem

2017-01-01

Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013–2014 (n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government (‘General Medical Services’ 54.6%; 4337/7949). Few practices were limited companies with locally negotiated ‘Alternative Provider Medical Services’ contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference −3.04, 95% CI −4.15 to −1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (−12.78, 95% CI −15.17 to −10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013–2014. PMID:29096580

Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey.

PubMed

Cowling, Thomas E; Laverty, Anthony A; Harris, Matthew J; Watt, Hilary C; Greaves, Felix; Majeed, Azeem

2017-11-01

Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013-2014 ( n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government ('General Medical Services' 54.6%; 4337/7949). Few practices were limited companies with locally negotiated 'Alternative Provider Medical Services' contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference -3.04, 95% CI -4.15 to -1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (-12.78, 95% CI -15.17 to -10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013-2014.

Highway Safety Program Manual: Volume 12: Highway Design, Construction and Maintenance.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

Volume 12 of the 19-volume Highway Safety Program Manual (which provides guidance to State and local governments on preferred highway safety practices) focuses on highway design, construction and maintenance. The purpose and specific objectives of such a program are described. Federal authority in the area of highway safety and policies regarding…

A Comparison of Regional and SiteSpecific Volume Estimation Equations

Treesearch

Joe P. McClure; Jana Anderson; Hans T. Schreuder

1987-01-01

Regression equations for volume by region and site class were examined for lobiolly pine. The regressions for the Coastal Plain and Piedmont regions had significantly different slopes. The results shared important practical differences in percentage of confidence intervals containing the true total volume and in percentage of estimates within a specific proportion of...

Potential means of cost reduction in grade crossing automatic gate systems. volume II : improved gate arm concepts for railroad/highway grade crossings gate systems

DOT National Transportation Integrated Search

1977-02-28

This report, Volume II of a two-volume study, examines the potential for reduction of the cost of installing and maintaining automatic gates at railroad-highway grade crossings. It includes a review of current practices, equipment, and standards; con...

Highway Safety Program Manual: Volume 14: Pedestrian Safety.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

Volume 14 of the 19-volume Highway Safety Program Manual (which provides guidance to State and local governments on preferred highway safety practices) concentrates on pedestrian safety. The purpose and objectives of a pedestrian safety program are outlined. Federal authority in the area of pedestrian safety and policies regarding a safety program…

Update on Gifted Education. Volume 1, 1991.

ERIC Educational Resources Information Center

Update on Gifted Education, 1991

1991-01-01

This document is the first volume of a projected quarterly publication designed to assure that the most current information, both on the latest research and on successful practices in the field of gifted education is made available to schools as quickly and efficiently as possible. The four issues of this volume contain the following articles:…

Highway Safety Program Manual: Volume 15: Police Traffic Services.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

Volume 15 of the 19-volume Highway Safety Program Manual (which provides guidance to State and local governments on preferred highway safety practices) focuses on police traffic services. The purpose and objectives of a police services program are described. Federal authority in the areas of highway safety and policies regarding a police traffic…

Highway Safety Program Manual: Volume 11: Emergency Medical Services.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

Volume 11 of the 19-volume Highway Safety Program Manual (which provides guidance to State and local governments on preferred highway safety practices) concentrates on emergency medical services. The purpose of the program, Federal authority in the area of medical services, and policies related to an emergency medical services (EMS) program are…

Highway Safety Program Manual: Volume 6: Codes and Laws.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

Volume 6 of the 19-volume Highway Safety Program Manual (which provides guidance to State and local governments on preferred safety practices) concentrates on codes and laws. The purpose and specific objectives of the Codes and Laws Program, Federal authority in the area of highway safety, and policies regarding traffic regulation are described.…

Highway Safety Program Manual: Volume 9: Identification and Surveillance of Accident Locations.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

Volume 9 of the 19-volume Highway Safety Program Manual (which provides guidance to State and local governments on preferred highway safety practices) focuses on identification and surveillance of accident locations. The purpose of the program, its specific objectives, and its relationship with other programs are explored. Federal authority in the…

Studies in Mathematics Education. Volume 6. Out-of-School Mathematics Education.

ERIC Educational Resources Information Center

Morris, Robert, Ed.

This is the sixth volume in a series designed to improve mathematics instruction by providing resource materials for those responsible for mathematics teaching. Focusing on out-of-school mathematics education, this volume presents a panorama of current practices around the world and suggests future trends. Subjects considered include: (1)…

Classroom Reading Specialist Program. Year-end Report. Volume III.

ERIC Educational Resources Information Center

Earle, Richard; And Others

As the third in a four volume final report of a Right to Read preservice competency-based, modular reading specialist project, this volume presents the module outlines for components seven, eight and nine of the classroom program. Component seven, administration and supervision, offers on-the-job practical training where students experience…

Medical Laboratory Technician (Chemistry and Urinalysis). (AFSC 92470).

ERIC Educational Resources Information Center

Thompson, Joselyn H.

This four-volume student text is designed for use by Air Force personnel enrolled in a self-study extension course for medical laboratory technicians. Covered in the individual volumes are medical laboratory administration and clinical chemistry (career opportunities, general laboratory safety and materials, general medical laboratory…

Theoretical Studies of Microstrip Antennas : Volume I, General Design Techniques and Analyses of Single and Coupled Elements

DOT National Transportation Integrated Search

1979-09-01

Volume 1 of Theoretical Studies of Microstrip Antennas deals with general techniques and analyses of single and coupled radiating elements. Specifically, we review and then employ an important equivalence theorem that allows a pair of vector potentia...

General practice research: attitudes and involvement of Queensland general practitioners.

PubMed

Askew, Deborah A; Clavarino, Alexandra M; Glasziou, Paul P; Del Mar, Christopher B

2002-07-15

To determine general practitioners' (GPs') attitudes towards and involvement in general practice research. Postal survey and semi-structured interviews conducted from May to September 2001. 467 of 631 GPs in four Queensland Divisions of General Practice responded to the survey (74% response rate); 18 selected GPs were interviewed. Survey - attitudes to research; access to information resources; and involvement in research. Interviews - the need for general practice research; barriers against and factors enabling greater participation in research. 389/463 (84%) GPs, especially younger and more recent graduates, had positive attitudes to research, but only 29% wanted more involvement. 223/462 (48%) were aware they had access to MEDLINE, although presumably all those with Internet access (89%) would have free access via PubMed. Barriers included the general practice environment (especially fee-for-service funding), and the culture of general practice. Enabling factors included academic mentors; opportunities to participate in reputable, established research activities relevant to general practice; and access to information resources. Although Australian general practice has a weak research culture, about a third of GPs would like to increase their involvement in research. However, the research must be perceived as relevant, and structured to minimise the inherent barriers in the environment and culture of general practice.

Validated School Business Practices That Work. Volume III: Sharing Business Success.

ERIC Educational Resources Information Center

Association of School Business Officials of the United States and Canada, Park Ridge, IL. Research Corp.

Seventeen validated school business practices are described in this document. The practices were selected through the Sharing Business Success (SBS) program, in which the Federal Department of Education, 41 state education agencies, and State Associations of School Business Officials cooperate to identify successful school district practices,…

The development of professional practice standards for Australian general practice nurses.

PubMed

Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine

2017-08-01

The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Concurrent mixed methods design. Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses' practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance. © 2017 John Wiley & Sons Ltd.

Research on interpolation methods in medical image processing.

PubMed

Pan, Mei-Sen; Yang, Xiao-Li; Tang, Jing-Tian

2012-04-01

Image interpolation is widely used for the field of medical image processing. In this paper, interpolation methods are divided into three groups: filter interpolation, ordinary interpolation and general partial volume interpolation. Some commonly-used filter methods for image interpolation are pioneered, but the interpolation effects need to be further improved. When analyzing and discussing ordinary interpolation, many asymmetrical kernel interpolation methods are proposed. Compared with symmetrical kernel ones, the former are have some advantages. After analyzing the partial volume and generalized partial volume estimation interpolations, the new concept and constraint conditions of the general partial volume interpolation are defined, and several new partial volume interpolation functions are derived. By performing the experiments of image scaling, rotation and self-registration, the interpolation methods mentioned in this paper are compared in the entropy, peak signal-to-noise ratio, cross entropy, normalized cross-correlation coefficient and running time. Among the filter interpolation methods, the median and B-spline filter interpolations have a relatively better interpolating performance. Among the ordinary interpolation methods, on the whole, the symmetrical cubic kernel interpolations demonstrate a strong advantage, especially the symmetrical cubic B-spline interpolation. However, we have to mention that they are very time-consuming and have lower time efficiency. As for the general partial volume interpolation methods, from the total error of image self-registration, the symmetrical interpolations provide certain superiority; but considering the processing efficiency, the asymmetrical interpolations are better.

Surgery in World War 2. Activities of Surgical Consultants. Volume 1

DTIC Science & Technology

1962-01-01

ACTIVITIES OF SURGICAL CONSULTANTS Volume I Prepared and published uinder the direction of Lieutenant General LEONARD D. HEATON The Surgeon, General, United...States Army Editor in Chief Colonel JOHN BlOYD COATES, Jr., MC Editor for Activities of Surgical Consultants B. NOLAND CARTER, M.D. Associate Editor...Chief, Information Activities Branch Major ALBRERT C. RIGoS, Jr., Chief, General Reference and Research Branch, TIAZEL G. HINE, Chief

Engaging participants in a complex intervention trial in Australian General Practice

PubMed Central

Perkins, David; Harris, Mark F; Tan, Jocelyn; Christl, Bettina; Taggart, Jane; Fanaian, Mahnaz

2008-01-01

Background The paper examines the key issues experienced in recruiting and retaining practice involvement in a large complex intervention trial in Australian General Practice. Methods Reflective notes made by research staff and telephone interviews with staff from general practices which expressed interest, took part or withdrew from a trial of a complex general practice intervention. Results Recruitment and retention difficulties were due to factors inherent in the demands and context of general practice, the degree of engagement of primary care organisations (Divisions of General Practice), perceived benefits by practices, the design of the trial and the timing and complexity of data collection. Conclusion There needs to be clearer articulation to practices of the benefits of the research to participants and streamlining of the design and processes of data collection and intervention to fit in with their work practices. Ultimately deeper engagement may require additional funding and ongoing participation through practice research networks. Trial Registration Current Controlled Trials ACTRN12605000788673 PMID:18700984

Improvement of mathematical models for simulation of vehicle handling : volume 7 : technical manual for the general simulation

DOT National Transportation Integrated Search

1980-03-01

This volume is the technical manual for the general simulation. Mathematical modelling of the vehicle and of the human driver is presented in detail, as are differences between the APL simulation and the current one. Information on model validation a...

17 CFR 15.04 - Reportable trading volume level.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 17 Commodity and Securities Exchanges 1 2014-04-01 2014-04-01 false Reportable trading volume level. 15.04 Section 15.04 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION REPORTS-GENERAL PROVISIONS § 15.04 Reportable trading volume level. The volume quantity for the purpose of...

Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

PubMed Central

Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

2015-01-01

Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study.

PubMed

Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

2015-03-01

The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. © 2014 International Hepato-Pancreato-Biliary Association.

Evaluating the effectiveness of management practices on hydrology and water quality at watershed scale with a rainfall-runoff model.

PubMed

Liu, Yaoze; Bralts, Vincent F; Engel, Bernard A

2015-04-01

The adverse influence of urban development on hydrology and water quality can be reduced by applying best management practices (BMPs) and low impact development (LID) practices. This study applied green roof, rain barrel/cistern, bioretention system, porous pavement, permeable patio, grass strip, grassed swale, wetland channel, retention pond, detention basin, and wetland basin, on Crooked Creek watershed. The model was calibrated and validated for annual runoff volume. A framework for simulating BMPs and LID practices at watershed scales was created, and the impacts of BMPs and LID practices on water quantity and water quality were evaluated with the Long-Term Hydrologic Impact Assessment-Low Impact Development 2.1 (L-THIA-LID 2.1) model for 16 scenarios. The various levels and combinations of BMPs/LID practices reduced runoff volume by 0 to 26.47%, Total Nitrogen (TN) by 0.30 to 34.20%, Total Phosphorus (TP) by 0.27 to 47.41%, Total Suspended Solids (TSS) by 0.33 to 53.59%, Lead (Pb) by 0.30 to 60.98%, Biochemical Oxygen Demand (BOD) by 0 to 26.70%, and Chemical Oxygen Demand (COD) by 0 to 27.52%. The implementation of grass strips in 25% of the watershed where this practice could be applied was the most cost-efficient scenario, with cost per unit reduction of $1m3/yr for runoff, while cost for reductions of two pollutants of concern was $445 kg/yr for Total Nitrogen (TN) and $4871 kg/yr for Total Phosphorous (TP). The scenario with very high levels of BMP and LID practice adoption (scenario 15) reduced runoff volume and pollutant loads from 26.47% to 60.98%, and provided the greatest reduction in runoff volume and pollutant loads among all scenarios. However, this scenario was not as cost-efficient as most other scenarios. The L-THIA-LID 2.1 model is a valid tool that can be applied to various locations to help identify cost effective BMP/LID practice plans at watershed scales. Copyright © 2014 Elsevier B.V. All rights reserved.

Patient initiated aggression - prevalence and impact for general practice staff.

PubMed

Herath, Pushpani; Forrest, Laura; McRae, Ian; Parker, Rhian

2011-06-01

Patient initiated aggression toward general practice staff can cause distress among staff, however, it is unknown how frequently practice staff experience patient aggression in the workplace. The aim of this study is to determine the national prevalence of patient aggression toward general practice staff. A clustered cross sectional survey involving general practice staff working in Australia. A questionnaire was posted to 1109 general practices nationally and 217 questionnaires were completed and returned (19.6% response rate). It was found that verbal aggression is commonly experienced by practice staff, particularly receptionists, whereas physical aggression is infrequent. Staff working in larger practices experience more verbal aggression and property damage or theft and it was reported that verbal aggression has a greater impact on staff wellbeing than physical aggression. This study provides some national evidence of the prevalence of patient aggression toward general practice staff. This may inform the development of policy and procedures.

The proposed general practice descriptors--will they influence preventive medicine?

PubMed

Moorhead, R G

1989-01-01

The proposed descriptor bill to change Medicare rebates to general practice patients could have a benefit to general practice preventive medicine. This seems possible through rewarding practitioners who spend more time with their patients and the positive effects of continuing medical education. However, the potential exists for whittling away any rewards for these practitioners by future governments and the audit of general practices could become a method of political control of Australian general practice.

Influences on final year medical students' attitudes to general practice as a career.

PubMed

Parker, Johanna E; Hudson, Ben; Wilkinson, Tim J

2014-03-01

General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. General practitioners (GPs) play a key role in influencing medical students' attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.

Low-volume road engineering : Best Management Practices : Field Guide

DOT National Transportation Integrated Search

2003-07-01

Improperly constructed roads can negatively impact everything from terrestrial plant populations and soil conservation efforts to water quality and populations of aquatic organisms in receiving waters. This Low-Volume Roads Engineering Best Managemen...

The economic benefit for family/general medicine practices employing physician assistants.

PubMed

Grzybicki, Dana M; Sullivan, Paul J; Oppy, J Miller; Bethke, Anne-Marie; Raab, Stephen S

2002-07-01

To measure the economic benefit of a family/general medicine physician assistant (PA) practice. Qualitative description of a model PA practice in a family/general medicine practice office setting, and comparison of the financial productivity of a PA practice with that of a non-PA (physician-only) practice. The study site was a family/general medicine practice office in southwestern Pennsylvania. The description of PA practice was obtained through direct observation and semistructured interviews during site visits in 1998. Comparison of site practice characteristics with published national statistics was performed to confirm the site's usefulness as a model practice. Data used for PA productivity analyses were obtained from site visits, interviews, office billing records, office appointment logs, and national organizations. The PA in the model practice had a same-task substitution ratio of 0.86 compared with the supervising physician. The PA was economically beneficial for the practice, with a compensation-to-production ratio of 0.36. Compared with a practice employing a full-time physician, the annual financial differential of a practice employing a full-time PA was $52,592. Sensitivity analyses illustrated the economic benefit of a PA practice in a variety of theoretical family/general medicine practice office settings. Family/general medicine PAs are of significant economic benefit to practices that employ them.

Dose distribution for dental cone beam CT and its implication for defining a dose index

PubMed Central

Pauwels, R; Theodorakou, C; Walker, A; Bosmans, H; Jacobs, R; Horner, K; Bogaerts, R

2012-01-01

Objectives To characterize the dose distribution for a range of cone beam CT (CBCT) units, investigating different field of view sizes, central and off-axis geometries, full or partial rotations of the X-ray tube and different clinically applied beam qualities. The implications of the dose distributions on the definition and practicality of a CBCT dose index were assessed. Methods Dose measurements on CBCT devices were performed by scanning cylindrical head-size water and polymethyl methacrylate phantoms, using thermoluminescent dosemeters, a small-volume ion chamber and radiochromic films. Results It was found that the dose distribution can be asymmetrical for dental CBCT exposures throughout a homogeneous phantom, owing to an asymmetrical positioning of the isocentre and/or partial rotation of the X-ray source. Furthermore, the scatter tail along the z-axis was found to have a distinct shape, generally resulting in a strong drop (90%) in absorbed dose outside the primary beam. Conclusions There is no optimal dose index available owing to the complicated exposure geometry of CBCT and the practical aspects of quality control measurements. Practical validation of different possible dose indices is needed, as well as the definition of conversion factors to patient dose. PMID:22752320

Marketing in developing countries.

PubMed

Pickering, A H

1979-10-27

I fully support the views of Mr. Chetley of War on Want on the marketing of infant foods in developing countries (Oct. 6, p. 747). My experience of eight years medical work in West Africa prompts me to broaden the debate. Advertising and promotional practices used by many European and American pharmaceutical companies are in many instances directed primarily to the non-professional and often poorly educated general public and appear to be geared simply to achieve the maximum volume of sales. Likewise, the cynical disregard of cigarette manufacturers for the dangers of smoking is very apparent in the way in which advertising and promotional campaigns are conducted in developing countries. Fifteen years ago cigarettes were largely imported items but now, certainly in one major West African country, there is a large and flourishing tobacco industry which appears to be run primarily by European interests and which is obviously not there for the health benefit of the people. Is it not a sad reflection on the morality of the society in which we live that, while striving to control unethical and undesirable practices at home, we make little or no effort to regulate those practices abroad when profit is the objective?

User's manual for Axisymmetric Diffuser Duct (ADD) code. Volume 1: General ADD code description

NASA Technical Reports Server (NTRS)

Anderson, O. L.; Hankins, G. B., Jr.; Edwards, D. E.

1982-01-01

This User's Manual contains a complete description of the computer codes known as the AXISYMMETRIC DIFFUSER DUCT code or ADD code. It includes a list of references which describe the formulation of the ADD code and comparisons of calculation with experimental flows. The input/output and general use of the code is described in the first volume. The second volume contains a detailed description of the code including the global structure of the code, list of FORTRAN variables, and descriptions of the subroutines. The third volume contains a detailed description of the CODUCT code which generates coordinate systems for arbitrary axisymmetric ducts.

General volume sizing strategy for thermal storage system using phase change material for concentrated solar thermal power plant

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

Xu, Ben; Li, Peiwen; Chan, Cholik

With an auxiliary large capacity thermal storage using phase change material (PCM), Concentrated Solar Power (CSP) is a promising technology for high efficiency solar energy utilization. In a thermal storage system, a dual-media thermal storage tank is typically adopted in industry for the purpose of reducing the use of the heat transfer fluid (HTF) which is usually expensive. While the sensible heat storage system (SHSS) has been well studied, a dual-media latent heat storage system (LHSS) still needs more attention and study. The volume sizing of the thermal storage tank, considering daily cyclic operations, is of particular significance. In thismore » paper, a general volume sizing strategy for LHSS is proposed, based on an enthalpy-based 1D transient model. One example was presented to demonstrate how to apply this strategy to obtain an actual storage tank volume. With this volume, a LHSS can supply heat to a thermal power plant with the HTF at temperatures above a cutoff point during a desired 6 hours of operation. This general volume sizing strategy is believed to be of particular interest for the solar thermal power industry.« less

General volume sizing strategy for thermal storage system using phase change material for concentrated solar thermal power plant

DOE PAGES

Xu, Ben; Li, Peiwen; Chan, Cholik; ...

2014-12-18

With an auxiliary large capacity thermal storage using phase change material (PCM), Concentrated Solar Power (CSP) is a promising technology for high efficiency solar energy utilization. In a thermal storage system, a dual-media thermal storage tank is typically adopted in industry for the purpose of reducing the use of the heat transfer fluid (HTF) which is usually expensive. While the sensible heat storage system (SHSS) has been well studied, a dual-media latent heat storage system (LHSS) still needs more attention and study. The volume sizing of the thermal storage tank, considering daily cyclic operations, is of particular significance. In thismore » paper, a general volume sizing strategy for LHSS is proposed, based on an enthalpy-based 1D transient model. One example was presented to demonstrate how to apply this strategy to obtain an actual storage tank volume. With this volume, a LHSS can supply heat to a thermal power plant with the HTF at temperatures above a cutoff point during a desired 6 hours of operation. This general volume sizing strategy is believed to be of particular interest for the solar thermal power industry.« less

Volume monogamy of quantum steering ellipsoids for multiqubit systems

NASA Astrophysics Data System (ADS)

Cheng, Shuming; Milne, Antony; Hall, Michael J. W.; Wiseman, Howard M.

2016-10-01

The quantum steering ellipsoid can be used to visualize 2-qubit states, and thus provides a generalization of the Bloch picture for the single qubit. Recently, a monogamy relation for the volumes of steering ellipsoids has been derived for pure 3-qubit states and shown to be stronger than the celebrated Coffman-Kundu-Wootters inequality. We first demonstrate the close connection between this volume monogamy relation and the classification of pure 3-qubit states under stochastic local operations and classical communication. We then show that this monogamy relation does not hold for general mixed 3-qubit states and derive a weaker monogamy relation that does hold for such states. We also prove a volume monogamy relation for pure 4-qubit states (further conjectured to hold for the mixed case), and generalize our 3-qubit inequality to n qubits. Finally, we study the effect of noise on the quantum steering ellipsoid and find that the volume of any 2-qubit state is nonincreasing when the state is exposed to arbitrary local noise. This implies that any volume monogamy relation for a given class of multiqubit states remains valid under the addition of local noise. We investigate this quantitatively for the experimentally relevant example of isotropic noise.

Lithographically-fabricated channel arrays for confocal x-ray fluorescence microscopy and XAFS

NASA Astrophysics Data System (ADS)

Woll, Arthur R.; Agyeman-Budu, David; Choudhury, Sanjukta; Coulthard, Ian; Finnefrock, Adam C.; Gordon, Robert; Hallin, Emil; Mass, Jennifer

2014-03-01

Confocal X-ray Fluorescence Microscopy (CXRF) employs overlapping focal regions of two x-ray optics—a condenser and collector—to directly probe a 3D volume. The minimum-achievable size of this probe volume is limited by the collector, for which polycapillaries are generally the optic of choice. Recently, we demonstrated an alternative collection optic for CXRF, consisting of an array of micron-scale collimating channels, etched in silicon, and arranged like spokes of a wheel directed towards a single source position. The optic, while successful, had a working distance of only 0.2 mm and exhibited relatively low total collection efficiency, limiting its practical application. Here, we describe a new design in which the collimating channels are formed by a staggered array of pillars whose side-walls taper away from the channel axis. This approach improves both collection efficiency and working distance, while maintaining excellent spatial resolution. We illustrate these improvements with confocal XRF data obtained at the Cornell High Energy Synchrotron Source (CHESS) and the Advanced Photon Source (APS) beamline 20-ID-B.

Method and apparatus for modeling interactions

DOEpatents

Xavier, Patrick G.

2000-08-08

A method and apparatus for modeling interactions between bodies. The method comprises representing two bodies undergoing translations and rotations by two hierarchical swept volume representations. Interactions such as nearest approach and collision can be modeled based on the swept body representations. The present invention can serve as a practical tool in motion planning, CAD systems, simulation systems, safety analysis, and applications that require modeling time-based interactions. A body can be represented in the present invention by a union of convex polygons and convex polyhedra. As used generally herein, polyhedron includes polygon, and polyhedra includes polygons. The body undergoing translation can be represented by a swept body representation, where the swept body representation comprises a hierarchical bounding volume representation whose leaves each contain a representation of the region swept by a section of the body during the translation, and where the union of the regions is a superset of the region swept by the surface of the body during translation. Interactions between two bodies thus represented can be modeled by modeling interactions between the convex hulls of the finite sets of discrete points in the swept body representations.

Linear Approximation to Optimal Control Allocation for Rocket Nozzles with Elliptical Constraints

NASA Technical Reports Server (NTRS)

Orr, Jeb S.; Wall, Johnm W.

2011-01-01

In this paper we present a straightforward technique for assessing and realizing the maximum control moment effectiveness for a launch vehicle with multiple constrained rocket nozzles, where elliptical deflection limits in gimbal axes are expressed as an ensemble of independent quadratic constraints. A direct method of determining an approximating ellipsoid that inscribes the set of attainable angular accelerations is derived. In the case of a parameterized linear generalized inverse, the geometry of the attainable set is computationally expensive to obtain but can be approximated to a high degree of accuracy with the proposed method. A linear inverse can then be optimized to maximize the volume of the true attainable set by maximizing the volume of the approximating ellipsoid. The use of a linear inverse does not preclude the use of linear methods for stability analysis and control design, preferred in practice for assessing the stability characteristics of the inertial and servoelastic coupling appearing in large boosters. The present techniques are demonstrated via application to the control allocation scheme for a concept heavy-lift launch vehicle.

Highway Safety Program Manual: Volume 16: Debris Hazard Control and Cleanup.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

Volume 16 of the 19-volume Highway Safety Program Manual (which provides guidance to State and local governments on preferred highway safety practices) concentrates on debris hazard control and cleanup. The purpose and objectives of such a program are outlined. Federal authority in the area of highway safety and policies regarding a debris control…

Managing Leaf Area for Maximum Volume Production in a Loblolly Pine Plantation

Treesearch

Shufang Yu; Quang V. Cao; Jim L. Chambers; Zhenmin Tang; James D. Haywood

1999-01-01

To manage loblolly pine (Pinus taeda L.) stands for maximum volume growth, the relationships between volume growth and leaf area at the tree and stand level under different cultural practices (thinning and fertilization) were examined. Forty-eight trees were harvested in 1995, six years after treatment, for individual tree measurements, and 336...

Behavioral Disorders: Practice Concerns and Students with EBD. Advances in Special Education. Volume 23

ERIC Educational Resources Information Center

Bakken, Jeffrey P., Ed.; Obiakor, Festus E., Ed.; Rotatori, Anthony F., Ed.

2012-01-01

Volumes 22 and 23 of the "Advances in Special Education" address the current top perspectives and issues in the field of emotional and behavioral disorders (EBD) by providing chapters written by active researchers and scholarly university professors who specialize in this area. Volume 22 first delineates legal issues, themes, and dimensions…

Maryland English Journal. Volume 28, Numbers 1-2, Fall 1993 and Spring 1994.

ERIC Educational Resources Information Center

Pula, Judith J., Ed.

1993-01-01

A semi-annual refereed publication of research and instructional practices in English/language arts and allied fields, preschool through adult levels, this volume of "Maryland English Journal" presents articles on a variety of subjects and showcases the work of young writers. Articles in volume 28, number 1 focus on ethnographic studies…

Feedback to Managers, Volume II: A Review and Comparison of Sixteen Multi-Rater Feedback Instruments.

ERIC Educational Resources Information Center

Van Velsor, Ellen; Leslie, Jean Brittain

"Feedback to Managers" is a two-volume report. Volume 2 compares 16 of the better feedback instruments available. The following are the instruments: (1) ACUMEN Group Feedback; (2) BENCHMARKS; (3) the Campbell Leadership Index; (4) COMPASS: the Managerial Practices Survey; (5) the Executive Success Profile; (6) Leader Behavior Analysis…

Current Scientific Approaches to Decision Making in Complex Systems. 3. Volume 2. Conference Position Papers

DTIC Science & Technology

1980-01-01

Search: Traffic on a Multi- dimensional Structure R. i. Atkin, University of Essex, England b. Annex. Volume 3: Decision: Foundation and Practice Brian R...Gaines, University of Essex, England Volume 4: Competing Modes of Cognition and Communication in Simulated and Self-Reflective Systems Stein Braten... University of Oslo, Norway Volume 5: On the Spontaneous Emergence of Decision Making Constraints in Communicating Hierarchical Structure John S

Democratic Practices in Education: Implications for Teacher Education

ERIC Educational Resources Information Center

Pearl, Art, Ed.; Pryor, Caroline R., Ed.

2005-01-01

This book presents the findings of eleven teacher educators as they examine the meaning of democracy and its application to classroom practice. There is a shared belief among all contributors to this volume: that incorporating democratic practice into teacher education is an essential requirement to introducing democratic practices in K-12…

Aggression and Young Children. Research in Practice Series. Volume 11, Number 1

ERIC Educational Resources Information Center

Szarkowicz, Diane Louise

2004-01-01

The "Research in Practice Series" is a practical, easy-to-read resource, offering effective new approaches for those challenging issues which arise in the care and education of young children. Early Childhood Australia's "Research in Practice Series" is an essential resource for those involved in the early childhood field.…

Regional gray matter volume in the posterior precuneus is associated with general self-efficacy.

PubMed

Sugiura, Ayaka; Aoki, Ryuta; Murayama, Kou; Yomogida, Yukihito; Haji, Tomoki; Saito, Atsuko; Hasegawa, Toshikazu; Matsumoto, Kenji

2016-12-14

Motivation in doing a task is influenced not only by the expected outcome of the task but also by the belief that one has in successfully executing the task. Over time, individuals accumulate experiences that contribute toward a general belief in one's overall ability to successfully perform tasks, which is called general self-efficacy (GSE). We investigated the relationship between regional gray matter volume and individual differences in GSE. Brain anatomy was analyzed using magnetic resonance images obtained from 64 healthy right-handed participants who had completed Sherer's GSE scale. After controlling for other factors related to motivation, age, sex, and total gray matter volume of each participant, results showed that regional gray matter volume in the posterior part of the precuneus significantly and positively correlated with the GSE score. These results suggest that one's accumulated experiences of success and failure, which contribute toward GSE, also influence the anatomical characteristics of the precuneus.

'Predatory' open access: a longitudinal study of article volumes and market characteristics.

PubMed

Shen, Cenyu; Björk, Bo-Christer

2015-10-01

A negative consequence of the rapid growth of scholarly open access publishing funded by article processing charges is the emergence of publishers and journals with highly questionable marketing and peer review practices. These so-called predatory publishers are causing unfounded negative publicity for open access publishing in general. Reports about this branch of e-business have so far mainly concentrated on exposing lacking peer review and scandals involving publishers and journals. There is a lack of comprehensive studies about several aspects of this phenomenon, including extent and regional distribution. After an initial scan of all predatory publishers and journals included in the so-called Beall's list, a sample of 613 journals was constructed using a stratified sampling method from the total of over 11,000 journals identified. Information about the subject field, country of publisher, article processing charge and article volumes published between 2010 and 2014 were manually collected from the journal websites. For a subset of journals, individual articles were sampled in order to study the country affiliation of authors and the publication delays. Over the studied period, predatory journals have rapidly increased their publication volumes from 53,000 in 2010 to an estimated 420,000 articles in 2014, published by around 8,000 active journals. Early on, publishers with more than 100 journals dominated the market, but since 2012 publishers in the 10-99 journal size category have captured the largest market share. The regional distribution of both the publisher's country and authorship is highly skewed, in particular Asia and Africa contributed three quarters of authors. Authors paid an average article processing charge of 178 USD per article for articles typically published within 2 to 3 months of submission. Despite a total number of journals and publishing volumes comparable to respectable (indexed by the Directory of Open Access Journals) open access journals, the problem of predatory open access seems highly contained to just a few countries, where the academic evaluation practices strongly favor international publication, but without further quality checks.

Google and Women's Health-Related Issues: What Does the Search Engine Data Reveal?

PubMed

Baazeem, Mazin; Abenhaim, Haim

2014-01-01

Identifying the gaps in public knowledge of women's health related issues has always been difficult. With the increasing number of Internet users in the United States, we sought to use the Internet as a tool to help us identify such gaps and to estimate women's most prevalent health concerns by examining commonly searched health-related keywords in Google search engine. We collected a large pool of possible search keywords from two independent practicing obstetrician/gynecologists and classified them into five main categories (obstetrics, gynecology, infertility, urogynecology/menopause and oncology), and measured the monthly average search volume within the United States for each keyword with all its possible combinations using Google AdWords tool. We found that pregnancy related keywords were less frequently searched in general compared to other categories with an average of 145,400 hits per month for the top twenty keywords. Among the most common pregnancy-related keywords was "pregnancy and sex' while pregnancy-related diseases were uncommonly searched. HPV alone was searched 305,400 times per month. Of the cancers affecting women, breast cancer was the most commonly searched with an average of 247,190 times per month, followed by cervical cancer then ovarian cancer. The commonly searched keywords are often issues that are not discussed in our daily practice as well as in public health messages. The search volume is relatively related to disease prevalence with the exception of ovarian cancer which could signify a public fear.

Minerals, lands, and geology for the common defence and general welfare, Volume 3, 1904-1939 : A history of geology in relation to the development of public-land, federal-science, and mapping policies and the development of mineral resources in the United States from the 25th to the 60th year of the U.S. Geological Survey

USGS Publications Warehouse

Rabbitt, Mary C.

1986-01-01

Mrs. Rabbitt's third volume covers the years 1904 to 1939, from the beginning of the conservation movement under Theodore Roosevelt to the beginning of World War II. From a national perspective, these were years of great development and change in the use of energy, trouble in the coal industry, and a great expansion in the oil industry. They were also years in which the public perceived for the first time that the Nation's mineral resources are not infinite, and the mineral industry realized its dependence on international trade. In these years, water became an increasingly valuable commodity, and the need for a national mapping program became abundantly evident. These were also the years when the Federal Government for the most part practiced stringent economy in funding science, but State and municipal agencies increasingly sought the services of the Survey's topographic and water specialists to aid in the solution of local problems. The balance maintained between fundamental and practical research during the first 25 years was more than once upset during the next 25 years, but the successful struggle to maintain a significant level of research laid the groundwork for the tremendous expansion in the Survey in the subsequent years.

The energy dependence of the lateral dose response functions of detectors with various densities in photon-beam dosimetry.

PubMed

Looe, Hui Khee; Harder, Dietrich; Poppe, Björn

2017-02-07

The lateral dose response function is a general characteristic of the volume effect of a detector used for photon dosimetry in a water phantom. It serves as the convolution kernel transforming the true absorbed dose to water profile, which would be produced within the undisturbed water phantom, into the detector-measured signal profile. The shape of the lateral dose response function characterizes (i) the volume averaging attributable to the detector's size and (ii) the disturbance of the secondary electron field associated with the deviation of the electron density of the detector material from the surrounding water. In previous work, the characteristic dependence of the shape of the lateral dose response function upon the electron density of the detector material was studied for 6 MV photons by Monte Carlo simulation of a wall-less voxel-sized detector (Looe et al 2015 Phys. Med. Biol. 60 6585-07). This study is here continued for 60 Co gamma rays and 15 MV photons in comparison with 6 MV photons. It is found (1) that throughout these photon spectra the shapes of the lateral dose response functions are retaining their characteristic dependence on the detector's electron density, and (2) that their energy-dependent changes are only moderate. This appears as a practical advantage because the lateral dose response function can then be treated as practically invariant across a clinical photon beam in spite of the known changes of the photon spectrum with increasing distance from the beam axis.

[Manual therapy in general practice].

PubMed

Березуцкий, Владимир И

2016-01-01

The article is devoted to manual therapy practice for diagnostics and treatment of vertebrogenic pain syndrome in general practice. Analytical roundup of sources proves medical advantage of implementation of manual therapy basic methods by general practice specialists.

Aerial photo volume tables for Douglas-fir in the Pacific Northwest.

Treesearch

Robert B. Pope

1961-01-01

The aerial photo volume tables in this report are tools to be used in obtaining better timber inventories. Volume estimates based on tables such as these, properly field checked, are generally cheaper than ground cruises of comparable accuracy. Photo volume tables also permit rough volume estimates to be made from aerial photos alone when limited time, bad weather, or...

Human resource management in general practice: survey of current practice.

PubMed Central

Newton, J; Hunt, J; Stirling, J

1996-01-01

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters of practice managers reported having received some type of formal training in staff management. CONCLUSION: This study shows that practice size is a major factor associated with differences in the organization and management of staffing. Any initiatives which increase the scale of primary care functions and services would have to address the issues of communication and coordination that might be associated with such a change. PMID:8855013

The Future of General Surgery: Evolving to Meet a Changing Practice.

PubMed

Webber, Eric M; Ronson, Ashley R; Gorman, Lisa J; Taber, Sarah A; Harris, Kenneth A

2016-01-01

Similar to other countries, the practice of General Surgery in Canada has undergone significant evolution over the past 30 years without major changes to the training model. There is growing concern that current General Surgery residency training does not provide the skills required to practice the breadth of General Surgery in all Canadian communities and practice settings. Led by a national Task Force on the Future of General Surgery, this project aimed to develop recommendations on the optimal configuration of General Surgery training in Canada. A series of 4 evidence-based sub-studies and a national survey were launched to inform these recommendations. Generalized findings from the multiple methods of the project speak to the complexity of the current practice of General Surgery: (1) General surgeons have very different practice patterns depending on the location of practice; (2) General Surgery training offers strong preparation for overall clinical competence; (3) Subspecialized training is a new reality for today's general surgeons; and (4) Generation of the report and recommendations for the future of General Surgery. A total of 4 key recommendations were developed to optimize General Surgery for the 21st century. This project demonstrated that a high variability of practice dependent on location contrasts with the principles of implementing the same objectives of training for all General Surgery graduates. The overall results of the project have prompted the Royal College to review the training requirements and consider a more "fit for purpose" training scheme, thus ensuring that General Surgery residency training programs would optimally prepare residents for a broad range of practice settings and locations across Canada. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Integrating counselling into general practice.

PubMed

Stone, L; Blashki, G

2000-03-01

General practice counselling has many significant differences to counselling in other settings. General practitioners have long term relationships with their patients involving physical as well as mental health care. General practitioners are often the first point of contact for distressed patients who may not perceive their problem to have a psychological basis. There are barriers to counselling including time management and cultural expectations of the consultation. To outline a practical biopsychosocial model for counselling in the general practice setting using the knowledge and skills unique to each GP. Theoretical and practical barriers to counselling commonly encountered in general practice are discussed. Assessing the problem in a biopsychosocial format highlights strengths and skills the patient already possesses and involves consideration of physical sensations, emotions, behaviours, key relationships, family, social roles and resources. Counselling in general practice requires flexibility and an ability to adapt available resources to address patient needs in an individually appropriate way.

Network Aggregation in Transportation Planning : Volume I : Summary and Survey

DOT National Transportation Integrated Search

1978-04-01

Volume 1 summarizes research on network aggregation in transportation models. It includes a survey of network aggregation practices, definition of an extraction aggregation model, computational results on a heuristic implementation of the model, and ...

Wayside Energy Storage Study : Volume 1. Summary.

DOT National Transportation Integrated Search

1979-02-01

Volume I summarizes an in-depth application study which was conducted to determine the practicality and viability of using large wayside flywheels to recuperate braking energy from freight trains on long downgrades. The study examined the route struc...

Feasibility planning study for a behavior database. Volume III Appendix B, Compendium of survey questions on drinking and driving and occupant restraints

DOT National Transportation Integrated Search

1987-04-01

The general objective of the project was to determine the feasibility of and the general requirements for a centralized database on driver behavior and attitudes related to drunk driving and occupant restraints. Volume III is a compendium of question...

Feasibility planning study for a behavior database. Volume 2 Appendix A, Summary information on the drinking and driving and occupant restraint surveys

DOT National Transportation Integrated Search

1987-04-24

The general objective of the project was to determine the feasibility of and the general requirements for a centralized database on driver behavior and attitudes related to drunk driving and occupant restraints. Volume I assesses the extent of pertin...

Vertical Integration in Teaching And Learning (VITAL): an approach to medical education in general practice.

PubMed

Dick, Marie-Louise B; King, David B; Mitchell, Geoffrey K; Kelly, Glynn D; Buckley, John F; Garside, Susan J

2007-07-16

There is increasing demand to provide clinical and teaching experiences in the general practice setting. Vertical integration in teaching and learning, whereby teaching and learning roles are shared across all learner stages, has the potential to decrease time demands and stress on general practitioners, to provide teaching skills and experience to GP registrars, and to improve the learning experience for medical students, and may also help meet the increased demand for teaching in general practice. We consider potential advantages and barriers to vertical integration of teaching in general practice, and provide results of focus group discussions with general practice principals and registrars about vertical integration. We recommend further research into the feasibility of using vertical integration to enhance the capacity to teach medical students in general practice.

Flexible but boring: medical students' perceptions of a career in general practice.

PubMed

Koehler, Nicole; McMenamin, Christine

2016-07-01

Australia will continue to face a general practitioner (GP) shortage unless a significant number of medical students make general practice their chosen career. Perceptions regarding general practice may influence career choices. Thus this study investigated what Australian medical students perceived to be the advantages and disadvantages of pursuing a career in general practice via an anonymous online survey. Fifty-one students indicated general practice to be their first ranked career preference, 200 indicated a career other than general practice, and 106 were undecided. Two-hundred and two students reported having been on a GP placement, whereas 88 students had not. Flexibility, continuity of patient care and work-life balance were the three most common stated advantages to pursuing a career in general practice whereas general practice being boring, poorly paid, and of low prestige were the three most common disadvantages stated. Some disadvantages stated by those with a non-GP preference were not stated by those with a GP preference (e.g. lack of procedural skills, lack of career advancement opportunities). Students with more than 80 h of GP placement experience were more likely to list the advantages of work-life balance and a diversity of problems/illnesses/patients than those with no placement experience but were also more likely to list the disadvantage of low prestige. Negative stereotypes regarding general practice continue to exist which may influence students' career choices.

Best Management Practices, Policies and Programs

EPA Pesticide Factsheets

The National Great Practice Compendium highlights outstanding activities, technologies, and programs that prevent trash from entering the aquatic environment and/or that reduce the overall volume of trash that is generated.

A qualitative study of the barriers and enablers to fertility-awareness education in general practice.

PubMed

Hampton, Kerry D; Newton, Jennifer M; Parker, Rhian; Mazza, Danielle

2016-07-01

To understand the barriers and enablers to fertility-awareness education in general practice. Most women along with their primary care practitioners - general practitioners and practice nurses - believe that women should be educated about fertility-awareness when first reporting trouble conceiving. To date, no in-depth study has examined the enablers and challenges of this type of education in general practice. A descriptive exploratory qualitative study using deductive content analysis. General practitioners (N = 11) and practice nurses (N = 20) were recruited from general practices in three socioculturally diverse areas in Victoria, Australia. Data were collected through semistructured interviews based on the 12 domains of a theoretical behaviour change framework from April-August 2012. The participants' responses were organized into themes that fall under the framework domains. The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The biggest enablers were a greater use of nurses trained in fertility-awareness in a collaborative team care arrangement with general practitioners. This study has identified several important barriers and enablers to fertility-awareness education in general practice. Translation into practice of our findings is imperative as the first step in establishing a primary care model in fertility-awareness. This would fill an important gap in the primary care of infertile women and build capacity in general practice to reduce infertility through women's enhanced fertility knowledge. © 2016 John Wiley & Sons Ltd.

Development of a general method for obtaining the geometry of microfluidic networks

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

Razavi, Mohammad Sayed, E-mail: m.sayedrazavi@gmail.com; Salimpour, M. R.; Shirani, Ebrahim

2014-01-15

In the present study, a general method for geometry of fluidic networks is developed with emphasis on pressure-driven flows in the microfluidic applications. The design method is based on general features of network's geometry such as cross-sectional area and length of channels. Also, the method is applicable to various cross-sectional shapes such as circular, rectangular, triangular, and trapezoidal cross sections. Using constructal theory, the flow resistance, energy loss and performance of the network are optimized. Also, by this method, practical design strategies for the fabrication of microfluidic networks can be improved. The design method enables rapid prediction of fluid flowmore » in the complex network of channels and is very useful for improving proper miniaturization and integration of microfluidic networks. Minimization of flow resistance of the network of channels leads to universal constants for consecutive cross-sectional areas and lengths. For a Y-shaped network, the optimal ratios of consecutive cross-section areas (A{sub i+1}/A{sub i}) and lengths (L{sub i+1}/L{sub i}) are obtained as A{sub i+1}/A{sub i} = 2{sup −2/3} and L{sub i+1}/L{sub i} = 2{sup −1/3}, respectively. It is shown that energy loss in the network is proportional to the volume of network. It is also seen when the number of channels is increased both the hydraulic resistance and the volume occupied by the network are increased in a similar manner. Furthermore, the method offers that fabrication of multi-depth and multi-width microchannels should be considered as an integral part of designing procedures. Finally, numerical simulations for the fluid flow in the network have been performed and results show very good agreement with analytic results.« less

Decreased hypothalamus volumes in generalized anxiety disorder but not in panic disorder.

PubMed

Terlevic, Robert; Isola, Miriam; Ragogna, Maria; Meduri, Martina; Canalaz, Francesca; Perini, Laura; Rambaldelli, Gianluca; Travan, Luciana; Crivellato, Enrico; Tognin, Stefania; Como, Giuseppe; Zuiani, Chiara; Bazzocchi, Massimo; Balestrieri, Matteo; Brambilla, Paolo

2013-04-25

The hypothalamus is a brain structure involved in the neuroendocrine aspect of stress and anxiety. Evidence suggests that generalized anxiety disorder (GAD) and panic disorder (PD) might be accompanied by dysfunction of the hypothalamus-pituitary-adrenal axis (HPA), but so far structural alterations were not studied. We investigated hypothalamic volumes in patients with either GAD or PD and in healthy controls. Twelve GAD patients, 11 PD patients and 21 healthy controls underwent a 1.5T MRI scan. Hypothalamus volumes were manually traced by a rater blind to subjects' identity. General linear model for repeated measures (GLM-RM) was used to compare groups on hypothalamic volumes, controlling for total intracranial volume, age and sex. The hypothalamus volume was significantly reduced (p=0.04) in GAD patients, with significant reductions in both the left (p=0.02) and right side (p=0.04). Patients with PD did not differ significantly (p=0.73). Anxiety scores were inversely correlated with hypothalamic volumes. The small sample size could reduce the generalizability of the results while the lack of stress hormone measurements renders functional assessment of the hypothalamus-pituitary-adrenal axis not feasible. The present study showed decreased hypothalamic volumes in GAD patients but not in those with PD. Future longitudinal studies should combine volumetric data with measurements of stress hormones to better elucidate the role of the HPA axis in GAD. Copyright © 2012 Elsevier B.V. All rights reserved.

Atmospheric model development in support of SEASAT. Volume 1: Summary of findings

NASA Technical Reports Server (NTRS)

Kesel, P. G.

1977-01-01

Atmospheric analysis and prediction models of varying (grid) resolution were developed. The models were tested using real observational data for the purpose of assessing the impact of grid resolution on short range numerical weather prediction. The discretionary model procedures were examined so that the computational viability of SEASAT data might be enhanced during the conduct of (future) sensitivity tests. The analysis effort covers: (1) examining the procedures for allowing data to influence the analysis; (2) examining the effects of varying the weights in the analysis procedure; (3) testing and implementing procedures for solving the minimization equation in an optimal way; (4) describing the impact of grid resolution on analysis; and (5) devising and implementing numerous practical solutions to analysis problems, generally.

I-131 Radiation-Induced Myelosuppression in Differentiated Thyroid Cancer Therapy.

PubMed

Probst, Stephan; Abikhzer, Gad; Chaussé, Guillaume; Tamilia, Michael

2018-06-07

Radioactive iodine (RAI) treatment of differentiated thyroid cancer has been used in clinical practice for almost 60 years and is generally accepted to be a safe and efficacious treatment. Severe toxicity in the form of radiation pneumonitis, sometimes progressing to fibrosis, and bone marrow suppression are reported but remain rare. We present a case of severe myelosuppression requiring hospitalization and transfusion support in an otherwise well, young female patient who had received 175 mCi I-131 for low-volume micronodular lung disease one month prior, with a cumulative lifetime administered activity of 575 mCi. The most important risk factors for myelosuppression following RAI are the activity received, the amount of functioning thyroid tissue present, and the lifetime cumulative activity received.

DDM at Work: Reply to comments on "Dependency distance: A new perspective on syntactic patterns in natural languages".

PubMed

Xu, Chunshan; Liang, Junying; Liu, Haitao

2017-07-01

We provide responses to the commentaries in this volume to evaluate, clarify and extend some of the arguments in Dependency distance: A new perspective on syntactic patterns in natural languages. Evidences show that DDM (dependency distance minimization) is an important linguistic universal, biologically or cognitively motivated, in shaping the language system. As a general tendency, DDM works quite well in theoretical argumentations as well as practical applications. However, this does not mean that DDM is the only linguistic universal that works: it is highly possible that other factors, which might be biologically, physically, socially or culturally motivated, work as well to jointly mold languages. Copyright © 2017 Elsevier B.V. All rights reserved.

Moving toward uniform and evidence-based practice of radiotherapy for management of cervical cancer in Ontario, Canada.

PubMed

Shahid, Negin; Craig, Timothy; Westerland, Mary; Ashworth, Allison; Ang, Michelle; D'Souza, David; Sankreacha, Raxa; Fyles, Anthony; Milosevic, Michael; Kong, Iwa

2018-04-19

To recognize the practice of radiotherapy for management of cervical cancer in Ontario, Canada, and to use the results of the survey to harmonize and standardize practice across the province. An electronic survey (SurveyMonkey) was sent to all 14 provincial cancer centers by Cancer Care Ontario Gynecology Community of Practice (CoP) in 2013. The survey included 72 questions in four different categories: general/demographic, pretreatment assessment, external beam radiotherapy (EBRT), and brachytherapy (BT). Ten of 14 centers treated cervical cancer patients and had a dedicated BT suite. All 10 centers had a peer review process for quality assurance. EBRT technique was a 4-field box in eight of 10 centers. The dose/fractionation for pelvic EBRT was 45-50 Gy in 1.8-2 Gy/fraction in all but one center. Nine of 10 centers used high-dose-rate BT. Only one center offered interstitial BT. For treatment planning, two centers used CT and MRI, five centers used CT, and three centers used orthogonal x-rays. Groupe Européen de Curiethérapie and the European Society for Radiotherapy & Oncology guidelines were used in four of seven of the centers for target volume delineation and in five of seven centers for organs at risk dose constraints. All but one center prescribed and reported dose to Point A. The survey identified areas where practice varied across the province. Gynecology CoP used this information to identify priorities for practice change and implemented several strategies to harmonize the care of women with cervical cancer. This highlights the value of interdisciplinary, grass-roots initiatives such as CoPs to standardize practice in a practical manner that directly benefits patients. Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

O*NET Final Technical Report. Volume I [and] Volume II [and] Volume III.

ERIC Educational Resources Information Center

Peterson, Norman G.; Mumford, Michael D.; Borman, Walter C.; Jeanneret, P. Richard; Fleishman, Edwin A.; Levin, Kerry Y.

This document contains the three volumes of the technical report for development of the prototype of the Occupational Information Network (O*NET), which is intended to replace the "Dictionary of Occupational Titles.""General Introduction" (Norman G. Peterson) presents an overview of O*NET's purpose, content, and structure.…

Numeracy and Beyond. Proceedings of the Annual Meeting of the Mathematics Education Research Group of Australasia Incorporated (24th, Sydney, Australia, June 30-July 4, 2001). Volume 1 [and] Volume 2.

ERIC Educational Resources Information Center

Bobis, Janette, Ed.; Perry, Bob, Ed.; Mitchelmore, Michael, Ed.

This document represents volumes 1 and 2 of the proceedings of the 24th annual conference of the Mathematics Education Research Group of Australasia (MERGA) held at the University of Sydney, June 30-July 4, 2001. In volume 1, papers include: (1) "Connecting Mathematics Education Research to Practice" (Judith Sowder); (2) "Understanding, Assessing,…

Mathematics Education beyond 2000: Proceedings of the Annual Meeting of the Mathematics Education Research Group of Australasia (23rd, Fremantle, Western Australia, Australia, July 5-9, 2000). Volume 1 [and] Volume 2.

ERIC Educational Resources Information Center

Bana, Jack, Ed.; Chapman, Anne, Ed.

This document contains Volumes 1 and 2 of the proceedings of the 23rd annual conference of the Mathematics Education Research Group of Australasia Incorporated (MERGA) held at Fremantle, Western Australia, July 5-9, 2000. Papers in Volume 1 include: (1) "Bridging Practices: Intertwining Content and Pedagogy in Teaching and Learning To Teach"…

Outcomes of Cryoballoon Ablation in High- and Low-Volume Atrial Fibrillation Ablation Centres: A Russian Pilot Survey

PubMed Central

Mikhaylov, Evgeny N.; Lebedev, Dmitry S.; Pokushalov, Evgeny A.; Davtyan, Karapet V.; Ivanitskii, Eduard A.; Nechepurenko, Anatoly A.; Kosonogov, Alexey Ya.; Kolunin, Grigory V.; Morozov, Igor A.; Termosesov, Sergey A.; Maykov, Evgeny B.; Khomutinin, Dmitry N.; Eremin, Sergey A.; Mayorov, Igor M.; Romanov, Alexander B.; Shabanov, Vitaliy V.; Shatakhtsyan, Victoria; Tsivkovskii, Viktor; Revishvili, Amiran Sh.; Shlyakhto, Evgeny V.

2015-01-01

Purpose. The results of cryoballoon ablation (CBA) procedure have been mainly derived from studies conducted in experienced atrial fibrillation (AF) ablation centres. Here, we report on CBA efficacy and complications resulting from real practice of this procedure at both high- and low-volume centres. Methods. Among 62 Russian centres performing AF ablation, 15 (24%) used CBA technology for pulmonary vein isolation. The centres were asked to provide a detailed description of all CBA procedures performed and complications, if encountered. Results. Thirteen sites completed interviews on all CBAs in their centres (>95% of CBAs in Russia). Six sites were high-volume AF ablation (>100 AF cases/year) centres, and 7 were low-volume AF ablation. There was no statistical difference in arrhythmia-free rates between high- and low-volume centres (64.6 versus 60.8% at 6 months). Major complications developed in 1.5% of patients and were equally distributed between high- and low-volume centres. Minor procedure-related events were encountered in 8% of patients and were more prevalent in high-volume centres. Total event and vascular access site event rates were higher in women than in men. Conclusions. CBA has an acceptable efficacy profile in real practice. In less experienced AF ablation centres, the major complication rate is equal to that in high-volume centres. PMID:26640789

What determines medical students' career preference for general practice residency training?: a multicenter survey in Japan.

PubMed

Ie, Kenya; Murata, Akiko; Tahara, Masao; Komiyama, Manabu; Ichikawa, Shuhei; Takemura, Yousuke C; Onishi, Hirotaka

2018-01-01

Few studies have systematically explored factors affecting medical students' general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students' general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, "plan to inherit other's practice" positively associated with choosing general practice, whereas "having physician parent" had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: "clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% CI 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% CI 1.01-1.38)". On the contrary, "acute care rather than chronic care", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration. Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

Aquatic Trash Prevention National Great Practices Compendium

EPA Pesticide Factsheets

The National Great Practice Compendium highlights outstanding activities, technologies, and programs that prevent trash from entering the aquatic environment and/or that reduce the overall volume of trash that is generated.

Technology Assessment of Avanced propulsion Systems for Some Classes of Combat Vehicles. Volume 3. Appendices G-M.

DTIC Science & Technology

1978-09-01

generally recognized that the best possible configura- tion for engines operating at high speeds and at high-pressure levels is probably the single...engines is invariably accom- plished by the operation of computer simulation models that generate specific numerical data rather than the generalized re...lationships common to other forms of prime mover based on units of mass or volume. Thus, providing such generalized relation- ships for a Stirling

More practical critical height sampling.

Treesearch

Thomas B. Lynch; Jeffrey H. Gove

2015-01-01

Critical Height Sampling (CHS) (Kitamura 1964) can be used to predict cubic volumes per acre without using volume tables or equations. The critical height is defined as the height at which the tree stem appears to be in borderline condition using the point-sampling angle gauge (e.g. prism). An estimate of cubic volume per acre can be obtained from multiplication of the...

High School Symposium for Earth Systems Education (Columbus, Ohio, October 1994). Proceedings and Summary.

ERIC Educational Resources Information Center

Fortner, Rosanne W., Ed.; Mayer, Victor J., Ed.

This volume contains the proceedings and summary for the Earth Systems Education high school symposium conducted in October, 1994. Selected participants were invited to contribute papers for inclusion in this volume so that other teachers can see how Earth Systems Education (ESE) looks in practice. The volume also contains the context for ESE in…

BOOK REVIEW: Mathematica for Theoretical Physics: Electrodynamics, Quantum Mechanics, General Relativity and Fractals

NASA Astrophysics Data System (ADS)

Heusler, Stefan

2006-12-01

The main focus of the second, enlarged edition of the book Mathematica for Theoretical Physics is on computational examples using the computer program Mathematica in various areas in physics. It is a notebook rather than a textbook. Indeed, the book is just a printout of the Mathematica notebooks included on the CD. The second edition is divided into two volumes, the first covering classical mechanics and nonlinear dynamics, the second dealing with examples in electrodynamics, quantum mechanics, general relativity and fractal geometry. The second volume is not suited for newcomers because basic and simple physical ideas which lead to complex formulas are not explained in detail. Instead, the computer technology makes it possible to write down and manipulate formulas of practically any length. For researchers with experience in computing, the book contains a lot of interesting and non-trivial examples. Most of the examples discussed are standard textbook problems, but the power of Mathematica opens the path to more sophisticated solutions. For example, the exact solution for the perihelion shift of Mercury within general relativity is worked out in detail using elliptic functions. The virial equation of state for molecules' interaction with Lennard-Jones-like potentials is discussed, including both classical and quantum corrections to the second virial coefficient. Interestingly, closed solutions become available using sophisticated computing methods within Mathematica. In my opinion, the textbook should not show formulas in detail which cover three or more pages—these technical data should just be contained on the CD. Instead, the textbook should focus on more detailed explanation of the physical concepts behind the technicalities. The discussion of the virial equation would benefit much from replacing 15 pages of Mathematica output with 15 pages of further explanation and motivation. In this combination, the power of computing merged with physical intuition would be of benefit even for newcomers. In summary, this book shows in a convincing manner how classical problems in physics can be attacked with modern computing technology. The second volume is interesting for experienced users of Mathematica. For students, the textbook can be very useful in combination with a seminar.

Authenticity in the Language Classroom and Beyond: Children and Adolescent Learners. TESOL Classroom Practice Series

ERIC Educational Resources Information Center

Dantas-Whitney, Maria, Ed.; Rilling, Sarah, Ed.

2010-01-01

This volume in the TESOL Classroom Practice Series presents instructional practices that are particularly successful with children and adolescent language learners. These practices take into account the unique needs and characteristics of these age groups and reflect a wide range of educational contexts, goals, and challenges from classrooms in…

The generalization of charged AdS black hole specific volume and number density

NASA Astrophysics Data System (ADS)

Wang, Zi-Liang; He, Miao; Fang, Chao; Sun, Dao-Quan; Deng, Jian-Bo

2017-04-01

In this paper, by proposing a generalized specific volume, we restudy the P- V criticality of charged AdS black holes in the extended phase space. The results show that most of the previous conclusions can be generalized without change, but the ratio {\\tilde{ρ }}_c should be 3 {\\tilde{α }}/16 in general case. Further research on the thermodynamical phase transition of black hole leads us to a natural interpretation of our assumption, and more black hole properties can be generalized. Finally, we study the number density for charged AdS black hole in higher dimensions, the results show the necessity of our assumption.

The associations between indices of patellofemoral geometry and knee pain and patella cartilage volume: a cross-sectional study

PubMed Central

2010-01-01

Background Whilst patellofemoral pain is one of the most common musculoskeletal disorders presenting to orthopaedic clinics, sports clinics, and general practices, factors contributing to its development in the absence of a defined arthropathy, such as osteoarthritis (OA), are unclear. The aim of this cross-sectional study was to describe the relationships between parameters of patellofemoral geometry (patella inclination, sulcus angle and patella height) and knee pain and patella cartilage volume. Methods 240 community-based adults aged 25-60 years were recruited to take part in a study of obesity and musculoskeletal health. Magnetic resonance imaging (MRI) of the dominant knee was used to determine the lateral condyle-patella angle, sulcus angle, and Insall-Salvati ratio, as well as patella cartilage and bone volumes. Pain was assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) VA pain subscale. Results Increased lateral condyle-patella angle (increased medial patella inclination) was associated with a reduction in WOMAC pain score (Regression coefficient -1.57, 95% CI -3.05, -0.09) and increased medial patella cartilage volume (Regression coefficient 51.38 mm3, 95% CI 1.68, 101.08 mm3). Higher riding patella as indicated by increased Insall-Salvati ratio was associated with decreased medial patella cartilage volume (Regression coefficient -3187 mm3, 95% CI -5510, -864 mm3). There was a trend for increased lateral patella cartilage volume associated with increased (shallower) sulcus angle (Regression coefficient 43.27 mm3, 95% CI -2.43, 88.98 mm3). Conclusion These results suggest both symptomatic and structural benefits associated with a more medially inclined patella while a high-riding patella may be detrimental to patella cartilage. This provides additional theoretical support for the current use of corrective strategies for patella malalignment that are aimed at medial patella translation, although longitudinal studies will be needed to further substantiate this. PMID:20459700

The associations between indices of patellofemoral geometry and knee pain and patella cartilage volume: a cross-sectional study.

PubMed

Tanamas, Stephanie K; Teichtahl, Andrew J; Wluka, Anita E; Wang, Yuanyuan; Davies-Tuck, Miranda; Urquhart, Donna M; Jones, Graeme; Cicuttini, Flavia M

2010-05-10

Whilst patellofemoral pain is one of the most common musculoskeletal disorders presenting to orthopaedic clinics, sports clinics, and general practices, factors contributing to its development in the absence of a defined arthropathy, such as osteoarthritis (OA), are unclear.The aim of this cross-sectional study was to describe the relationships between parameters of patellofemoral geometry (patella inclination, sulcus angle and patella height) and knee pain and patella cartilage volume. 240 community-based adults aged 25-60 years were recruited to take part in a study of obesity and musculoskeletal health. Magnetic resonance imaging (MRI) of the dominant knee was used to determine the lateral condyle-patella angle, sulcus angle, and Insall-Salvati ratio, as well as patella cartilage and bone volumes. Pain was assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) VA pain subscale. Increased lateral condyle-patella angle (increased medial patella inclination) was associated with a reduction in WOMAC pain score (Regression coefficient -1.57, 95% CI -3.05, -0.09) and increased medial patella cartilage volume (Regression coefficient 51.38 mm3, 95% CI 1.68, 101.08 mm3). Higher riding patella as indicated by increased Insall-Salvati ratio was associated with decreased medial patella cartilage volume (Regression coefficient -3187 mm3, 95% CI -5510, -864 mm3). There was a trend for increased lateral patella cartilage volume associated with increased (shallower) sulcus angle (Regression coefficient 43.27 mm3, 95% CI -2.43, 88.98 mm3). These results suggest both symptomatic and structural benefits associated with a more medially inclined patella while a high-riding patella may be detrimental to patella cartilage. This provides additional theoretical support for the current use of corrective strategies for patella malalignment that are aimed at medial patella translation, although longitudinal studies will be needed to further substantiate this.

Supervision--growing and building a sustainable general practice supervisor system.

PubMed

Thomson, Jennifer S; Anderson, Katrina J; Mara, Paul R; Stevenson, Alexander D

2011-06-06

This article explores various models and ideas for future sustainable general practice vocational training supervision in Australia. The general practitioner supervisor in the clinical practice setting is currently central to training the future general practice workforce. Finding ways to recruit, retain and motivate both new and experienced GP teachers is discussed, as is the creation of career paths for such teachers. Some of the newer methods of practice-based teaching are considered for further development, including vertically integrated teaching, e-learning, wave consulting and teaching on the run, teaching teams and remote teaching. Approaches to supporting and resourcing teaching and the required infrastructure are also considered. Further research into sustaining the practice-based general practice supervision model will be required.

STORMWATER BEST MANAGEMENT PRACTICES DESIGN GUIDE VOLUME 3 - BASIN BEST MANAGEMENT PRACTICES

EPA Science Inventory

This manual provides design guidelines for a group of stormwater management (SWM) best management practices (BMPs) broadly referred to as basin or pond BMPs. Basin BMPs are the mainstay of stormwater management. Water resources engineers have designed small and large ponds for ma...

Professional Practice Schools: Building a Model. Volume II.

ERIC Educational Resources Information Center

Levine, Marsha, Ed.

This collection of papers addresses three important aspects of professional practice schools: student learning, teacher development, and implementation issues related to collaboration among institutions and state policy environment. The first paper, "The Child as Meaning Maker: The Organizing Theme of Professional Practice Schools" (Ellen M.…

A Survey of Optometry Graduates to Determine Practice Patterns: Part II: Licensure and Practice Establishment Experiences.

ERIC Educational Resources Information Center

Bleimann, Robert L.; Smith, Lee W.

1985-01-01

A summary of Part II of a two-volume study of optometry graduates conducted by the Association of Schools and Colleges of Optometry is presented. Part II includes the analysis of the graduates' licensure and practice establishment experiences. (MLW)

Video-assisted feedback in general practice internships using German general practitioner's guidelines

PubMed Central

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. Teaching method: First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient – student – consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. Feasibility: The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept. The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. Conclusion: This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out. PMID:23255963

Video-assisted feedback in general practice internships using German general practitioner's guidelines.

PubMed

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient - student - consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The Following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept.The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out.

Brain structure mediates the association between height and cognitive ability.

PubMed

Vuoksimaa, Eero; Panizzon, Matthew S; Franz, Carol E; Fennema-Notestine, Christine; Hagler, Donald J; Lyons, Michael J; Dale, Anders M; Kremen, William S

2018-05-11

Height and general cognitive ability are positively associated, but the underlying mechanisms of this relationship are not well understood. Both height and general cognitive ability are positively associated with brain size. Still, the neural substrate of the height-cognitive ability association is unclear. We used a sample of 515 middle-aged male twins with structural magnetic resonance imaging data to investigate whether the association between height and cognitive ability is mediated by cortical size. In addition to cortical volume, we used genetically, ontogenetically and phylogenetically distinct cortical metrics of total cortical surface area and mean cortical thickness. Height was positively associated with general cognitive ability and total cortical volume and cortical surface area, but not with mean cortical thickness. Mediation models indicated that the well-replicated height-general cognitive ability association is accounted for by individual differences in total cortical volume and cortical surface area (highly heritable metrics related to global brain size), and that the genetic association between cortical surface area and general cognitive ability underlies the phenotypic height-general cognitive ability relationship.

Manufacturing cost analysis of a parabolic dish concentrator (General Electric design) for solar thermal electric power systems in selected production volumes

NASA Technical Reports Server (NTRS)

1981-01-01

The manufacturing cost of a General Electric 12 meter diameter concentrator was estimated. This parabolic dish concentrator for solar thermal system was costed in annual production volumes of 100 - 1,000 - 5,000 - 10,000 - 50,000 100,000 - 400,000 and 1,000,000 units. Presented for each volume are the costs of direct labor, material, burden, tooling, capital equipment and buildings. Also presented is the direct labor personnel and factory space requirements. All costs are based on early 1981 economics.

Integrated Information Support System (IISS). Volume 5. Common Data Model Subsystem. Part 2. CDMP Test Case Report.

DTIC Science & Technology

1985-11-01

As a o11066v. nlstle VSuSY £6I5PSAY I’ Iu PAS 11. Title Integrated Information Support System (1SS) Vol V - Common Data Model Subsystem Part 2 - CIMP ...AD-Mel1 236 INTEGRATED INFORMATION SUPPORT SYSTEM (IISS) VOLUME 5 1/2 COMMON DATA MODEL S.. (U) GENERAL ELECTRIC CO SCHENECTADY NY PRODUCTION...Volume V - Common Data Model Subsystem Part 2 - CDMP Test Case Report General Electric Company Production Resources Consulting One River Road

A real-world approach to Evidence-Based Medicine in general practice: a competency framework derived from a systematic review and Delphi process.

PubMed

Galbraith, Kevin; Ward, Alison; Heneghan, Carl

2017-05-03

Evidence-Based Medicine (EBM) skills have been included in general practice curricula and competency frameworks. However, GPs experience numerous barriers to developing and maintaining EBM skills, and some GPs feel the EBM movement misunderstands, and threatens their traditional role. We therefore need a new approach that acknowledges the constraints encountered in real-world general practice. The aim of this study was to synthesise from empirical research a real-world EBM competency framework for general practice, which could be applied in training, in the individual pursuit of continuing professional development, and in routine care. We sought to integrate evidence from the literature with evidence derived from the opinions of experts in the fields of general practice and EBM. We synthesised two sets of themes describing the meaning of EBM in general practice. One set of themes was derived from a mixed-methods systematic review of the literature; the other set was derived from the further development of those themes using a Delphi process among a panel of EBM and general practice experts. From these two sets of themes we constructed a real-world EBM competency framework for general practice. A simple competency framework was constructed, that acknowledges the constraints of real-world general practice: (1) mindfulness - in one's approach towards EBM itself, and to the influences on decision-making; (2) pragmatism - in one's approach to finding and evaluating evidence; and (3) knowledge of the patient - as the most useful resource in effective communication of evidence. We present a clinical scenario to illustrate how a GP might demonstrate these competencies in their routine daily work. We have proposed a real-world EBM competency framework for general practice, derived from empirical research, which acknowledges the constraints encountered in modern general practice. Further validation of these competencies is required, both as an educational resource and as a strategy for actual practice.

A multifractal approach to space-filling recovery for PET quantification

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

Willaime, Julien M. Y., E-mail: julien.willaime@siemens.com; Aboagye, Eric O.; Tsoumpas, Charalampos

2014-11-01

Purpose: A new image-based methodology is developed for estimating the apparent space-filling properties of an object of interest in PET imaging without need for a robust segmentation step and used to recover accurate estimates of total lesion activity (TLA). Methods: A multifractal approach and the fractal dimension are proposed to recover the apparent space-filling index of a lesion (tumor volume, TV) embedded in nonzero background. A practical implementation is proposed, and the index is subsequently used with mean standardized uptake value (SUV {sub mean}) to correct TLA estimates obtained from approximate lesion contours. The methodology is illustrated on fractal andmore » synthetic objects contaminated by partial volume effects (PVEs), validated on realistic {sup 18}F-fluorodeoxyglucose PET simulations and tested for its robustness using a clinical {sup 18}F-fluorothymidine PET test–retest dataset. Results: TLA estimates were stable for a range of resolutions typical in PET oncology (4–6 mm). By contrast, the space-filling index and intensity estimates were resolution dependent. TLA was generally recovered within 15% of ground truth on postfiltered PET images affected by PVEs. Volumes were recovered within 15% variability in the repeatability study. Results indicated that TLA is a more robust index than other traditional metrics such as SUV {sub mean} or TV measurements across imaging protocols. Conclusions: The fractal procedure reported here is proposed as a simple and effective computational alternative to existing methodologies which require the incorporation of image preprocessing steps (i.e., partial volume correction and automatic segmentation) prior to quantification.« less

The impact of new forms of large-scale general practice provider collaborations on England's NHS: a systematic review.

PubMed

Pettigrew, Luisa M; Kumpunen, Stephanie; Mays, Nicholas; Rosen, Rebecca; Posaner, Rachel

2018-03-01

Over the past decade, collaboration between general practices in England to form new provider networks and large-scale organisations has been driven largely by grassroots action among GPs. However, it is now being increasingly advocated for by national policymakers. Expectations of what scaling up general practice in England will achieve are significant. To review the evidence of the impact of new forms of large-scale general practice provider collaborations in England. Systematic review. Embase, MEDLINE, Health Management Information Consortium, and Social Sciences Citation Index were searched for studies reporting the impact on clinical processes and outcomes, patient experience, workforce satisfaction, or costs of new forms of provider collaborations between general practices in England. A total of 1782 publications were screened. Five studies met the inclusion criteria and four examined the same general practice networks, limiting generalisability. Substantial financial investment was required to establish the networks and the associated interventions that were targeted at four clinical areas. Quality improvements were achieved through standardised processes, incentives at network level, information technology-enabled performance dashboards, and local network management. The fifth study of a large-scale multisite general practice organisation showed that it may be better placed to implement safety and quality processes than conventional practices. However, unintended consequences may arise, such as perceptions of disenfranchisement among staff and reductions in continuity of care. Good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce. As more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why. © British Journal of General Practice 2018.

An Independent Scientific Assessment of Well Stimulation in California Volume III

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

Jane C.S. Long; Laura C. Feinstein; Birkholzer, Jens

This study is issued in three volumes. Volume I, issued in January 2015, describes how well stimulation technologies work, how and where operators deploy these technologies for oil and gas production in California, and where they might enable production in the future. Volume II, issued in July 2015, discusses how well stimulation could affect water, atmosphere, seismic activity, wildlife and vegetation, and human health. Volume II reviews available data, and identifies knowledge gaps and alternative practices that could avoid or mitigate these possible impacts. Volume III, this volume, presents case studies that assess environmental issues and qualitative risks for specificmore » geographic regions. The Summary Report summarizes key findings, conclusions and recommendations of all three volumes.« less

An Independent Scientific Assessment of Well Stimulation in California Volume II

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

Jane C.S. Long; Laura C. Feinstein; Corinne E. Bachmann

This study is issued in three volumes. Volume I, issued in January 2015, describes how well stimulation technologies work, how and where operators deploy these technologies for oil and gas production in California, and where they might enable production in the future. Volume II, the present volume, discusses how well stimulation could affect water, atmosphere, seismic activity, wildlife and vegetation, and human health. Volume II reviews available data, and identifies knowledge gaps and alternative practices that could avoid or mitigate these possible impacts. Volume III, also issued in July 2015, presents case studies that assess environmental issues and qualitative risksmore » for specific geographic regions. A final Summary Report summarizes key findings, conclusions and recommendations of all three volumes.« less

Camping and Backpacking. A Guide to Information Sources. Volume 2 in the Sports, Games and Pastimes Information Guide Series.

ERIC Educational Resources Information Center

Clotfelter, Cecil F.; Clotfelter, Mary L.

Sources of information regarding camping, backpacking, and related activities are annotated in a comprehensive listing of books, films and other non-print media, pamphlets, and periodicals largely dating from 1960. The volume contains chapters pertaining to: general directories, general camping, organized camping, camp related activities,…

Teaching Language-Deviant Children to Generalize Newly Taught Language: A Socio-Ecological Approach. Volume II. Final Report.

ERIC Educational Resources Information Center

Schiefelbusch, R. L.; Rogers-Warren, Ann

The second volume of a final report on language generalization of severely and moderately retarded and mildly language delayed children is composed of eight appendixes. Introductory information lists project dissemination activities, including published articles and presented papers. Appendix 1 details the two language training programs used in…

Field Operations and Enforcement Manual for Air Pollution Control. Volume II: Control Technology and General Source Inspection.

ERIC Educational Resources Information Center

Weisburd, Melvin I.

The Field Operations and Enforcement Manual for Air Pollution Control, Volume II, explains in detail the following: technology of source control, modification of operations, particulate control equipment, sulfur dioxide removal systems for power plants, and control equipment for gases and vapors; inspection procedures for general sources, fuel…

Survey of attitudes, materials and methods employed in endodontic treatment by general dental practitioners in North Jordan.

PubMed

Al-Omari, Wael M

2004-09-10

BACKGROUND: General dental practitioners provide the majority of endodontic treatment in Jordan. The aim of this study was to gather information on the methods, materials and attitudes employed in root canal treatment by dentists in North Jordan, in order to evaluate and improve the quality of current practice. METHODS: A questionnaire was posted to all registered general dental practitioners working in private practice in Irbid Governate in North Jordan (n = 181). The questionnaire included information on methods, materials and techniques used in endodontic treatment. RESULTS: Reply rate was 72% (n = 131). The results demonstrated that only five dentists used rubber dam occasionally and not routinely. The majority used cotton rolls for isolation solely or in combination with a high volume saliva ejector (n = 116). The most widely used irrigants were sodium hypochlorite and hydrogen peroxide, which were used by 32.9% (n = 43) and 33.6% (n = 44) of the respondents, respectively. Forty eight percent of the respondents (n = 61) used the cold lateral condensation technique for canal obturation, 31.3% (n = 41) used single cone, 9.9% (n = 13) used vertical condensation and 12.2% (n = 16) used paste or cement only for the obturation. The majority used zinc oxide eugenol as a sealer (72.5%). All, but one, respondents used hand instruments for canal preparation and the technique of choice was step back (52.7%). More than 50% (n = 70) of the dentists took one radiograph for determining the working length, whilst 22.9% (n = 30) did not take any radiograph at all. Most practitioners performed treatment in three visits for teeth with two or more root canals, and in two visits for teeth with a single root canal. CONCLUSIONS: This study indicates that dentists practicing in North Jordan do not comply with international quality standards and do not use recently introduced techniques. Many clinicians never take a radiograph for determining the working length and never used rubber dam or intra-canal medicaments.

Improving the Test-Retest Reliability of Resting State fMRI by Removing the Impact of Sleep.

PubMed

Wang, Jiahui; Han, Junwei; Nguyen, Vinh T; Guo, Lei; Guo, Christine C

2017-01-01

Resting state functional magnetic resonance imaging (rs-fMRI) provides a powerful tool to examine large-scale neural networks in the human brain and their disturbances in neuropsychiatric disorders. Thanks to its low demand and high tolerance, resting state paradigms can be easily acquired from clinical population. However, due to the unconstrained nature, resting state paradigm is associated with excessive head movement and proneness to sleep. Consequently, the test-retest reliability of rs-fMRI measures is moderate at best, falling short of widespread use in the clinic. Here, we characterized the effect of sleep on the test-retest reliability of rs-fMRI. Using measures of heart rate variability (HRV) derived from simultaneous electrocardiogram (ECG) recording, we identified portions of fMRI data when subjects were more alert or sleepy, and examined their effects on the test-retest reliability of functional connectivity measures. When volumes of sleep were excluded, the reliability of rs-fMRI is significantly improved, and the improvement appears to be general across brain networks. The amount of improvement is robust with the removal of as much as 60% volumes of sleepiness. Therefore, test-retest reliability of rs-fMRI is affected by sleep and could be improved by excluding volumes of sleepiness as indexed by HRV. Our results suggest a novel and practical method to improve test-retest reliability of rs-fMRI measures.

Volume-preserving normal forms of Hopf-zero singularity

NASA Astrophysics Data System (ADS)

Gazor, Majid; Mokhtari, Fahimeh

2013-10-01

A practical method is described for computing the unique generator of the algebra of first integrals associated with a large class of Hopf-zero singularity. The set of all volume-preserving classical normal forms of this singularity is introduced via a Lie algebra description. This is a maximal vector space of classical normal forms with first integral; this is whence our approach works. Systems with a nonzero condition on their quadratic parts are considered. The algebra of all first integrals for any such system has a unique (modulo scalar multiplication) generator. The infinite level volume-preserving parametric normal forms of any nondegenerate perturbation within the Lie algebra of any such system is computed, where it can have rich dynamics. The associated unique generator of the algebra of first integrals are derived. The symmetry group of the infinite level normal forms are also discussed. Some necessary formulas are derived and applied to appropriately modified Rössler and generalized Kuramoto-Sivashinsky equations to demonstrate the applicability of our theoretical results. An approach (introduced by Iooss and Lombardi) is applied to find an optimal truncation for the first level normal forms of these examples with exponentially small remainders. The numerically suggested radius of convergence (for the first integral) associated with a hypernormalization step is discussed for the truncated first level normal forms of the examples. This is achieved by an efficient implementation of the results using Maple.

Regionalisation of general practice training--are we meeting the needs of rural Australia?

PubMed

Campbell, David G; Greacen, Jane H; Giddings, Patrick H; Skinner, Lesley P

2011-06-06

The concept of "social accountability" has underpinned the development of many medical education programs over the past decade. Success of the regionalisation of the general practice training program in Australia will ultimately be measured by the ability of the program to deliver a sufficient rural general practice workforce to meet the health needs of rural communities. Regionalisation of general practice training in Australia arose from the 1998 recommendations of the Ministerial Review of General Practice Training. The resultant competitive structure adopted by government was not the preferred option of the Review Committee, and may be a negative influence on rural workforce, as the competitive corporate structure of regional training providers has created barriers to meaningful vertical integration. Available data suggest that the regionalised training program is not yet providing a sustainable general practice workforce to rural Australia. The current increase in medical student and general practice training places provides an opportunity to address some of these issues. In particular, it is recommended that changes be made to registrar selection processes, the rural pipeline and vertical integration of training, and training for procedural rural practice. To achieve these goals, perhaps it is time for another comprehensive ministerial review of general practice training in Australia.

Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice.

PubMed

MacKichan, Fiona; Brangan, Emer; Wye, Lesley; Checkland, Kath; Lasserson, Daniel; Huntley, Alyson; Morris, Richard; Tammes, Peter; Salisbury, Chris; Purdy, Sarah

2017-05-04

To describe how processes of primary care access influence decisions to seek help at the emergency department (ED). Ethnographic case study combining non-participant observation, informal and formal interviewing. Six general practitioner (GP) practices located in three commissioning organisations in England. Reception areas at each practice were observed over the course of a working week (73 hours in total). Practice documents were collected and clinical and non-clinical staff were interviewed (n=19). Patients with recent ED use, or a carer if aged 16 and under, were interviewed (n=29). Past experience of accessing GP care recursively informed patient decisions about where to seek urgent care, and difficulties with access were implicit in patient accounts of ED use. GP practices had complicated, changeable systems for appointments. This made navigating appointment booking difficult for patients and reception staff, and engendered a mistrust of the system. Increasingly, the telephone was the instrument of demand management, but there were unintended consequences for access. Some patient groups, such as those with English as an additional language, were particularly disadvantaged, and the varying patient and staff semantic of words like 'urgent' and 'emergency' was exacerbated during telephone interactions. Poor integration between in-hours and out-of-hours care and patient perceptions of the quality of care accessible at their GP practice also informed ED use. This study provides important insight into the implicit role of primary care access on the use of ED. Discourses around 'inappropriate' patient demand neglect to recognise that decisions about where to seek urgent care are based on experiential knowledge. Simply speeding up access to primary care or increasing its volume is unlikely to alleviate rising ED use. Systems for accessing care need to be transparent, perceptibly fair and appropriate to the needs of diverse patient groups. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The place of knowledge and evidence in the context of Australian general practice nursing.

PubMed

Mills, Jane; Field, John; Cant, Robyn

2009-01-01

The purpose of the study was to ascertain the place of knowledge and evidence in the context of Australian general practice nursing. General practice nursing is a rapidly developing area of specialized nursing in Australia. The provision of primary care services in Australia rests largely with medical general practitioners who employ nurses in a small business model. A statistical research design was used that included a validated instrument: the developing evidence-based practice questionnaire (Gerrish et al. 2007). A total of 1,800 Victorian practice nurses were surveyed with a return of 590 completed questionnaires, equaling a response rate of 33%. Lack of time to access knowledge for practice was a barrier for participants in this study. In-service education and training opportunities were ranked as the number one source of knowledge for general practice nurses. Experiential learning and interactions with clients, peers, medical practitioners, and specialist nurses were also considered very important sources of knowledge. Research journals were ranked much lower than experiential learning and personal interactions. Participants assessed their own skills at sourcing and translating evidence into practice knowledge as low. Younger general practice nurses were more likely than older nurses to assess themselves as competent at using the library and Internet to locate evidence. The predominantly oral culture of nursing needs to be identified and incorporated into methods for disseminating evidence from research findings in order to increase the knowledge base of Australian general practice nurses. Findings from this study will be significant for policy makers and funders of Australian nursing in general practice. The establishment of a career structure for general practice nurses that includes salaried positions for clinical nurse specialists would assist in the translation of evidence into knowledge for utilization at the point of care.

Challenges in Accommodating Volume Change of Si Anodes for Li-Ion Batteries

PubMed Central

Ko, Minseong; Chae, Sujong; Cho, Jaephil

2015-01-01

Si has been considered as a promising alternative anode for next-generation Li-ion batteries (LIBs) because of its high theoretical energy density, relatively low working potential, and abundance in nature. However, Si anodes exhibit rapid capacity decay and an increase in the internal resistance, which are caused by the large volume changes upon Li insertion and extraction. This unfortunately limits their practical applications. Therefore, managing the total volume change remains a critical challenge for effectively alleviating the mechanical fractures and instability of solid-electrolyte-interphase products. In this regard, we review the recent progress in volume-change-accommodating Si electrodes and investigate their ingenious structures with significant improvements in the battery performance, including size-controlled materials, patterned thin films, porous structures, shape-preserving shell designs, and graphene composites. These representative approaches potentially overcome the large morphologic changes in the volume of Si anodes by securing the strain relaxation and structural integrity in the entire electrode. Finally, we propose perspectives and future challenges to realize the practical application of Si anodes in LIB systems. PMID:27525208

General practitioners’ experiences using cognitive behavioural therapy in general practice: A qualitative study

PubMed Central

Aschim, Bente; Lundevall, Sverre; Martinsen, Egil W.; Frich, Jan C.

2011-01-01

Objective To explore GPs’ experiences using cognitive behavioural therapy (CBT), with a focus on factors that promote or limit the use of CBT in general practice. Design Qualitative study using data from written evaluation reports and focus-group interviews. Setting Norwegian general practice. Subjects GPs who participated in a longitudinal CBT course in the continuous medical education (CME) programme for GPs in Norway, of whom 19 filled in evaluation forms and 15 participated in focus-group interviews. Main outcome measures Experiences with the use of CBT in general practice. Results GPs used CBT mainly in the treatment of patients with anxiety disorders and depression. Factors that promoted the use of CBT in general practice were structured supervision and group counselling, receiving feedback on individual video-recorded consultations, and experiencing that one mastered the therapeutic techniques. Limiting factors were that it took some time before one mastered the techniques, lack of eligible patients, constraints related to attending group supervision during office hours, and the lack of financial incentives to use CBT in general practice. Conclusion Tailored training programmes in CBT for GPs may contribute to more frequent use of CBT in general practice. A formal recognition of CBT in the reimbursement scheme for GPs might counter limiting factors to an increased use of CBT in general practice. PMID:21861599

Thaw weakening and load restriction practices on low volume roads

DOT National Transportation Integrated Search

2000-06-01

Low volume roads subjected to seasonal freezing are highly susceptible to damage from traffic during midwinter and spring thaws. Such traffic-induced damage can be minimized by a variety of design methods; however, most are not economically feasible....

Wayside Energy Storage Study : Volume 2. Detailed Description of Analysis.

DOT National Transportation Integrated Search

1979-02-01

Volume II summarizes an in-depth application study which was conducted to determine the practicality and viability of using large wayside flywheels to recuperate braking energy from freight trains on long downgrades. The study examined the route stru...

Lateral support systems and underpinning, volume III : construction methods.

DOT National Transportation Integrated Search

1976-04-01

This report provides current information and design guidelines on cut-and-cover tunneling for practicing engineers. The main emphasis is on the geotechnical aspects of engineering. Included in this volume is a state-of-the-art summary of displacement...

Lateral support systems and underpinning, volume II : design fundamentals.

DOT National Transportation Integrated Search

1976-04-01

This report provides current information and design guidelines on cut-and-cover : tunneling for practicing engineers. The main emphasis is on the geotechnical : aspects of engineering. Included in this volume is a state-of-the-art summary of : displa...

Lateral Support Systems And Underpinning. Volume II. Design Fundamentals

DOT National Transportation Integrated Search

1976-04-01

This report provides current information and design guidelines on cut-and-cover tunneling for practicing engineers. The main emphasis is on the geotechnical aspects of engineering. Included in this volume is a state-of-the-art summary of displacement...

Improving vaccination cold chain in the general practice setting.

PubMed

Page, Sue L; Earnest, Arul; Birden, Hudson; Deaker, Rachelle; Clark, Chris

2008-10-01

This study compared temperature control in different types of vaccine storing refrigerators in general practice and tested knowledge of general practice staff in vaccine storage requirements. Temperature data loggers were set to serially record the temperature within vaccine refrigerators in 28 general practices, recording at 12 minute intervals over a period of 10 days on each occasion. A survey of vaccine storage knowledge and records of divisions of general practice immunisation contacts were also obtained. There was a significant relationship between type of refrigerator and optimal temperature, with the odds ratio for bar style refrigerator being 0.005 (95% CI: 0.001-0.044) compared to the purpose built vaccine refrigerators. Score on a survey of vaccine storage was also positively associated with optimal storage temperature. General practices that invest in purpose built vaccine refrigerators will achieve standards of vaccine cold chain maintenance significantly more reliably than can be achieved through regular cold chain monitoring and practice supports.

Shared learning in general practice--facilitators and barriers.

PubMed

van de Mortel, Thea; Silberberg, Peter; Ahern, Christine

2013-03-01

Capacity for teaching in general practice clinics is limited. Shared learning sessions are one form of vertically integrated teaching that may ameliorate capacity constraints. This study sought to understand the perceptions of general practitioner supervisors, learners and practice staff of the facilitators of shared learning in general practice clinics. Using a grounded theory approach, semistructured interviews were conducted and analysed to generate a theory about the topic. Thirty-five stakeholders from nine general practices participated. Facilitators of shared learning included enabling factors such as small group facilitation skills, space, administrative support and technological resources; reinforcing factors such as targeted funding, and predisposing factors such as participant attributes. Views from multiple stakeholders suggest that the implementation of shared learning in general practice clinics would be supported by an ecological approach that addresses all these factors.

The Operative Burden of General Surgical Disease and Non-Battle Injury in a Deployed Military Treatment Facility in Afghanistan.

PubMed

Hollingsworth, Andrew C; Bowley, Douglas M; Lundy, Jonathan B

2016-09-01

Contemporary medical operations support a mobile, nonconventional force involved in nation building, counterinsurgency, and humanitarian operations. Prior reports have described surgical care for disease and nonbattle injuries (DNBI). The purpose of this report is to describe the prevalence and scope of DNBI managed by general surgeons in a contemporary, deployed medical facility. A 2-year retrospective review of the operative logbook from the U.K. Role 3 Multinational Hospital, Camp Bastion, Afghanistan, was performed to determine the prevalence and makeup of procedures performed for DNBI by general surgeons. Nontrauma general surgical procedures accounted for 7.7% (n = 279 of 3,607 cases) of cases; appendectomy (n = 146) was the most common, followed by drainage of soft tissue (n = 55) and oral abscesses (n = 5), scrotal exploration (n = 12), and hernia repair (n = 7). A total of 7.2% (n = 20 of 279) of cases fell outside the standard scope of practice of an urban, civilian general surgeon. Although the prevalence of operative procedures for DNBI was low, the spectrum of cases included those not typically managed in the civilian setting of the United Kingdom. With an evolving decline in case volume performed in multiple anatomic locations due to subspecialization during surgical training, this gap in expertise is likely to increase. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

APA Handbook of Industrial and Organizational Psychology. Three-Volume Set--Volume 1: Building and Developing the Organization. Volume 2: Selecting and Developing Members for the Organization. Volume 3: Maintaining, Expanding, and Contracting the Organization. APA Handbooks in Psychology Series. APA Reference Books Collection

ERIC Educational Resources Information Center

Zedeck, Sheldon, Ed.

2011-01-01

APA Books® announces the "APA Handbook of Industrial and Organizational Psychology"--the first offering in an new reference series covering core and emerging subdisciplines, the "APA Handbooks in Psychology." I/O Psychology is both a science/practice and an applied/basic research discipline. Appropriately, the "APA…

Mission of the Future. Proceedings of the Annual Convention of the Association for the Development of Computer-Based Instructional Systems. Volume I: General Session Papers and Project Reports (San Diego, California, February 27 to March 1, 1979).

ERIC Educational Resources Information Center

Association for the Development of Computer-based Instructional Systems.

The first of three volumes of papers presented at the 1979 ADCIS convention, this collection includes most of the 30 papers presented at the general session and 34 project reports. The general session opened with seven papers on various aspects of videodisc technology and five papers describing phases in the life of CBE sites. The remaining…

Improving communication between health-care professionals and patients with limited English proficiency in the general practice setting.

PubMed

Attard, Melanie; McArthur, Alexa; Riitano, Dagmara; Aromataris, Edoardo; Bollen, Chris; Pearson, Alan

2015-01-01

Quality service provision and patient safety and satisfaction in encounters with health-care professionals relies on effective communication between the practitioner and patient. This study aimed to identify effective practices for improving communication between clinical staff in general practice and patients with limited English proficiency, and to promote their implementation in general practice. Effective interventions and strategies were identified from a review of international research. Experiences with their use in practice were explored via focus group discussions with general practitioners and practice nurses. The results suggest that, wherever possible, communication in the patient's primary language is preferable; use of a qualified medical interpreter should be promoted, and practices should have a standardised and documented procedure for accessing interpreter services. General practice staff must increase their awareness about services that are available to facilitate communication with patients with limited English proficiency, and also develop attitudes, both individual and organisational, that will maximise the effectiveness of these strategies. These findings were used to develop brief, evidence-based practice guidelines that were disseminated to focus group participants for evaluation of utility and general feedback. This evidence-based guidance is now available to assist clinical and administrative general practice staff across regional and metropolitan South Australia.

Effective Second Language Writing. TESOL Classroom Practice Series

ERIC Educational Resources Information Center

Kasten, Susan, Ed.

2010-01-01

The classroom practices discussed in "Effective Second Language Writing" reflect various trends and methodologies; however, the underlying theme in this volume of the Classroom Practice Series is the need for clear and meaningful communication between ESL writers and their readers. While approaches differ, two core beliefs are constant: ESL…

[Remuneration distribution - should morbidity-dependent overall remuneration also be distributed after adjustments for morbidity?].

PubMed

Walendzik, A; Trottmann, M; Leonhardt, R; Wasem, J

2013-04-01

In the 2009 reform of the German collective remuneration system for outpatient medical care, on the level of overall remuneration, the morbidity risk was transferred to the health funds fulfilling a long-term demand of physicians. Nevertheless not transferring morbidity adjustment to the levels of physician groups and singular practices can lead to budgets not related to patient needs and to incentives for risk selection for individual doctors. The systematics of the distribution of overall remuneration in the German remuneration system for outpatient care are analysed focusing on the aspect of morbidity adjustment. Using diagnostic and pharmaceutical information of about half a million insured subjects, a risk adjustment model able to predict individual expenditures for outpatient care for different provider groups is presented. This model enables to additively split the individual care burden into several parts attributed to different physician groups. Conditions for the use of the model in the distribution of overall remuneration between physician groups are developed. A simulation of the use of diagnoses-based risk adjustment in standard service volumes then highlights the conditions for a successfull installation of standard service volumes representing a higher degree of risk adjustment. The presented estimation model is generally applicable for the distribution of overall remuneration to different physician groups. The simulation of standard service volumes using diagnosis-based risk adjustment does not provide a more accurate prediction of the expenditures on the level of physician practices than the age-related calculation currently used in the German remuneration system for outpatient medical care. Using elements of morbidity-based risk adjustment the current German collective system for outpatient medical care could be transformed towards a higher degree of distributional justice concerning medical care for patients and more appropriate incentives avoiding risk selection. Limitations of the applicability of risk-adjustment can be especially pointed out when a high share of lump-sum-payments is used for the remuneration of some physician groups. © Georg Thieme Verlag KG Stuttgart · New York.

Downed wood in Micronesian mangrove forests

USGS Publications Warehouse

Allen, J.A.; Ewel, K.C.; Keeland, B.D.; Tara, T.; Smith, T. J.

2000-01-01

Dead, downed wood is an important component of upland forest and aquatic ecosystems, but its role in wetland ecosystems, including mangroves, is poorly understood. We measured downed wood in ten sites on the western Pacific islands of Kosrae, Pohnpei, and Yap, all located within the Federated States of Micronesia. Our goals were to examine patterns of variability in the quantity of downed wood in these mangrove ecosystems, provide a general characterization of downed wood in a region with no previously published accounts, and investigate the relationship between harvesting practices and the amount of downed wood. The overall mean volume of downed wood at our study sites was estimated to be 60.8 m3 ha-1 (20.9 t ha-1), which is greater than most published data for forested wetlands. There were significant differences among islands, with the sites on Kosrae (104.2 m3 ha-1) having a much greater mean volume of downed wood than those on Pohnpei (43.1 m3 ha-1) or Yap (35.1 m3 ha-1). Part of the difference among islands may be attributable to differences in stand age and structure, but the most important factor seems to be the greater amount of wood harvesting on Kosrae, coupled with a low efficiency of use of cut trees. Of a total of 45 cut trees examined on Kosrae, no wood had been removed from 18 (40%); these are believed to be trees cut down because other, more valuable, trees were caught on them as they were felled. Of the other 27 trees, only 24 to 42% of the stem volume (to a 10 cm top) was removed from the forest, the amount varying by species. The impacts of current harvesting practices are unknown but may include important effects on tree regeneration and the abundance and species composition of crab populations.

Assessing the P-wave attenuation and phase velocity characteristics of fractured media based on creep and relaxation tests

NASA Astrophysics Data System (ADS)

Milani, Marco; Germán Rubino, J.; Müller, Tobias M.; Quintal, Beatriz; Holliger, Klaus

2014-05-01

Fractures are present in most geological formations and they tend to dominate not only their mechanical but also, and in particular, their hydraulic properties. For these reasons, the detection and characterization of fractures are of great interest in several fields of Earth sciences. Seismic attenuation has been recognized as a key attribute for this purpose, as both laboratory and field experiments indicate that the presence of fractures typically produces significant energy dissipation and that this attribute tends to increase with increasing fracture density. This energy loss is generally considered to be primarily due to wave-induced pressure diffusion between the fractures and the embedding porous matrix. That is, due to the strong compressibility contrast between these two domains, the propagation of seismic waves can generate a strong fluid pressure gradient and associated pressure diffusion, which leads to fluid flow and in turn results in frictional energy dissipation. Numerical simulations based on Biot's poroelastic wave equations are computationally very expensive. Alternative approaches consist in performing numerical relaxation or creep tests on representative elementary volumes (REV) of the considered medium. These tests are typically based on Biot's consolidation equations. Assuming that the heterogeneous poroelastic medium can be replaced by an effective, homogeneous viscoelastic solid, these numerical creep and relaxation tests allow for computing the equivalent seismic P-wave attenuation and phase velocity. From a practical point of view, an REV is typically characterized by the smallest volume for which rock physical properties are statistically stationary and representative of the probed medium in its entirety. A more general definition in the context of wavefield attributes is to consider an REV as the smallest volume over which the P-wave attenuation and phase velocity dispersion are independent of the applied boundary conditions. That is, the corresponding results obtained from creep and relaxation tests must be equivalent. For most analyses of media characterized by patchy saturation or double-porosity-type structures these two definitions are equivalent. It is, however, not clear whether this equivalence remains true in the presence of strong material contrasts as those prevailing in fractured rocks. In this work, we explore this question for periodically fractured media. To this end, we build a medium composed of infinite replicas of a unit volume containing one fracture. This unit volume coincides with the smallest possible volume that is statistically representative of the whole. Then, we perform several creep and relaxation tests on samples composed of an increasing number of these unit volumes. We find that the wave field signatures determined from relaxation tests are independent from the number of unit volumes. Conversely, the P-wave attenuation and phase velocity characteristics inferred from creep tests are different and vary with the number of unit volumes considered. Quite interestingly, the creep test results converge with those of the relaxation tests as the number of unit volumes increases. These findings are expected to have direct implications for corresponding laboratory measurements as well as for our understanding of seismic wave propagation in fractured media.

Integrating postgraduate and undergraduate general practice education: qualitative study.

PubMed

O'Regan, Andrew; Culhane, Aidan; Dunne, Colum; Griffin, Michael; McGrath, Deirdre; Meagher, David; O'Dwyer, Pat; Cullen, Walter

2013-05-01

Educational activity in general practice has increased considerably in the past 20 years. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' capacity to fulfil this role. To explore the potential for vertical integration in undergraduate and postgraduate education in general practice, by describing the experience of (and attitudes towards) 'vertical integration in general practice education' among key stakeholder groups. Qualitative study of GPs, practice staff, GPs-in-training and medical students involving focus groups which were thematically analysed. We identified four overarching themes: (1) Important practical features of vertical integration are interaction between learners at different stages, active involvement in clinical teams and interagency collaboration; (2) Vertical integration may benefit GPs/practices, students and patients through improved practice systems, exposure to team-working and multi-morbidity and opportunistic health promotion, respectively; (3) Capacity issues may challenge its implementation; (4) Strategies such as recognising and addressing diverse learner needs and inter-agency collaboration can promote vertical integration. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' teaching capacity. Recognising the diverse educational needs of learners at different stages and collaboration between agencies responsible for the planning and delivery of specialist training and medical degree programmes would appear to be important.

Practical Approaches to Curriculum Development. A Management Handbook. Project HIRE: A Curriculum Management System for Instructing the Handicapped. Final Report, Volume 2.

ERIC Educational Resources Information Center

Gardner, David C.; Beatty, Grace Joely

Within the context of the major objectives of developing, field testing, and refining the curriculum materials described in volume 1 of this final report (CE 024 117), Volume 2 describes and critiques the management system used by Project HIRE in that development process. (See Note for availability of curriculum materials.) Chapter 1 introduces…

An Overview of Skill Standards Systems in Education & Industry. Systems in the U.S. and Abroad. Volume I.

ERIC Educational Resources Information Center

Institute for Educational Leadership, Washington, DC.

This first volume in a four-volume study of industry- and education-driven skill standards in the United States and other countries describes current practice. Chapter I is the executive summary. Chapter II is an overview of historical and current issues that will affect a voluntary network of industry-based skill standards, competencies, and…

Wildlife conservation in fragmented tropical forests: A case of South Garo Hills, Meghalaya, North East India

Treesearch

Ashish Kumar; Bruce G. Marcot; Rohitkumar Patel

2017-01-01

This volume presents findings on, and implications for, wildlife conservation in the tropical forests in Garo Hills of Meghalaya state in the North East India. A companion volume presented the findings on forest fragmentation due to practice of slash and burn agriculture in the region. Both of the volumes summarize work completed over more than a decade on...

Merchantable height of trees in Oregon—a comparison of current logging practice and volume table specifications.

Treesearch

Don Minore; Donald R. Gedney

1960-01-01

A large proportion of present-day timber cruising is done by measuring or estimating three tree dimensions: diameter at breast height, form class, and merchantable height. Tree volumes are then determined from tables which equate volume to the varying combinations of height, d.b.h., and form class. Assumptions concerning merchantable height were made in constructing...

Gross yield and mortality tables for fully stocked stands of Douglas-fir.

Treesearch

George R. Staebler

1955-01-01

Increasing interest in the practice of intensive forestry has demonstrated the need for gross yield tables for Douglas-fir showing the volume of trees that die as well as volume of live trees. Net yield tables for Douglas-fir, published in 1930, give the live volume in fully stocked stands at different ages on different sites. As in all normal yield tables, no...

Becoming willing to role model. Reciprocity between new graduate nurses and experienced practice nurses in general practice in New Zealand: a constructivist grounded theory.

PubMed

Hoarea, Karen J; Millsc, Jane; Francis, Karen

2013-01-01

Graduate nurses in general practice became a feature of New Zealand's health care system in 2008 following an expansion of the New Entrant to Practice Programme. General practice in New Zealand comprises general practitioner business owners who employ nursing and administration staff. Practice nurses are an ageing workforce in New Zealand, it is imperative therefore to attract younger nurses into general practice. This paper reports a section of the findings from a constructivist grounded theory study which examines the use of information by practice nurses in New Zealand. Initially data were collected using the ethnographic technique of observation and field notations in one general practice. Theoretical sensitivity to the value of role models was heightened by this first phase of data collection. A total of eleven practice nurses were interviewed from six general practices. One practice nurse agreed to a second interview; five of the interviewees were new graduate nurses and the other six were experienced practice nurses. The grounded theory constructed from this research was reciprocal role modelling which comprises the following three categories, becoming willing, realising potential and becoming a better practitioner. Graduate nurses and experienced practice nurses enter into a relationship of reciprocal role modelling. Becoming willing, the first core category of this grounded theory features three sub-categories: building respectful relationships, proving yourself and discerning decision making which are reported in this paper. Findings from this study may address the reported phenomenon of 'transition shock' of newly graduated nurses in the work place.

Understanding general practice: a conceptual framework developed from case studies in the UK NHS.

PubMed

Checkland, Kath

2007-01-01

General practice in the UK is undergoing a period of rapid and profound change. Traditionally, research into the effects of change on general practice has tended to regard GPs as individuals or as members of a professional group. To understand the impact of change, general practices should also be considered as organisations. To use the organisational studies literature to build a conceptual framework of general practice organisations, and to test and develop this empirically using case studies of change in practice. This study used the implementation of National Service Frameworks (NSFs) and the new General Medical Services (GMS) contract as incidents of change. In-depth, qualitative case studies. The design was iterative: each case study was followed by a review of the theoretical ideas. The final conceptual framework was the result of the dynamic interplay between theory and empirical evidence. Five general practices in England, selected using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and nonparticipant observation, and examination of documents. A conceptual framework was developed that can be used to understand how and why practices respond to change. This framework enabled understanding of observed reactions to the introduction of NSFs and the new GMS contract. Important factors for generating responses to change included the story that the practice members told about their practice, beliefs about what counted as legitimate work, the role played by the manager, and previous experiences of change. Viewing general practices as small organisations has generated insights into factors that influence responses to change. Change tends to occur from the bottom up and is determined by beliefs about organisational reality. The conceptual framework suggests some questions that can be asked of practices to explain this internal reality.

Predictors of a positive attitude of medical students towards general practice - a survey of three Bavarian medical faculties.

PubMed

Schneider, Antonius; Karsch-Völk, Marlies; Rupp, Alica; Fischer, Martin R; Drexler, Hans; Schelling, Jörg; Berberat, Pascal

2013-01-01

Germany is witnessing an increasing shortage of general practitioners (GPs). The aim was to determine predictors of the job-related motivation of medical students of three medical faculties with different institutionalisation of general practice as an academic discipline. Medical students were surveyed with a standardised questionnaire about their attitudes towards general practice and their motivation to work as a GP in different working conditions. Predictors for positive attitudes and motivation were calculated using logistic regression models. 940 (15.2%) out of 6182 medical students from three Bavarian medical faculties participated in an online survey. 585 (62.7%) were female, and the average age was 25.0 (standard deviation 3.7). The average grade of a university-entrance diploma was 1.6 (standard deviation 0.5). 718 (76.4%) could imagine working as a GP. However, they favoured being employed within another organisation and not having their own private practice (65.5% vs. 35.1%). "Presence of a professorship of general practice" was associated with a positive attitude towards general practice (OR 1.57; 95%CI 1.13-2.417). Motivation for working as a GP was associated with "being female" (OR 2.56; 95%CI 1.80-3.56) and "presence of a professorship of general practice" (OR 1.68; 95%CI 1.14-2.46). Having a lower grade for one's university-entrance diploma was associated with a higher preference to work in one's own practice (OR 1.39; 95%CI 1.02-1.90). A high amount of medical students were open-minded towards general practice. However, they favoured employment within an organization over working in their own practice. Institutionalisation of general practice as an academic discipline might be of importance to gain positive attitudes towards general practice and motivate medical students to work as a GP.

Low volume undiluted Btk application against heavy gypsy moth population densities in southern Corsica

Treesearch

Robert A. Fusco; Jean-Claude Martin

2003-01-01

Low volume undiluted applications of Bacillus thuringiensis are common and efficacious against coniferous forest pests such as pine processionary moth and spruce budworm, but have not been common practice against deciduous forest pests due to coverage issues.

SWMM IMPROVEMENT FOR ANALYZING BMP/LTD PERFORMANCE

EPA Science Inventory

Pollution and treatment costs associated with wet weather flows (WWFs) have caused a need for reducing stormwater runoff volumes as well as loads. A number of strategies and best management practices (BMPs) are being used to mitigate runoff volumes and associated nonpoint source...

MANUAL: BIOVENTING PRINCIPLES AND PRACTICE VOLUME II. BIOVENTING DESIGN

EPA Science Inventory

The results from bioventing research and development efforts and from the pilot-scale bioventing systems have been used to produce this two-volume manual. Although this design manual has been written based on extensive experience with petroleum hydrocarbons (and thus, many exampl...

Automobile Engine Control Parameters Study : Volume 2. Status of Foreign Engine Control Practices.

DOT National Transportation Integrated Search

1977-02-01

The report contains the results of a study to evaluate automobile engine control parameters and their effects on vehicle fuel economy and emissions. Volume II treats selected foreign manufacturers. The principal topics reviewed for the twenty-eight e...

Attitudes of newly qualified doctors towards a career in general practice: a qualitative focus group study.

PubMed

Merrett, Alexandra; Jones, Daniel; Sein, Kim; Green, Trish; Macleod, Una

2017-04-01

A key element of the NHS is universal access to a GP. Recently, UK general practice has been described as being in crisis, with training places unfilled and multiple practices reporting vacancies or facing closure. The recruitment of GPs continues to be a key focus for both the Royal College of General Practitioners (RCGP) and the government. To understand the attitudes of newly qualified doctors towards a career in general practice, to appreciate potential reasons for the crisis in GP recruitment, and to recommend ways to improve recruitment. A qualitative study comprising five focus groups with 74 Foundation Year 1 (FY1) doctors from one Yorkshire deanery. Audio recordings were transcribed verbatim and thematic analysis undertaken. Foundation Year 1 doctors' thoughts towards a career in general practice were summarised in four themes: quality of life, job satisfaction, uncertainty surrounding the future of general practice, and the lack of respect for GPs among both doctors and the public. Participants felt that general practice could provide a good work-life balance, fair pay, and job stability. Job satisfaction, with the ability to provide care from the cradle to the grave, and to work within a community, was viewed positively. Uncertainties around future training, skill levels, pay, and workload, together with a perceived stigma experienced in medical schools and hospitals, were viewed as a deterrent to a career in general practice. This study has gathered the opinions of doctors at a critical point in their careers, before they choose a future specialty. Findings highlight areas of concern and potential deterrents to a career in general practice, together with recommendations to address these issues. © British Journal of General Practice 2017.

Satisfaction and comfort with nursing in Australian general practice.

PubMed

2015-01-01

The practice nursing workforce has grown exponentially in recent years. Whilst evidence has shown the important contributions of nurses to general practice service delivery, the consumer perspective of nursing in general practice has received limited attention. Given that acceptability of nurses is influenced by patient satisfaction which can in turn improve both treatment adherence and clinical outcomes, this is an important area for investigation. The primary aim of this study was to evaluate consumer satisfaction with chronic disease management by nurses in general practice (NiGP) and comfort with the tasks undertaken by nurses in general practice. Consumers receiving chronic disease services from nurses in general practice participating in a larger study were recruited to complete a survey. The survey comprised of demographic information, and items related to satisfaction with the nurse encounter (SPN-9) and consumer comfort with nurse roles in general practice (CPN-18). Eighty-one consumers participated in the study. Cronbach's alpha values of the SPN-9 and the CPN-18 were 0.95 and 0.97 respectively. SPN-9 results demonstrated high levels of satisfaction with PN consultations. Bivariate analysis did not show any significant differences within the consumer group relating to satisfaction. However, those who presented for diabetes-related reasons were more likely to report high comfort levels with the nurse encounter compare to those who presented to general practice for other chronic disease conditions (38% versus 14%, p = 0.016). The results of this study demonstrate that consumers are generally satisfied with nursing consultations in general practice related to chronic disease. However, further research evaluating consumer confidence, comfort and satisfaction with nursing care is needed to ensure that nursing services meet consumer needs.

Influence on general practitioners of teaching undergraduates: qualitative study of London general practitioner teachers

PubMed Central

Hartley, Sarah; Macfarlane, Fraser; Gantley, Madeleine; Murray, Elizabeth

1999-01-01

Objective To examine the perceived effect of teaching clinical skills and associated teacher training programmes on general practitioners' morale and clinical practice. Design Qualitative semistructured interview study. Setting General practices throughout north London. Subjects 30 general practitioners who taught clinical skills were asked about the effect of teaching and teacher training on their morale, confidence in clinical and teaching skills, and clinical practice. Results The main theme was a positive effect on morale. Within teacher training this was attributed to developing peer and professional support; improved teaching skills; and revision of clinical knowledge and skills. Within teaching this was attributed to a broadening of horizons; contact with enthusiastic students; increased time with patients; improved clinical practice; improved teaching skills; and an improved image of the practice. Problems with teaching were due to external factors such as lack of time and space and anxieties about adequacy of clinical cover while teaching. Conclusions Teaching clinical skills can have a positive effect on the morale of general practitioner teachers as a result of contact with students and peers, as long as logistic and funding issues are adequately dealt with. Key messagesThe increase in community based teaching of clinical skills requires an increase in the number of general practitioner teachersLittle evidence is available about the effect of teaching of clinical skills and teacher training on general practitioner teachers and practicesGeneral practitioner teachers reported an increase in morale, improvements in clinical skills, and changes in clinical practice and in practice infrastructure as a result of teaching and trainingGeneral practitioner teachers reported problems because of pressure on time, lack of space, problems recruiting patients, and unsupportive practice partnersPositive effects on morale and clinical practice may be important for sustainable teaching and continuing medical education PMID:10541508

How much tumor surgery do early-career orthopaedic oncologists perform?

PubMed

Miller, Benjamin J; Rajani, Rajiv; Leddy, Lee; Carmody Soni, Emily E; White, Jeremy R

2015-02-01

There are few data on the types of procedures orthopaedic oncologists perform in their first years of practice. Because fellowships are graduating fellows each year and the number of tumor patients is limited, defining the practice patterns of early-career orthopaedic oncologists may help diminish early employment discontent and enhance workforce discussions. The aim of the study was to use the objective case log volumes of a cross-section of early career orthopaedic oncologists to describe (1) the number of operations performed annually; (2) the proportion of tumor, trauma, adult reconstruction, and other operations for individual participants, (3) individual practice characteristics that were associated with the number of tumor procedures; and (4) the sources of satisfaction and challenges in each individual's career and surgical practice. Fifteen fellowship-trained orthopaedic oncologists out of a potential pool of 33 (45%) in their first 4 years of practice responded to a survey by submitting complete operative case lists for a 2-year period. We recorded the type of procedure and determined associations between the annual number of tumor operations and total operative caseload, years in practice, and some details of individual practice patterns. Each participant completed a survey regarding practice-related sources of stress and satisfaction. A total of 5611 surgical cases were available for review. For the entire cohort, there were 3303 (59%) tumor procedures, 973 (17%) trauma, 890 (16%) adult reconstruction, and 445 (8%) other. The median annual number of total operations was 214 (range, 63-356) and median annual number of tumor operations was 135 (range, 47-216). The median proportion of tumor operations in an individual practice was 56% (range, 43%-94%). The annual number of tumor operations correlated with the total annual number of operations (r = 0.73, p < 0.001). Sources of stress and satisfaction were similar to the general membership of the Musculoskeletal Tumor Society (MSTS), apart from more early-career surgeons regarding case volume as important (29 of 104 [28%] of MSTS versus 11 of 15 [73%] of early-career, p < 0.001). The typical early-career orthopaedic tumor surgeon had fewer than 60% of his or her operative procedures directly related to the subject of his or her fellowship training in orthopaedic oncology. Overall, the challenges and rewards of clinical practice are similar to oncologic surgeons later in their career. This study is a first step in assessing early practice characteristics and may be of value to the prospective orthopaedic oncologist, fellowship educators, and the society in workforce discussions. Early-career practice patterns have not been previously presented, to our knowledge, for any subspecialty of orthopaedic surgery, and we hope that this study will stimulate similar efforts throughout the field. Level IV, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

Commencement Bay Study. Volume I. Summary and Synthesis.

DTIC Science & Technology

1981-12-31

Volume II Land and Water Use Volume VI Physical Oceanography Volume III Fish and Wetlands Volume VII Sediments, Noise, Climate and Volume IV...Invertebrates Air Quality, Birds IS. KEY WORDS (Conthwe an fever"e *#do I 06ee87 end idenltf by block -her) Salmonids Wetlands Noise Aesthetics Marine Fish ...ENVIRONMENT 18 4 .1 GENERAL 18 4.2 BENTHIC INVERTSBRATUS 19 4.3 COMMERCIAL AND RECREATIONAL SHELLFISH 22 4.4 FISH 23 4.4.1 juvenile and Adult Salonids 24 4.4.2

The ethics of experimenting in dental practice.

PubMed

Chambers, David W

2014-01-01

There is a common misconception that scientists conduct research in their labs or clinics and practitioners do not experiment, but only use the best results reported in the literature. This confusion comes about because dentists are not trained in, nor do they normally observe, the formal requriments of research protocol or ethics. It is generally believed that the norms that apply to clinical practice also cover all situations where dentists innovate in their treatment protocols with a view toward discovering more effective ways to treat patients or where they modify a standard protocol in hopes of better serving the needs of an atypical patient. In this 2002 paper from the Dental Clinics of North America (Volume 46, Number 1, pp. 29-44), David W. Chambers challenges the concept that useful general knowledge is created only outside dental practice and then transferred into the office. But if it is the case that practitioners experiment, even to the limited extent of customizing materials and methods to their own needs or the particular circumstances of patients, there are ethical considerations. All modifications are not equally justifiable, the patient should be involved in "partially tested" approaches in a different way from the routine, and there needs to be sound reason to believe the innovation will not fall below the standard of care. Experimental practice has the characteristics of high probability of success, structured observation, realistic settings, and careful documentation. Heroic measures can only be undertaken when available options have failed and with full consent of the patient. A two-part ethical test is proposed for experimenting in practice: (a) If the dentist believes members of the community (patients, colleagues, or society generally) would be offended or outraged by an action, provided that they became aware of the relevant details--to not do it! (b) If the dentist believes members of the community would be concerned by an action, provided they became aware of the relevant details--discuss it with them. There is also an ethics of evaluating and adopting the research literature to one's office. Some of the requriments in this area include maintaining a current and critical familiarity with developments, understanding the difference between the internal validity of studies in the context where they were conducted and the likely adaptations or cautions needed when customizing the literature to individual practices, and knowing the proper weights to give to the literature and one's own clinical experience.

Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007-14.

PubMed

Hobbs, F D Richard; Bankhead, Clare; Mukhtar, Toqir; Stevens, Sarah; Perera-Salazar, Rafael; Holt, Tim; Salisbury, Chris

2016-06-04

Primary care is the main source of health care in many health systems, including the UK National Health Service (NHS), but few objective data exist for the volume and nature of primary care activity. With rising concerns that NHS primary care workload has increased substantially, we aimed to assess the direct clinical workload of general practitioners (GPs) and practice nurses in primary care in the UK. We did a retrospective analysis of GP and nurse consultations of non-temporary patients registered at 398 English general practices between April, 2007, and March, 2014. We used data from electronic health records routinely entered in the Clinical Practice Research Datalink, and linked CPRD data to national datasets. Trends in age-standardised and sex-standardised consultation rates were modelled with joinpoint regression analysis. The dataset comprised 101,818,352 consultations and 20,626,297 person-years of observation. The crude annual consultation rate per person increased by 10·51%, from 4·67 in 2007-08, to 5·16 in 2013-14. Consultation rates were highest in infants (age 0-4 years) and elderly people (≥85 years), and were higher for female patients than for male patients of all ages. The greatest increases in age-standardised and sex-standardised rates were in GPs, with a rise of 12·36% per 10,000 person-years, compared with 0·9% for practice nurses. GP telephone consultation rates doubled, compared with a 5·20% rise in surgery consultations, which accounted for 90% of all consultations. The mean duration of GP surgery consultations increased by 6·7%, from 8·65 min (95% CI 8·64-8·65) to 9·22 min (9·22-9·23), and overall workload increased by 16%. Our findings show a substantial increase in practice consultation rates, average consultation duration, and total patient-facing clinical workload in English general practice. These results suggest that English primary care as currently delivered could be reaching saturation point. Notably, our data only explore direct clinical workload and not indirect activities and professional duties, which have probably also increased. This and additional research questions, including the outcomes of workload changes on other sectors of health care, need urgent answers for primary care provision internationally. Department of Health Policy Research Programme. Copyright © 2016 Hobbs et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Air quality impacts of intercity freight. Volume 2 : appendices

DOT National Transportation Integrated Search

1998-07-01

This document presents best practices and practical advice on how to acquire the software components of Intelligent Transportation Systems (ITS). The executive summary briefly describes the themes and activities developed during the project developme...

Development and psychometric validation of the general practice nurse satisfaction scale.

PubMed

Halcomb, Elizabeth J; Caldwell, Belinda; Salamonson, Yenna; Davidson, Patricia M

2011-09-01

To develop an instrument to assess consumer satisfaction with nursing in general practice to provide feedback to nurses about consumers' perceptions of their performance. Prospective psychometric instrument validation study. A literature review was conducted to generate items for an instrument to measure consumer satisfaction with nursing in general practice. Face and content validity were evaluated by an expert panel, which had extensive experience in general practice nursing and research. Included in the questionnaire battery was the 27-item General Practice Nurse Satisfaction (GPNS) scale, as well as demographic and health status items. This survey was distributed to 739 consumers following intervention administered by a practice nurse in 16 general practices across metropolitan, rural, and regional Australia. Participants had the option of completing the survey online or receiving a hard copy of the survey form at the time of their visit. These data were collected between June and August 2009. Satisfaction data from 739 consumers were collected following their consultation with a general practice nurse. From the initial 27-item GPNS scale, a 21-item instrument was developed. Two factors, "confidence and credibility" and "interpersonal and communication" were extracted using principal axis factoring and varimax rotation. These two factors explained 71.9% of the variance. Cronbach's α was 0.97. The GPNS scale has demonstrated acceptable psychometric properties and can be used both in research and clinical practice for evaluating consumer satisfaction with general practice nurses. Assessing consumer satisfaction is important for developing and evaluating nursing roles. The GPNS scale is a valid and reliable tool that can be utilized to assess consumer satisfaction with general practice nurses and can assist in performance management and improving the quality of nursing services. © 2011 Sigma Theta Tau International.

Systems and complexity thinking in the general practice literature: an integrative, historical narrative review.

PubMed

Sturmberg, Joachim P; Martin, Carmel M; Katerndahl, David A

2014-01-01

Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine. We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to general practice/family medicine and published before December 2010. A total of 16,242 articles were retrieved, of which 49 were published in general practice/family medicine journals. Hand searches and snowballing retrieved another 35. After a full-text review, we included 56 articles dealing specifically with systems sciences and general/family practice. General practice/family medicine engaged with the emerging systems and complexity theories in 4 stages. Before 1995, articles tended to explore common phenomenologic general practice/family medicine experiences. Between 1995 and 2000, articles described the complex adaptive nature of this discipline. Those published between 2000 and 2005 focused on describing the system dynamics of medical practice. After 2005, articles increasingly applied the breadth of complex science theories to health care, health care reform, and the future of medicine. This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline's philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing health care reform.

Systems and Complexity Thinking in the General Practice Literature: An Integrative, Historical Narrative Review

PubMed Central

Sturmberg, Joachim P.; Martin, Carmel M.; Katerndahl, David A.

2014-01-01

PURPOSE Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine. METHODS We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to general practice/family medicine and published before December 2010. A total of 16,242 articles were retrieved, of which 49 were published in general practice/family medicine journals. Hand searches and snowballing retrieved another 35. After a full-text review, we included 56 articles dealing specifically with systems sciences and general/family practice. RESULTS General practice/family medicine engaged with the emerging systems and complexity theories in 4 stages. Before 1995, articles tended to explore common phenomenologic general practice/family medicine experiences. Between 1995 and 2000, articles described the complex adaptive nature of this discipline. Those published between 2000 and 2005 focused on describing the system dynamics of medical practice. After 2005, articles increasingly applied the breadth of complex science theories to health care, health care reform, and the future of medicine. CONCLUSIONS This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline’s philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing health care reform. PMID:24445105

Guidelines for computer security in general practice.

PubMed

Schattner, Peter; Pleteshner, Catherine; Bhend, Heinz; Brouns, Johan

2007-01-01

As general practice becomes increasingly computerised, data security becomes increasingly important for both patient health and the efficient operation of the practice. To develop guidelines for computer security in general practice based on a literature review, an analysis of available information on current practice and a series of key stakeholder interviews. While the guideline was produced in the context of Australian general practice, we have developed a template that is also relevant for other countries. Current data on computer security measures was sought from Australian divisions of general practice. Semi-structured interviews were conducted with general practitioners (GPs), the medical software industry, senior managers within government responsible for health IT (information technology) initiatives, technical IT experts, divisions of general practice and a member of a health information consumer group. The respondents were asked to assess both the likelihood and the consequences of potential risks in computer security being breached. The study suggested that the most important computer security issues in general practice were: the need for a nominated IT security coordinator; having written IT policies, including a practice disaster recovery plan; controlling access to different levels of electronic data; doing and testing backups; protecting against viruses and other malicious codes; installing firewalls; undertaking routine maintenance of hardware and software; and securing electronic communication, for example via encryption. This information led to the production of computer security guidelines, including a one-page summary checklist, which were subsequently distributed to all GPs in Australia. This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake.

Effectiveness of Needleless Vial Adaptors and Blunt Cannulas for Drug Administration in a Microgravity Environment

NASA Technical Reports Server (NTRS)

Hailey, M.; Bayuse, T.

2010-01-01

Fluid Isolation in the medication vial: Air/ fluid isolation maneuvers were used to move the medication to the septum end of vial. This isolation may be achieved in multiple ways based on the experience of the astronaut with fluid management in microgravity. If vial adaptors/blunt cannula or syringe assembly is inserted into the to vial before fluid isolation commences, the stability of this assembly should be considered in an effort to limit the risk of "slinging off" of the vial during isolation. Alternatively, fluid isolation can be performed prior to attaching the syringe/vial adaptor assembly. Terrestrial practices for medication withdrawal from a nonvented vial require injection of an equivalent amount of air as the expected medication volume prior to withdrawing liquid. In microgravity, this action is still valid, however the injection of additional air into the vial creates a multitude of micro bubbles and increases the volume of medication mixed with air that then must be withdrawn to achieve the desired drug volume in syringe. This practice is more likely to be required when using vials >30ml in size and injection volumes >10mL. It is felt that based on the microgravity flight, the practice of air injection is more of a hindrance than help.

General practice registrars' intentions for future practice: implications for rural medical workforce planning.

PubMed

Harding, Catherine; Seal, Alexa; McGirr, Joe; Caton, Tim

2016-11-01

The models of practice that general practice registrars (GPRs) envisage undertaking will affect workforce supply. The aim of this research was to determine practice intentions of current GPRs in a regional general practice training program (Coast City Country General Practice Training). Questionnaires were circulated to 220 GPRs undertaking general practice placements to determine characteristics of ideal practice models and intentions for future practice. Responses were received for 99 participants (45%). Current GPRs intend to work an average of less than eight half-day sessions/week, with male participants intending to work more hours (t(91)=3.528, P=0.001). More than one-third of this regional cohort intends to practice in metropolitan centres. Proximity to family and friends was the most important factor influencing the choice of practice location. Men ranked remuneration for work as more important (t (88)=-4.280, P<0.001) and women ranked the ability to work part-time higher (t(94)=3.697, P<0.001). Fee-for-service payment alone, or in combination with capitation, was the preferred payment system. Only 22% of Australian medical graduates intend to own their own practice compared with 52% of international medical graduates (χ 2 (1)=8.498, P=0.004). Future general practitioners (GPs) intend to work fewer hours than current GPs. Assumptions about lifestyle factors, practice models and possible professional roles should be carefully evaluated when developing strategies to recruit GPs and GPRs into rural practice.

EVALUATION OF GROUNDWATER EXTRACTION REMEDIES - VOLUME III

EPA Science Inventory

This volume is the third of a three-volume report documenting the results of an evaluation of ground-water extraction remedies at hazardous waste sites. It consists of a collection of 112 data base reports presenting general information on sites where ground-water extraction sys...

47 CFR 68.6 - Telephones with volume control.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Telephones with volume control. 68.6 Section 68.6 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) CONNECTION OF TERMINAL EQUIPMENT TO THE TELEPHONE NETWORK General § 68.6 Telephones with volume control. As...

47 CFR 68.6 - Telephones with volume control.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Telephones with volume control. 68.6 Section 68.6 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) CONNECTION OF TERMINAL EQUIPMENT TO THE TELEPHONE NETWORK General § 68.6 Telephones with volume control. As...

Frequency Domain Computer Programs for Prediction and Analysis of Rail Vehicle Dynamics : Volume 1. Technical Report

DOT National Transportation Integrated Search

1975-12-01

Frequency domain computer programs developed or acquired by TSC for the analysis of rail vehicle dynamics are described in two volumes. Volume I defines the general analytical capabilities required for computer programs applicable to single rail vehi...

Refugee experiences of general practice in countries of resettlement: a literature review.

PubMed

Cheng, I-Hao; Drillich, Ann; Schattner, Peter

2015-03-01

Refugees and asylum seekers often struggle to use general practice services in resettlement countries. To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. © British Journal of General Practice 2015.

Exact finite volume expectation values of local operators in excited states

NASA Astrophysics Data System (ADS)

Pozsgay, B.; Szécsényi, I. M.; Takács, G.

2015-04-01

We present a conjecture for the exact expression of finite volume expectation values in excited states in integrable quantum field theories, which is an extension of an earlier conjecture to the case of general diagonal factorized scattering with bound states and a nontrivial bootstrap structure. The conjectured expression is a spectral expansion which uses the exact form factors and the excited state thermodynamic Bethe Ansatz as building blocks. The conjecture is proven for the case of the trace of the energy-moment tensor. Concerning its validity for more general operators, we provide numerical evidence using the truncated conformal space approach. It is found that the expansion fails to be well-defined for small values of the volume in cases when the singularity structure of the TBA equations undergoes a non-trivial rearrangement under some critical value of the volume. Despite these shortcomings, the conjectured expression is expected to be valid for all volumes for most of the excited states, and as an expansion above the critical volume for the rest.

VOFTools - A software package of calculation tools for volume of fluid methods using general convex grids

NASA Astrophysics Data System (ADS)

López, J.; Hernández, J.; Gómez, P.; Faura, F.

2018-02-01

The VOFTools library includes efficient analytical and geometrical routines for (1) area/volume computation, (2) truncation operations that typically arise in VOF (volume of fluid) methods, (3) area/volume conservation enforcement (VCE) in PLIC (piecewise linear interface calculation) reconstruction and(4) computation of the distance from a given point to the reconstructed interface. The computation of a polyhedron volume uses an efficient formula based on a quadrilateral decomposition and a 2D projection of each polyhedron face. The analytical VCE method is based on coupling an interpolation procedure to bracket the solution with an improved final calculation step based on the above volume computation formula. Although the library was originally created to help develop highly accurate advection and reconstruction schemes in the context of VOF methods, it may have more general applications. To assess the performance of the supplied routines, different tests, which are provided in FORTRAN and C, were implemented for several 2D and 3D geometries.

Estimated maximal and current brain volume predict cognitive ability in old age

PubMed Central

Royle, Natalie A.; Booth, Tom; Valdés Hernández, Maria C.; Penke, Lars; Murray, Catherine; Gow, Alan J.; Maniega, Susana Muñoz; Starr, John; Bastin, Mark E.; Deary, Ian J.; Wardlaw, Joanna M.

2013-01-01

Brain tissue deterioration is a significant contributor to lower cognitive ability in later life; however, few studies have appropriate data to establish how much influence prior brain volume and prior cognitive performance have on this association. We investigated the associations between structural brain imaging biomarkers, including an estimate of maximal brain volume, and detailed measures of cognitive ability at age 73 years in a large (N = 620), generally healthy, community-dwelling population. Cognitive ability data were available from age 11 years. We found positive associations (r) between general cognitive ability and estimated brain volume in youth (male, 0.28; females, 0.12), and in measured brain volume in later life (males, 0.27; females, 0.26). Our findings show that cognitive ability in youth is a strong predictor of estimated prior and measured current brain volume in old age but that these effects were the same for both white and gray matter. As 1 of the largest studies of associations between brain volume and cognitive ability with normal aging, this work contributes to the wider understanding of how some early-life factors influence cognitive aging. PMID:23850342

Breast cancer management: is volume related to quality? Clinical Advisory Panel.

PubMed

Ma, M; Bell, J; Campbell, S; Basnett, I; Pollock, A; Taylor, I

1997-01-01

A method of carrying out region-wide audit for breast cancer was developed by collaboration between the cancer registry, providers and purchasers as part of work to fulfill the 'Calman-Hine' recommendations. In order to test the audit method, a retrospective audit in North Thames East compared practice in 1992 against current guidelines. The analysis compared care in specialist and non-specialist centres. A stratified random sample comprising 28% of all breast cancer patients diagnosed in 1992 was selected from the population-based Thames Cancer Registry. The data for 309 patients with stage I-III tumours were analysed by hospital type using local guidelines. No difference between specialist (high volume) and non-specialist centres was detected for factors important in survival. Pathological staging was good with over 70% reporting tumour size and grade. A small number of patients were undertreated; after conservative surgery, 10% (19) of women did not receive radiotherapy, and 15% (8) of node-positive premenopausal women did not receive chemotherapy or ovarian ablation. In contrast, a significant trend with hospital volume was found for several quality of life factors. These included access to a specialist breast surgeon and specialist breast nurses, availability of fine-needle aspiration (FNA), which ranged from 84% in high-volume to 42% in low-volume centres, and quality of surgery (axillary clearance rates ranged from 51% to 8% and sampling of less than three nodes from 3% to 25% for high- and very low-volume centres respectively). Confidential feedback of results to surgeons was welcomed and initiated change. The summary information gave purchasers information relevant to the evaluation of cancer services. While the audit applied present standards to past practice, it provided the impetus for prospective audit of current practice (now being implemented in North Thames).

Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams.

PubMed

Grant, Suzanne; Ring, Adele; Gabbay, Mark; Guthrie, Bruce; McLean, Gary; Mair, Frances S; Watt, Graham; Heaney, David; O'Donnell, Catherine

2015-01-01

In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Changes in pathology test ordering by early career general practitioners: a longitudinal study.

PubMed

Magin, Parker J; Tapley, Amanda; Morgan, Simon; Henderson, Kim; Holliday, Elizabeth G; Davey, Andrew R; Ball, Jean; Catzikiris, Nigel F; Mulquiney, Katie J; van Driel, Mieke L

2017-07-17

To assess the number of pathology tests ordered by general practice registrars during their first 18-24 months of clinical general practice. Longitudinal analysis of ten rounds of data collection (2010-2014) for the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing, multicentre, cohort study of general practice registrars in Australia. The principal analysis employed negative binomial regression in a generalised estimating equations framework (to account for repeated measures on registrars).Setting, participants: General practice registrars in training posts with five of 17 general practice regional training providers in five Australian states. The registrar participation rate was 96.4%. Number of pathology tests requested per consultation. The time unit for analysis was the registrar training term (the 6-month full-time equivalent component of clinical training); registrars contributed data for up to four training terms. 876 registrars contributed data for 114 584 consultations. The number of pathology tests requested increased by 11% (95% CI, 8-15%; P < 0.001) per training term. Contrary to expectations, pathology test ordering by general practice registrars increased significantly during their first 2 years of clinical practice. This causes concerns about overtesting. As established general practitioners order fewer tests than registrars, test ordering may peak during late vocational training and early career practice. Registrars need support during this difficult period in the development of their clinical practice patterns.

Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared?

PubMed

Stol, Daphne M; Hollander, Monika; Nielen, Markus M J; Badenbroek, Ilse F; Schellevis, François G; de Wit, Niek J

2018-03-01

Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention. Observational study. Dutch primary care. General practices. Organizational characteristics. General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p = .000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as 'frontrunners' of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%). The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention. Key Points   There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices.   • The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention.   • Implementation of selective CMD prevention programs including easily accessible services for lifestyle support should be the focus of attention.   • Policy makers, health insurance companies and healthcare professionals share the responsibility to realize structural funding for selective CMD prevention.

Social communication skills of chiropractors: implications for professional practice.

PubMed

Marchiori, Dennis M; Henkin, Alan B; Hawk, Cheryl

2008-01-01

Social communication skills are critical in the health professions. The aim of this study was to measure and identify professional practice predictors of social communication skills of practicing chiropractors. The study population was derived from a group of doctors of chiropractic who participated in a practice-based research program. Participating chiropractors agreed to complete a survey detailing the chiropractor's sex, years in practice, practice type, size of the practice community, typical weekly practice volume, and an instrument to measure skills of social communication. Regression analysis was applied to identify associations between independent variables and responses to the social skills instrument. Results suggested that selected characteristics of clinical practice may be associated with clinician's social skills of communication. The weekly volume of patients to the practice emerged as a salient explanatory factor of overall social communication skills and as a factor individually for dimensions of social expressivity and social control. The practice arrangement (solo vs group) proved important in terms of respondent emotional control scores. Similarly, the solo vs group practice variable was associated with higher levels of emotional sensitivity; however, this association was mediated by the sex of the doctor of chiropractic; men reported lower levels of emotional sensitivity than women. The findings of this study suggest associations between dimensions of social communication skills, practice characteristics, practice arrangements, and sex that may inform the efforts of educators as they endeavor to better prepare health professionals for practice in a wide spectrum of settings.

["General Practice is a great job anyway" - a qualitative study with vocational trainees].

PubMed

Steinhäuser, Jost; Paulus, Jan; Roos, Marco; Peters-Klimm, Frank; Ledig, Thomas; Szecsenyi, Joachim; Joos, Stefanie

2011-01-01

Due to the increasing lack of physicians, an ageing and thus multi-morbid society and a misdistribution of physicians in Germany primary care provided by general practitioners is at risk. Therefore, approaches to recruit more physicians for general practice are being sought. The aim of the present study was to explore individual motivations for choosing a career in general practice, vocational trainees' perspectives on the current situation of vocational training and to identify possible approaches to improve the situation with suggestions from vocational trainees in Germany. A qualitative study was conducted by interviewing 13 trainees. The interviews that were based on a predefined interview guideline were recorded and transcribed. The analysis was performed according to Mayring supported by the software Atlas.ti. In general, the reasons given for choosing general practice include the holistic view towards patients, the opportunity to see the direct impact of therapies and self-employment. Furthermore, general practice was perceived as a job with a positive work-life balance. Barriers to vocational training are the lack of structure of individual rotations and the low salaries during the rotation in practice. Furthermore, the basic conditions for working as a self-employed general practitioner in Germany were described as being a disincentive. A general suggestion for improvement was to promote professional recognition of general practice at universities. A qualification of vocational trainers was requested. Specific suggestions were: better payment, better-structured rotations and a specific preparation for the self-employed general practitioner. The results of this study reveal that a single measure is insufficient for recruiting more young doctors for general practice. In fact, a package of measures is necessary to improve aspects of the vocational training but also general conditions for the profession. Copyright © 2010. Published by Elsevier GmbH.

Datasets collected in general practice: an international comparison using the example of obesity.

PubMed

Sturgiss, Elizabeth; van Boven, Kees

2018-06-04

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not be able to partake in these kinds of comparison studies. What are the implications for practitioners? Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved.

The Impact of the Hospital Volume on the Performance of Residents on the General Medicine In-Training Examination: A Multicenter Study in Japan.

PubMed

Mizuno, Atsushi; Tsugawa, Yusuke; Shimizu, Taro; Nishizaki, Yuji; Okubo, Tomoya; Tanoue, Yusuke; Konishi, Ryota; Shiojiri, Toshiaki; Tokuda, Yasuharu

2016-01-01

Objective Although several studies have been conducted worldwide on factors that might improve residents' knowledge, the relationship between the hospital volume and the internal medicine residents' knowledge has not been fully understood. We conducted a cross-sectional study to compare the relationships of the hospital volume and hospital resources with the residents' knowledge assessed by the In-training Examination. Methods We conducted a retrospective survey and a clinical knowledge evaluation of postgraduate year 1 and 2 (PGY-1 and -2) resident physicians in Japan by using the General Medicine In-training Examination (GM-ITE) in 2014. We compared the ITE score and the hospital volume. Results A total of 2,015 participants (70.6% men; age, 27.3±2.9 years old) from 208 hospitals were retrospectively analyzed. Generalized estimating equations were used, and the results revealed that an increasing number of hospitalizations, decreasing staff number, decreasing age and PGY-2 were significantly associated with higher GM-ITE scores. Conclusion The hospital volume, such as the number of hospitalizations, is thus considered to have a positive impact on the GM-ITE scores.

Increasing medical student interest in general practice in New Zealand: where to from here?

PubMed

Poole, Phillippa; Bourke, David; Shulruf, Boaz

2010-05-28

To meet increasing health demands, increasing the proportion of local graduates entering general practice is imperative. Students entering or exiting The University of Auckland's medical programme from 2006 to 2008 were invited to complete a tracking project survey. Levels of interest in general practice were determined along with characteristics associated with a greater or lesser interest in this career. 712 students replied--a response rate of 80%. At entry, 40% of students had a strong interest in a career in general practice, and at exit, 29% (P =0.003). A quarter at each time point had no interest. The proportion of domestic students born outside NZ or Australia was 160/376 (42.5%). There were significantly higher levels of interest in general practice among females, students born in NZ, and those from outside Auckland--especially rural origin. Flexibility in career was more important to students with a strong interest in general practice than those with no interest. Auckland medical students have levels of interest in general practice comparable with international data. Increasing this interest further may require admission of a greater proportion of students from those groups with higher interest levels, greater emphasis on the positive aspects of general practice, and on GPs as equals to other specialists.

Private or salaried practice: how do young general practitioners make their career choice? A qualitative study.

PubMed

Kinouani, Shérazade; Boukhors, Gary; Luaces, Baptiste; Durieux, William; Cadwallader, Jean-Sébastien; Aubin-Auger, Isabelle; Gay, Bernard

2016-09-01

Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners. A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently. Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice. National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.

Integrating patient empowerment as an essential characteristic of the discipline of general practice/family medicine.

PubMed

Mola, Ernesto; De Bonis, Judith A; Giancane, Raffaele

2008-01-01

Efforts to improve the quality of healthcare for patients with chronic conditions have resulted in growing evidence supporting the inclusion of patient empowerment as a key ingredient of care. In 2002, WONCA Europe issued the European Definition of General Practice/Family Medicine, which is currently considered the point of reference for European health institutions and general medical practice. Patient empowerment does not appear among the 11 characteristics of the discipline. The aim of this study is to show that many characteristics of general practice are already oriented towards patient empowerment. Therefore, promoting patient empowerment and self-management should be included as a characteristic of the discipline. The following investigation was conducted: analysing the concept and approach to empowerment as applied to healthcare in the literature; examining whether aspects of empowerment are already part of general medical practice; and identifying reasons why the European definition of general practice/family medicine should contain empowerment as a characteristic of the discipline. General practice/family medicine is the most suitable setting for promoting patient empowerment, because many of its characteristics are already oriented towards encouraging it and because its widespread presence can ensure the generalization of empowerment promotion and self-management education to the totality of patients and communities. "Promoting patient empowerment and self-management" should be considered one of the essential characteristics of general practice/family medicine and should be included in its definition.

Financial Management Regulation. Volume 1. General Financial Management Information, Systems, and Requirements

DTIC Science & Technology

1993-05-01

20301-1100 DoD Components will be provided copies of this Volume of the Regulation through normal publication channels. Other Federal Agencies and the... public may obtain copies of this Volume from the National Technical Information Service, 5285 Port Royal Road, Springfield, VA 22161, (703) 487- 4650...SECTION 1 PARAGRAPH 1 SUtHI’ARAGRAIlTS ii DoD Financial Management Regulation Volume 1, Introductionp PUBLICATIONS SUPERSEDED This Volume of the

The Comprehensive Health Challenge: Promoting Health through Education. Volume One; Volume Two.

ERIC Educational Resources Information Center

Cortese, Peter, Ed.; Middleton, Kathleen, Ed.

The 32 chapters in this book (presented in two volumes) cover a continuum of issues in comprehensive school health education, including a review of the past and a vision of the future. Volume 1 opens with a foreword by Dr. M. Jocelyn Elders (Surgeon General of the United States) and provides the following chapters: (1) "School Health…

Data package for the Low-Level Waste Disposal Development and Demonstration Program environmental impact statement: Volume 2, Appendices E-O

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

Ketelle, R.H.

1988-09-01

This volume contains 11 appendices to the main document in Volume 1. Topics in Volume 2 include hydrologic data for a proposed solid waste storage area, soil characterizations, well logs, surface water discharge data, water quality data, atmospheric precipitation and stream flow, a small mammal survey, and general ecological information. (TEM)

Fuzzy Regression Prediction and Application Based on Multi-Dimensional Factors of Freight Volume

NASA Astrophysics Data System (ADS)

Xiao, Mengting; Li, Cheng

2018-01-01

Based on the reality of the development of air cargo, the multi-dimensional fuzzy regression method is used to determine the influencing factors, and the three most important influencing factors of GDP, total fixed assets investment and regular flight route mileage are determined. The system’s viewpoints and analogy methods, the use of fuzzy numbers and multiple regression methods to predict the civil aviation cargo volume. In comparison with the 13th Five-Year Plan for China’s Civil Aviation Development (2016-2020), it is proved that this method can effectively improve the accuracy of forecasting and reduce the risk of forecasting. It is proved that this model predicts civil aviation freight volume of the feasibility, has a high practical significance and practical operation.

16 CFR 0.11 - Office of the General Counsel.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Office of the General Counsel. 0.11 Section 0.11 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.11 Office of the General Counsel. The General Counsel is the Commission's chief law officer...

Doctors' attitudes and confidence towards providing nutrition care in practice: Comparison of New Zealand medical students, general practice registrars and general practitioners.

PubMed

Crowley, Jennifer; Ball, Lauren; Han, Dug Yeo; McGill, Anne-Thea; Arroll, Bruce; Leveritt, Michael; Wall, Clare

2015-09-01

Improvements in individuals' nutrition behaviour can improve risk factors and outcomes associated with lifestyle-related chronic diseases. This study describes and compares New Zealand medical students, general practice registrars and general practitioners' (GPs') attitudes towards incorporating nutrition care into practice, and self-perceived skills in providing nutrition care. A total of 183 New Zealand medical students, 51 general practice registrars and 57 GPs completed a 60-item questionnaire investigating attitudes towards incorporating nutrition care into practice and self-perceived skills in providing nutrition care. Items were scored using a 5-point Likert scale. Factor analysis was conducted to group questionnaire items and a generalised linear model compared differences between medical students, general practice registrars and GPs. All groups indicated that incorporating nutrition care into practice is important. GPs displayed more positive attitudes than students towards incorporating nutrition in routine care (p<0.0001) and performing nutrition recommendations (p<0.0001). General practice registrars were more positive than students towards performing nutrition recommendations (p=0.004), specified practices (p=0.037), and eliciting behaviour change (p=0.024). All groups displayed moderate confidence towards providing nutrition care. GPs were more confident than students in areas relating to wellness and disease (p<0.0001); macronutrients (p=0.030); micronutrients (p=0.010); and women, infants and children (p<0.0001). New Zealand medical students, general practice registrars and GPs have positive attitudes and moderate confidence towards incorporating nutrition care into practice. It is possible that GPs' experience providing nutrition care contributes to greater confidence. Strategies to facilitate medical students developing confidence in providing nutrition care are warranted.

Simulated pressure denaturation thermodynamics of ubiquitin.

PubMed

Ploetz, Elizabeth A; Smith, Paul E

2017-12-01

Simulations of protein thermodynamics are generally difficult to perform and provide limited information. It is desirable to increase the degree of detail provided by simulation and thereby the potential insight into the thermodynamic properties of proteins. In this study, we outline how to analyze simulation trajectories to decompose conformation-specific, parameter free, thermodynamically defined protein volumes into residue-based contributions. The total volumes are obtained using established methods from Fluctuation Solution Theory, while the volume decomposition is new and is performed using a simple proximity method. Native and fully extended ubiquitin are used as the test conformations. Changes in the protein volumes are then followed as a function of pressure, allowing for conformation-specific protein compressibility values to also be obtained. Residue volume and compressibility values indicate significant contributions to protein denaturation thermodynamics from nonpolar and coil residues, together with a general negative compressibility exhibited by acidic residues. Copyright © 2017 Elsevier B.V. All rights reserved.

Exploring Dutch surgeons' views on volume-based policies: a qualitative interview study.

PubMed

Mesman, Roos; Faber, Marjan J; Westert, Gert P; Berden, Bart

2018-01-01

Objective In many countries, the evidence for volume-outcome associations in surgery has been transferred into policy. Despite the large body of research that exists on the topic, qualitative studies aimed at surgeons' views on, and experiences with, these volume-based policies are lacking. We interviewed Dutch surgeons to gain more insight into the implications of volume-outcome policies for daily clinical practice, as input for effective surgical quality improvement. Methods Semi-structured interviews were conducted with 20 purposively selected surgeons from a stratified sample for hospital type and speciality. The interviews were recorded, transcribed verbatim and underwent inductive content analysis. Results Two overarching themes were inductively derived from the data: (1) minimum volume standards and (2) implications of volume-based policies. Although surgeons acknowledged the premise 'more is better', they were critical about the validity and underlying evidence for minimum volume standards. Patients often inquire about caseload, which is met with both understanding and discomfort. Surgeons offered many examples of controversies surrounding the process of determining thresholds as well as the ways in which health insurers use volume as a purchasing criterion. Furthermore, being held accountable for caseload may trigger undesired strategic behaviour, such as unwarranted operations. Volume-based policies also have implications for the survival of low-volume providers and affect patient travel times, although the latter is not necessarily problematic in the Dutch context. Conclusions Surgeons in this study acknowledged that more volume leads to better quality. However, validity issues, undesired strategic behaviour and the ways in which minimum volume standards are established and applied have made surgeons critical of current policy practice. These findings suggest that volume remains a controversial quality measure and causes polarization that is not conducive to a collective effort for quality improvement. We recommend enforcing thresholds that are based on the best achievable level of consensus and assessing additional criteria when passing judgement on quality of care.

Undergraduate teaching in UK general practice: a geographical snapshot.

PubMed

Derbyshire, Helen; Rees, Eliot; Gay, Simon P; McKinley, Robert K

2014-06-01

Learning in general practice is an essential component of undergraduate medical education; currently, on average, 13% of clinical placements in the UK are in general practice. However, whether general practice can sustainably deliver more undergraduate placements is uncertain. To identify the geographical distribution of undergraduate teaching practices and their distance from the host medical school. National survey of all medical schools in the UK. All 33 UK medical schools were invited to provide the postcodes of their undergraduate teaching practices. These were collated, de-duplicated, and mapped. The distance in kilometres and journey times by car and public transport between each medical school and its teaching practices was estimated using Transport Direct (www.transportdirect.info). The postcodes of every practice in the UK were obtained from the UK's health departments. All 33 UK medical schools responded; 4392 practices contributed to teaching, with a median (minimum-maximum) of 142 (17-385) practices per school. The median (minimum-maximum) distance between a school and a teaching practice was 28 km (0-1421 km), 41 (0:00-23:26) minutes' travel by car and 1 hour 12 (0:00-17:29) minutes' travel by public transport. All teaching practices were accessible by public transport in one school and 90-99% were in a further four schools; 24 schools had >20% of practices that were inaccessible by public transport. The 4392 undergraduate teaching general practices are widely distributed and potentially any practice, no matter how isolated, could contribute to undergraduate education. However, this is, at the price of a considerable travel burden. © British Journal of General Practice 2014.

BEST PRACTICES TO SUPPORT AND IMPROVE PAVEMENT MANAGEMENT SYSTEMS FOR LOW-VOLUME PAVED ROADS – PHASE I

DOT National Transportation Integrated Search

2018-02-02

The Colorado Department of Transportation (CDOT) has been trying to identify the most effective methods for managing low-volume roads (LVRs). These roads are facing multiple challenges including: reductions in maintenance budgets, impact of industria...

Healing Magazine, Volume 8, 2003.

ERIC Educational Resources Information Center

2003

This volume of "Healing Magazine" features practical, clinical information aimed at sharing current work in children's mental health. The first issue contains articles on intervention for self-injurious behavior, providing school-based grief groups, effectively using time-out as a parenting tool, and KidsPeace's suicide prevention…

Cost, volume and profitability analysis.

PubMed

Tarantino, David P

2002-01-01

If you want to increase your income by seeing more patients, it's important to figure out the financial impact such a move could have on your practice. Learn how to run a cost, volume, and profitability analysis to determine how business decisions can change your financial picture.

Locomotive crashworthiness research : volume 2 : design concept generation and evaluation

DOT National Transportation Integrated Search

1995-07-01

This is the second volume in a series of four that reports on a study in which computer models were developed and applied to evaluate whether various crashworthiness features, as defined in Public Law 102-365, can provide practical benefit to the occ...

Bridges, 1999.

ERIC Educational Resources Information Center

Wilcox, Bonita; Manear, John; Slifkin, Josh M.

This volume contains articles about writing, best practice, portfolio assessment, and technology, as well as original poetry and book reviews. Articles in the volume are: "Teaching Writing: Making Connections" (Eric Schott); "Empowering Teachers: A Success Story" (Sandra L. Krivak); "Bridging the Gap between the Classroom and Employment" (Linda C.…

THE EDUCATIONAL MEDIA INDEX.

ERIC Educational Resources Information Center

Educational Media Council, Inc., New York, NY.

THIS 14-VOLUME SERIES INCLUDES TITLES AND DESCRIPTIONS FOR ALL CURRENT AND GENERALLY AVAILABLE EDUCATIONAL MEDIA, EXCLUDING STANDARD PRINT MATERIALS. EACH VOLUME COVERS A SPECIFIC SUBJECT AREA, LISTS TITLES ALPHABETICALLY AND BY SUBJECT, DESCRIBES EACH ENTRY, AND LISTS NAMES AND ADDRESSES OF SOURCES FOR THE MATERIALS. VOLUME 14 IS A CUMULATIVE…

46 CFR 520.12 - Time/Volume rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 9 2010-10-01 2010-10-01 false Time/Volume rates. 520.12 Section 520.12 Shipping FEDERAL MARITIME COMMISSION REGULATIONS AFFECTING OCEAN SHIPPING IN FOREIGN COMMERCE CARRIER AUTOMATED TARIFFS § 520.12 Time/Volume rates. (a) General. Common carriers or conferences may publish in their...

Models of railroad passenger-car requirements in the northeast corridor : volume 1. formulation and results.

DOT National Transportation Integrated Search

1976-09-30

Models and techniques for determining passenger-car requirements in railroad service were developed and applied by a research project of which this is the final report. The report is published in two volumes. This volume considers a general problem o...

Ethics and the University. Professional Ethics Series.

ERIC Educational Resources Information Center

Davis, Michael

This book brings together the closely related topics of the practice of ethics in the university, "academic ethics," and the teaching of practical, or applied, ethics in the university. The volume considers practical ethics, research ethics, the teaching of ethics, and sexual ethics as related to the university. The chapters are: (1) "The Ethics…

What attributions do Australian high-performing general practices make for their success? Applying the clinical microsystems framework: a qualitative study

PubMed Central

Dunham, Annette H; Dunbar, James A; Johnson, Julie K; Fuller, Jeff; Morgan, Mark; Ford, Dale

2018-01-01

Objectives To identify the success attributions of high-performing Australian general practices and the enablers and barriers they envisage for practices wishing to emulate them. Design Qualitative study using semi-structured interviews and content analysis of the data. Responses were recorded, transcribed verbatim and coded according to success characteristics of high-performing clinical microsystems. Setting Primary healthcare with the participating general practices representing all Australian states and territories, and representing metropolitan and rural locations. Participants Twenty-two general practices identified as high performing via a number of success criteria. The 52 participants were 19 general practitioners, 18 practice managers and 15 practice nurses. Results Participants most frequently attributed success to the interdependence of the team members, patient-focused care and leadership of the practice. They most often signalled practice leadership, team interdependence and staff focus as enablers that other organisations would need to emulate their success. They most frequently identified barriers that might be encountered in the form of potential deficits or limitations in practice leadership, staff focus and mesosystem support. Conclusions Practice leaders need to empower their teams to take action through providing inclusive leadership that facilitates team interdependence. Mesosystem support for quality improvement in general practice should focus on enabling this leadership and team building, thereby ensuring improvement efforts are converted into effective healthcare provision. PMID:29643162

Design and Control of Chemical Grouting : Volume 3 - Engineering Practice

DOT National Transportation Integrated Search

1983-04-01

Recent improvements in the engineering practice of chemical grouting have provided increased confidence in this method of ground modification. Designers can significantly improve the success of chemical grouting by defining their grouting program obj...

Overcoming the Practical Barriers to Spinal Cord Cell Transplantation for ALS

DTIC Science & Technology

2013-10-01

not be neglected. Moreover, escalating numbers and volumes of injections seem to be associated with lack of accuracy and reflux . Histological...with intact segments. Histological analysis will also determine whether reflux occurs with volume escalation as well as with fast (hand-held...analysis of reflux and transient morbidity with number and volume of injection of hNPCs (Boulis). Create a cell bank of astrocyte restricted

Developing an Interventional Pulmonary Service in a Community-Based Private Practice: A Case Study.

PubMed

French, Kim D; Desai, Neeraj R; Diamond, Edward; Kovitz, Kevin L

2016-04-01

Interventional pulmonology (IP) is a field that uses minimally invasive techniques to diagnose, treat, and palliate advanced lung disease. Technology, formal training, and reimbursement for IP procedures have been slow to catch up with other interventional subspecialty areas. A byproduct of this pattern has been limited IP integration in private practice settings. We describe the key aspects and programmatic challenges of building an IP program in a community-based setting. A philosophical and financial buy-in by stakeholders and a regionalization of services, within and external to a larger practice, are crucial to success. Our experience demonstrates that a successful launch of an IP program increases overall visits as well as procedural volume without cannibalizing existing practice volume. We hope this might encourage others to provide this valuable service to their own communities. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Recovery of Navy distillate fuel from reclaimed product. Volume II. Literature review

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

Brinkman, D.W.; Whisman, M.L.

In an effort to assist the Navy to better utilize its waste hydrocarbons, NIPER, with support from the US Department of Energy, is conducting research designed to ultimately develop a practical technique for converting Reclaimed Product (RP) into specification Naval Distillate Fuel (F-76). This first phase of the project was focused on reviewing the literature and available information from equipment manufacturers. The literature survey has been carefully culled for methodology applicable to the conversion of RP into diesel fuel suitable for Navy use. Based upon the results of this study, a second phase has been developed and outlined in whichmore » experiments will be performed to determine the most practical recycling technologies. It is realized that the final selection of one particular technology may be site-specific due to vast differences in RP volume and available facilities. A final phase, if funded, would involve full-scale testing of one of the recommended techniques at a refueling depot. The Phase I investigations are published in two volumes. Volume 1, Technical Discussion, includes the narrative and Appendices I and II. Appendix III, a detailed Literature Review, includes both a narrative portion and an annotated bibliography containing about 800 references and abstracts. This appendix, because of its volume, has been published separately as Volume 2.« less

The Core Competencies for General Orthopaedic Surgeons.

PubMed

Kellam, James F; Archibald, Douglas; Barber, James W; Christian, Eugene P; D'Ascoli, Richard J; Haynes, Richard J; Hecht, Suzanne S; Hurwitz, Shepard R; Kellam, James F; McLaren, Alexander C; Peabody, Terrance D; Southworth, Stephen R; Strauss, Robert W; Wadey, Veronica M R

2017-01-18

With the changing delivery of orthopaedic surgical care, there is a need to define the knowledge and competencies that are expected of an orthopaedist providing general and/or acute orthopaedic care. This article provides a proposal for the knowledge and competencies needed for an orthopaedist to practice general and/or acute care orthopaedic surgery. Using the modified Delphi method, the General Orthopaedic Competency Task Force consisting of stakeholders associated with general orthopaedic practice has proposed the core knowledge and competencies that should be maintained by orthopaedists who practice emergency and general orthopaedic surgery. For relevancy to clinical practice, 2 basic sets of competencies were established. The assessment competencies pertain to the general knowledge needed to evaluate, investigate, and determine an overall management plan. The management competencies are generally procedural in nature and are divided into 2 groups. For the Management 1 group, the orthopaedist should be competent to provide definitive care including assessment, investigation, initial or emergency care, operative or nonoperative care, and follow-up. For the Management 2 group, the orthopaedist should be competent to assess, investigate, and commence timely non-emergency or emergency care and then either transfer the patient to the appropriate subspecialist's care or provide definitive care based on the urgency of care, exceptional practice circumstance, or individual's higher training. This may include some higher-level procedures usually performed by a subspecialist, but are consistent with one's practice based on experience, practice environment, and/or specialty interest. These competencies are the first step in defining the practice of general orthopaedic surgery including acute orthopaedic care. Further validation and discussion among educators, general orthopaedic surgeons, and subspecialists will ensure that these are relevant to clinical practice. These competencies provide many stakeholders, including orthopaedic educators and orthopaedists, with what may be the minimum knowledge and competencies necessary to deliver acute and general orthopaedic care. This document is the first step in defining a practice-based standard for training programs and certification groups.

Business plans--tips from the toolkit 6.

PubMed

Steer, Neville

2010-07-01

General practice is a business. Most practices can stay afloat by having appointments, billing patients, managing the administration processes and working long hours. What distinguishes the high performance organisation from the average organisation is a business plan. This article examines how to create a simple business plan that can be applied to the general practice setting and is drawn from material contained in The Royal Australian College of General Practitioners' 'General practice management toolkit'.

Leadership and management skills of general practice nurses: experience or education?

PubMed

Lau, Rosalind; Cross, Wendy; Moss, Cheryle; Campbell, Annie; De Castro, Magali; Oxley, Victoria

2014-12-01

A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.

Spot-checks to measure general hygiene practice.

PubMed

Sonego, Ina L; Mosler, Hans-Joachim

2016-01-01

A variety of hygiene behaviors are fundamental to the prevention of diarrhea. We used spot-checks in a survey of 761 households in Burundi to examine whether something we could call general hygiene practice is responsible for more specific hygiene behaviors, ranging from handwashing to sweeping the floor. Using structural equation modeling, we showed that clusters of hygiene behavior, such as primary caregivers' cleanliness and household cleanliness, explained the spot-check findings well. Within our model, general hygiene practice as overall concept explained the more specific clusters of hygiene behavior well. Furthermore, the higher general hygiene practice, the more likely children were to be categorized healthy (r = 0.46). General hygiene practice was correlated with commitment to hygiene (r = 0.52), indicating a strong association to psychosocial determinants. The results show that different hygiene behaviors co-occur regularly. Using spot-checks, the general hygiene practice of a household can be rated quickly and easily.

A framework for developing rural academic general practices: a qualitative case study in rural Victoria.

PubMed

Brown, J B; Morrison, Tracy; Bryant, Melanie; Kassell, Lisa; Nestel, Debra

2015-01-01

There is increasing pressure for Australian rural general practices to engage in educational delivery as a means of addressing workforce issues and accommodating substantial increases in learners. For practices that have now developed a strong focus on education, there is the challenge to complement this by engaging in research activity. This study develops a rural academic general practice framework to assist rural practices in developing both comprehensive educational activity and a strong research focus thus moving towards functioning as mature academic units. A case study research design was used with the unit of analysis at the level of the rural general practice. Purposively sampled practices were recruited and individual interviews conducted with staff (supervisors, practice managers, nurses), learners (medical students, interns and registrars) and patients. Three practices hosted 'multi-level learners', two practices hosted one learner group and one had no learners. Forty-four individual interviews were conducted with staff, learners and patients. Audio recordings were transcribed for thematic analysis. After initial inductive coding, deductive analysis was undertaken with reference to recent literature and the expertise of the research team resulting in the rural academic general practice framework. Three key themes emerged with embedded subthemes. For the first theme, organisational considerations, subthemes were values/vision/culture, patient population and clinical services, staffing, physical infrastructure/equipment, funding streams and governance. For the second theme, educational considerations, subthemes were processes, clinical supervision, educational networks and learner presence. Third, for research considerations, there were the subthemes of attitude to research and research activity. The framework maps the development of a rural academic practice across these themes in four progressive stages: beginning, emerging, consolidating and established. The data enabled a framework to be constructed to map rural general practice activity with respect to activity characteristic of an academic general practice. The framework offers guidance to practices seeking to transition towards becoming a mature academic practice. The framework also offers guidance to educational institutions and funding bodies to support the development of academic activity in rural general practices. The strengths and limitations of the study design are outlined.

Health sciences libraries’ subscriptions to journals: expectations of general practice departments and collection-based analysis

PubMed Central

Barreau, David; Bouton, Céline; Renard, Vincent; Fournier, Jean-Pascal

2018-01-01

Objective The aims of this study were to (i) assess the expectations of general practice departments regarding health sciences libraries’ subscriptions to journals and (ii) describe the current general practice journal collections of health sciences libraries. Methods A cross-sectional survey was distributed electronically to the thirty-five university general practice departments in France. General practice departments were asked to list ten journals to which they expected access via the subscriptions of their health sciences libraries. A ranked reference list of journals was then developed. Access to these journals was assessed through a survey sent to all health sciences libraries in France. Adequacy ratios (access/need) were calculated for each journal. Results All general practice departments completed the survey. The total reference list included 44 journals. This list was heterogeneous in terms of indexation/impact factor, language of publication, and scope (e.g., patient care, research, or medical education). Among the first 10 journals listed, La Revue Prescrire (96.6%), La Revue du Praticien–Médecine Générale (90.9%), the British Medical Journal (85.0%), Pédagogie Médicale (70.0%), Exercer (69.7%), and the Cochrane Database of Systematic Reviews (62.5%) had the highest adequacy ratios, whereas Family Practice (4.2%), the British Journal of General Practice (16.7%), Médecine (29.4%), and the European Journal of General Practice (33.3%) had the lowest adequacy ratios. Conclusions General practice departments have heterogeneous expectations in terms of health sciences libraries’ subscriptions to journals. It is important for librarians to understand the heterogeneity of these expectations, as well as local priorities, so that journal access meets users’ needs. PMID:29632446

Influences on students’ career decisions concerning general practice: a focus group study

PubMed Central

Nicholson, Sandra; Hastings, Adrian Michael; McKinley, Robert Kee

2016-01-01

Background Despite concerns about recruitment to UK general practice, there has been no concerted educational intervention to address them. Aim To better understand how medical students’ perceptions of their experiences of their undergraduate curriculum may affect choosing general practice as a career. Design and setting Qualitative study comprising focus groups of a total of 58 students from a range of medical schools across the UK. Method A range of UK medical schools students were invited by email to participate in focus groups and return a questionnaire detailing their current career choice to facilitate sampling students with varied career preferences. Students late in their studies were sampled as they were likely to be considering future careers. Focus group discussions were audiotaped, transcribed, and anonymised for both school and participant, then thematically analysed. Perceived differences in medical school culture, curriculum philosophy, design, and intent were explored. Results Six focus groups (58 students) were convened. Some student participants’ career aspirations were strongly shaped by family and home, but clinical placements remained important in confirming or refuting these choices. High-quality general practice attachments are a powerful attractor to general practice and, when they reflect authentic clinical practice, promote general practice careers. GP tutors can be powerful, positive role models. Students’ comments revealed conflicting understandings about general practice. Conclusion Attracting rather than coercing students to general practice is likely to be more effective at changing their career choices. Early, high-quality, ongoing and, authentic clinical exposure promotes general practice and combats negative stereotyping. It is recommended that increasing opportunities to help students understand what it means to be a ‘good GP’ and how this can be achieved are created. PMID:27578812

Validation of an instrument to measure inter-organisational linkages in general practice.

PubMed

Amoroso, Cheryl; Proudfoot, Judith; Bubner, Tanya; Jayasinghe, Upali W; Holton, Christine; Winstanley, Julie; Beilby, Justin; Harris, Mark F

2007-12-03

Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice's linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. An interview to measure surgery-level (rather than individual clinician-level) clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations). Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. The resulting General Practice Clinical Linkages Interview (GP-CLI) is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however, comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples exploring the impact, outcomes, and facilitators of high quality clinical linkages in general practice.

Editorial quality, diffusion and bibliometric indicators of the Revista Espaãnola de Enfermedades Digestivas.

PubMed

López-Cózar, E D; Ruiz-Pérez, R; Jiménez-Contreras, E

1999-01-01

To evaluate the editorial quality, diffusion, relevance of the scientific content, and the publication practices of the specialised journal Revista Española de Enfermedades Digestivas. We checked 136 parameters based on ISO standards, the recommendations of scientific and editorial organisations, and studies of scientific editing and international publishing practices for biomedical journals. Diffusion was calculated using national and international databases, specialised libraries in Spain, and Internet sources. The analysis of the scientific content and publication practices was based on bibliometric indicators for the journal, authorship, and contributions. The sample for this study comprised six alternate issues of volume number 88 (1996), the last issue of this volume, and the first issue of volume 89 (1997). The samples used for the bibliometric analysis varied depending on the characteristics of specific indicators and the availability of information. The overall mean value for compliance with standards was 46.1%, while the real mean was calculated at 72.21%. The editorial procedures at the journal are similar to those of analogous international journals. The Revista Española de Enfermedades Digestivas is included in international databases of biomedical journals, and in the interdisciplinary international database SCI. It was found to be present in 70% of the medical libraries of Spanish universities, and in 73% of the hospital libraries studied. Bibliometric indicators showed co-authorship to be 5.5%; the origin of the authors grouped by province and by type of institutional affiliations showed 27.8% of all authors to be from Madrid, and that more were affiliated with general hospitals than with university hospitals. The mean delay between initial receipt of a manuscript and its publication was 300 days. Cocitation analysis gave the journal a central position amongst the 38 Spanish biomedical journals considered representative of the field. The journal's impact factor for 1996 was 0.260. The Revista Española de Enfermedades Digestivas is a high-quality vehicle of research results, and has acceptable internal editorial procedures. The journal is widely distributed, though its visibility on the Internet should be improved. Co-authorship is similar to that seen in other medical journals. Steps should be taken to make this journal better known within Spain, and to reduce the delay between the initial receipt and the final publication of manuscripts. Its impact factor is increasing steadily.

A general Kastler-Kalau-Walze type theorem for manifolds with boundary

NASA Astrophysics Data System (ADS)

Wang, Jian; Wang, Yong

2016-11-01

In this paper, we establish a general Kastler-Kalau-Walze type theorem for any dimensional manifolds with boundary which generalizes the results in [Y. Wang, Lower-dimensional volumes and Kastler-Kalau-Walze type theorem for manifolds with boundary, Commun. Theor. Phys. 54 (2010) 38-42]. This solves a problem of the referee of [J. Wang and Y. Wang, A Kastler-Kalau-Walze type theorem for five-dimensional manifolds with boundary, Int. J. Geom. Meth. Mod. Phys. 12(5) (2015), Article ID: 1550064, 34 pp.], which is a general expression of the lower dimensional volumes in terms of the geometric data on the manifold.

Secure distributed genome analysis for GWAS and sequence comparison computation.

PubMed

Zhang, Yihua; Blanton, Marina; Almashaqbeh, Ghada

2015-01-01

The rapid increase in the availability and volume of genomic data makes significant advances in biomedical research possible, but sharing of genomic data poses challenges due to the highly sensitive nature of such data. To address the challenges, a competition for secure distributed processing of genomic data was organized by the iDASH research center. In this work we propose techniques for securing computation with real-life genomic data for minor allele frequency and chi-squared statistics computation, as well as distance computation between two genomic sequences, as specified by the iDASH competition tasks. We put forward novel optimizations, including a generalization of a version of mergesort, which might be of independent interest. We provide implementation results of our techniques based on secret sharing that demonstrate practicality of the suggested protocols and also report on performance improvements due to our optimization techniques. This work describes our techniques, findings, and experimental results developed and obtained as part of iDASH 2015 research competition to secure real-life genomic computations and shows feasibility of securely computing with genomic data in practice.

Secure distributed genome analysis for GWAS and sequence comparison computation

PubMed Central

2015-01-01

Background The rapid increase in the availability and volume of genomic data makes significant advances in biomedical research possible, but sharing of genomic data poses challenges due to the highly sensitive nature of such data. To address the challenges, a competition for secure distributed processing of genomic data was organized by the iDASH research center. Methods In this work we propose techniques for securing computation with real-life genomic data for minor allele frequency and chi-squared statistics computation, as well as distance computation between two genomic sequences, as specified by the iDASH competition tasks. We put forward novel optimizations, including a generalization of a version of mergesort, which might be of independent interest. Results We provide implementation results of our techniques based on secret sharing that demonstrate practicality of the suggested protocols and also report on performance improvements due to our optimization techniques. Conclusions This work describes our techniques, findings, and experimental results developed and obtained as part of iDASH 2015 research competition to secure real-life genomic computations and shows feasibility of securely computing with genomic data in practice. PMID:26733307

[Guided bone regeneration: general survey].

PubMed

Cosyn, Jan; De Bruyn, Hugo

2009-01-01

The principle of 'guided bone regeneration' was first described in 1988 on the basis of animal-experimental data. Six weeks after transmandibular defects had been created and protected by non-resorbable teflonmembranes, complete bone regeneration was found. The technique was based on the selective repopulation of the wound: every infiltration of cells outside the neighbouring bone tissue was prevented by the application of the membrane. Additional animal experiments showed that guided bone regeneration was a viable treatment option for local bone defects surrounding dental implants. Clinical practice, however, showed that premature membrane exposure was a common complication, which was responsible for a tremendous reduction in regenerated bone volume. In addition, a second surgical intervention was always necessary to remove the membrane. As a result, resorbable alternatives were developed. Since these are less rigid, bone fillers are usually used simultaneously. These comprise autogenous bone chips and bone substitutes from allogenic or xenogenic origine. Also alloplastic materials could be used for this purpose. Based on their characteristics this article provides an overview of the biomaterials that could be considered for guided bone regeneration. Specific attention goes to their application in clinical practice.

Research of a smart cutting tool based on MEMS strain gauge

NASA Astrophysics Data System (ADS)

Zhao, Y.; Zhao, Y. L.; Shao, YW; Hu, T. J.; Zhang, Q.; Ge, X. H.

2018-03-01

Cutting force is an important factor that affects machining accuracy, cutting vibration and tool wear. Machining condition monitoring by cutting force measurement is a key technology for intelligent manufacture. Current cutting force sensors exist problems of large volume, complex structure and poor compatibility in practical application, for these problems, a smart cutting tool is proposed in this paper for cutting force measurement. Commercial MEMS (Micro-Electro-Mechanical System) strain gauges with high sensitivity and small size are adopted as transducing element of the smart tool, and a structure optimized cutting tool is fabricated for MEMS strain gauge bonding. Static calibration results show that the developed smart cutting tool is able to measure cutting forces in both X and Y directions, and the cross-interference error is within 3%. Its general accuracy is 3.35% and 3.27% in X and Y directions, and sensitivity is 0.1 mV/N, which is very suitable for measuring small cutting forces in high speed and precision machining. The smart cutting tool is portable and reliable for practical application in CNC machine tool.

';Best' Practices for Aggregating Subset Results from Archived Datasets

NASA Astrophysics Data System (ADS)

Baskin, W. E.; Perez, J.

2013-12-01

In response to the exponential growth in science data analysis and visualization capabilities Data Centers have been developing new delivery mechanisms to package and deliver large volumes of aggregated subsets of archived data. New standards are evolving to help data providers and application programmers deal with growing needs of the science community. These standards evolve from the best practices gleaned from new products and capabilities. The NASA Atmospheric Sciences Data Center (ASDC) has developed and deployed production provider-specific search and subset web applications for the CALIPSO, CERES, TES, and MOPITT missions. This presentation explores several use cases that leverage aggregated subset results and examines the standards and formats ASDC developers applied to the delivered files as well as the implementation strategies for subsetting and processing the aggregated products. The following topics will be addressed: - Applications of NetCDF CF conventions to aggregated level 2 satellite subsets - Data-Provider-Specific format requirements vs. generalized standards - Organization of the file structure of aggregated NetCDF subset output - Global Attributes of individual subsetted files vs. aggregated results - Specific applications and framework used for subsetting and delivering derivative data files

[A brief textual research on circulated versions of Dan tai yu an (Jade Case Records of Red Stage].

PubMed

Xu, Gao; Zhu, Jianping

2014-03-01

Dan tai yu an (Jade Case Records of Red Stage) was compiled by a doctor of the Ming Dynasty Sun Wenyin, including 6 volumes. This book involves Chinese internal medicine, paediatrics, gynaecology, external medicine, and Department of the sense organs (ENT) classified into 73 categories, each of which contains 80 kinds of disease. The total number of disease was 157. Each kind of disease is discussed under the order of etiology, syndrome, pulse condition and treatment. The range of traditional Chinese prescriptions in this book is rather extensive with its indications, administrations and modification of main prescriptions given concretely. Both internal and external treatment are included, and the individual drug and proved recipe are practical and effective, which is a significant reference to clinical practice. There are many versions of this book extant. According to our investigation and research, we replenished some information to the"General Catalogue of TCM Ancient Books", and at the same time, correct some mistakes, providing the basis for further collation and publishing.

Resident operative experience in general surgery, plastic surgery, and urology 5 years after implementation of the ACGME duty hour policy.

PubMed

Simien, Christopher; Holt, Kathleen D; Richter, Thomas H; Whalen, Thomas V; Coburn, Michael; Havlik, Robert J; Miller, Rebecca S

2010-08-01

Resident duty hour restrictions were implemented in 2002-2003. This study examines changes in resident surgical experience since these restrictions were put into place. Operative log data for 3 specialties were examined: general surgery, urology, and plastic surgery. The academic year immediately preceding the duty hour restrictions, 2002-2003, was used as a baseline for comparison to subsequent academic years. Operative log data for graduating residents through 2007-2008 were the primary focus of the analysis. Examination of associated variables that may moderate the relationship between fewer duty hours and surgical volume was also included. Plastic surgery showed no changes in operative volume following duty hour restrictions. Operative volume increased in urology programs. General surgery showed a decrease in volume in some operative categories but an increase in others. Specifically the procedures in vascular, plastic, and thoracic areas showed a consistent decrease. There was no increase in the percentage of programs' graduates falling below minimum requirements. Procedures in pancreas, endocrine, and laparoscopic areas demonstrated an increase in volume. Graduates in larger surgical programs performed fewer procedures than graduates in smaller programs; this was not the case for urology or plastic surgery programs. The reduction of duty hours has not resulted in an across the board decrease in operative volume. Factors other than duty hour reforms may be responsible for some of the observed findings.

Google and Women’s Health-Related Issues: What Does the Search Engine Data Reveal?

PubMed Central

Baazeem, Mazin

2014-01-01

Objectives Identifying the gaps in public knowledge of women’s health related issues has always been difficult. With the increasing number of Internet users in the United States, we sought to use the Internet as a tool to help us identify such gaps and to estimate women’s most prevalent health concerns by examining commonly searched health-related keywords in Google search engine. Methods We collected a large pool of possible search keywords from two independent practicing obstetrician/gynecologists and classified them into five main categories (obstetrics, gynecology, infertility, urogynecology/menopause and oncology), and measured the monthly average search volume within the United States for each keyword with all its possible combinations using Google AdWords tool. Results We found that pregnancy related keywords were less frequently searched in general compared to other categories with an average of 145,400 hits per month for the top twenty keywords. Among the most common pregnancy-related keywords was “pregnancy and sex’ while pregnancy-related diseases were uncommonly searched. HPV alone was searched 305,400 times per month. Of the cancers affecting women, breast cancer was the most commonly searched with an average of 247,190 times per month, followed by cervical cancer then ovarian cancer. Conclusion The commonly searched keywords are often issues that are not discussed in our daily practice as well as in public health messages. The search volume is relatively related to disease prevalence with the exception of ovarian cancer which could signify a public fear. PMID:25422723

1970 MLA Abstracts of Articles in Scholarly Journals, Volume I: General, English, American, Medieval and Neo-Latin, Celtic Literatures; and Folklore.

ERIC Educational Resources Information Center

Fisher, John H., Comp.; Achtert, Walter S., Comp.

The first volume of an annual series following the arrangement of the "MLA International Bibliography" includes sections on General, English, American, Medieval and Neo-Latin, Celtic literatures, and Folklore. A classified collection of 1,744 brief abstracts of journalarticles on the modern languages and literatures to be used in conjunction with…

Sex Differences in Brain Volume Are Related to Specific Skills, Not to General Intelligence

ERIC Educational Resources Information Center

Burgaleta, Miguel; Head, Kevin; Alvarez-Linera, Juan; Martinez, Kenia; Escorial, Sergio; Haier, Richard; Colom, Roberto

2012-01-01

It has been proposed that males would show higher mean scores than females in general intelligence ("g") because (1) men have, on average, larger brains than women, and (2) brain volume correlates with "g." Here we report a failure to support the conclusion derived from these premises. High resolution MRIs were acquired in a sample of one hundred…

Engaging Musical Practices: A Sourcebook for Middle School General Music

ERIC Educational Resources Information Center

Burton, Suzanne L., Ed.

2012-01-01

Middle school general music may be a student's last encounter with school music. A practical book with accessible pedagogical resources on middle school general music is needed for methods courses and music practitioners' use. The book "Engaging Musical Practices: A Sourcebook for Middle School General Music" presents numerous ways to engage…

Predictors of laparoscopic simulation performance among practicing obstetrician gynecologists.

PubMed

Mathews, Shyama; Brodman, Michael; D'Angelo, Debra; Chudnoff, Scott; McGovern, Peter; Kolev, Tamara; Bensinger, Giti; Mudiraj, Santosh; Nemes, Andreea; Feldman, David; Kischak, Patricia; Ascher-Walsh, Charles

2017-11-01

While simulation training has been established as an effective method for improving laparoscopic surgical performance in surgical residents, few studies have focused on its use for attending surgeons, particularly in obstetrics and gynecology. Surgical simulation may have a role in improving and maintaining proficiency in the operating room for practicing obstetrician gynecologists. We sought to determine if parameters of performance for validated laparoscopic virtual simulation tasks correlate with surgical volume and characteristics of practicing obstetricians and gynecologists. All gynecologists with laparoscopic privileges (n = 347) from 5 academic medical centers in New York City were required to complete a laparoscopic surgery simulation assessment. The physicians took a presimulation survey gathering physician self-reported characteristics and then performed 3 basic skills tasks (enforced peg transfer, lifting/grasping, and cutting) on the LapSim virtual reality laparoscopic simulator (Surgical Science Ltd, Gothenburg, Sweden). The association between simulation outcome scores (time, efficiency, and errors) and self-rated clinical skills measures (self-rated laparoscopic skill score or surgical volume category) were examined with regression models. The average number of laparoscopic procedures per month was a significant predictor of total time on all 3 tasks (P = .001 for peg transfer; P = .041 for lifting and grasping; P < .001 for cutting). Average monthly laparoscopic surgical volume was a significant predictor of 2 efficiency scores in peg transfer, and all 4 efficiency scores in cutting (P = .001 to P = .015). Surgical volume was a significant predictor of errors in lifting/grasping and cutting (P < .001 for both). Self-rated laparoscopic skill level was a significant predictor of total time in all 3 tasks (P < .0001 for peg transfer; P = .009 for lifting and grasping; P < .001 for cutting) and a significant predictor of nearly all efficiency scores and errors scores in all 3 tasks. In addition to total time, there was at least 1 other objective performance measure that significantly correlated with surgical volume for each of the 3 tasks. Higher-volume physicians and those with fellowship training were more confident in their laparoscopic skills. By determining simulation performance as it correlates to active physician practice, further studies may help assess skill and individualize training to maintain skill levels as case volumes fluctuate. Copyright © 2017 Elsevier Inc. All rights reserved.

General surgery graduates may be ill prepared to enter rural or community surgical practice.

PubMed

Gillman, Lawrence M; Vergis, Ashley

2013-06-01

Rural/community surgery presents unique challenges to general surgeons. Not only are they required to perform "classic" general surgery procedures, but they are also often expected to be competent in other surgical disciplines. Final-year Canadian-trained residents in general surgery were asked to complete the survey. The survey explored chief residents' career plans for the following year and whether or not they would independently perform various procedures, some general surgical, and others now considered within the domain of the subspecialties. Sixty-four residents (71%) completed the survey. Twenty percent planned to undertake a rural surgical practice, 17% an urban community practice, and 55% had confirmed fellowships. Most residents (>90%) expressed comfort with basic general surgical procedures. However, residents were less comfortable with subspecialty procedures that are still performed by general surgeons in many rural practices. More than half of graduating general surgery residents are choosing subspecialty fellowship training over proceeding directly to practice. Those choosing a rural or community practice are likely to feel ill prepared to replace existing surgeons. Copyright © 2013 Elsevier Inc. All rights reserved.

Three Twentieth-Century Multiauthored Neurological Handbooks – A Historical Analysis and Bibliometric Comparison

PubMed Central

Koehler, Peter J.; Stahnisch, Frank W.

2013-01-01

The emergence of neurology as a separate specialty from internal medicine and psychiatry took several decades, starting at the end of the nineteenth century. This can be adequately reconstructed by focusing on the establishment of specialized journals, societies, university chairs, the invention and application of specific instruments, medical practices, and certainly also the publication of pivotal textbooks in the field. Particularly around 1900, the German-speaking countries played an integral role in this process. In this article, one aspect is extensively explored, notably the publication (in the twentieth century) of three comprehensive and influential multivolume and multiauthor handbooks entirely devoted to neurology. All available volumes of Max Lewandowsky's Handbuch der Neurologie (1910–1914) and the Handbuch der Neurologie (1935–1937) of Oswald Bumke and Otfrid Foerster were analyzed. The handbooks were then compared with Pierre Vinken's and George Bruyn's Handbook of Clinical Neurology (1968–2002). Over the span of nearly a century these publications became ever more comprehensive and developed into a global, encompassing project as is reflected in the increasing number of foreign authors. Whereas the first two handbooks were published mainly in German, “Vinken & Bruyn” was eventually published entirely in English, indicating the general changes in the scientific language of neurology after World War II. Distinctions include the uniformity of the series, manner of editorial involvement, thematic comprehensiveness, inclusion of volume editors in “Vinken & Bruyn,” and the provision of index volumes. The increasing use of authorities in various neurological subspecialties is an important factor by which these handbooks contrast with many compact neurological textbooks that were available at the time. For historiographical purposes, the three neurological handbooks considered here were important sources for the general study of the history of medicine and science and the history of neurology in particular. Moreover, they served as important catalyzers of the emergence of neurology as a new clinical specialty during the first decades of the twentieth century. PMID:24083680

Quantifying the proportion of general practice and low-acuity patients in the emergency department.

PubMed

Nagree, Yusuf; Camarda, Vanessa J; Fatovich, Daniel M; Cameron, Peter A; Dey, Ian; Gosbell, Andrew D; McCarthy, Sally M; Mountain, David

2013-06-17

To accurately estimate the proportion of patients presenting to the emergency department (ED) who may have been suitable to be seen in general practice. Using data sourced from the Emergency Department Information Systems for the calendar 2013s 2009 to 2011 at three major tertiary hospitals in Perth, Western Australia, we compared four methods for calculating general practice-type patients. These were the validated Sprivulis method, the widely used Australasian College for Emergency Medicine method, a discharge diagnosis method developed by the Tasmanian Department of Human and Health Services, and the Australian Institute of Health and Welfare (AIHW) method. General practice-type patient attendances to EDs, estimated using the four methods. All methods except the AIHW method showed that 10%-12% of patients attending tertiary EDs in Perth may have been suitable for general practice. These attendances comprised 3%-5% of total ED length of stay. The AIHW method produced different results (general practice-type patients accounted for about 25% of attendances, comprising 10%-11% of total ED length of stay). General practice-type patient attendances were not evenly distributed across the week, with proportionally more patients presenting during weekday daytime (08:00-17:00) and proportionally fewer overnight (00:00-08:00). This suggests that it is not a lack of general practitioners that drives patients to the ED, as weekday working hours are the time of greatest GP availability. The estimated proportion of general practice-type patients attending the EDs of Perth's major hospitals is 10%-12%, and this accounts for < 5% of the total ED length of stay. The AIHW methodology overestimates the actual proportion of general practice-type patient attendances.

Clinical accuracy of point-of-care urine culture in general practice.

PubMed

Holm, Anne; Cordoba, Gloria; Sørensen, Tina Møller; Jessen, Lisbeth Rem; Frimodt-Møller, Niels; Siersma, Volkert; Bjerrum, Lars

2017-06-01

To assess the clinical accuracy (sensitivity (SEN), specificity (SPE), positive predictive value and negative predictive value) of two point-of-care (POC) urine culture tests for the identification of urinary tract infection (UTI) in general practice. Prospective diagnostic accuracy study comparing two index tests (Flexicult™ SSI-Urinary Kit or ID Flexicult™) with a reference standard (urine culture performed in the microbiological department). General practice in the Copenhagen area patients. Adult female patients consulting their general practitioner with suspected uncomplicated, symptomatic UTI. (1) Overall accuracy of POC urine culture in general practice. (2) Individual accuracy of each of the two POC tests in this study. (3) Accuracy of POC urine culture in general practice with enterococci excluded, since enterococci are known to multiply in boric acid used for transportation for the reference standard. (4) Accuracy based on expert reading of photographs of POC urine cultures performed in general practice. Standard culture performed in the microbiological department was used as reference standard for all four measures. Twenty general practices recruited 341 patients with suspected uncomplicated UTI. The overall agreement between index test and reference was 0.76 (CI: 0.71-0.80), SEN 0.88 (CI: 0.83-0.92) and SPE 0.55 (CI: 0.46-0.64). The two POC tests produced similar results individually. Overall agreement with enterococci excluded was 0.82 (0.77-0.86) and agreement between expert readings of photographs and reference results was 0.81 (CI: 0.76-0.85). POC culture used in general practice has high SEN but low SPE. Low SPE could be due to both misinterpretation in general practice and an imperfect reference standard. Registration number: ClinicalTrials.gov NCT02323087.

How do Australian patients rate their general practitioner? A descriptive study using the General Practice Assessment Questionnaire.

PubMed

Potiriadis, Maria; Chondros, Patty; Gilchrist, Gail; Hegarty, Kelsey; Blashki, Grant; Gunn, Jane M

2008-08-18

To report patient responses to the General Practice Assessment Questionnaire (GPAQ) as a measure of satisfaction with health care received from Australian general practitioners. A clustered cross-sectional study involving general practice patients from 30 randomly selected general practices in Victoria. Between January and December 2005, a screening survey, including a postal version of the GPAQ, was mailed to 17 780 eligible patients. Scores on the six GPAQ items. We analysed data from 7130 patients who completed the screening survey and fulfilled our eligibility criteria. Levels of patient satisfaction with general practice care were generally high: mean GPAQ scores ranged from 68.6 (95% CI, 66.1-71.0) for satisfaction with access to the practice to 84.0 (95% CI, 82.2-85.4) for satisfaction with communication. Intracluster correlations for the GPAQ items ranged from 0.016 for overall satisfaction with the practice to 0.163 for satisfaction with access to the practice. Compared with national benchmarks in the United Kingdom, the GPs and practices participating in our study were rated higher on all six GPAQ items. Multivariable mixed effects linear regression showed that patients who were older, rated their health more highly, visited their GP more frequently and saw the same GP each time tended to express greater satisfaction with their care. Generally patients reported high levels of satisfaction with GP care. Greater satisfaction with care was associated with older patients, good health, more frequent contact with the GP, and seeing the one GP consistently.

Elastic properties of uniaxial-fiber reinforced composites - General features

NASA Astrophysics Data System (ADS)

Datta, Subhendu; Ledbetter, Hassel; Lei, Ming

The salient features of the elastic properties of uniaxial-fiber-reinforced composites are examined by considering the complete set of elastic constants of composites comprising isotropic uniaxial fibers in an isotropic matrix. Such materials exhibit transverse-isotropic symmetry and five independent elastic constants in Voigt notation: C(11), C(33), C(44), C(66), and C(13). These C(ij) constants are calculated over the entire fiber-volume-fraction range 0.0-1.0, using a scattered-plane-wave ensemple-average model. Some practical elastic constants such as the principal Young moduli and the principal Poisson ratios are considered, and the behavior of these constants is discussed. Also presented are the results for the four principal sound velocities used to study uniaxial-fiber-reinforced composites: v(11), v(33), v(12), and v(13).

Multinational Activities of Major U.S. Automotive Producers : Volume 5. Diffusion of Production and Sales Operations Abroad.

DOT National Transportation Integrated Search

1978-09-01

This is Volume V on the multi-national activities of the major U.S. automotive producers. The purpose of this Volume is to evaluate the foreign manufacturing and sales activities of the General Motors Corporation, Ford Motor Company, and Chrysler Cor...

Comparing the Volumes of Rectangular Prisms

ERIC Educational Resources Information Center

Assuah, Charles K.; Wiest, Lynda R.

2010-01-01

Can middle-grades students determine which of two rectangular prisms has a larger volume? Can they do so without using a formula? Geometry, and particularly the concept of volume, is important in many subjects, such as physics and chemistry. Students greatly enhance their mathematics knowledge when they make generalizations and construct arguments…

Logistics of building a laser practice for the treatment of hypertrophic burn scars.

PubMed

Hultman, Charles Scott; Edkins, Renee E; Cairns, Bruce A; Meyer, Anthony A

2013-05-01

Although lasers can improve burn scars, such treatment has not been adopted universally, due to operational challenges starting a practice and the perception that such a program is not financially viable. We report the logistics of building a laser practice for the treatment of hypertrophic burn scars. We analyzed the clinical, operational, and financial components of our laser practice, focusing on treatment of hypertrophic burn scars, using pulsed dye laser, fractional CO2 laser, and intense pulsed light. Cases were performed in an operating room, with anesthesia, after preauthorization. We examined professional charges and collections, case time, variable and indirect expenses, and breakeven volumes. Our practice grew as follows: 2008, 1 case; 2009, 44 cases; 2010, 169 cases; and 2011, 415 cases. Overall collection rate was 32.1%. Expenses incurred by the provider, per 8-hour session, included laser rental/lease ($2375), personnel salaries ($1900), and physician overhead ($808), for a total cost of $5083. Mean charge was $1642 per case; mean collection was $527 per case. Median case time (procedure plus turnover) was 40 minutes. In this model, breakeven volume is 9.7 cases per day; breakeven time is 49.7 minutes. Provider profit margin for 10 cases per day, or 83% capacity utilization, is $187 per day (income - expenses = $5270 - $5083). Despite high costs associated with starting and operating a laser practice for the treatment of hypertrophic burn scars, a sustainable enterprise can be achieved when the provider has accrued enough volume to batch cases over an entire day. Critical to achieving breakeven is preauthorization, controlling overhead, and efficient throughput.

The impact of electronic health records on workflow and financial measures in primary care practices.

PubMed

Fleming, Neil S; Becker, Edmund R; Culler, Steven D; Cheng, Dunlei; McCorkle, Russell; da Graca, Briget; Ballard, David J

2014-02-01

To estimate a commercially available ambulatory electronic health record's (EHR's) impact on workflow and financial measures. Administrative, payroll, and billing data were collected for 26 primary care practices in a fee-for-service network that rolled out an EHR on a staggered schedule from June 2006 through December 2008. An interrupted time series design was used. Staffing, visit intensity, productivity, volume, practice expense, payments received, and net income data were collected monthly for 2004-2009. Changes were evaluated 1-6, 7-12, and >12 months postimplementation. Data were accessed through a SQLserver database, transformed into SAS®, and aggregated by practice. Practice-level data were divided by full-time physician equivalents for comparisons across practices by month. Staffing and practice expenses increased following EHR implementation (3 and 6 percent after 12 months). Productivity, volume, and net income decreased initially but recovered to/close to preimplementation levels after 12 months. Visit intensity did not change significantly, and a secular trend offset the decrease in payments received. Expenses increased and productivity decreased following EHR implementation, but not as much or as persistently as might be expected. Longer term effects still need to be examined. © Health Research and Educational Trust.

78 FR 43898 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-22

... volume control credits were added to Stormwater Management. Incorporating low impact development practices will result in cleaner rainwater runoff. It will also delay urban runoff into floodplains, resulting in reduced stormwater volume that can otherwise have a detrimental scouring impact on a stream's...