[HIV/AIDS spread and influence on other health-related Millennium Development Goals].

PubMed

Alban, Anita; Andersen, Nina Bjerglund

2006-09-04

HIV/AIDS is threatening the development of countries with high HIV prevalence. This article analyses the impact of HIV/AIDS on the Millennium Development Goals for Health. The analysis is based on a literature survey on the impact of HIV on child health, maternal mortality, tuberculosis and malaria. We find a strong correlation between HIV and child mortality and HIV and TB. We conclude that, in order to reach the Millennium Development Goals, health strategies must include a comprehensive and coordinated approach to fight major health problems including improved resource allocation.

Culturally Tailored Intervention for Rural African Americans With Type 2 Diabetes

PubMed Central

Utz, Sharon W.; Williams, Ishan C.; Jones, Randy; Hinton, Ivora; Alexander, Gina; Yan, Guofen; Moore, Cynthia; Blankenship, Jean; Steeves, Richard; Oliver, M. Norman

2013-01-01

Purpose The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study. Methods Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included storytelling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period. Results Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME. Conclusions The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions using a culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended. PMID:18832290

Libraries and E-Commerce: Improving Information Services and Beyond.

ERIC Educational Resources Information Center

Harris, Lesley Ellen

2000-01-01

Explains e-commerce and discusses how it can be used by special libraries. Highlights include library goals; examples of successful uses of e-commerce; how e-commerce can improve information services, including access to information, new information resources, delivery of information, and broadening information markets; and developing an…

Excerpts from Managing CQI in Radiology and Diagnostic Imaging Services: A CQI Handbook.

PubMed

Joseph, E D; Lesher, C; Zage, R

1994-01-01

Continuous quality improvement (CQI) is currently the most popular and influential quality management program used in healthcare organizations. It is an effective methodology for identifying and acting on opportunities to improve the efficiency, effectiveness and value of services provided to customers. CQI implementation can be broken down into four components: (1) achievement objectives and goal identification, (2) system process analysis, (3) action planning and implementation, and (4) performance measurement and follow-up. As the project team establishes goals, it should consider customer and staff needs, what constitutes "quality," existing guidelines and regulations, and how results will be measured. Many techniques can be used to analyze the procedure or function targeted for improvement, including charts and diagrams, formal monitoring, data collection and statistical analysis. After the project team has identified potential service improvements, they develop an action plan, which may include education, recruitment, reassignment or equipment acquisition. The team must consider the impact of proposed changes and the financial and logistical feasibility of various proposals. The dynamic challenges of radiology and diagnostic imaging cannot be addressed through single, isolated actions; efforts to improve quality should be continuous. Accordingly, the project team should measure and analyze results of the action plan, reappraise goals and look for opportunities to further improve service.

Improving computer usage for students with physical disabilities through a collaborative approach: a pilot study.

PubMed

Borgestig, Maria; Falkmer, Torbjörn; Hemmingsson, Helena

2013-11-01

The aim of this study was to evaluate the effect of an assistive technology (AT) intervention to improve the use of available computers as assistive technology in educational tasks for students with physical disabilities during an ongoing school year. Fifteen students (aged 12-18) with physical disabilities, included in mainstream classrooms in Sweden, and their teachers took part in the intervention. Pre-, post-, and follow-up data were collected with Goal Attainment Scaling (GAS), a computer usage diary, and with the Psychosocial Impact of Assistive Devices Scale (PIADS). Teachers' opinions of goal setting were collected at follow-up. The intervention improved the goal-related computer usage in educational tasks and teachers reported they would use goal setting again when appropriate. At baseline, students reported a positive impact from computer usage with no differences over time regarding the PIADS subscales independence, adaptability, or self-esteem. The AT intervention showed a positive effect on computer usage as AT in mainstream schools. Some additional support to teachers is recommended as not all students improved in all goal-related computer usage. A clinical implication is that students' computer usage can be improved and collaboratively established computer-based strategies can be carried out by teachers in mainstream schools.

Abatement of tropospheric ozone: effects of strategies to improve air quality on public health and other sectors.

PubMed

Guest, C S; Morgan, P; Moss, J R; Woodward, A J; McMichael, A J

1996-06-01

The National Health and Medical Research Council's air quality goal for ozone in the troposphere (near the earth's surface) is 0.12 parts per million (ppm), averaged over one hour, similar to the United States standard, but less stringent than the guideline for Europe. We aimed to identify the environmental, economic and social changes that would be associated with changing the goal. Methods included literature review, economic assessments and group interviews. The group to benefit from lower exposures may include outdoor workers, school children and people not in regular day-time work indoors, because ozone is most prevalent during the daylight hours of the warmer months. A lower level could improve the yield of some crops. The causes and effects of tropospheric ozone are not appreciated except among groups with relevant commercial, industrial or scientific experience. However, the consultations identified frustration about the social problems caused by dependence on private motor vehicles. Short-term costs of compliance with a more stringent goal would fall principally on the users of transport. The value of the benefits was enough for many to support making the ozone goal more stringent, but those who required a demonstration of financial benefit (even including savings of health care costs) did not support any change to the goal. Based primarily on averted detriment to health, we recommend the more stringent level of 0.08 ppm (one-hour average) as the goal for the year 2005 in Australia and elsewhere. The addition of a goal with longer averaging time is also proposed.

Evaluation of behavior change goal-setting action plan on oral health activity and status.

PubMed

Lepore, Lindsay M; Yoon, Richard K; Chinn, Courtney H; Chussid, Steven

2011-11-01

This experimental study determined if a "report card-like" oral health action plan was effective in improving oral health behaviors in a sample of 69 patients, ages 1 to 6 years. Participants were divided randomly into control and intervention groups. Data collected included dmft, plaque score, Streptococcus mutans levels and oral health behaviors. Participants in the intervention group received an oral health action plan that included: 1. child's current caries-risk status; 2. identification issues of concern; and 3. one "goal" to improve on for the next visit. All participants returned after two months for follow-up examination and data collection.

Equality, Quality and Quantity: The Elusive Triangle in Indian Education.

ERIC Educational Resources Information Center

Naik, J. P.

1979-01-01

Since independence in 1947, India's educational goals have included expansion, improved quality, and equal opportunity. The author analyzes India's successes and failures in reaching these goals in the context of its limited economic resources, the traditional educational values of its people, and its traditionally stratified social system. (SJL)

Healthcare professional versus patient goal setting in intermittent allergic rhinitis.

PubMed

O'Connor, J; Seeto, C; Saini, B; Bosnic-Anticevich, S; Krass, I; Armour, C; Smith, L

2008-01-01

To examine the impact of healthcare professional versus patient goal setting for the self-management of intermittent allergic rhinitis (AR) on symptom severity and quality of life. This was a 6 week, parallel group study. Group A participants, with pharmacist facilitation, nominated personally relevant goals and strategies relating to their AR. Group B participants had their goals and strategies set by the pharmacist. The main outcome measures used included perceived symptom severity and quality of life. In addition, goals and strategies data from participants of both groups were collected and analysed. Both groups demonstrated significant improvements in symptom severity and quality of life scores however Group B symptom severity scores improved more. Group B set a greater number of goals and strategies which were better structured and more task specific. This is the first study to investigate the impact of goal setting on patient behaviour in a chronic yet episodic illness. Our results suggest that self-management goals set by the healthcare professional which are clinically indicated but tailored to the patient's nominated symptoms yields better outcomes than goals nominated by the patient. A brief, structured intervention, tailored to patient symptoms, can enhance self-management of intermittent allergic rhinitis.

Impact of including growth, carcass and feed efficiency traits in the breeding goal for combined milk and beef production systems.

PubMed

Hietala, P; Juga, J

2017-04-01

Improving feed efficiency in dairy cattle could result in more profitable and environmentally sustainable dairy production through lowering feed costs and emissions from dairy farming. In addition, beef production based on dairy herds generates fewer greenhouse gas emissions per unit of meat output than beef production from suckler cow systems. Different scenarios were used to assess the profitability of adding traits, excluded from the current selection index for Finnish Ayrshire, to the breeding goal for combined dairy and beef production systems. The additional breeding goal traits were growth traits (average daily gain of animals in the fattening and rearing periods), carcass traits (fat covering, fleshiness and dressing percentage), mature live weight (LW) of cows and residual feed intake (RFI) traits. A breeding scheme was modeled for Finnish Ayrshire under the current market situation in Finland using the deterministic simulation software ZPLAN+. With the economic values derived for the current production system, the inclusion of growth and carcass traits, while preventing LW increase generated the highest improvement in the discounted profit of the breeding program (3.7%), followed by the scenario where all additional traits were included simultaneously (5.1%). The use of a selection index that included growth and carcass traits excluding LW, increased the profit (0.8%), but reduced the benefits resulted from breeding for beef traits together with LW. A moderate decrease in the profit of the breeding program was obtained when adding only LW to the breeding goal (-3.1%), whereas, adding only RFI traits to the breeding goal resulted in a minor increase in the profit (1.4%). Including beef traits with LW in the breeding goal showed to be the most potential option to improve the profitability of the combined dairy and beef production systems and would also enable a higher rate of self-sufficiency in beef. When considering feed efficiency related traits, the inclusion of LW traits in the breeding goal that includes growth and carcass traits could be more profitable than the inclusion of RFI, because the marginal costs of measuring LW can be expected to be lower than for RFI and it is readily available for selection. In addition, before RFI can be implemented as a breeding objective, the genetic correlations between RFI and other breeding goal traits estimated for the studied population as well as information on the most suitable indicator traits for RFI are needed to assess more carefully the consequences of selecting for RFI.

Infrastructure for Large-Scale Quality-Improvement Projects: Early Lessons from North Carolina Improving Performance in Practice

ERIC Educational Resources Information Center

Newton, Warren P.; Lefebvre, Ann; Donahue, Katrina E.; Bacon, Thomas; Dobson, Allen

2010-01-01

Introduction: Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods: Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3)…

Translating exercise interventions to an in-home setting for seniors: preliminary impact on physical activity and function.

PubMed

Dondzila, Christopher J; Swartz, Ann M; Keenan, Kevin G; Harley, Amy E; Azen, Razia; Strath, Scott J

2016-12-01

The purpose of this study is to investigate whether an in-home, individually tailored intervention is efficacious in promoting increases in physical activity (PA) and improvements in physical functioning (PF) in low-active older adults. Participants were randomized to two groups for the 8-week intervention. The enhanced physical activity (EPA) group received individualized exercise programming, including personalized step goals and a resistance band training program, and the standard of care (SoC) group received a general activity goal. Pre- and post-intervention PF measures included choice step reaction time, knee extension/flexion strength, hand grip strength, and 8 ft up and go test completion time. Thirty-nine subjects completed this study (74.6 ± 6.4 years). Significant increases in steps/day were observed for both the EPA and SoC groups, although the improvements in the EPA group were significantly higher when including only those who adhered to weekly step goals. Both groups experienced significant PF improvements, albeit greater in the EPA group for the 8 ft up and go test and knee extension strength. A low cost, in-home intervention elicited improvements in both PA and PF. Future research is warranted to expand upon the size and scope of this study, exploring dose thresholds (and time frames) for PA to improve PF and strategies to further bolster adherence rates to maximize intervention benefits.

Annual Report of the Chancellor, San Diego Community College District.

ERIC Educational Resources Information Center

Parnell, Dale

This document contains a review of the goals of the San Diego Community College District for 1975-76 and the progress that has been made to date in accomplishing those goals. Broad categories reviewed include stabilization and improvement of the environment for teaching and learning, systematization of management efforts, the search for new…

Health Policy Brief: Global Mental Health and the United Nations' Sustainable Development Goals.

PubMed

Cratsley, Kelso; Mackey, Tim K

2018-01-25

Increased awareness of the importance of mental health for global health has led to a number of new initiatives, including influential policy instruments issued by the World Health Organization (WHO) and the United Nations (UN). This policy brief describes two WHO instruments, the Mental Health Action Plan for 2013-2020 (World Health Organization, 2013) and the Mental Health Atlas (World Health Organization, 2015), and presents a comparative analysis with the Sustainable Development Goals (SDGs) of the UN's 2030 Agenda for Sustainable Development (United Nations, 2015). The WHO's Action Plan calls for several specific objectives and targets, with a focus on improving global mental health governance and service coverage. In contrast, the UN's Sustainable Development Goals include only one goal specific to mental health, with a single indicator tracking suicide mortality rates. The discrepancy between the WHO and UN frameworks suggests a need for increased policy coherence. Improved global health governance can provide the basis for ensuring and accelerating progress in global mental health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Baseload Nitrate Salt Central Receiver Power Plant Design Final Report

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

Tilley, Drake; Kelly, Bruce; Burkholder, Frank

The objectives of the work were to demonstrate that a 100 MWe central receiver plant, using nitrate salt as the receiver coolant, thermal storage medium, and heat transport fluid in the steam generator, can 1) operate, at full load, for 6,400 hours each year using only solar energy, and 2) satisfy the DOE levelized energy cost goal of $0.09/kWhe (real 2009 $). To achieve these objectives the work incorporated a large range of tasks relating to many different aspects of a molten salt tower plant. The first Phase of the project focused on developing a baseline design for a Moltenmore » Salt Tower and validating areas for improvement. Tasks included a market study, receiver design, heat exchanger design, preliminary heliostat design, solar field optimization, baseline system design including PFDs and P&IDs and detailed cost estimate. The baseline plant met the initial goal of less than $0.14/kWhe, and reinforced the need to reduce costs in several key areas to reach the overall $0.09/kWhe goal. The major improvements identified from Phase I were: 1) higher temperature salt to improve cycle efficiency and reduce storage requirements, 2) an improved receiver coating to increase the efficiency of the receiver, 3) a large receiver design to maximize storage and meet the baseload hours objective, and 4) lower cost heliostat field. The second Phase of the project looked at advancing the baseline tower with the identified improvements and included key prototypes. To validate increasing the standard solar salt temperature to 600 °C a dynamic test was conducted at Sandia. The results ultimately proved the hypothesis incorrect and showed high oxide production and corrosion rates. The results lead to further testing of systems to mitigate the oxide production to be able to increase the salt temperature for a commercial plant. Foster Wheeler worked on the receiver design in both Phase I and Phase II looking at both design and lowering costs utilizing commercial fossil boiler manufacturing. The cost and design goals for the project were met with this task, but the most interesting results had to do with defining the failure modes and looking at a “shakedown analysis” of the combined creep-fatigue failure. A separate task also looked at improving the absorber coatings on the receiver tubes that would improve the efficiency of the receiver. Significant progress was made on developing a novel paint with a high absorptivity that was on par with the current Pyromark, but shows additional potential to be optimized further. Although the coating did not meet the emissivity goals, preliminary testing the new paint shows potential to be much more durable, and potential to improve the receiver efficiency through a higher average absorptivity over the lifetime. Additional coatings were also designed and modeled results meet the project goals, but were not tested. Testing for low cycle fatigue of the full length receiver tubes was designed and constructed, but is still currently undergoing testing. A novel small heliostat was developed through an extensive brainstorming and down select. The concept was then detailed further with inputs from component testing and eventually a full prototype was built and tested. This task met or exceeded the accuracy and structure goals and also beat the cost goal. This provides a significant solar field costs savings for Abengoa that will be developed further to be used in future commercial plants. Ultimately the $0.09/kWhe (real 2009 $) and 6,400 hours goals of the project were met.« less

SEL's Software Process-Improvement Program

NASA Technical Reports Server (NTRS)

Basili, Victor; Zelkowitz, Marvin; McGarry, Frank; Page, Jerry; Waligora, Sharon; Pajerski, Rose

1995-01-01

The goals and operations of the Software Engineering Laboratory (SEL) is reviewed. For nearly 20 years the SEL has worked to understand, assess, and improve software and the development process within the production environment of the Flight Dynamics Division (FDD) of NASA's Goddard Space Flight Center. The SEL was established in 1976 with the goals of reducing: (1) the defect rate of delivered software, (2) the cost of software to support flight projects, and (3) the average time to produce mission-support software. After studying over 125 projects of FDD, the results have guided the standards, management practices, technologies, and the training within the division. The results of the studies have been a 75 percent reduction in defects, a 50 percent reduction in cost, and a 25 percent reduction in development time. Over time the goals of SEL have been clarified. The goals are now stated as: (1) Understand baseline processes and product characteristics, (2) Assess improvements that have been incorporated into the development projects, (3) Package and infuse improvements into the standard SEL process. The SEL improvement goal is to demonstrate continual improvement of the software process by carrying out analysis, measurement and feedback to projects with in the FDD environment. The SEL supports the understanding of the process by study of several processes including, the effort distribution, and error detection rates. The SEL assesses and refines the processes. Once the assessment and refinement of a process is completed, the SEL packages the process by capturing the process in standards, tools and training.

Safety Goals at NASA: How Safe is Safe Enough and How to Get There

NASA Technical Reports Server (NTRS)

Stamatelatos, Michael

2010-01-01

NASA is developing and implementing safety improvements in all its activities including mission design, mission operations, and occupational safety. Decisions regarding where and how improvements are implemented to optimally enhance safety are discussed.

A School-Based Quality Improvement Program.

ERIC Educational Resources Information Center

Rappaport, Lewis A.

1993-01-01

As one Brooklyn high school discovered, quality improvement begins with administrator commitment and participants' immersion in the literature. Other key elements include ongoing training of personnel involved in the quality-improvement process, tools such as the Deming Cycle (plan-do-check-act), voluntary and goal-oriented teamwork, and a worthy…

Does Goal Attainment Scaling improve satisfaction regarding performance of activities of younger knee arthroplasty patients? Study protocol of the randomized controlled ACTION trial.

PubMed

Witjes, Suzanne; Hoorntje, Alexander; Kuijer, P Paul F M; Koenraadt, Koen L M; Blankevoort, Leendert; Kerkhoffs, Gino M M J; van Geenen, Rutger C I

2016-03-02

Knee arthroplasty is being increasingly performed, and also more often in a younger patient population (<65 years of age). Up to 20 % of patients remain dissatisfied after knee arthroplasty, despite the apparent technical success of the operation. Recent studies suggest that the fulfilment of patients' expectations plays an important role in achieving satisfaction. Thus, addressing preoperative expectations more explicitly might improve patient satisfaction. The primary aim of the present study is to investigate the effect of a multidisciplinary, goal attained and individualized rehabilitation on satisfaction of activities of younger patients (<65 years) after knee arthroplasty. A single-centre randomized controlled trial will be conducted. In total, 120 patients (<65 years of age) with knee osteoarthritis who will undergo knee arthroplasty, will be randomly allocated to either goal attainment scaling rehabilitation or usual care rehabilitation. Goal attainment scaling rehabilitation includes drafting individually set rehabilitation goals preoperatively and measuring progress of rehabilitation on a six-point scale (-3 to +2). The primary outcome is patient satisfaction concerning activities in daily life, work and leisure time, including sports. Secondary outcome measures include KOOS, OKS, SQUASH and WORQ questionnaires and activity objectively measured with the Activ8® activity monitor. The findings of this study will help to elucidate whether goal attainment scaling is an effective rehabilitation method for achieving higher levels of patient satisfaction, with a focus on activities, in younger patients after knee arthroplasty. This trial is since June 15(th) 2015 registered at the Dutch Trial Register: NTR5251 .

Trends in dietary patterns and compliance with World Health Organization recommendations: a cross-country analysis.

PubMed

Mazzocchi, Mario; Brasili, Cristina; Sandri, Elisa

2008-05-01

To investigate time patterns of compliance with nutrient goals recommended by the World Health Organization (WHO). A single aggregated indicator of distance from the key WHO recommendations for a healthy diet is built using FAOSTAT intake data, bounded between 0 (maximum possible distance from goals) and 1 (perfect adherence). Two hypotheses are tested for different country groupings: (1) whether adherence has improved over time; and (2) whether cross-country disparities in terms of diet healthiness have decreased. One hundred and forty-nine countries, including 26 countries belonging to the Organisation for Economic Co-operation and Development (OECD) and 115 developing countries (including 43 least developed countries), with yearly data over the period 1961-2002. The Recommendation Compliance Index (RCI) shows significant improvements in adherence to WHO goals for both developing and especially OECD countries. The latter group of countries show the highest levels of the RCI and the largest increase over time, especially between 1981 and 2002. No improvement is detected for least developed countries. A reduction in disparities (convergence of the RCI) is observed only within the OECD grouping. Adherence to healthy eating guidelines depends on economic development. Diets are improving and converging in advanced economies, but developing and especially least developed countries are still far from meeting WHO nutrition goals. This confirms findings on the double burden of malnutrition and suggests that economic drivers are more relevant than socio-cultural factors in determining the healthiness of diets.

Management goals for type 1 Gaucher disease: An expert consensus document from the European working group on Gaucher disease.

PubMed

Biegstraaten, M; Cox, T M; Belmatoug, N; Berger, M G; Collin-Histed, T; Vom Dahl, S; Di Rocco, M; Fraga, C; Giona, F; Giraldo, P; Hasanhodzic, M; Hughes, D A; Iversen, P O; Kiewiet, A I; Lukina, E; Machaczka, M; Marinakis, T; Mengel, E; Pastores, G M; Plöckinger, U; Rosenbaum, H; Serratrice, C; Symeonidis, A; Szer, J; Timmerman, J; Tylki-Szymańska, A; Weisz Hubshman, M; Zafeiriou, D I; Zimran, A; Hollak, C E M

2018-02-01

Gaucher Disease type 1 (GD1) is a lysosomal disorder that affects many systems. Therapy improves the principal manifestations of the condition and, as a consequence, many patients show a modified phenotype which reflects manifestations of their disease that are refractory to treatment. More generally, it is increasingly recognised that information as to how a patient feels and functions [obtained by patient- reported outcome measurements (PROMs)] is critical to any comprehensive evaluation of treatment. A new set of management goals for GD1 in which both trends are reflected is needed. To this end, a modified Delphi procedure among 25 experts was performed. Based on a literature review and with input from patients, 65 potential goals were formulated as statements. Consensus was considered to be reached when ≥75% of the participants agreed to include that specific statement in the management goals. There was agreement on 42 statements. In addition to the traditional goals concerning haematological, visceral and bone manifestations, improvement in quality of life, fatigue and social participation, as well as early detection of long-term complications or associated diseases were included. When applying this set of goals in medical practice, the clinical status of the individual patient should be taken into account. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

The millennium development goals and tobacco control.

PubMed

Collishaw, Neil E

2010-03-01

The eight Millennium Development Goals were proposed by the UN Secretary-General in 2001. They are goals with measurable targets to be achieved by 2015 or earlier. The Goals were distilled from the 2000 United Nations Millennium Declaration, a sweeping statement of development values, principles, objectives and proposed actions. The Framework Convention on Tobacco Control (FCTC) is a demonstrable translation of some of the ideas in the Millennium Declaration into reality. With 165(i) Parties, the FCTC does more than just improve global tobacco control: * The FCTC contributes to achievement of many of the Millennium Development Goals, and benefits from success in implementation of the Goals in other sectors. * The treaty itself is a demonstration of strengthened international and national rule of law, central tenets of the Millennium Declaration. * The FCTC expands international law into the health sector and provides better balance of international law among economic, environmental, social and health sectors. The Millennium Declaration calls for a more equitable distribution of the benefits of globalization, and the FCTC delivers this result. * The FCTC provides a model for addressing other unsolved global problems through greater use of international law. Alcohol control and dietary improvements including greater control of empty calories in manufactured foods are examples of problems that may benefit from greater governance by international law. Were that to come to pass, those new treaties would also improve implementation of the Millennium Declaration and the Millennium Development Goals.

Achieving Goal-Concordant Care: A Conceptual Model and Approach to Measuring Serious Illness Communication and Its Impact

PubMed Central

Curtis, J. Randall; Tulsky, James A.

2018-01-01

Abstract Background: High-quality care for seriously ill patients aligns treatment with their goals and values. Failure to achieve “goal-concordant” care is a medical error that can harm patients and families. Because communication between clinicians and patients enables goal concordance and also affects the illness experience in its own right, healthcare systems should endeavor to measure communication and its outcomes as a quality assessment. Yet, little consensus exists on what should be measured and by which methods. Objectives: To propose measurement priorities for serious illness communication and its anticipated outcomes, including goal-concordant care. Methods: We completed a narrative review of the literature to identify links between serious illness communication, goal-concordant care, and other outcomes. We used this review to identify gaps and opportunities for quality measurement in serious illness communication. Results: Our conceptual model describes the relationship between communication, goal-concordant care, and other relevant outcomes. Implementation-ready measures to assess the quality of serious illness communication and care include (1) the timing and setting of serious illness communication, (2) patient experience of communication and care, and (3) caregiver bereavement surveys that include assessment of perceived goal concordance of care. Future measurement priorities include direct assessment of communication quality, prospective patient or family assessment of care concordance with goals, and assessment of the bereaved caregiver experience. Conclusion: Improving serious illness care necessitates ensuring that high-quality communication has occurred and measuring its impact. Measuring patient experience and receipt of goal-concordant care should be our highest priority. We have the tools to measure both. PMID:29091522

Achieving Goal-Concordant Care: A Conceptual Model and Approach to Measuring Serious Illness Communication and Its Impact.

PubMed

Sanders, Justin J; Curtis, J Randall; Tulsky, James A

2018-03-01

High-quality care for seriously ill patients aligns treatment with their goals and values. Failure to achieve "goal-concordant" care is a medical error that can harm patients and families. Because communication between clinicians and patients enables goal concordance and also affects the illness experience in its own right, healthcare systems should endeavor to measure communication and its outcomes as a quality assessment. Yet, little consensus exists on what should be measured and by which methods. To propose measurement priorities for serious illness communication and its anticipated outcomes, including goal-concordant care. We completed a narrative review of the literature to identify links between serious illness communication, goal-concordant care, and other outcomes. We used this review to identify gaps and opportunities for quality measurement in serious illness communication. Our conceptual model describes the relationship between communication, goal-concordant care, and other relevant outcomes. Implementation-ready measures to assess the quality of serious illness communication and care include (1) the timing and setting of serious illness communication, (2) patient experience of communication and care, and (3) caregiver bereavement surveys that include assessment of perceived goal concordance of care. Future measurement priorities include direct assessment of communication quality, prospective patient or family assessment of care concordance with goals, and assessment of the bereaved caregiver experience. Improving serious illness care necessitates ensuring that high-quality communication has occurred and measuring its impact. Measuring patient experience and receipt of goal-concordant care should be our highest priority. We have the tools to measure both.

The People Side of Performance Improvement.

ERIC Educational Resources Information Center

Gerson, Richard F.

1999-01-01

Discusses 11 keys to the personal side of performance improvement, including positive attitude, high self esteem and positive self-image, communication skills, lifelong learning, caring about other people, health and well-being, motivation, goal setting, relaxation, visualization, and personal value system. (LRW)

Achieving the Vision: Rethinking Librarianship.

ERIC Educational Resources Information Center

Martin, Susan K.

1993-01-01

Discussion of the profession of librarianship and its future focuses on the "Strategic Visions" program that identifies needed values and goals for the profession. Highlights include a new professional structure; improved library school accreditation processes; improvement of educational standards; certification of librarians; continuing…

Overarching goals: a strategy for improving healthcare quality and safety?

PubMed

Nanji, Karen C; Ferris, Timothy G; Torchiana, David F; Meyer, Gregg S

2013-03-01

The management literature reveals that many successful organisations have strategic plans that include a bold 'stretch-goal' to stimulate progress over a ten-to-thirty-year period. A stretch goal is clear, compelling and easily understood. It serves as a unifying focal point for organisational efforts. The ambitiousness of such goals has been emphasised with the phrase Big Hairy Audacious Goal ('BHAG'). President Kennedy's proclamation in 1961 that 'this Nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to earth' provides a famous example. This goal energised the US National Aeronautics and Space Administration, and it captured the attention of the American public and resulted in one of the largest accomplishments of any organisation. The goal set by Sony, a small, cash-strapped electronics company in the 1950s, to change the poor image of Japanese products around the world represents a classic BHAG. Few examples of quality goals that conform to the BHAG definition exist in the healthcare literature. However, the concept may provide a useful framework for organisations seeking to transform the quality of care they deliver. This review examines the merits and cautions of setting overarching quality goals to catalyse quality improvement efforts, and assists healthcare organisations with determining whether to adopt these goals.

Does Pedometer Goal Setting Improve Physical Activity among Native Elders? Results from a Randomized Pilot Study

ERIC Educational Resources Information Center

Sawchuk, Craig N.; Russo, Joan E.; Charles, Steve; Goldberg, Jack; Forquera, Ralph; Roy-Byrne, Peter; Buchwald, Dedra

2011-01-01

We examined if step-count goal setting resulted in increases in physical activity and walking compared to only monitoring step counts with pedometers among American Indian/Alaska Native elders. Outcomes included step counts, self-reported physical activity and well-being, and performance on the 6-minute walk test. Although no significant…

Agenda for Action: Policy Directions for Children with Disabilities and Families. Children and Family Series.

ERIC Educational Resources Information Center

Bach, Michael

In response to the development of a National Children's Agenda (NCA) to improve the well-being of Canada's children, this document presents specific policy goals to ensure the inclusion of children with disabilities and their families in the NCA. These goals include: (1) establishing inclusive values, rights and approaches for healthy child…

Thematic versus Subject-Based Curriculum Delivery and Achievement Goals: Findings from a Single-School Study

ERIC Educational Resources Information Center

Putwain, Dave; Whiteley, Helen; Caddick, Lee

2011-01-01

Background: It has been claimed that thematic or integrated approaches to curriculum delivery offer a range of advantages over subject-based modes of delivery including improved pupil motivation. Purpose: This study put claims regarding pupil motivation to the test, using the achievement goals framework. This contemporary approach to understanding…

Advanced Life Support

NASA Technical Reports Server (NTRS)

Chambliss, Joe

2004-01-01

Viewgraphs on Advanced Life Support (ALS) Systems are presented. The topics include: 1) Fundamental Need for Advanced Life Support; 2) ALS organization; 3) Requirements and Rationale; 4) Past Integrated tests; 5) The need for improvements in life support systems; 6) ALS approach to meet exploration goals; 7) ALS Projects showing promise to meet exploration goals; and 9) GRC involvement in ALS.

Transition to Work: Effects of Preparedness and Goal Construction on Employment and Depressive Symptoms

ERIC Educational Resources Information Center

Koivisto, Petri; Vuori, Jukka; Vinokur, Amiram D.

2010-01-01

This study examines the mediating role of employment preparedness in improving employment, mental health, and construction of work-life goals among young vocational school graduates who participated in the School-to-Work effectiveness trial. The trial included a 1-week intervention program that focused on enhancing employment preparedness. In this…

Community & Technical College Share of Washington's Educational Attainment Goals for 2023

ERIC Educational Resources Information Center

Washington State Board for Community and Technical Colleges, 2015

2015-01-01

In 2013, the Washington Student Achievement Council (WSAC) set a 10 year plan for improving the educational attainment of Washington residents. The Roadmap included two educational attainment goals for 2023: (1) All adults in Washington, ages 25-44, will have a high school diploma or equivalent; and (2) At least 70 percent of Washington adults,…

Vehicle trust management for connected vehicles : final research report.

DOT National Transportation Integrated Search

2016-01-01

The goal of this project is to research a wide range of transportation-related issues : including: improving health and safety for all users of the transportation system, including : bicycles, pedestrians and transit modes; reducing carbon emissions ...

Improving blood pressure control in end stage renal disease through a supportive educative nursing intervention.

PubMed

Kauric-Klein, Zorica

2012-01-01

Hypertension in patients on hemodialysis (HD) contributes significantly to their morbidity and mortality. This study examined whether a supportive nursing intervention incorporating monitoring, goal setting, and reinforcement can improve blood pressure (BP) control in a chronic HD population. A randomized controlled design was used and 118 participants were recruited from six HD units in the Detroit metro area. The intervention consisted of (1) BP education sessions; (2) a 12-week intervention, including monitoring, goal setting, and reinforcement; and (3) a 30-day post-intervention follow-up period. Participants in the treatment were asked to monitor their BP, sodium, and fluid intake weekly for 12 weeks in weekly logs. BP, fluid and sodium logs were reviewed weekly with the researcher to determine if goals were met or not met. Reinforcement was given for goals met and problem solving offered when goals were not met. The control group received standard care. Both systolic and diastolic BPs were significantly decreased in the treatment group.

Obstacles to implementation of an intervention to improve surgical services in an Ethiopian hospital: a qualitative study of an international health partnership project.

PubMed

Aveling, Emma-Louise; Zegeye, Desalegn Tegabu; Silverman, Michael

2016-08-17

Access to safe surgical care represents a critical gap in healthcare delivery and development in many low- and middle-income countries, including Ethiopia. Quality improvement (QI) initiatives at hospital level may contribute to closing this gap. Many such quality improvement initiatives are carried out through international health partnerships. Better understanding of how to optimise quality improvement in low-income settings is needed, including through partnership-based approaches. Drawing on a process evaluation of an intervention to improve surgical services in an Ethiopian hospital, this paper offers lessons to help meet this need. We conducted a qualitative process evaluation of a quality improvement project which aimed to improve access to surgical services in an Ethiopian referral hospital through better management. Data was collected longitudinally and included: 66 in-depth interviews with surgical staff and project team members; observation (135 h) in the surgery department and of project meetings; project-related documentation. Thematic analysis, guided by theoretical constructs, focused on identifying obstacles to implementation. The project largely failed to achieve its goals. Key barriers related to project design, partnership working and the implementation context, and included: confusion over project objectives and project and partner roles and responsibilities; logistical challenges concerning overseas visits; difficulties in communication; gaps between the time and authority team members had and that needed to implement and engage other staff; limited strategies for addressing adaptive-as opposed to technical-challenges; effects of hierarchy and resource scarcity on QI efforts. While many of the obstacles identified are common to diverse settings, our findings highlight ways in which some features of low-income country contexts amplify these common challenges. We identify lessons for optimising the design and planning of quality improvement interventions within such challenging healthcare contexts, with specific reference to international partnership-based approaches. These include: the need for a funded lead-in phase to clarify and agree goals, roles, mutual expectations and communication strategies; explicitly incorporating adaptive, as well as technical, solutions; transparent management of resources and opportunities; leadership which takes account of both formal and informal power structures; and articulating links between project goals and wider organisational interests.

Does pedometer goal setting improve physical activity among Native elders? Results from a randomized pilot study.

PubMed

Sawchuk, Craig N; Russo, Joan E; Charles, Steve; Goldberg, Jack; Forquera, Ralph; Roy-Byrne, Peter; Buchwald, Dedra

2011-01-01

We examined if step-count goal setting resulted in increases in physical activity and walking compared to only monitoring step counts with pedometers among American Indian/Alaska Native elders. Outcomes included step counts, self-reported physical activity and well-being, and performance on the 6-minute walk test. Although no significant between-group differences were found, within-group analyses indicated that elders significantly improved on the majority of step count, physical activity, health-related quality of life, and 6-minute walk outcomes.

Advanced Oil Recovery Technologies for Improved Recovery From Slope Basin Clastic Reservoirs, Nash Draw Brushy Canyon Pool, Eddy County, New Mexico

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

Mark B. Murphy

The overall goal of this project is to demonstrate that an advanced development drilling and pressure maintenance program based on advanced reservoir management methods can significantly improve oil recovery. The plan included developing a control area using standard reservoir management techniques and comparing its performance to an area developed using advanced methods. A key goal is to transfer advanced methodologies to oil and gas producers in the Permian Basin and elsewhere, and throughout the US oil and gas industry.

Nutrition and Physical Activity Strategies for Cancer Prevention in Current National Comprehensive Cancer Control Program Plans

PubMed Central

Puckett, Mary; Neri, Antonio; Underwood, J. Michael; Stewart, Sherri L.

2016-01-01

Obesity, diet and physical inactivity are risk factors for some cancers. Grantees of the National Comprehensive Cancer Control Program (NCCCP) in US states, tribes, and territories develop plans to coordinate funding and activities for cancer prevention and control. Including information and goals related to nutrition and physical activity (NPA) is a key opportunity for primary cancer prevention, but it is currently unclear to what extent NCCCP plans address these issues. We reviewed 69 NCCCP plans and searched for terms related to NPA. Plans were coded as (1) knowledge of NPA and cancer link; (2) goals to improve NPA behaviors; and (3) strategies to increase healthy NPA activities, environments, or systems changes. NPA content was consistently included in all cancer plans examined across all years. Only 4 (6 %) outlined only the relationship between NPA and cancer without goals or strategies. Fifty-nine plans (89 %) contained goals or strategies related to NPA, with 53 (82 %) including both. However, numbers of goals, strategies, and detail provided varied widely. All programs recognized the importance of NPA in cancer prevention. Most plans included NPA goals and strategies. Increasing the presence of NPA strategies that can be modified or adapted appropriately locally could help with more widespread implementation and measurement of NPA interventions. PMID:26994988

[Achievement of low-density lipoprotein cholesterol therapeutic goal in lipid and vascular risk units of the Spanish Arteriosclerosis Society].

PubMed

Pedro-Botet, Juan; Mostaza, José M; Pintó, Xavier; Banegas, José R

2013-01-01

To evaluate low-density lipoprotein-cholesterol (LDLc) goal achievement among dyslipidemic patients treated in lipid and vascular risk units of the Spanish Society of Arteriosclerosis (SEA). The LDLc goal was based on the 2007 European guidelines for cardiovascular prevention. Observational, longitudinal, retrospective, multicenter national study that included consecutive patients of both sexes over 18 years of age referred for dyslipidemia and cardiovascular risk. Information was collected from medical records corresponding to two visits in the lipid unit. We included 1,828 patients from 43 lipid units. In the initial visit, 846 (46.3%) patients were on lipid lowering drug treatment. On the follow-up there was a significant increase in the use of cholesterol-lowering agents, except for a decrease in the use of nicotinic acid. 65.3% of patients with vascular disease and 50.4% with diabetes achieved an LDLc level <100mg/dL. Overall, 44.7% of patients achieved the LDLc goal and the predictors in the multivariate analysis were age, waist circumference, diabetes and the presence of vascular disease. Dyslipidemic patients referred to SEA lipid units have improved LDLc goal achievement after follow-up compared with data reported from previous studies in other health care settings. This improvement was associated with a substantial increase in the prescription of statins, both in monotherapy and combined with ezetimibe. There is still a wide room for improvement in the effectiveness of hypercholesterolemia treatment. Copyright © 2013 Elsevier España, S.L. y SEA. All rights reserved.

Goal disturbance changes pre/post-renal transplantation are related to changes in distress.

PubMed

de Vries, Alicia M; Schulz, Torben; Westerhuis, Ralf; Navis, Gerjan J; Niesing, Jan; Ranchor, Adelita V; Schroevers, Maya J

2017-09-01

Renal transplantation (RTx) is considered the treatment of choice for end-stage renal disease (ESRD) given its association with lower mortality, and improved overall quality of life and psychological functioning compared to dialysis. However, much less is known about which factors underlie these psychological improvements across RTx. Goal theory suggests that experienced disturbances in important goals are related to lower psychological functioning. This study aimed to (1) identify the most disturbed and most important goals for patients before RTx, (2) to examine changes in goal disturbance and goal importance pre/post-RTx, and (3) to examine whether changes in goal disturbance are associated with changes in psychological distress over time, and whether this relationship is mediated by changes in perceived control. In this longitudinal study, 220 patients completed questionnaires before and after RTx, including questionnaires to assess goals (GOALS questionnaire), psychological distress (GHQ-12), and perceived control (Mastery scale). End-stage renal disease affected both general and disease-specific goals. Approximately 30% of the patients indicated to experience high or very high disturbance before transplantation. Goal disturbance generally decreased significantly pre- to post-RTx, whereas goal importance did not change significantly pre- to post-RTx. No mediation effect of perceived control was found. Instead, both changes in goal disturbance and perceived control showed independent effects on changes in distress. Intervention strategies targeting attainable and realistic goal setting, and perceived control in RTx recipients who do not benefit optimally from RTx, might enhance psychological functioning in this population. Statement of contribution What is already known on this subject? Kidney transplantation improves patients' psychological functioning. Experienced disturbances in important life goals are related to lower psychological functioning in chronic illness. What does this study add? Goal disturbance decreases after renal transplantation, and this is related to a decrease in distress over time. Perceived control does not mediate the relationship between goal disturbance and distress pre/post-transplantation. Changes in perceived control have an additional main effect on changes in distress. © 2017 The British Psychological Society.

U.S. energy sector impacts of technology innovation, fuel price, and electric sector CO 2 policy: Results from the EMF 32 model intercomparison study

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

Hodson, Elke L.; Brown, Maxwell; Cohen, Stuart

We study the impact of achieving technology innovation goals, representing significant technology cost reductions and performance improvements, in both the electric power and end-use sectors by comparing outputs from four energy-economic models through the year 2050. We harmonize model input assumptions and then compare results in scenarios that vary natural gas prices, technology cost and performance metrics, and the implementation of a representative national electricity sector carbon dioxide (CO 2) policy. Achieving the representative technology innovation goals decreases CO 2 emissions in all models, regardless of natural gas price, due to increased energy efficiency and low-carbon generation becoming more costmore » competitive. For the models that include domestic natural gas markets, achieving the technology innovation goals lowers wholesale electricity prices, but this effect diminishes as projected natural gas prices increase. Higher natural gas prices lead to higher wholesale electricity prices but fewer coal capacity retirements. Some of the models include energy efficiency improvements as part of achieving the high-technology goals. Absent these energy efficiency improvements, low-cost electricity facilitates greater electricity consumption. The effect of implementing a representative electricity sector CO 2 policy differs considerably depending on the cost and performance of generating and end-use technologies. The CO 2 policy influences electric sector evolution in the cases with reference technology assumptions but has little to no influence in the cases that achieve the technology innovation goals. This outcome implies that meeting the representative technology innovation goals achieves a generation mix with similar CO 2 emissions to the representative CO 2 policy but with smaller increases to wholesale electricity prices. Finally, higher natural gas prices, achieving the representative technology innovation goals, and the combination of the two, increases the amount of renewable generation that is cost-effective to build and operate while slowing the growth of natural-gas fired generation, which is the predominant generation type in 2050 under reference conditions.« less

Motivation and placebos: do different mechanisms occur in different contexts?

PubMed

Hyland, Michael E

2011-06-27

This paper challenges the common assumption that the mechanisms underlying short-term placebo paradigms (where there is no motivation for health improvement) and long-term placebo paradigms (where patients value improvement in their health) are the same. Three types of motivational theory are reviewed: (i) classical placebo motivation theory that the placebo response results from the desire for therapeutic improvement; (ii) goal activation model that expectancy-driven placebo responses are enhanced when the placebo response satisfies an activated goal; and (iii) motivational concordance model that the placebo response is the consequence of concordance between the placebo ritual and significant intrinsic motives. It is suggested that current data are consistent with the following theory: response expectancy, conditioning and goal activation are responsible for short-term placebo effects but long-term therapeutic change is achieved through the effects of goal satisfaction and affect on the inflammatory response system and hypothalamic-pituitary-adrenal axis. Empirical predictions of this new theory are outlined, including ways in which placebo effects can be combined with other psychologically mediated effects on short-term and long-term psychological and physiological state.

Motivation and placebos: do different mechanisms occur in different contexts?

PubMed Central

Hyland, Michael E.

2011-01-01

This paper challenges the common assumption that the mechanisms underlying short-term placebo paradigms (where there is no motivation for health improvement) and long-term placebo paradigms (where patients value improvement in their health) are the same. Three types of motivational theory are reviewed: (i) classical placebo motivation theory that the placebo response results from the desire for therapeutic improvement; (ii) goal activation model that expectancy-driven placebo responses are enhanced when the placebo response satisfies an activated goal; and (iii) motivational concordance model that the placebo response is the consequence of concordance between the placebo ritual and significant intrinsic motives. It is suggested that current data are consistent with the following theory: response expectancy, conditioning and goal activation are responsible for short-term placebo effects but long-term therapeutic change is achieved through the effects of goal satisfaction and affect on the inflammatory response system and hypothalamic–pituitary–adrenal axis. Empirical predictions of this new theory are outlined, including ways in which placebo effects can be combined with other psychologically mediated effects on short-term and long-term psychological and physiological state. PMID:21576140

Applying Continuous Quality Improvement Principles in Secondary School Vocational Education, with Emphasis on Special Populations.

ERIC Educational Resources Information Center

McLean, Gary N.

1993-01-01

Principles of quality management applicable to education for secondary special populations include process orientation, cascading, top commitment, vertical/horizontal communication, continuous improvement, shared vision, primacy of customers, investment in people, constancy of purpose, and shared goal setting. (JOW)

Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children's occupational therapy.

PubMed

Kolehmainen, Niina; MacLennan, Graeme; Ternent, Laura; Duncan, Edward A S; Duncan, Eilidh M; Ryan, Stephen B; McKee, Lorna; Francis, Jill J

2012-08-16

Access and equity in children's therapy services may be improved by directing clinicians' use of resources toward specific goals that are important to patients. A practice-change intervention (titled 'Good Goals') was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children's occupational therapy services. Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and 'tools for change'. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers' observations. Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists' time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists' behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children's LoT decreased by two months [95% CI -8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists' salary bands. Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts.

Meeting the Pepsi Challenge: Preparing Evaluation Programs for Scholastic Improvement.

ERIC Educational Resources Information Center

Hopkins, Mona S.

This document provides guidelines for preparing evaluation programs for scholastic improvement. The philosophy underlying assessment and accountability is discussed, with specific reference to the positive and negative aspects of assessment. The design of a curriculum evaluation model is presented, including goal identification, data gathering,…

Effective Teaching for FAS & FAE Children.

ERIC Educational Resources Information Center

Root, Pam

This paper discusses the importance of teaching social skills to children with Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effect (FAE) and the interrelationship between social skills and academic improvement. Goals and techniques for teaching social skills are identified, including: (1) improving the skill of compliance by setting reasonable…

Vendor management: a model for collaboration and quality improvement.

PubMed

Friedman, M D; Bailit, M H; Michel, J O

1995-11-01

The Massachusetts Medicaid agency, also known as the Division of Medical Assistance, has developed a quality-driven approach for managing its managed care suppliers. Such an approach has, as its foundation, principles of continuous quality improvement (CQI). Suppliers participate in an annual process whereby CQI goals are negotiated between the division and its suppliers. The division then works with suppliers to achieve such goals. A cornerstone of the division's approach is the notion that data can highlight an unlimited number of opportunities for improvement and that pursuit of such opportunities will ultimately result in meaningful improvements in the health status of recipients who are served by the division. The agency's approach involves five key steps: 1) the development of contractual terms and purchasing specifications; 2) the identification of improvement priorities; 3) the negotiation of improvement goals; 4) efforts directed at meeting improvement goals and measurement of success; and 5) collaboration to achieve mutual objectives. Overall, suppliers report many benefits of collaborative participation in CQI activities with the division. Suppliers have enhanced their understanding of the importance of meeting the needs of the customer and have further accrued benefits resulting from discussions with managed care vendors throughout the site regarding benchmarking of efforts and CQI efforts. Conversely, suppliers are challenged by the need to balance and allocate resources to meet increasing demands, which are not always consistent, from various purchasers, including the division. The division has been challenged in the evolution of its contract management strategy by an uneven level of knowledge among managed care vendors regarding CQI; goal setting and measurement issues; the length of time and level of effort required to develop good relationships with suppliers; and the critical importance of comparable, valid, and timely submission of data. Over the last three years, the division has seen a dramatic increase in the responsiveness of managed care suppliers to meet its needs as a purchaser. Specifically, this has been expressed through supplier ability to meet mutually negotiated improvement goals. The division is also pleased that it is beginning to achieve some measurable improvements in outcomes of care.

CA6-02: Collaborative Goal Setting and HbA1c Control Among Patients With Diabetes

PubMed Central

Lafata, Jennifer Elston; Dobie, Elizabeth; Morris, Heather; Heisler, Michele; Werner, Rachel; Divine, George; Thomas, Abraham

2012-01-01

Background/Aims Helping patients set and follow up on goals may be an effective way to help patients improve their confidence (self-efficacy) and commitment to improve diabetes self- management. We evaluate associations among patient-reported use of collaborative goal setting with clinicians, patient-reported self-efficacy, and clinical control (measured by HbA1c) among patients with diabetes. Methods A cohort of insured patients aged 18+ years with diabetes who initiated oral mono-therapy between 2000–2005 was surveyed in 2008. The survey included the 3 collaborative goal-setting items from the Patient Assessment of Chronic Illness Care (PACIC), a 4-item measure of self-efficacy, measures of socio-demographics, age of diabetes onset, and height/weight. Survey data were joined with automated laboratory and encounter data for the 12 months prior to and following survey administration. A structural equation model (SEM), using path analysis and adjusting for baseline patient characteristics (including HbA1c and diabetes-related co-morbidities and complications), was fit to investigate relationships among collaborative goal setting, self-efficacy and HbA1c control. Results Completed surveys were available for 1070 patients (n=956 mail and n=114 telephone; 77% response rate). Survey respondents were on average 68 years, half were female, 60% white, 31% black, and 57% reported low self-efficacy. On average, patients reported engaging in collaborative goal setting with their clinicians ‘sometimes’ (mean = 3.1, range 1 [never]-5 [always]). At baseline, mean HbA1c was 7.2%, with 22% =8%. Results from the SEM did not support a direct relationship between the collaborative goal setting factor (Cronbach Alpha=0.83) and HbA1c control, but did support an indirect relationship (asymmetric distribution of products 95% CI = −0.02, −0.002) with increases in collaborative goal setting positively associated with a greater likelihood of average or high self-efficacy (beta, p<0.01), and average or high self-efficacy associated with lower follow-up HbA1cs level (-beta, p<0.01). These relationships persisted after controlling for baseline HbA1c and other patient characteristics. Discussion While collaborative goal setting between patients with diabetes and their clinicians is not directly associated with better clinical control, it is associated with improved self-efficacy, which in turn, is associated with improved clinical control.

Citizen Science as a Tool for Scientific Research and Societal Benefit at NASA

NASA Technical Reports Server (NTRS)

Kaminski, Amy

2018-01-01

NASA's strategic goals include advancing knowledge and opportunity in space and improving life on Earth. We support these goals through extensive programs in space and Earth science research accomplished via space-based missions and research funding. NASA's "system" is configured to conduct science using (1) in-house personnel and (2) grants, contracts, and agreements with external entities (academia, industry, international space agencies.

WCSC environmental process improvement study and demonstration program

NASA Technical Reports Server (NTRS)

Pawlick, Joseph F., Jr.; Severo, Orlando C.

1993-01-01

CSTAR's objective to develop commercial infrastructure is multi-faceted and includes diverse elements of the orbital and suborbital missions. Goals to this eight-month project with the WCSC are aimed at simplifying the environmental assessment, approval, and licensing process for commercial users. Included in this overarching set of goals are two specific processes: (1) air pollution control, and (2) the environmental assessment mechanism. Resolution of the potentially user unfriendly aspects of these environmentally sensitive criteria are readily transferable to other ranges where commercial space activity will be supported.

Variation in juvenile growth and wood properties in half-sib cottonwood families

Treesearch

R.E., Jr. Farmer; J.R. Wilcox

1966-01-01

Maximum early gains in the genetic improvement of eastern cottonwood (Populus deltoides Bartr.) in the lower Mississippi Valley are most likely to be achieved through identification and commercial vegetative propagation of superior genotypes. A relatively simple improvement program having this goal might include evaluation of progeny from...

Wisconsin Farm to School Programs: Dietary Outcomes in Elementary Students

ERIC Educational Resources Information Center

Bontrager Yoder, Andrea Beth H.

2014-01-01

Background. High overweight and obesity prevalence has instigated many programs to improve children's health. Farm to School (F2S) is a grassroots-organized program that seeks to improve children's dietary habits, especially fruit and vegetable (FV) consumption, through various educational activities. Long-term goals include reducing obesity…

Rehabilitation of low back pain patients. A review.

PubMed

Revel, M

1995-01-01

Numerous methods have been developed for the rehabilitation of low back pain patients, including spinal flexion and extension exercises, lumbar spine locking in an intermediate position, enhancement of spinal and pelvic proprioceptive sensibility, swimming pool therapy, back schools, and functional restoration. Each seeks to achieve a goal assumed to be central to the prevention of a first or recurrent episode of low back pain. Goals include short-term pain relief, an improved ability to achieve self-sedation, abdominal and lumbar muscle strengthening, increased hip and lumbar spine mobility, improved lumbar and pelvic proprioceptive sensibility, intervertebral joint stabilization, lumbar posture modification and improved general fitness. Less than 30 studies meeting widely accepted validity and applicability criteria for therapeutic trials have addressed the clinical efficacy of rehabilitation in low back pain patients. Most studies of the back school approach have found no benefit. Spinal flexion and extension exercise programs have yielded short-lived improvements, with no differences across methods. There is evidence that functional restoration programs based on graded activity may provide long-term benefits including better social and occupational outcomes. We have evaluated the physical therapy methods most commonly taught to and used by physical therapists in France.

Effect of a web-based audit and feedback intervention with outreach visits on the clinical performance of multidisciplinary teams: a cluster-randomized trial in cardiac rehabilitation.

PubMed

Gude, Wouter T; van Engen-Verheul, Mariëtte M; van der Veer, Sabine N; Kemps, Hareld M C; Jaspers, Monique W M; de Keizer, Nicolette F; Peek, Niels

2016-12-09

The objective of this study was to assess the effect of a web-based audit and feedback (A&F) intervention with outreach visits to support decision-making by multidisciplinary teams. We performed a multicentre cluster-randomized trial within the field of comprehensive cardiac rehabilitation (CR) in the Netherlands. Our participants were multidisciplinary teams in Dutch CR centres who were enrolled in the study between July 2012 and December 2013 and received the intervention for at least 1 year. The intervention included web-based A&F with feedback on clinical performance, facilities for goal setting and action planning, and educational outreach visits. Teams were randomized either to receive feedback that was limited to psychosocial rehabilitation (study group A) or to physical rehabilitation (study group B). The main outcome measure was the difference in performance between study groups in 11 care processes and six patient outcomes, measured at patient level. Secondary outcomes included effects on guideline concordance for the four main CR therapies. Data from 18 centres (14,847 patients) were analysed, of which 12 centres (9353 patients) were assigned to group A and six (5494 patients) to group B. During the intervention, a total of 233 quality improvement goals was identified by participating teams, of which 49 (21%) were achieved during the study period. Except for a modest improvement in data completeness (4.5% improvement per year; 95% CI 0.65 to 8.36), we found no effect of our intervention on any of our primary or secondary outcome measures. Within a multidisciplinary setting, our web-based A&F intervention engaged teams to define local performance improvement goals but failed to support them in actually completing the improvement actions that were needed to achieve those goals. Future research should focus on improving the actionability of feedback on clinical performance and on addressing the socio-technical perspective of the implementation process. NTR3251.

Improving the Management of Psoriatic Arthritis and Axial Spondyloarthritis: Roundtable Discussions with Healthcare Professionals and Patients.

PubMed

Garrido-Cumbrera, Marco; Hillmann, Ottfrid; Mahapatra, Raj; Trigos, David; Zajc, Petra; Weiss, Luisa; Bostynets, Galya; Gossec, Laure; Coates, Laura C

2017-12-01

Psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA) are both chronic, inflammatory conditions that result in a substantial burden of disease and reduced quality of life for patients. Patient involvement in developing optimal disease management strategies, including defining appropriate goals, therapies, and treatment options, as well as in setting policy priorities and agendas, is key. A working group of patient organization representatives and rheumatologists explored what patients consider to be unmet needs, important treatment gaps, and future priorities in PsA and AxSpA management. Reducing pain and fatigue, and improving physical and social functioning and work productivity were identified as important treatment goals for patients. Although the major treatment target for both PsA and AxSpA is remission, with low/minimal disease activity an alternative target for patients with established or long-standing disease, the meaning of remission from the patient's perspective needs to be explored further as it may differ considerably from the physician's perspective. Key recommendations from the working group to tackle unmet needs included reducing time to diagnosis, increasing patient and physician disease awareness, focusing on patients' priorities for treatment goals, and improving patient-physician communication. By addressing these key action points moving forward, the hope is that outcomes will continue to improve for patients with PsA and AxSpA.

NASA / Pratt and Whitney Collaborative Partnership Research in Ultra High Bypass Cycle Propulsion Concepts

NASA Technical Reports Server (NTRS)

Hughes, Chris; Lord, Wed

2008-01-01

Current collaborative research with Pratt & Whitney on Ultra High Bypass Engine Cycle noise, performance and emissions improvements as part of the Subsonic Fixed Wing Project Ultra High Bypass Engine Partnership Element is discussed. The Subsonic Fixed Wing Project goals are reviewed, as well as their relative technology level compared to previous NASA noise program goals. Progress toward achieving the Subsonic Fixed Wing Project goals over the 2008 fiscal year by the UHB Partnership in this area of research are reviewed. The current research activity in Ultra High Bypass Engine Cycle technology, specifically the Pratt & Whitney Geared Turbofan, at NASA and Pratt & Whitney are discussed including the contributions each entity bring toward the research project, and technical plans and objectives. Pratt & Whitney Geared Turbofan current and future technology and business plans are also discussed, including the role the NASA SFW UHB partnership plays toward achieving those goals.

4 CFR 9.1 - GAO Senior Executive Service.

Code of Federal Regulations, 2011 CFR

2011-01-01

... measured on the basis of individual and organizational performance (including such factors as improvements... performance and success in meeting equal employment opportunity goals); (3) Assure that senior executives are...

NREL Model Car Competitions | NREL

Science.gov Websites

skills in both math and science. The goals of the competition include: Generating enthusiasm for science , technology, engineering, and math (STEM) Improving students' understanding of scientific concepts and

Rural transportation emergency preparedness plans.

DOT National Transportation Integrated Search

2009-07-01

Improving the emergency preparedness of rural transportation systems is the overall goal of this research. Unique characteristics exist in rural transportation systems including widely dispersed and diverse populations and geographic areas. Exploring...

Collaborative goal setting with adults attending physiotherapy at a specialist neuromuscular centre: is it always appropriate? A cross-sectional survey.

PubMed

Hartley, S E; Stockley, R C

2016-12-01

Collaborative goal setting is an integral component of treatment planning for adults with neuromuscular disorders (NMD). However, due to the unique challenges for these individuals, identifying a process for goal setting that is advantageous for all can be problematic. This study aimed to evaluate collaborative goal setting at a specialist NMD centre, as reported by service users attending physiotherapy. It also aimed to generate discussion about collaborative goal setting and the practice of goal setting in adults with NMD in order to inform future practice. Specialist NMD community-based centre in the UK. One hundred and four adults with NMD who attended the centre. Cross-sectional survey. Thematic and content analyses of goals set were performed alongside demographic data collection. One hundred and four patients (34 females) with a range of neuromuscular conditions - including Becker, facioscapularhumeral, limb girdle, Duchenne and myotonic muscular dystrophies - completed the survey. Thirty-six respondents (37%) stated that they had set goals with the physiotherapist, whilst 62 (63%) stated that they had not set goals with the physiotherapist. Respondents' goals were grouped into four themes: symptom management, maintenance, improving physical condition, and learning to live with the condition. Readiness to take part in collaborative goal setting is unique to each individual. Physiotherapists need to be skilful in supporting adults with NMD through the goal-setting process until they are capable of sharing responsibility. Setting personal goals to improve emotional well-being may help to develop confidence to take more control of their situation, hence facilitating skills in self-management. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Implementation of a Goal-Directed Mechanical Ventilation Order Set Driven by Respiratory Therapists Improves Compliance With Best Practices for Mechanical Ventilation.

PubMed

Radosevich, Misty A; Wanta, Brendan T; Meyer, Todd J; Weber, Verlin W; Brown, Daniel R; Smischney, Nathan J; Diedrich, Daniel A

2017-01-01

Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice. We evaluated 1302 patients undergoing invasive mechanical ventilation (1693 separate episodes of invasive mechanical ventilation) prior to and after institution of a standardized, goal-directed mechanical ventilation order set using a controlled before-and-after study design. Patient-specific goals for oxygenation partial pressure of oxygen in arterial blood (Pao 2 ), ARDS Network [Net] positive end-expiratory pressure [PEEP]/fraction of inspired oxygen [Fio 2 ] table use) and ventilation (pH, partial pressure of carbon dioxide) were selected by prescribers and implemented by RTs. Compliance with the new mechanical ventilation order set was high: 88.2% compliance versus 3.8% before implementation of the order set ( P < .001). Adherence to the PEEP/Fio 2 table after implementation of the order set was significantly greater (86.0% after vs 82.9% before, P = .02). There was no difference in duration of mechanical ventilation, intensive care unit (ICU) length of stay, and in-hospital or ICU mortality. A standardized best practice mechanical ventilation order set can be implemented by a multidisciplinary team and is associated with improved compliance to written orders and adherence to the ARDSNet PEEP/Fio 2 table.

Partridge Creek Diversion Project

EPA Pesticide Factsheets

Goal: prevent mercury contamination by keeping the creek from flowing through a mine pit. The project improved brook trout habitat, green infrastructure, the local economy, and decreased human health risks. Includes before-and-after photos.

A framework for assessing the performance of health systems.

PubMed Central

Murray, C. J.; Frenk, J.

2000-01-01

Health systems vary widely in performance, and countries with similar levels of income, education and health expenditure differ in their ability to attain key health goals. This paper proposes a framework to advance the understanding of health system performance. A first step is to define the boundaries of the health system, based on the concept of health action. Health action is defined as any set of activities whose primary intent is to improve or maintain health. Within these boundaries, the concept of performance is centred around three fundamental goals: improving health, enhancing responsiveness to the expectations of the population, and assuring fairness of financial contribution. Improving health means both increasing the average health status and reducing health inequalities. Responsiveness includes two major components: (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). Fairness of financial contribution means that every household pays a fair share of the total health bill for a country (which may mean that very poor households pay nothing at all). This implies that everyone is protected from financial risks due to health care. The measurement of performance relates goal attainment to the resources available. Variation in performance is a function of the way in which the health system organizes four key functions: stewardship (a broader concept than regulation); financing (including revenue collection, fund pooling and purchasing); service provision (for personal and non-personal health services); and resource generation (including personnel, facilities and knowledge). By investigating these four functions and how they combine, it is possible not only to understand the proximate determinants of health system performance, but also to contemplate major policy challenges. PMID:10916909

A framework for assessing the performance of health systems.

PubMed

Murray, C J; Frenk, J

2000-01-01

Health systems vary widely in performance, and countries with similar levels of income, education and health expenditure differ in their ability to attain key health goals. This paper proposes a framework to advance the understanding of health system performance. A first step is to define the boundaries of the health system, based on the concept of health action. Health action is defined as any set of activities whose primary intent is to improve or maintain health. Within these boundaries, the concept of performance is centred around three fundamental goals: improving health, enhancing responsiveness to the expectations of the population, and assuring fairness of financial contribution. Improving health means both increasing the average health status and reducing health inequalities. Responsiveness includes two major components: (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). Fairness of financial contribution means that every household pays a fair share of the total health bill for a country (which may mean that very poor households pay nothing at all). This implies that everyone is protected from financial risks due to health care. The measurement of performance relates goal attainment to the resources available. Variation in performance is a function of the way in which the health system organizes four key functions: stewardship (a broader concept than regulation); financing (including revenue collection, fund pooling and purchasing); service provision (for personal and non-personal health services); and resource generation (including personnel, facilities and knowledge). By investigating these four functions and how they combine, it is possible not only to understand the proximate determinants of health system performance, but also to contemplate major policy challenges.

To Plan or Not to Plan, That Is the Question

ERIC Educational Resources Information Center

Dolph, David A.

2016-01-01

Strategic planning is a process utilized by numerous organizations, including K-12 school boards, intent on improvement and reform. A thoughtful strategic planning process can help develop a board's desired future driven by goals and strategies aimed at progress. However, improvement processes such as strategic planning are challenging. In fact,…

Improving Learning with Information Technology: Report of a Workshop (Washington, DC, January 24-25, 2001).

ERIC Educational Resources Information Center

Pritchard, Gail E., Ed.

This report summarizes the proceedings of a symposium on learning with information technology. Part 1 discusses the initial ILIT (Improving Learning with Information Technology) activity, including: the confluence of issues and opportunities that catalyzed the project; ILIT committee goals; the evening symposium sessions; participant observations…

A Dean Speaks Out: The Financial Aid Profession in Higher Education.

ERIC Educational Resources Information Center

Meyerson, Ely

1981-01-01

Although financial aid staff feel they are treated as second-class citizens, they are seen as their own worst enemy. Some recommendations to improve the profession include: avoid use of jargon, reduce use of forms, promote the consolidation of loan activities, establish goals and objectives, and improve organizational development. (MLW)

Continuous Improvement in Business Education: Insights from the For-Profit Sector and Business School Deans.

ERIC Educational Resources Information Center

Bailey, Allan R.; Chow, Chee W.; Hadad, Kamal M.

1999-01-01

The balanced scorecard, a customer-based continuous improvement system, can be applied to business schools. Business deans (n=38) suggested goals and measures for a customer perspective, including such factors as stakeholders, program and service quality, public image, teaching/learning excellence, curriculum excellence, fund raising, and human…

Module Degradation Mechanisms Studied by a Multi-Scale Approach

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

Johnston, Steve; Al-Jassim, Mowafak; Hacke, Peter

2016-11-21

A key pathway to meeting the Department of Energy SunShot 2020 goals is to reduce financing costs by improving investor confidence through improved photovoltaic (PV) module reliability. A comprehensive approach to further understand and improve PV reliability includes characterization techniques and modeling from module to atomic scale. Imaging techniques, which include photoluminescence, electroluminescence, and lock-in thermography, are used to locate localized defects responsible for module degradation. Small area samples containing such defects are prepared using coring techniques and are then suitable and available for microscopic study and specific defect modeling and analysis.

Diabetic hyperglycemic hyperosmolar syndrome

MedlinePlus

... glucose Evaluation for possible causes may include: Blood cultures Chest x-ray Electrocardiogram (ECG) Urinalysis Treatment At the start of treatment, the goal is to correct the water loss. This will improve the blood pressure, urine output, ...

Maryland motor carrier program performance enhancement : [research summary].

DOT National Transportation Integrated Search

2014-02-01

The Maryland Motor Carrier Program (MMCP) involves the regulation of : commercial vehicle safety inspections. This includes roadside inspections : programs which have a goal of improving safety and reducing crashes : involving commercial vehicles. Th...

Goals of care conversation teaching in residency - a cross-sectional survey of postgraduate program directors.

PubMed

Roze des Ordons, Amanda; Kassam, Aliya; Simon, Jessica

2017-01-06

Residents are commonly involved in establishing goals of care for hospitalized patients. While education can improve the quality of these conversations, whether and how postgraduate training programs integrate such teaching into their curricula is not well established. The objective of this study was to characterize perceptions of current teaching and assessment of goals of care conversations, and program director interest in associated curricular integration. An electronic survey was sent to all postgraduate program directors at the University of Calgary. Quantitative data was analyzed using descriptive statistics and qualitative comments were analyzed using thematic analysis. The survey response rate was 34% (22/64). Formal goals of care conversation teaching is incorporated into 63% of responding programs, and most commonly involves lectures. Informal teaching occurs in 86% of programs, involving discussion, direct observation and role modeling in the clinical setting. Seventy-three percent of programs assess goals of care conversation skills, mostly in the clinical setting through feedback. Program directors believe that over two-thirds of clinical faculty are prepared to teach goals of care conversations, and are interested in resources to teach and assess goals of care conversations. Themes that emerged include 1) general perceptions, 2) need for teaching, 3) ideas for teaching, and 4) assessment of goals of care conversations. The majority of residency training programs at the University of Calgary incorporate some goals of care conversation teaching and assessment into their curricula. Program directors are interested in resources to improve teaching and assessment of goals of care conversations.

78 FR 72755 - Version 5 Critical Infrastructure Protection Reliability Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-03

... (e.g., thumb drives and laptop computers) that fall outside of the BES Cyber Asset definition.\\5... implementation study is part of a larger program that includes the development of guidance, outreach to industry... the goals of the implementation study include: (1) Improving industry's understanding of the technical...

Evaluating Community Engagement in an Academic Medical Center

PubMed Central

Shone, Laura P.; Dozier, Ann M.; Newton, Gail L.; Green, Theresa; Bennett, Nancy M.

2014-01-01

From the perspective of academic medical centers (AMCs), community engagement is a collaborative process of working toward mutually defined goals to improve the community’s health, and involves partnerships between AMCs, individuals, and entities representing the surrounding community. AMCs increasingly recognize the importance of community engagement, and recent programs such as Prevention Research Centers and Clinical and Translational Science Awards have highlighted community engagement activities. However, there is no standard or accepted metric for evaluating AMCs’ performance and impact of community engagement activities. In this article, the authors present a framework for evaluating AMCs’ community engagement activities. The framework includes broad goals and specific activities within each goal, wherein goals and activities are evaluated using a health services research framework consisting of structure, process, and outcome criteria. To illustrate how to use this community engagement evaluation framework, the authors present specific community engagement goals and activities of the University of Rochester Medical Center to (1) improve the health of the community served by the AMC; (2) increase the AMC’s capacity for community engagement; and (3) increase generalizable knowledge and practices in community engagement and public health. Using a structure-process-outcomes framework, a multidisciplinary team should regularly evaluate an AMC’s community engagement program with the purpose of measurably improving the performance of the AMC and the health of its surrounding community. PMID:24556768

Empowering the Girl Child, Improving Global Health.

PubMed

Cesario, Sandra K; Moran, Barbara

The health and productivity of a global society is dependent upon the elimination of gender inequities that prevent girls from achieving their full potential. Although some progress has been made in reducing social, economic, and health disparities between men and women, gender equality continues to be an elusive goal. The Millennium Development Goals (2000-2015) and the Sustainable Development Goals (2015-2030) include intergovernmental aspirations to empower women and stress that change must begin with the girl child. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

150 {mu}A 18F{sup -} target and beam port upgrade for the IBA 18/9 cyclotron

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

Stokely, M. H.; Peeples, J. L.; Poorman, M. C.

2012-12-19

A high power ({approx}3 kW) target platform has been developed for the IBA 18/9 cyclotron. New designs for the airlock, collimator and target subsystems have been fabricated and deployed. The primary project goal is reliable commercial production of 18F{sup -} at 150 {mu}A or greater, while secondary goals include improving serviceability and extending service intervals relative to OEM systems. Reliable operation in a production environment has been observed at beam currents up to 140 {mu}A. Challenges include ion source lifetime and localized peaking in the beam intensity distribution.

Student views on the role of self-regulated learning in a surgery clerkship.

PubMed

Lyons-Warren, Ariel M; Kirby, John P; Larsen, Douglas P

2016-12-01

Self-regulated learning, including student-generated learning goals and flexibility in the learning structure are increasingly being used to enhance medical education. The role of these practices in surgical education of medical students has not been studied. We administered an 18-question electronic survey to all third-year medical students at Washington University in St. Louis School of Medicine. Of the 126 students invited, 64 responded and 56 were included in the analysis. We found that third-year medical students develop learning goals at the beginning of the surgery clerkship. Although these learning goals theoretically can be a mechanism for enhanced student-faculty engagement, students are not aware of formal mechanisms for sharing these goals with faculty members. Furthermore, students report a lack of flexibility within the surgery clerkship and discomfort with requesting specific learning opportunities. Finally, students report that they believe increased flexibility could improve student engagement, learning, and the overall clerkship experience. We therefore propose that a mechanism for students to share their learning goals with faculty and an infrastructure in which student learning experiences can be tailored to fit with these individualized goals would enhance student surgical learning. Copyright © 2016 Elsevier Inc. All rights reserved.

Goal Management Training and Mindfulness Meditation improve executive functions and transfer to ecological tasks of daily life in polysubstance users enrolled in therapeutic community treatment.

PubMed

Valls-Serrano, Carlos; Caracuel, Alfonso; Verdejo-Garcia, Antonio

2016-08-01

We have previously shown that Goal Management Training+Mindfulness Meditation (GMT+MM) improves executive functions in polysubstance users enrolled in outpatient treatment. The aim of this study was to establish if GMT+MM has similar positive effects on executive functions in polysubstance users in residential treatment, and if executive functions' gains transfer to more ecologically valid goal-oriented tasks. Thirty-two polysbustance users were randomly allocated to eight weeks of GMT+MM (n=16) or control, i.e., no-intervention (n=16); both groups received treatment as usual. Outcome measures included performance in laboratory tasks of basic and complex executive functions (i.e., basic: working memory and inhibition; complex: planning and self-regulation) and in an ecological task of goal-directed behavior (the Multiple Errands Test - contextualized version, MET-CV) measured post-interventions. Results showed that GMT+MM was superior to control in improving basic measures of working memory (Letter-number sequencing; F=4.516, p=0.049) and reflection impulsivity (Information Sampling Test; F=6.217, p=0.018), along with initial thinking times during planning (Zoo Map Test; F=8.143, p=0.008). In addition, GMT+MM was superior to control in improving performance in the MET-CV (task failures; F=8.485, p=0.007). Our findings demonstrate that GMT+MM increases reflective processes and the achievement of goals in daily activities, furthermore ecological test can detects changes easily than laboratory tasks. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Morristown National Historical Park (NHP) alternative transportation system planning study

DOT National Transportation Integrated Search

2001-12-01

This alternative transportation plan aims to define a more efficient transit plan for visitors to Morristown. Goals include protecting environmental resources, improving visitor experiences and safety, maximizing use of infrastructure, ensuring compa...

Development of the Neurological Institute: a strategic, improvement, and systems approach.

PubMed

Tinsley, Nancy; McCartney, Leigh Ann; Hdeib, Alia; Selman, Warren R

2011-06-01

The Neurological Institute at University Hospitals Case Medical Center is designed to be responsive to the ever-changing healthcare environment, aligning clinical services and goals in response to internal and external pressures for change. These goals are many, including the further development of system integration across disciplines and geographic locations, creation of a regional strategy, and research as well as education strategies that are aligned with clinical services, patient outcomes that demonstrate improved health status management, and improved financial strength. There are many details to the development of a strategic business unit such as the Neurological Institute, but this article focuses on the high-level strategies of developing the Neurological Institute and takes a closer look at the growth of one of its 16 centers of excellence.

What We See: A Department of Education's View of a State-Sponsored Urban School Improvement Initiative.

ERIC Educational Resources Information Center

Reece, Gary T.; Alvarez, Frank R.

This paper presents the State of New Jersey Board of Education's evaluation of the Operation School Renewal (OSR) Program, a multi-year assistance program involving the urban school districts of Trenton, East Orange, and Neptune Township (New Jersey). Goals included the following: (1) attendance improvement; (2) reduction of disruptive pupil…

The Role of Public Health Nutrition in Achieving the Sustainable Development Goals in the Asia Pacific Region.

PubMed

Binns, Colin; Lee, Mi Kyung; Low, Wah Yun; Zerfas, Alfred

2017-10-01

The Sustainable Development Goals (SDGs) replaced the Millennium Development Goals (MDCs) in 2015, which included several goals and targets primarily related to nutrition: to eradicate extreme poverty and hunger and to reduce child mortality and improve maternal health. In the Asia-Pacific Academic Consortium for Public Health (APACPH) member countries as a group, infant and child mortality were reduced by more than 65% between 1990 and 2015, achieving the MDG target of two-thirds reduction, although these goals were not achieved by several smaller countries. The SDGs are broader in focus than the MDGs, but include several goals that relate directly to nutrition: 2 (zero hunger-food), 3 (good health and well-being-healthy life), and 12 (responsible consumption and production-sustainability). Other SDGs that are closely related to nutrition are 4 and 5 (quality education and equality in gender-education and health for girls and mothers, which is very important for infant health) and 13 (climate action). Goal 3 is "good health and well-being," which includes targets for child mortality, maternal mortality, and reducing chronic disease. The Global Burden of Disease Project has confirmed that the majority of risk for these targets can be attributed to nutrition-related targets. Dietary Guidelines were developed to address public health nutrition risk in the Asia Pacific region at the 48th APACPH 2016 conference and they are relevant to the achievement of the SDGs. Iron deficiency increases the risk of maternal death from haemorrhage, a cause of 300000 deaths world-wide each year. Improving diets and iron supplementation are important public health interventions in the APACPH region. Chronic disease and obesity rates in the APACPH region are now a major challenge and healthy life course nutrition is a major public health priority in answering this challenge. This article discusses the role of public health nutrition in achieving the SDGs. It also examines the role of APACPH in education and advocacy and in fulfilling the educational needs of public health students in public health nutrition.

"Rheum to Improve": Quality Improvement in Outpatient Rheumatology.

PubMed

Chow, Shirley L; Shojania, Kaveh G

2017-09-01

The commitment to improve care processes and patient outcomes is a professional mandate for clinicians and is also seen as an operational priority for institutions. Quality improvement now figures in the accreditation of training programs, specialty examinations, and hospital scorecards. Rheumatologists have traditionally focused primarily on quality problems such as guideline adherence; however, improvement goals should also include other aspects of care that are helpful to patients and are professionally rewarding for practitioners. This review makes use of improvement projects in outlining tangible tools rheumatologists can use to resolve quality concerns in their practices.

Locomotive crashworthiness research : locomotive crew egress evaluation

DOT National Transportation Integrated Search

2002-05-01

The objectives of this study include the identification of aspects of locomotive design and operation related to crew egress or access by rescuers in accidents, with the goal of improving crew survivability. This work identifies the considerations an...

FFY 2007 annual report for the Montana Department of Transportation Research Programs

DOT National Transportation Integrated Search

2008-01-01

The Montana Department of Transportation (MDT) conducts research to discover, develop, or extend knowledge needed to operate, maintain, and improve the statewide multimodal transportation system. Specific goals include: evaluation and advancement of ...

Improving Communication During Cardiac ICU Multidisciplinary Rounds Through Visual Display of Patient Daily Goals.

PubMed

Justice, Lindsey B; Cooper, David S; Henderson, Carla; Brown, James; Simon, Katherine; Clark, Lindsey; Fleckenstein, Elizabeth; Benscoter, Alexis; Nelson, David P

2016-07-01

To improve communication during daily cardiac ICU multidisciplinary rounds. Quality improvement methodology. Twenty-five-bed cardiac ICUs in an academic free-standing pediatric hospital. All patients admitted to the cardiac ICU. Implementation of visual display of patient daily goals through a write-down and read-back process. The Rounds Effectiveness Assessment and Communication Tool was developed based on the previously validated Patient Knowledge Assessment Tool to evaluate comprehension of patient daily goals. Rounds were assessed for each patient by the bedside nurse, nurse practitioner or fellow, and attending physician, and answers were compared to determine percent agreement per day. At baseline, percent agreement for patient goals was only 62%. After initial implementation of the daily goal write-down/read-back process, which was written on paper by the bedside nurse, the Rounds Effectiveness Assessment and Communication Tool survey revealed no improvement. With adaptation of the intervention so goals were written on whiteboards for visual display during rounds, the percent agreement improved to 85%. Families were also asked to complete a survey (1-6 Likert scale) of their satisfaction with rounds and understanding of daily goals before and after the intervention. Family survey results improved from a mean of 4.6-5.7. Parent selection of the best possible score for each question was 19% at baseline and 75% after the intervention. Visual display of patient daily goals via a write-down/read-back process improves comprehension of goals by all team members and improves parent satisfaction. The daily goal whiteboard facilitates consistent development of a comprehensive plan of care for each patient, fosters goal-directed care, and provides a checklist for providers and parents to review throughout the day.

Low voltage 30-cm ion thruster development. [including performance and structural integrity (vibration) tests

NASA Technical Reports Server (NTRS)

King, H. J.

1974-01-01

The basic goal was to advance the development status of the 30-cm electron bombardment ion thruster from a laboratory model to a flight-type engineering model (EM) thruster. This advancement included the more conventional aspects of mechanical design and testing for launch loads, weight reduction, fabrication process development, reliability and quality assurance, and interface definition, as well as a relatively significant improvement in thruster total efficiency. The achievement of this goal was demonstrated by the successful completion of a series of performance and structural integrity (vibration) tests. In the course of the program, essentially every part and feature of the original 30-cm Thruster was critically evaluated. These evaluations, led to new or improved designs for the ion optical system, discharge chamber, cathode isolator vaporizer assembly, main isolator vaporizer assembly, neutralizer assembly, packaging for thermal control, electrical terminations and structure.

Identifying and applying psychological theory to setting and achieving rehabilitation goals.

PubMed

Scobbie, Lesley; Wyke, Sally; Dixon, Diane

2009-04-01

Goal setting is considered to be a fundamental part of rehabilitation; however, theories of behaviour change relevant to goal-setting practice have not been comprehensively reviewed. (i) To identify and discuss specific theories of behaviour change relevant to goal-setting practice in the rehabilitation setting. (ii) To identify 'candidate' theories that that offer most potential to inform clinical practice. The rehabilitation and self-management literature was systematically searched to identify review papers or empirical studies that proposed a specific theory of behaviour change relevant to setting and/or achieving goals in a clinical context. Data from included papers were extracted under the headings of: key constructs, clinical application and empirical support. Twenty-four papers were included in the review which proposed a total of five theories: (i) social cognitive theory, (ii) goal setting theory, (iii) health action process approach, (iv) proactive coping theory, and (v) the self-regulatory model of illness behaviour. The first three of these theories demonstrated most potential to inform clinical practice, on the basis of their capacity to inform interventions that resulted in improved patient outcomes. Social cognitive theory, goal setting theory and the health action process approach are theories of behaviour change that can inform clinicians in the process of setting and achieving goals in the rehabilitation setting. Overlapping constructs within these theories have been identified, and can be applied in clinical practice through the development and evaluation of a goal-setting practice framework.

What motivates health professionals? Opportunities to gain greater insight from theory.

PubMed

Buetow, Stephen

2007-07-01

Health care policy-makers and researchers need to pay more attention to understanding the influence of motivation on professional behaviour. Goal setting theory, including two hypotheses - the business case and the pride case - dominates current attempts to motivate professionals. However, the predominance of goal setting theory stifles other approaches to conceptualizing professional motivation. These approaches include other cognitive theories of motivation, such as self-determination theory (concerned with how to use extrinsic rewards that enhance intrinsic motivation), as well as content, psychoanalytic and environmental theories. A valuable opportunity exists to develop and test such theories in addition to possible hybrids, for example, by elaborating goal setting theory in health care. The results can be expected to inform health policy and motivate individual professionals, groups, organizations and workforces to improve and deliver high quality care.

Better Tests, Better Care: Improved Diagnostics for Infectious Diseases

PubMed Central

Caliendo, Angela M.; Gilbert, David N.; Ginocchio, Christine C.; Hanson, Kimberly E.; May, Larissa; Quinn, Thomas C.; Tenover, Fred C.; Alland, David; Blaschke, Anne J.; Bonomo, Robert A.; Carroll, Karen C.; Ferraro, Mary Jane; Hirschhorn, Lisa R.; Joseph, W. Patrick; Karchmer, Tobi; MacIntyre, Ann T.; Reller, L. Barth; Jackson, Audrey F.

2013-01-01

In this IDSA policy paper, we review the current diagnostic landscape, including unmet needs and emerging technologies, and assess the challenges to the development and clinical integration of improved tests. To fulfill the promise of emerging diagnostics, IDSA presents recommendations that address a host of identified barriers. Achieving these goals will require the engagement and coordination of a number of stakeholders, including Congress, funding and regulatory bodies, public health agencies, the diagnostics industry, healthcare systems, professional societies, and individual clinicians. PMID:24200831

Using Performance Feedback and Goal Setting to Improve Elementary Students' Writing Fluency: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Koenig, Elizabeth A.; Eckert, Tanya L.; Hier, Bridget O.

2016-01-01

Although performance feedback interventions successfully lead to improvements in students' performance, research suggests that the combination of feedback and goal setting leads to greater performance than either component alone and that graphing performance in relation to a goal can lead to improvements in academic performance. The goal of the…

Improving the Efficiency of Physical Examination Services

PubMed Central

Chih, Mingchang; Bair, Aaron E.

2009-01-01

The objective of our project was to improve the efficiency of the physical examination screening service of a large hospital system. We began with a detailed simulation model to explore the relationships between four performance measures and three decision factors. We then attempted to identify the optimal physician inquiry starting time by solving a goal-programming problem, where the objective function includes multiple goals. One of our simulation results shows that the proposed optimal physician inquiry starting time decreased patient wait times by 50% without increasing overall physician utilization. Electronic supplementary material  The online version of this article (doi:10.1007/s10916-009-9271-z) contains supplementary material, which is available to authorized users. PMID:20703912

Materials for a new generation of vehicles

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

Grobstein, T.

1995-12-31

The Partnership for a New Generation of Vehicles (PNGV) is a national initiative with three goals: first, to significantly improve national competitiveness in manufacturing; second, to implement commercially viable innovations from ongoing research on conventional vehicles, and third, to develop a vehicle to achieve up to three times the fuel efficiency of today`s comparable vehicle (i.e., the 1994 Chrysler Concorde, Ford Taurus, and Chevrolet Lumina). Note this vehicle will have the equivalent customer purchase price of today`s vehicles adjusted for economics, while meeting the customers` needs for quality, performance, and utility. Eight federal agencies are currently contributing to these goals,more » as well as the three principal US automobile manufacturers, numerous automotive component suppliers, research laboratories, and universities. Materials research and development is a significant effort within PNGV. The goals in this area include development of lightweight, recyclable materials for structural applications, high strength, long-life, high temperature materials for engine components, improved materials for alternative propulsion and energy storage systems, and cost-effective process technologies and component fabrication methods. Application of advanced materials to automobiles will involve consideration of diverse factors, including weight savings, affordability, recyclability, crashworthiness, repairability, and manufacturability.« less

Professional Development, Capacity Building, and Research Needs: Critical Issues for Response to Intervention Implementation

ERIC Educational Resources Information Center

Danielson, Louis; Doolittle, Jennifer; Bradley, Renee

2007-01-01

The No Child Left Behind Act of 2001 in conjunction with the Individuals With Disabilities Education Act amendments of 2004 (IDEA) have created incentives to improve how K-12 instruction is provided and to improve the achievement of all students, including those with disabilities. To reach these goals, however, a thorough research base is needed,…

Smart Start and Preschool Child Care Quality in North Carolina: Change Over Time and Relation to Children's Readiness.

ERIC Educational Resources Information Center

Bryant, Donna; Maxwell, Kelly; Taylor, Karen; Poe, Michele; Peisner-Feinberg, Ellen; Bernier, Kathleen

The primary goal of Smart Start is to ensure that all children enter school healthy and prepared to succeed. Smart Start has funded a variety of technical assistance (TA) activities to improve child care, including on-site technical assistance, quality improvement and facility grant, teacher education scholarships, license upgrades, teacher salary…

Using the Results of Teaching Evaluations to Improve Teaching: A Case Study of a New Systematic Process

ERIC Educational Resources Information Center

Malouff, John M.; Reid, Jackie; Wilkes, Janelle; Emmerton, Ashley J.

2015-01-01

This article describes a new 14-step process for using student evaluations of teaching to improve teaching. The new process includes examination of student evaluations in the context of instructor goals, student evaluations of the same course completed in prior terms, and evaluations of similar courses taught by other instructors. The process has…

Enhancing the prospects for palliative care at the end of life: A statewide educational demonstration project to improve advance care planning.

PubMed

Litzelman, Debra K; Cottingham, Ann H; Griffin, Wilma; Inui, Thomas S; Ivy, Steven S

2016-12-01

Although patients want to participate in discussions and decisions about their end-of-life care, studies show that providers frequently fail to invite them to explore advanced care preferences or goals for living. The purpose of our demonstration project was to provide education and coaching to individuals, health providers, and organizations across the state of Indiana intended to facilitate these conversations, documenting and honoring individuals' life goals and preferences for care during the final stages of life. Education and training engaged community members as well as healthcare providers to: (1) improve participant comfort and facility discussing end-of-life issues; (2) improve knowledge of healthcare choices, including palliative and hospice care; and (3) prepare all participants to explore and document personal values, life goals, and priorities as well as goals of care. Between January of 2013 and June of 2015, the team educated close to 5,000 participants. Participants' ratings of the quality and perceived usefulness of the educational events ranged from 4 to 5 (using a 5-point scale, with 5 = most effective). Participant comments were overwhelmingly favorable and indicated an intention to put the advance care planning resources, communication skills, knowledge of palliative and hospice care, and personal renewal techniques into practice. Participant motivation to foster advance care planning, discussions of palliative care, and end-of-life conversations was facilitated by the reframing of these conversations as identifying goals of care and priorities for living well during an important stage of life. Successful strategies included helping providers and patients to adopt a broader meaning for "sustaining hope" (not for cure, but for engaging in highly valued activities), developing provider communication skills and comfort in initiating potentially difficult discussions, engaging a new community health workforce who will develop trusting relationships with patients in home-based services, and fostering self-awareness and self-care among palliative care providers.

Evaluation of a driving simulator for ground-vehicle operator training

DOT National Transportation Integrated Search

2006-01-31

Improving runway safety is part of the Federal Aviation Administration (FAA) Flight Plan (FAA, 2005) with annual goals established for the reduction of runway incursions, including vehicle pedestrian deviations (VPDs). Reducing VPDs is a difficult ta...

5 CFR 470.301 - Program expectations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining to Demonstration... improved personnel methods. (b) The demonstration project must be proposed in a research context. The project plan must include a research design which contains: (1) Measurable goals or objectives; (2...

5 CFR 470.301 - Program expectations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining to Demonstration... improved personnel methods. (b) The demonstration project must be proposed in a research context. The project plan must include a research design which contains: (1) Measurable goals or objectives; (2...

5 CFR 470.301 - Program expectations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining to Demonstration... improved personnel methods. (b) The demonstration project must be proposed in a research context. The project plan must include a research design which contains: (1) Measurable goals or objectives; (2...

5 CFR 470.301 - Program expectations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining to Demonstration... improved personnel methods. (b) The demonstration project must be proposed in a research context. The project plan must include a research design which contains: (1) Measurable goals or objectives; (2...

The AAS Working Group on Accessibility and Disability (WGAD)

NASA Astrophysics Data System (ADS)

Monkiewicz, Jacqueline A.; Shanahan, J.; Murphy, Nicholas Arnold; Gilbert, Lauren

2016-06-01

The Working Group on Accessibility and Disability (WGAD) was formed by the Council of the American Astronomical Society in late 2015 in order to monitor and addresses issues of inclusivity in the astronomical community related to disability. WGAD promotes of the principles of universal accessibility and disability justice in both professional astronomy and astronomy education. The short term goals of WGAD for the next two years include producing a set of guidelines for a wide range of activities including supporting improved access to journals, data, and conferences. We will provide information and training regarding universal design as a guiding principle. The longer term goals of WGAD include integrating universal design as primary design strategy across the board in our many aspects of daily work life.

Leveraging information technology to drive improvement in patient satisfaction.

PubMed

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

2010-01-01

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

FitwitsTM Leads to Improved Parental Recognition of Childhood Obesity and Plans to Encourage Change.

PubMed

Edwards, Bethany A; Powell, Jonathan R; McGaffey, Ann; Wislo, Valerie M P; Boron, Elaine; D'Amico, Frank J; Hogan, Linda; Hughes, Kristin; Jewell, Ilene Katz; Abatemarco, Diane J

2017-01-01

Brief tools are needed to help physicians and parents reach consensus on body mass index (BMI) categories for children and to discuss health-improving behaviors. This study tested the Fitwits TM intervention with interactive flashcards and before and- after surveys to improve parents' perceptions of children's BMI status. We enrolled 140 parents and their 9- to 12-year-old children presenting for well child care, regardless of BMI status, scheduled with 53 Fitwits-trained physicians. The Fitwits tool guided a conversation with all parent-child dyads regarding understanding BMI, nutrition, activity, and portion sizes. A survey addressed BMI category perceptions before and after the intervention, requested 2 goal selections, and included open-ended comment areas. Fifty-three percent of children were overweight or obese. The primary outcome variable was the rate of correct parental identification of their child's weight status (underweight, healthy, overweight, or obese). The survey before the intervention resulted in 50.0% correct BMI category designations. This changed to 60.6% correct perceptions after the intervention, with movement between correct overweight (34.5% to 51.7%) and obese (4.4% to 24.4%) categories. Secondary outcome variables included specific behavior change goals and the qualitative responses of parents, children, and physicians to the intervention. Parent-child dyads predominantly commented favorably and chose (75.8%) goals corresponding to Fitwits card suggestions. An improvement was observed in parental ability to identify the correct BMI category after the intervention during a preadolescent well child visit. Parent underrecognition of overweight/obese children was also observed. Most parent comments were appreciative of the physician interaction, Fitwits flashcards, and health improvement exchange. © Copyright 2017 by the American Board of Family Medicine.

The Sustainable Development Goal for Urban Sanitation: Africa's Statistical Tragedy Continues?

PubMed

Buckley, Robert M; Kallergis, Achilles

2018-06-01

Sanitation delivery in the urban areas of sub-Saharan African countries has been a chronic issue, particularly difficult to tackle. Under the Millennium Development Goals, the sanitation target in urban sub-Saharan Africa was missed by a wide margin and witnessed almost no improvement. After 2 years of review, the WHO/UNICEF Joint Monitoring Programme published a new measure of access to sanitation as a baseline for the Sustainable Development Goals. There are a number of improvements in the new measure. However, despite the improvements, the new measure continues to be characterized by an important flaw: it continues to disregard how shared toilet facilities contribute towards the SDG sanitation target. As a result, the new measure does not indicate whether progress is being made in low-income urban areas where a large number of households rely on shared sanitation; nor does it provide a goal that can be achieved in cities of the poorest countries over the measurement period. But, its most egregious failing is that it directs resources towards investments which will often fail cost/benefit tests. In sum, it is not a surprise that a Working Group recommended that the measure should be changed to include some shared facilities. Following the Working Group's recommendation would have avoided the adverse consequences of continued reliance on a key component of the methodology used for monitoring sanitation improvements under the Millennium Development Goals. The paper discusses the limitations of this methodology in the context of urban sub-Saharan Africa, where current sanitation conditions are seriously lacking, and the significant future urban population growth will add more pressure for the delivery of vital sanitation services.

Recent Trends in Maternal, Newborn, and Child Health in Brazil: Progress Toward Millennium Development Goals 4 and 5

PubMed Central

Matijasevich, Alicia; Requejo, Jennifer Harris; Giugliani, Elsa; Maranhão, Ana Goretti; Monteiro, Carlos A.; Barros, Aluísio J. D.; Bustreo, Flavia; Merialdi, Mario; Victora, Cesar G.

2010-01-01

We analyzed Brazil's efforts in reducing child mortality, improving maternal and child health, and reducing socioeconomic and regional inequalities from 1990 through 2007. We compiled and reanalyzed data from several sources, including vital statistics and population-based surveys. We also explored the roles of broad socioeconomic and demographic changes and the introduction of health sector and other reform measures in explaining the improvements observed. Our findings provide compelling evidence that proactive measures to reduce health disparities accompanied by socioeconomic progress can result in measurable improvements in the health of children and mothers in a relatively short interval. Our analysis of Brazil's successes and remaining challenges to reach and surpass Millennium Development Goals 4 and 5 can provide important lessons for other low- and middle-income countries. PMID:20724669

Working conditions and effects of ISO 9000 in six furniture-making companies: implementation and processes.

PubMed

Karltun, J; Axelsson, J; Eklund, J

1998-08-01

What effects will the implementation of the quality standard ISO 9000 have regarding working conditions and competitive advantages? Which are the most important change process characteristics for assuring improved working conditions and other desired effects? These are the main questions behind this study of six furniture-making companies which implemented ISO 9000 during the period 1991-1994. The results show that customer requirement was the dominant goal to implement ISO 9000. Five of the six companies succeeded in gaining certification. The influence on working conditions was limited, but included better order and housekeeping, more positive attitudes towards discussing quality shortcomings, a few workplace improvements, work enrichment caused by additional tasks within the quality system and a better understanding of external customer demands. Among the negative effects were new, apparently meaningless, tasks for individual workers as well as more stress and more physically strenuous work. The effects on the companies included a decrease in external quality-related costs and improved delivery precision. The study confirms the importance for efficient change of the design of the change process, and identifies 'improvement methodology' as the most important process characteristic. Improved working conditions are enhanced by added relevant strategic goals and by a participative implementation process.

An overview and evaluation of the oncology family caregiver project: improving quality of life and quality of care for oncology family caregivers.

PubMed

Ferrell, Betty; Hanson, Jo; Grant, Marcia

2013-07-01

With changes in health care, oncology family caregivers (FCs) provide the vast majority of patient care. Yet, FCs assume their role with little or no training and with limited resources within the cancer setting to support them. The purpose of this project is to develop and implement a curriculum to improve the quality of life and quality of care for FCs by strengthening cancer care settings in this area. A National Cancer Institute (NCI) R25 grant funded the development of an FC curriculum for professional healthcare providers. The curriculum, based on the City of Hope Quality-of-Life Model, is presented to professionals from cancer centers in national training courses. The project brings together the most current evidence-based knowledge and multiple resources to help improve FC support. Participants develop goals related to implementation and dissemination of the course content and resources in their home institution. Goal evaluation follows at 6, 12, and 18 months. To date, three courses have been presented to 154 teams (322 individuals) representing 39 states. Course evaluations were positive, and participants have initiated institutional FC support goals. Although the goals are diverse, the broad categories include support groups, staff/FC/community education, resource development, assessment tools, and institutional change. There is a critical need to improve support for cancer FCs. This FC training course for professionals is a first step in addressing this need. Copyright © 2012 John Wiley & Sons, Ltd.

The end of measles and congenital rubella: an achievable dream?

PubMed

Adamo, G; Sturabotti, G; D'Andrea, E; Baccolini, V; Romano, F; Iannazzo, S; Marzuillo, C; Villari, P

2017-01-01

Despite substantial progress towards measles and rubella control, outbreaks continue to threaten elimination goals worldwide. This paper aims to document progress towards the global eradication of measles and rubella. In particular, it investigates the major challenges faced by Italy in reaching the elimination goals. A review of the most important literature was carried out. Furthermore, a systematic review of the scientific literature on measles and rubella in the Italian setting was performed for the period 2000-2016. In the National Plan 2010-2015, Italy renewed its commitment to eliminate measles and rubella by 2015. However, Italy recently experienced a high measles burden (2,205 cases in 2013, 1,694 in 2014). Between June 2015 and May 2016, 515 cases were reported, accounting for 28% all cases in Europe. Immunization coverage decreased in recent years, with no Region reaching the 95% target. The systematic review included a total of 175 papers, with an upward trend in the number of published articles, which demonstrates an increasing interest in the field of measles and rubella. The review highlights the need to improve the commitment of the Italian Regions to the elimination goals; to promote Supplementary Immunization Activities (SIAs); to improve the communication skills of health care workers; to improve the health literacy of citizens; and to enhance integrated measles and rubella surveillance. Elimination of measles and rubella in Italy will require a substantial improvement in both commitment of the 21 Regions and activity of the whole country towards the WHO goals.

Using goal attainment scaling to evaluate a needs-led exercise programme for people with severe and profound intellectual disabilities.

PubMed

Jones, Martyn C; Walley, Robert M; Leech, Amanda; Paterson, Marion; Common, Stephanie; Metcalf, Charlotte

2006-12-01

The aim of this study was to evaluate whether involvement in a 16 week exercise programme improved goal attainment in areas of behaviour, access to community-based experiences, health and physical competence. Participants were women with severe intellectual disability and associated challenging behaviour (setting A,N = 14) and male/female service users with profound physical and intellectual disabilities (setting B,N = 8). The exercise programme included active and passive exercise, walking, swimming, hydrotherapy, team games and rebound therapy. Significant gains in aggregated goal attainment were demonstrated by week 16. The reliability and validity of our goal attainment procedures were demonstrated with inter-rater reliabilities exceeding 80 percent. Changes in goal attainment were concurrent with global clinical impression scores in a series of single case studies. Continuing care settings should dedicate care staff to provide routinized, continuing exercise programmes.

Using Technology to Meet the Challenges of Medical Education

PubMed Central

Guze, Phyllis A.

2015-01-01

Medical education is rapidly changing, influenced by many factors including the changing health care environment, the changing role of the physician, altered societal expectations, rapidly changing medical science, and the diversity of pedagogical techniques. Changes in societal expectations put patient safety in the forefront, and raises the ethical issues of learning interactions and procedures on live patients, with the long-standing teaching method of “see one, do one, teach one” no longer acceptable. The educational goals of using technology in medical education include facilitating basic knowledge acquisition, improving decision making, enhancement of perceptual variation, improving skill coordination, practicing for rare or critical events, learning team training, and improving psychomotor skills. Different technologies can address these goals. Technologies such as podcasts and videos with flipped classrooms, mobile devices with apps, video games, simulations (part-time trainers, integrated simulators, virtual reality), and wearable devices (google glass) are some of the techniques available to address the changing educational environment. This article presents how the use of technologies can provide the infrastructure and basis for addressing many of the challenges in providing medical education for the future. PMID:26330687

Using Technology to Meet the Challenges of Medical Education.

PubMed

Guze, Phyllis A

2015-01-01

Medical education is rapidly changing, influenced by many factors including the changing health care environment, the changing role of the physician, altered societal expectations, rapidly changing medical science, and the diversity of pedagogical techniques. Changes in societal expectations put patient safety in the forefront, and raises the ethical issues of learning interactions and procedures on live patients, with the long-standing teaching method of "see one, do one, teach one" no longer acceptable. The educational goals of using technology in medical education include facilitating basic knowledge acquisition, improving decision making, enhancement of perceptual variation, improving skill coordination, practicing for rare or critical events, learning team training, and improving psychomotor skills. Different technologies can address these goals. Technologies such as podcasts and videos with flipped classrooms, mobile devices with apps, video games, simulations (part-time trainers, integrated simulators, virtual reality), and wearable devices (google glass) are some of the techniques available to address the changing educational environment. This article presents how the use of technologies can provide the infrastructure and basis for addressing many of the challenges in providing medical education for the future.

Adaptive management: Chapter 1

USGS Publications Warehouse

Allen, Craig R.; Garmestani, Ahjond S.; Allen, Craig R.; Garmestani, Ahjond S.

2015-01-01

Adaptive management is an approach to natural resource management that emphasizes learning through management where knowledge is incomplete, and when, despite inherent uncertainty, managers and policymakers must act. Unlike a traditional trial and error approach, adaptive management has explicit structure, including a careful elucidation of goals, identification of alternative management objectives and hypotheses of causation, and procedures for the collection of data followed by evaluation and reiteration. The process is iterative, and serves to reduce uncertainty, build knowledge and improve management over time in a goal-oriented and structured process.

Adaptive management

USGS Publications Warehouse

Allen, Craig R.; Garmestani, Ahjond S.

2015-01-01

Adaptive management is an approach to natural resource management that emphasizes learning through management where knowledge is incomplete, and when, despite inherent uncertainty, managers and policymakers must act. Unlike a traditional trial and error approach, adaptive management has explicit structure, including a careful elucidation of goals, identification of alternative management objectives and hypotheses of causation, and procedures for the collection of data followed by evaluation and reiteration. The process is iterative, and serves to reduce uncertainty, build knowledge and improve management over time in a goal-oriented and structured process.

Feedback and rewards part III: commitment, goals, compensation, and job changes.

PubMed

Harolds, Jay A

2013-03-01

Formal and informal feedback is important to improve the performance, skill sets, commitment, accountability, and morale of the person being evaluated. Feedback can help people achieve their goals. Feedback is a basis for changes in compensation and other rewards. Formal reviews can also be the foundation for job changes. The latter includes promotions, lateral moves that are a better fit or will help the individual have new experiences or achieve new areas of proficiency, or finding opportunities to work outside the organization.

Gaming supports youth with acquired brain injury? A pilot study.

PubMed

de Kloet, A J; Berger, M A M; Verhoeven, I M A J; van Stein Callenfels, K; Vlieland, T P M Vliet

2012-01-01

To explore the effects of usage of the Nintendo Wii on physical, cognitive and social functioning in patients with acquired brain injury (ABI). This multi-centre, observational proof-of-concept study included children, adolescents and young adults with ABI aged 6-29 years. A standardized, yet individually tailored 12-week intervention with the Nintendo Wii was delivered by trained instructors. The treatment goals were set on an individual basis and included targets regarding physical, mental and/or social functioning. Outcome assessments were done at baseline and after 12 weeks and included: the average number of minutes per week of recreational physical activity; the CAPE (Children's Assessment of Participation and Enjoyment); the ANT (Amsterdam Neuropsychological Tasks); the achievement of individual treatment goals (Goal Attainment Scaling); and quality-of-life (PedsQL; Pediatric Quality of Life Inventory). Statistical analyses included paired t-tests or Wilcoxon-Signed-Rank tests. Fifty patients were included (31 boys and 19 girls; mean age 17.1 years (SD = 4.4)), of whom 45 (90%) completed the study. Significant changes of the amount of physical activity, speed of information processing, attention, response inhibition and visual-motor coordination (p < 0.05) were seen after 12 weeks, whereas there were no differences in CAPE or PedsQL scores. Two-thirds of the patients reported an improvement of the main treatment goal. This study supports the potential benefits of gaming in children and youth with ABI.

Going beyond the vertical: leveraging a national HIV quality improvement programme to address other health priorities in Haiti.

PubMed

Joseph, Jean Paul; Jerome, Gregory; Lambert, Wesler; Almazor, Patrick; Cupidon, Colette Eugene; Hirschhorn, Lisa R

2015-07-01

Although the central role of quality to achieve targeted population health goals is widely recognized, how to spread the capacity to measure and improve quality across programmes has not been widely studied. We describe the successful leveraging of expertise and framework of a national HIV quality improvement programme to spread capacity and improve quality across a network of clinics in HIV and other targeted areas of healthcare delivery in rural Haiti.The work was led by Zamni LaSante, a Haitian nongovernment organization and its sister organization, Partners In Health working in partnership with the Haitian Ministry of Health in the Plateau Central and Lower Artibonite regions in 12 public sector facilities.Data included routinely collected organizational assessments of facility quality improvement capacity, national HIV performance measures and Zamni LaSante programme records.We found that facility quality improvement capacity increased with spread from HIV to other areas of inpatient and outpatient care, including tuberculosis (TB), maternal health and inpatient services in all 12 supported healthcare facilities. A significant increase in the quality of HIV care was also seen in most areas, including CD4 monitoring, TB screening, HIV treatment (all P < 0.01) and nutritional assessment and prevention of mother-to-child transmission (both P < .05), with an increase in average facility performance from 39 to 72% (P < .01).In conclusion, using a diagonal approach to leverage a national vertical programme for wider benefit resulted in accelerated change in professional culture and increased capacity to spread quality improvement activities across facilities and areas of healthcare delivery. This led to improvement within and beyond HIV care and contributed to the goal of quality of care for all.

Effect of playing tactics on goal scoring in Norwegian professional soccer.

PubMed

Tenga, Albin; Holme, Ingar; Ronglan, Lars Tore; Bahr, Roald

2010-02-01

Methods that include an assessment of opponent interactions are thought to provide a more valid analysis of team match performance. The purpose of this study was to examine the effect of playing tactics on goal scoring by assessing opponent interactions in Norwegian elite soccer. The sample included 203 team possessions leading to goals (cases) and 1688 random team possessions (control group) from 163 of 182 (90%) matches played in the men's professional league during the 2004 season. Multidimensional qualitative data using ten ordered categorical variables were obtained to characterize each team possession. The proportion of goals scored during counterattacks (52%) was higher than during elaborate attacks (48%), while for the control group the proportion using elaborate attacks (59%) was higher than when using counterattacks (41%) (P = 0.002). Multiple logistic regression analyses showed that, for the main variable "team possession type", counterattacks were more effective than elaborate attacks when playing against an imbalanced defence (OR = 1.64; 95% confidence interval: 1.03 to 2.61; P = 0.038). Assessment of opponent interactions is critical to evaluate the effectiveness of offensive playing tactics on the probability of scoring goals, and improves the validity of team match-performance analysis in soccer.

Big hopes for the children of the world: a review of the Millennium Development Goals.

PubMed

Keating, E M; Chock, M; Fischer, P R

2011-01-01

The Millennium Development Goals are a set of eight goals drafted by the United Nations in 2000 with the aim of improving the health and welfare of people worldwide. The goals provide specific targets to be met by 2015, using the 1990 basis as a standard. This review presents these goals as they relate to children, discussing progress and future aims. Although not all eight goals specifically address children, each has its own impact on global child health. Thus far, much progress has been made, but increased rates of improvement must be achieved in order to meet the goals by 2015 and improve the health of children worldwide.

A Nationally Scaled Telebehavioral Health Program for Chronic Pain: Characteristics, Goals, and Psychological Outcomes.

PubMed

Mochari-Greenberger, Heidi; Peters, Aimee; Vue, Lee; Pande, Reena L

2017-08-01

Millions of U.S. adults suffer from chronic pain with a high prevalence of comorbid mental health issues. Telehealth-delivered behavioral therapy for chronic pain has been evaluated in the research setting. The purpose of this study was 1) to describe a nationally scaled, standardized, telebehavioral therapy program for patients with chronic pain and behavioral comorbidities, and 2) evaluate characteristics, goals, and psychosocial outcomes among program participants. This was mixed-methods retrospective cohort analysis among consecutive program graduates (mean age 53y; 24% male). The 8-week program was delivered by a licensed therapist and a behavior coach through telephone/secure video and tailored to each participant's behavioral health needs and goals. Participant chief complaints, behavioral goals, and mood triggers were abstracted by deidentified clinical record review using structured qualitative research methods. Depression, anxiety, and stress symptom data were collected at baseline and program graduation using the validated Depression Anxiety Stress Scales 21. Back pain (42%) and hip/leg/knee pain (28%) comprised the most common chief complaints. Pain management (44%) and weight loss (43%) were the most frequently cited goals. At baseline, approximately half of participants had elevated depression (59%), anxiety (54%), and/or stress (48%) scores. Triggers for depressed, anxious, or stressed mood included severe pain (47%), health concerns (46%), and interpersonal relationship challenges (45%). At graduation, significant improvement in median depression (-54%), anxiety (-50%), and stress (-33%) symptom scores was observed among those with non-normal baseline values (p < 0.001); degree of improvement did not vary by participant age or sex. Participants in a nationally scaled telebehavioral health program for chronic pain experienced significant improvement in depression, anxiety, and stress symptoms and shared several complaints, goals, and mood triggers.

Developing a typology of patient-generated behavioral goals for cognitive behavioral therapy for chronic pain (CBT-CP): classification and predicting outcomes.

PubMed

Heapy, Alicia A; Wandner, Laura; Driscoll, Mary A; LaChappelle, Kathryn; Czlapinski, Rebecca; Fenton, Brenda T; Piette, John D; Aikens, James E; Janevic, Mary R; Kerns, Robert D

2018-04-01

Patient-generated treatment goals describe what patients value, yet the content of these goals, and the relationship among goal types, goal accomplishment, and treatment outcomes has received little examination. We used inductive sorting to categorize patient-generated goals made by 147 adults receiving cognitive-behavioral therapy for chronic pain. The resulting goal categories were: Physical Activity (29.0%), Functional Status (24.6%), Wellness (16.3%), Recreational Activities (11.3%), House/Yard Work (9.7%), Socializing (7.1%), and Work/School (2.0%). Next, we examined associations between number of goals by category, goal accomplishment, and clinically meaningful improvements in pain-related interference, pain intensity and depressive symptoms. Improvement in all outcome domains was related to goal accomplishment. Additionally, depressive symptoms were related to number of Physical Activity, House/Yard Work, Recreational Activities, and Wellness goals, whereas improved pain-intensity was significantly related to House/Yard Work. Classifying patient-generated goals facilitates investigation of the relationships among goal type, goal accomplishment and treatment outcomes.

The Long Term Agroecosystem Research Network - Shared research strategy

USDA-ARS?s Scientific Manuscript database

Agriculture faces tremendous challenges in meeting multiple societal goals, including a safe and plentiful food supply; climate change adaptation and mitigation; supplying sources of bioenergy; improving water, air, and soil quality; and maintaining biodiversity. The Long Term Agroecosystem Research...

Environmental Education.

ERIC Educational Resources Information Center

Bandhu, Desh, Ed.; Aulakh, G. S., Ed.

In India, environmental education (EE) is introduced at various levels. Goals of this country's EE programs include: improving the quality of environment to create awareness among the people on environmental problems and conservation; developing skills to solve environmental problems; creating the necessary atmosphere for citizen participation in…

Who Will Manage the Schools?

ERIC Educational Resources Information Center

Clinton, Bill

1986-01-01

The Governors' Task Force on Leadership and Management created an action agenda to develop policies that strengthen school leadership, encourage school renewal, and determine broad educational goals. Suggested improvements include provision of proper training and certification programs for principals, effective inservice management development…

Advanced IGCC/Hydrogen Gas Turbine Development

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

York, William; Hughes, Michael; Berry, Jonathan

2015-07-30

The objective of this program was to develop the technologies required for a fuel flexible (coal derived hydrogen or syngas) gas turbine for IGCC that met DOE turbine performance goals. The overall DOE Advanced Power System goal was to conduct the research and development (R&D) necessary to produce coal-based IGCC power systems with high efficiency, near-zero emissions, and competitive capital cost. To meet this goal, the DOE Fossil Energy Turbine Program had as an interim objective of 2 to 3 percentage points improvement in combined cycle (CC) efficiency. The final goal is 3 to 5 percentage points improvement in CCmore » efficiency above the state of the art for CC turbines in IGCC applications at the time the program started. The efficiency goals were for NOx emissions of less than 2 ppm NOx (@15 % O2). As a result of the technologies developed under this program, the DOE goals were exceeded with a projected 8 point efficiency improvement. In addition, a new combustion technology was conceived of and developed to overcome the challenges of burning hydrogen and achieving the DOE’s NOx goal. This report also covers the developments under the ARRA-funded portion of the program that include gas turbine technology advancements for improvement in the efficiency, emissions, and cost performance of gas turbines for industrial applications with carbon capture and sequestration. Example applications could be cement plants, chemical plants, refineries, steel and aluminum plants, manufacturing facilities, etc. The DOE’s goal for more than 5 percentage point improvement in efficiency was met with cycle analyses performed for representative IGCC Steel Mill and IGCC Refinery applications. Technologies were developed in this program under the following areas: combustion, larger latter stage buckets, CMC and EBC, advanced materials and coatings, advanced configurations to reduce cooling, sealing and rotor purge flows, turbine aerodynamics, advanced sensors, advancements in first stage hot gas path components, and systems analyses to determine benefits of all previously mentioned technologies to a gas turbine system in an IGCC configuration. This project built on existing gas turbine technology and product developments, and developed and validated the necessary turbine related technologies and sub-systems needed to meet the DOE turbine program goals. The scope of the program did not cover the design and validation of a full-scale prototype machine with the technology advances from this program incorporated. In summary, the DOE goals were met with this program. While the commercial landscape has not resulted in a demand for IGCC gas turbines many of the technologies that were developed over the course of the program are benefiting the US by being applied to new higher efficiency natural gas fueled gas turbines.« less

Integrated Strategies to Address Maternal and Child Health and Survival in Low-Income Settings: Implications for Haiti

PubMed Central

Bhutta, Zulfiqar A

2016-01-01

The Millennium Development Goals for improving maternal and child health globally were agreed on in 2000, and several monitoring and evaluation strategies were put in place, including “Countdown to 2015” for monitoring progress and intervention coverage to reach the goals. However, progress in achieving the goals has been slow, with only 13 of the 75 participating Countdown countries on track to reach the targets for reducing child mortality. An overview of child mortality rates in low-income countries is presented, followed by a discussion of evidenced-based interventions that can bridge the equity gaps in global health. Finally, comments are included on the companion article in this issue, “Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care” (page 59), and what is needed for that new project to succeed. PMID:27065474

Improved image processing of road pavement defect by infrared thermography

NASA Astrophysics Data System (ADS)

Sim, Jun-Gi

2018-03-01

This paper intends to achieve improved image processing for the clear identification of defects in damaged road pavement structure using infrared thermography non-destructive testing (NDT). To that goal, 4 types of pavement specimen including internal defects were fabricated to exploit the results obtained by heating the specimens by natural light. The results showed that defects located down to a depth of 3 cm could be detected by infrared thermography NDT using the improved image processing method.

Astrometry VLBI in Space (AVS

NASA Technical Reports Server (NTRS)

Altunin, V.; Alekseev, V.; Akim, E.; Eubanks, M.; Kingham, K.; Treuhaft, R.; Sukhanov, K.

1995-01-01

A proposed new space radio astronomy mission for astrometry is described. The Astrometry VLBI (very long baseline) in Space (AVS) nominal mission includes two identical spacecraft, each with a 4-m antenna sending data to a 70-m ground station. The goals of AVS are improving astrometry accuracy to the microarcsecond level and improving the accuracy of the transformation between the inertial radio and optical coordinate reference frames.

Developing a maximum energy efficiency improvement target for SIC 28: chemicals and allied products. Volume 3. Draft target and support document. Appendices. Part 2. [Soaps, cosmetics, detergents, and perfumes

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

Not Available

1976-07-01

Part 2 of this appendix contains the detailed supporting documentation and rationale for the energy efficiency improvement goals for each of the component industries in Standard Industrial Classification (SIC) 284 which includes soap, detergents and cleaning preparations, and cosmetics, perfumes and other toilet preparations.

Silicon dendritic web growth

NASA Technical Reports Server (NTRS)

Duncan, S.

1984-01-01

Technological goals for a silicon dendritic web growth program effort are presented. Principle objectives for this program include: (1) grow long web crystals front continuously replenished melt; (2) develop temperature distribution in web and melt; (3) improve reproductibility of growth; (4) develop configurations for increased growth rates (width and speed); (5) develop new growth system components as required for improved growth; and (6) evaluate quality of web growth.

The Case for Unit-Based Teams: A Model for Front-line Engagement and Performance Improvement

PubMed Central

Cohen, Paul M; Ptaskiewicz, Mark; Mipos, Debra

2010-01-01

Unit-based teams (UBTs)—defined as natural work groups of physicians, managers, and frontline staff who work collaboratively to solve problems, improve performance, and enhance quality—were established by the 2005 national agreement between Kaiser Permanente (KP) and the Coalition of KP Unions. They use established performance-improvement techniques and employee-engagement principles (including social-movement theory) to achieve clinical and operational goals. UBT members identify performance gaps and opportunities within their purview—issues they can address in the course of the day-to-day work, such as workflow or process improvement. By focusing on clear, agreed-on goals, UBTs encourage greater accountability and allow members to perform their full scope of work. UBTs are designed to deliver measurable benefits in clinical outcomes and operations, patient-experience enhancements, and physician-team performance or work life. For many physicians, UBTs will require new ways of engaging with their teams. However, evidence suggests that with organizational and physician support, these teams can achieve their goals. This article presents case examples of successful UBTs' outcomes; physicians' comments on their experience working with teams; an overview of UBTs' employee-engagement principles; and advice on how physicians can support and participate in the work of such teams. PMID:20740124

TRMM Data Improvement as Part of the GPM Data Processing

NASA Technical Reports Server (NTRS)

Stocker, Erich F.; Ji, Y.; Kwiatkowski, J.; Kelley, O.; Stout, J.; Woltz, L.

2016-01-01

NASA has a long standing commitment to the improvement of its mission datasets. Indeed, data reprocessing is always built into the plans, schedule and budget for the mission data processing system. However, in addition to these ongoing mission reprocessing, NASA also supports a final reprocessing of all the data for a mission upon its completion (known as Phase F). TRMM Phase F started with the end of the TRMM mission in June of 2015. This last reprocessing has two overall goals: improvement of the TRMM mission data products; incorporation of the 17+ years of TRMM data into the ongoing NASA/JAXA GPM data processing. The first goal guarantees that the latest algorithms used for precipitation retrievals will also be used in reprocessing the TRMM data. The second goal ensures that as GPM algorithms are improved, the entire TRMM data will always be reprocessed with each GPM reprocessing. In essence TRMM becomes another of the GPM constellation satellites. This paper will concentrate on presenting the improvements to TMI level 1 data including calibration, geolocation, and emissive antenna corrections. It will describe the format changes that will occur how the TMI level 1C product will be intercalibrated using GMI as the reference calibration. It will also provide an overview of changes in the precipitation radar products as well as the combined TMIPR product.

Overview of DOE-NE Proliferation and Terrorism Risk Assessment

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

Sadasivan, Pratap

2012-08-24

Research objectives are: (1) Develop technologies and other solutions that can improve the reliability, sustain the safety, and extend the life of current reactors; (2) Develop improvements in the affordability of new reactors to enable nuclear energy; (3) Develop Sustainable Nuclear Fuel Cycles; and (4) Understand and minimize the risks of nuclear proliferation and terrorism. The goal is to enable the use of risk information to inform NE R&D program planning. The PTRA program supports DOE-NE's goal of using risk information to inform R&D program planning. The FY12 PTRA program is focused on terrorism risk. The program includes a mixmore » of innovative methods that support the general practice of risk assessments, and selected applications.« less

Progress toward measles control - African region, 2001-2008.

PubMed

2009-09-25

In 2001, the countries of the World Health Organization (WHO) African Region (AFR) became part of a global initiative with a goal of reducing the number of measles deaths by 50% by 2005, compared with 1999. Recommended strategies for measles mortality reduction included 1) increasing routine coverage for the first dose of measles-containing vaccine (MCV1) for all children, 2) providing a second opportunity for measles vaccination through supplemental immunization activities (SIAs), 3) improving measles case management, and 4) establishing case-based surveillance with laboratory confirmation of all suspected measles cases. Before introduction of MCV throughout AFR, approximately 1 million measles cases had been reported each year in the early 1980s. After strengthening measles-control activities, annual reported cases declined to an estimated 300,000- -580,000 during the 1990s. This report summarizes the progress made during 2001- -2008 toward improving measles control in AFR. During 2001- -2008 estimated MCV1 coverage increased from 57% to 73%, SIAs vaccinated approximately 398 million children, and reported measles cases decreased by 93%, from 492,116 in 2001 to 32,278 in 2008. By 2005, global measles deaths had decreased by 60%, and the AFR goal had been achieved; AFR adopted a new goal to reduce deaths by 90%, compared with 2000, and that goal was achieved in 2006. However, inaccuracies in reported vaccination coverage exist, surveillance is suboptimal, and measles outbreaks continue to occur in AFR countries. Further progress in measles control will require full implementation of recommended strategies, including validation of vaccination coverage.

Quality improvement and emerging global health priorities

PubMed Central

Mensah Abrampah, Nana; Syed, Shamsuzzoha Babar; Hirschhorn, Lisa R; Nambiar, Bejoy; Iqbal, Usman; Garcia-Elorrio, Ezequiel; Chattu, Vijay Kumar; Devnani, Mahesh; Kelley, Edward

2018-01-01

Abstract Quality improvement approaches can strengthen action on a range of global health priorities. Quality improvement efforts are uniquely placed to reorient care delivery systems towards integrated people-centred health services and strengthen health systems to achieve Universal Health Coverage (UHC). This article makes the case for addressing shortfalls of previous agendas by articulating the critical role of quality improvement in the Sustainable Development Goal era. Quality improvement can stimulate convergence between health security and health systems; address global health security priorities through participatory quality improvement approaches; and improve health outcomes at all levels of the health system. Entry points for action include the linkage with antimicrobial resistance and the contentious issue of the health of migrants. The work required includes focussed attention on the continuum of national quality policy formulation, implementation and learning; alongside strengthening the measurement-improvement linkage. Quality improvement plays a key role in strengthening health systems to achieve UHC. PMID:29873793

What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families

PubMed Central

You, John J.; Dodek, Peter; Lamontagne, Francois; Downar, James; Sinuff, Tasnim; Jiang, Xuran; Day, Andrew G.; Heyland, Daren K.

2014-01-01

Background: The guideline-recommended elements to include in discussions about goals of care with patients with serious illness are mostly based on expert opinion. We sought to identify which elements are most important to patients and their families. Methods: We used a cross-sectional study design involving patients from 9 Canadian hospitals. We asked older adult patients with serious illness and their family members about the occurrence and importance of 11 guideline-recommended elements of goals-of-care discussions. In addition, we assessed concordance between prescribed goals of care and patient preferences, and we measured patient satisfaction with goals-of-care discussions using the Canadian Health Care Evaluation Project (CANHELP) questionnaire. Results: Our study participants included 233 patients (mean age 81.2 yr) and 205 family members (mean age 60.2 yr). Participants reported that clinical teams had addressed individual elements of goals-of-care discussions infrequently (range 1.4%–31.7%). Patients and family members identified the same 5 elements as being the most important to address: preferences for care in the event of life-threatening illness, values, prognosis, fears or concerns, and questions about goals of care. Addressing more elements was associated with both greater concordance between patients’ preferences and prescribed goals of care, and greater patient satisfaction. Interpretation: We identified elements of goals-of-care discussions that are most important to older adult patients in hospital with serious illness and their family members. We found that guideline-recommended elements of goals-of-care discussions are not often addressed by health care providers. Our results can inform interventions to improve the determination of goals of care in the hospital setting. PMID:25367427

Factors associated with positive outcomes in 131 patients treated with gauze-based negative pressure wound therapy.

PubMed

Dunn, Raymond; Hurd, Theresa; Chadwick, P; Cote, Julien; Cockwill, John; Mole, Trevor; Smith, Jennifer

2011-01-01

Negative Pressure Wound Therapy (NPWT) is commonly used in many surgical specialties to improve wound management and healing outcomes. This study reports the ability of gauze-based NPWT to address several treatment goals commonly defined at the onset of therapy. A prospective, multi-center, non-comparative clinical investigation was carried out using gauze-based NPWT in chronic and acute wounds. 131 patients including traumatic, post-surgical and chronic wounds were assessed. Weekly percentage reductions in wound area, depth and volume were 8.3%, 15.8% and 20.5% respectively (p < 0.001). A reduction in exudate level was observed from baseline to treatment discontinuation (p < 0.001). An increase (p = 0.007) in red granulation tissue and a decrease (p < 0.001) in non-viable tissue was observed. Baseline wound characteristics associated with slower rates of progress included chronic wound aetiologies, longer wound duration prior to NPWT and presence of diabetes as a co-morbidity. Important indicators of wounds which had improved sufficiently and no longer required NPWT included reduction in volume and exudate levels. Gauze-based NPWT can be used to address many of the treatment goals commonly defined at the onset of therapy including reduction in wound volume, management of exudate and infection status, and improvement in wound bed quality. Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Persons with Diet-Related Diseases.

ERIC Educational Resources Information Center

McNutt, Kristen W.; Steinberg, Louis H.

1980-01-01

This article focuses on the educational approach to dealing with people with diet related diseases, their prevention, detection, and treatment. Issues include content and goals of education, identification of factors affecting food choices, professional education improvement, coordination of nutrition education systems, and nutrition concerns. (SA)

A Description of the Hawthorn Center Early Intervention Program.

ERIC Educational Resources Information Center

Glovinsky, Ira; Keller, Jackie

An early intervention project for preschool handicapped children is described. Specific program goals (including improved functioning in social, emotional, communication, and preacademic areas) are listed, and roles of the interdisciplinary staff members are considered. Among evaluation approaches discussed are psychological measures, family…

Rational and Safe Design of Concrete Transportation Structures for Size Effect and Multi-Decade Sustainability

DOT National Transportation Integrated Search

2012-10-01

The overall goal of this project was to improve the safety and sustainability in the design of large : prestressed concrete bridges and other transportation structures. The safety of large concrete : structures, including bridges, has been insufficie...

Teaching Goals-Plans-Action Theory through a Negotiation Exercise

ERIC Educational Resources Information Center

Gan, Ivan

2014-01-01

Evidence that K-12 schools had successfully integrated conflict resolution into curricula (Johnson & Johnson, 2004; Stevahn, 2004) includes students' resolution of personal conflicts and improved academic performances (Johnson, Johnson, Dudley, & Magnuson, 1995; Stevahn, Johnson, Johnson, Green, & Laginski, 1997; Stevahn, Johnson,…

Water for Two Worlds: Designing Terrestrial Applications for Exploration-class Sanitation Systems

NASA Technical Reports Server (NTRS)

Adams, Constance; Andersson, Ingvar; Feighery, John

2004-01-01

At the United Nations Millennium Summit in September of 2000, the world leaders agreed on an ambitious agenda for reducing poverty and improving lives: the Millennium Development Goals (MDGs) , a list of issues they consider highly pernicious, threatening to human welfare and, thereby, to global security and prosperity. Among the eight goals are included fundamental human needs such as the eradication of extreme poverty and hunger, the promotion of gender equality, the reduction of child mortality and improvement of maternal health, and ensuring the sustainability of our shared environment. In order to help focus the efforts to meet these goals, the United Nations (UN) has established a set of eighteen concrete targets, each with an associated schedule. Among these is Target 10: "By 2015, reduce by half the proportion of people without access to safe drinking water." A closely related target of equal dignity was agreed at the World Summit on Sustainable Development (Johannesburg, September 2002): "By 2015, reduce by half the proportion of people without access to basic sanitation".

Pathway engineering to improve ethanol production by thermophilic bacteria

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

Lynd, L.R.

1998-12-31

Continuation of a research project jointly funded by the NSF and DOE is proposed. The primary project goal is to develop and characterize strains of C. thermocellum and C. thermosaccharolyticum having ethanol selectivity similar to more convenient ethanol-producing organisms. An additional goal is to document the maximum concentration of ethanol that can be produced by thermophiles. These goals build on results from the previous project, including development of most of the genetic tools required for pathway engineering in the target organisms. As well, we demonstrated that the tolerance of C. thermosaccharolyticum to added ethanol is sufficiently high to allow practicalmore » utilization should similar tolerance to produced ethanol be demonstrated, and that inhibition by neutralizing agents may explain the limited concentrations of ethanol produced in studies to date. Task 1 involves optimization of electrotransformation, using either modified conditions or alternative plasmids to improve upon the low but reproducible transformation, frequencies we have obtained thus far.« less

Evidence, Goals, and Outcomes in Stuttering Treatment: Applications With an Adolescent Who Stutters.

PubMed

Marcotte, Anne K

2018-01-09

The purpose of this clinical focus article is to summarize 1 possible process that a clinician might follow in designing and conducting a treatment program with John, a 14-year-old male individual who stutters. The available research evidence, practitioner experience, and consideration of individual preferences are combined to address goals, treatment procedures, and outcomes for John. The stuttering treatment research literature includes multiple well-designed reviews and individual studies that have shown the effectiveness of prolonged speech (and smooth speech and related variations) for improving stuttered speech and for improving social, emotional, cognitive, and related variables in adolescents who stutter. Based on that evidence, and incorporating the additional elements of practitioner experience and client preferences, this clinical focus article suggests that John would be likely to benefit from a treatment program based on prolonged speech. The basic structure of 1 possible such program is also described, with an emphasis on the goals and outcomes that John could be expected to achieve.

A prospective interrupted time series study of interventions to improve the quality, rating, framing and structure of goal-setting in community-based brain injury rehabilitation.

PubMed

Hassett, Leanne; Simpson, Grahame; Cotter, Rachel; Whiting, Diane; Hodgkinson, Adeline; Martin, Diane

2015-04-01

To investigate whether the introduction of an electronic goals system followed by staff training improved the quality, rating, framing and structure of goals written by a community-based brain injury rehabilitation team. Interrupted time series design. Two interventions were introduced six months apart. The first intervention comprised the introduction of an electronic goals system. The second intervention comprised a staff goal training workshop. An audit protocol was devised to evaluate the goals. A random selection of goal statements from the 12 months prior to the interventions (Time 1 baseline) were compared with all goal statements written after the introduction of the electronic goals system (Time 2) and staff training (Time 3). All goals were de-identified for client and time-period, and randomly ordered. A total of 745 goals (Time 1 n = 242; Time 2 n = 283; Time 3 n = 220) were evaluated. Compared with baseline, the introduction of the electronic goals system alone significantly increased goal rating, framing and structure (χ(2) tests 144.7, 18.9, 48.1, respectively, p < 0.001). The addition of staff training meant that the improvement in goal quality, which was only a trend at Time 2, was statistically significant at Time 3 (χ(2) 15.0, p ≤ 001). The training also led to a further significant increase in the framing and structuring of goals over the electronic goals system (χ(2) 11.5, 12.5, respectively, p ≤ 0.001). An electronic goals system combined with staff training improved the quality, rating, framing and structure of goal statements. © The Author(s) 2014.

Cross-country analysis of strategies for achieving progress towards global goals for women's and children's health.

PubMed

Ahmed, Syed Masud; Rawal, Lal B; Chowdhury, Sadia A; Murray, John; Arscott-Mills, Sharon; Jack, Susan; Hinton, Rachael; Alam, Prima M; Kuruvilla, Shyama

2016-05-01

To identify how 10 low- and middle-income countries achieved accelerated progress, ahead of comparable countries, towards meeting millennium development goals 4 and 5A to reduce child and maternal mortality. We synthesized findings from multistakeholder dialogues and country policy reports conducted previously for the Success Factors studies in 10 countries: Bangladesh, Cambodia, China, Egypt, Ethiopia, the Lao People's Democratic Republic, Nepal, Peru, Rwanda and Viet Nam. A framework approach was used to analyse and synthesize the data from the country reports, resulting in descriptive or explanatory conclusions by theme. Successful policy and programme approaches were categorized in four strategic areas: leadership and multistakeholder partnerships; health sector; sectors outside health; and accountability for resources and results. Consistent and coordinated inputs across sectors, based on high-impact interventions, were assessed. Within the health sector, key policy and programme strategies included defining standards, collecting and using data, improving financial protection, and improving the availability and quality of services. Outside the health sector, strategies included investing in girls' education, water, sanitation and hygiene, poverty reduction, nutrition and food security, and infrastructure development. Countries improved accountability by strengthening and using data systems for planning and evaluating progress. Reducing maternal and child mortality in the 10 fast-track countries can be linked to consistent and coordinated policy and programme inputs across health and other sectors. The approaches used by successful countries have relevance to other countries looking to scale-up or accelerate progress towards the sustainable development goals.

Work motivation among healthcare professionals.

PubMed

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

2017-06-19

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

Improving Continuity of Care via the Discharge Summary

PubMed Central

Sakaguchi, Farrant H.; Lenert, Leslie A.

2015-01-01

Discharge summaries (DCS) frequently fail to improve the continuity of care. A chart review of 188 DCS was performed to identify specific components that could be improved through health information technology. Medication reconciliations were analyzed for completeness and for medical reasoning. Documentation of pending results and follow-up details were analyzed. Patient preferences, patient goals, and the handover tone were noted. Patients were discharged on an average of 9.8 medications, only 3% of medication reconciliations were complete and medical reasoning was frequently absent. There were 358 pending results in 188 hospital discharges though only 14% were mentioned in the DCS. Documentation of clear, timely follow-up was present for less than 50% of patients. Patient preferences, patient goals, and lessons learned were rarely included. A handover tone was in only 17% of the DCS. Evaluating the DCS as a clinical handover is novel but information for safe handovers is frequently missing. PMID:26958250

High-reliability gas-turbine combined-cycle development program: Phase II, Volume 3. Final report

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

Hecht, K.G.; Sanderson, R.A.; Smith, M.J.

This three-volume report presents the results of Phase II of the multiphase EPRI-sponsored High-Reliability Gas Turbine Combined-Cycle Development Program whose goal is to achieve a highly reliable gas turbine combined-cycle power plant, available by the mid-1980s, which would be an economically attractive baseload generation alternative for the electric utility industry. The Phase II program objective was to prepare the preliminary design of this power plant. The power plant was addressed in three areas: (1) the gas turbine, (2) the gas turbine ancillaries, and (3) the balance of plant including the steam turbine generator. To achieve the program goals, a gasmore » turbine was incorporated which combined proven reliability characteristics with improved performance features. This gas turbine, designated the V84.3, is the result of a cooperative effort between Kraftwerk Union AG and United Technologies Corporation. Gas turbines of similar design operating in Europe under baseload conditions have demonstrated mean time between failures in excess of 40,000. The reliability characteristics of the gas turbine ancillaries and balance-of-plant equipment were improved through system simplification and component redundancy and by selection of component with inherent high reliability. A digital control system was included with logic, communications, sensor redundancy, and manual backup. An independent condition monitoring and diagnostic system was also included. Program results provide the preliminary design of a gas turbine combined-cycle baseload power plant. This power plant has a predicted mean time between failure of nearly twice the 3000-h EPRI goal. The cost of added reliability features is offset by improved performance, which results in a comparable specific cost and an 8% lower cost of electricty compared to present market offerings.« less

High-reliability gas-turbine combined-cycle development program: Phase II. Final report

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

Hecht, K.G.; Sanderson, R.A.; Smith, M.J.

This three-volume report presents the results of Phase II of the multiphase EPRI-sponsored High-Reliability Gas Turbine Combined-Cycle Development Program whose goal is to achieve a highly reliable gas turbine combined-cycle power plant, available by the mid-1980s, which would be an economically attractive baseload generation alternative for the electric utility industry. The Phase II program objective was to prepare the preliminary design of this power plant. This volume presents information of the reliability, availability, and maintainability (RAM) analysis of a representative plant and the preliminary design of the gas turbine, the gas turbine ancillaries, and the balance of plant including themore » steam turbine generator. To achieve the program goals, a gas turbine was incorporated which combined proven reliability characteristics with improved performance features. This gas turbine, designated the V84.3, is the result of a cooperative effort between Kraftwerk Union AG and United Technologies Corporation. Gas turbines of similar design operating in Europe under baseload conditions have demonstrated mean time between failures in excess of 40,000 hours. The reliability characteristics of the gas turbine ancillaries and balance-of-plant equipment were improved through system simplification and component redundancy and by selection of component with inherent high reliability. A digital control system was included with logic, communications, sensor redundancy, and mandual backup. An independent condition monitoring and diagnostic system was also included. Program results provide the preliminary design of a gas turbine combined-cycle baseload power plant. This power plant has a predicted mean time between failure of nearly twice the 3000-hour EPRI goal. The cost of added reliability features is offset by improved performance, which results in a comparable specific cost and an 8% lower cost of electricity compared to present market offerings.« less

Latin America and the Caribbean: Assessment of the Advances in Public Health for the Achievement of the Millennium Development Goals

PubMed Central

Mitra, Amal K.; Rodriguez-Fernandez, Gisela

2010-01-01

To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs), that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1) eradicating extreme poverty and hunger; (2) achieving universal primary education; (3) promoting gender equality; (4) reducing child mortality; (5) improving maternal health; (6) combating HIV/AIDS, malaria and other diseases; (7) ensuring environmental sustainability; and (8) developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC). The paper also identifies areas of deficits for the achievement of MDGs in LAC. PMID:20623022

Latin America and the Caribbean: assessment of the advances in public health for the achievement of the Millennium Development Goals.

PubMed

Mitra, Amal K; Rodriguez-Fernandez, Gisela

2010-05-01

To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs), that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1) eradicating extreme poverty and hunger; (2) achieving universal primary education; (3) promoting gender equality; (4) reducing child mortality; (5) improving maternal health; (6) combating HIV/AIDS, malaria and other diseases; (7) ensuring environmental sustainability; and (8) developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC). The paper also identifies areas of deficits for the achievement of MDGs in LAC.

U.S. Department of Energy, Office of Legacy Management Program Update, April-June 2009

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

None

2009-04-01

Welcome to the April-June 2009 issue of the U.S. Department of Energy (DOE) Office of Legacy Management (LM) Program Update. This publication is designed to provide a status of activities within LM. The Legacy Management goals are: (1) Protect human health and the environment through effective and efficient long-term surveillance and maintenance - This goal highlights DOE's responsibility to ensure long-term protection of people, the environment, and the integrity of engineered remedies and monitoring systems. (2) Preserve, protect, and make accessible legacy records and information - This goal recognizes LM's commitment to successfully manage records, information, and archives of legacymore » sites under its authority. (3) Support an effective and efficient work force structured to accomplish Departmental missions and assure continuity of contractor worker pension and medical benefits - This goal recognizes DOE's commitment to its contracted work force and the consistent management of pension and health benefits. As sites continue to close, DOE faces the challenges of managing pension plan and health benefits liability. (4) Manage legacy land and assets, emphasizing protective real and personal property reuse and disposition - This goal recognizes a DOE need for local collaborative management of legacy assets, including coordinating land use planning, personal property disposition to community reuse organizations, and protecting heritage resources (natural, cultural, and historical). (5) Improve program effectiveness through sound management - This goal recognizes that LM's goals cannot be attained efficiently unless the federal and contractor work force is motivated to meet requirements and work toward continuous performance improvement.« less

Personal goals and changes in life-space mobility among older people.

PubMed

Saajanaho, Milla; Rantakokko, Merja; Portegijs, Erja; Törmäkangas, Timo; Eronen, Johanna; Tsai, Li-Tang; Jylhä, Marja; Rantanen, Taina

2015-12-01

Life-space mobility - the spatial extent of mobility in daily life - is associated with quality of life and physical functioning but may also be influenced by future orientation expressed in personal goals. The aim of this study was to explore how different personal goals predict changes in older people's life-space mobility. This prospective cohort study with a 2-year follow-up included 824 community-dwelling people aged 75 to 90 years from the municipalities of Jyväskylä and Muurame in Central Finland. As part of the Life-Space Mobility in Old Age study (LISPE), which was conducted between 2012 and 2014, the participants responded to the Life-Space Assessment and Personal Project Analysis in addition to questions on socio-demographics and health. Data were analyzed using generalized estimation equation models. The results showed that goals indicating a desire to be active in daily life, to stay mentally alert, and to exercise were associated with higher life-space mobility, and that the associations remained over the follow-up years. Goals related to maintaining functioning predicted higher life-space mobility at the 2-year follow-up. In contrast, goals reflecting improvement of poor physical functioning predicted lower life-space mobility. The results remained significant even when adjusted for indicators of health and functioning. This study indicates that supporting older people in striving for relevant personal goals in their lives might contribute to a larger life-space and thus also to improved quality of life in old age. Copyright © 2015 Elsevier Inc. All rights reserved.

Activation and motivation of medical students for learning histoembrylogy.

PubMed

Stiblar-Martincic, D

1998-01-01

The paper described the present learning/teaching activities for the basic subject in the medical curriculum called histoembryology. Various forms of teaching are presented, but a special emphasis is put on computer assisted testing. The leading idea in the teaching activities is to improve the activation and motivation of the students. This goal has been only partly achieved presumably because of insufficient coordination and integration in the curriculum. The plans for further improvements in histoembryology teaching are presented, including the improvements in computer assisted testing.

Patients' perspectives on social and goal-based comparisons regarding their diabetes health status.

PubMed

Martinez, William; Wallston, Kenneth A; Schlundt, David G; Hickson, Gerald B; Bonnet, Kemberlee R; Trochez, Ricardo J; Elasy, Tom A

2018-01-01

Social comparisons (ie, self-evaluation in comparison with others) influence patients' perspectives of their disease and may impact motivation and health behavior; however, little is known about patients' perspectives toward receiving such information in a clinical context (eg, from their doctor's office or health system). This study aims to understand patients' perspectives and anticipated responses to receiving social comparison information regarding measures of their diabetes-related health status (eg, A1C) and how receiving such information would compare with goal-based comparisons (ie, self-evaluation in comparison with goal). We conducted semistructured interviews with 25 patients with type 2 diabetes mellitus (T2DM) regarding social and goal-based comparisons involving their diabetes health status and qualitatively analyzed interviews for themes. We identified seven major themes: self-relevance, motivation, self-concept, emotions, information seeking, medical care, and self-care. Participants commonly anticipated increased motivation and improved health behaviors in response to both social and goal-based comparisons. Subthemes unique to social comparisons included belief that this information would be motivating by engaging some patients' competitiveness, perception that this information was more 'personalized' than comparisons with a standard goal (eg, A1C<7), and desire to learn from individuals similar to oneself who were doing better. Our findings provide significant insights into the anticipated response of patients with T2DM to receiving social and goal-based comparison information regarding their diabetes health status. Providing patients with diabetes with social and goal-based comparison information may affect motivation, mood, and self-concept in ways that may improve or sustain diabetes self-care behaviors for some patients.

Goal setting as a strategy for dietary and physical activity behavior change: a review of the literature.

PubMed

Shilts, Mical Kay; Horowitz, Marcel; Townsend, Marilyn S

2004-01-01

Estimate effectiveness of goal setting for nutrition and physical activity behavior change, review the effect of goal-setting characteristics on behavior change, and investigate effectiveness of interventions containing goal setting. For this review, a literature search was conducted for the period January 1977 through December 2003 that included a Current Contents, Biosis Previews, Medline, PubMed, PsycINFO, and ERIC search of databases and a reference list search. Key words were goal, goal setting, nutrition, diet, dietary, physical activity, exercise, behavior change, interventions, and fitness. The search identified 144 studies, of which 28 met inclusion criteria for being published in a peer reviewed journal and using goal setting in an intervention to modify dietary or physical activity behaviors. Excluded from this review were those studies that (1) evaluated goal setting cross-sectionally without an intervention; (2) used goal setting for behavioral disorders, to improve academic achievement, or in sports performance; (3) were reviews. The articles were categorized by target audience and secondarily by research focus. Data extracted included outcome measure, research rating, purpose, sample, sample description, assignment, findings, and goal-setting support. Thirteen of the 23 adult studies used a goal-setting effectiveness study design and eight produced positive results supporting goal setting. No adolescent or child studies used this design. The results were inconclusive for the studies investigating goal-setting characteristics (n = 7). Four adult and four child intervention evaluation studies showed positive outcomes. No studies reported power calculations, and only 32% of the studies were rated as fully supporting goal setting. Goal setting has shown some promise in promoting dietary and physical activity behavior change among adults, but methodological issues still need to be resolved. The literature with adolescents and children is limited, and the authors are not aware of any published studies with this audience investigating the independent effect of goal setting on dietary or physical activity behavior. Although, goal setting is widely used with children and adolescents in nutrition interventions, its effectiveness has yet to be reported.

A case study of healthcare providers' goals during interprofessional rounds.

PubMed

Prystajecky, Michael; Lee, Tiffany; Abonyi, Sylvia; Perry, Robert; Ward, Heather

2017-07-01

Daily interprofessional rounds enhance collaboration among healthcare providers and improve hospital performance measures. However, it is unclear how healthcare providers' goals influence the processes and outcomes of interprofessional rounds. The purpose of this case study was to explore the goals of healthcare providers attending interprofessional rounds in an internal medicine ward. The second purpose was to explore the challenges encountered by healthcare providers while pursuing these goals. Three focus groups were held with healthcare providers of diverse professional backgrounds. Focus group field notes and transcripts were analysed using thematic analysis. The data indicated that there was no consensus among healthcare providers regarding the goals of interprofessional rounds. Discharge planning and patient care delivery were perceived as competing priorities during rounds, which limited the participation of healthcare providers. Nevertheless, study participants identified goals of rounds that were relevant to most care providers: developing shared perspectives of patients through direct communication, promoting collaborative decision making, coordinating care, and strengthening interprofessional relationships. Challenges in achieving the goals of interprofessional rounds included inconsistent attendance, exchange of irrelevant information, variable participation by healthcare providers, and inconsistent leadership. The findings of this study underscore the importance of shared goals in the context of interprofessional rounding.

Mapping patients' experiences after stroke onto a patient-focused intervention framework.

PubMed

Donnellan, C; Martins, A; Conlon, A; Coughlan, T; O'Neill, D; Collins, D R

2013-03-01

Stroke patients' involvement in the rehabilitation process including decision making has made significant advances clinically over the past two decades. However, development of patient-focused interventions in stroke rehabilitation is a relatively under developed area of research. The aim of this study was to interpret the explanations that patients gave of their experience after stroke and how these may validate an already established patient-focused intervention framework - the Quest for quality and improved performance (QQUIP) (2006) that includes seven quality improvement goals. A random purposive sample of eight stroke patients was interviewed between 3 and 6 months following discharge. Patients' reports of their experience after stroke were obtained using in-dept semi-structured interviews and analysed using Qualitative Content Analysis. Explanations given by patients included both positive and negative reports of the stroke experience. Regardless of consequences as a result of physical, psychological and social impairments, there were other life style disruptions that were reported by all patients such as taking new medication and adverse effects of these, experiencing increasing fatigue, difficulties with social activities and situations and having to make changes in health behaviours and lifestyle. Some of the core themes that emerged reflected the aims of QQUIP improvement goals that include improving health literacy, clinical decision-making, self-care, patient safety, access to health advice, care experience and service development. Further recommendations based on the findings from this study would be to consider using the QQUIP framework for developing intervention studies in stroke rehabilitation care that are person-centred. This framework provides a template that is equipped to address some of the main concerns that people have following the experience of stroke and also focuses on improving quality of care.

Research requirements for development of improved helicopter rotor efficiency

NASA Technical Reports Server (NTRS)

Davis, S. J.

1976-01-01

The research requirements for developing an improved-efficiency rotor for a civil helicopter are documented. The various design parameters affecting the hover and cruise efficiency of a rotor are surveyed, and the parameters capable of producing the greatest potential improvement are identified. Research and development programs to achieve these improvements are defined, and estimated costs and schedules are presented. Interaction of the improved efficiency rotor with other technological goals for an advanced civil helicopter is noted, including its impact on engine noise, hover and cruise performance, one-engine-inoperative hover capability, and maintenance and reliability.

An annotated bibliography of selected guides for stream habitat improvement in the Pacific Northwest

USGS Publications Warehouse

Keim, R.F.; Price, A.B.; Hardin, T. S.; Skaugset, Arne E.; Bateman, D.S.; Gresswell, R.E.; Tesch, S. D.

2004-01-01

This annotated bibliography is a response to widespread interest in stream habitat improvement in the Pacific Northwest by land managers, governmental and nongovernmental organizations, and the lay public. Several guides to stream habitat improvement have been written in the past, but may not be easily accessible to people from diverse backgrounds. This annotated bibliography reviews 11 guides to stream habitat improvement so that readers can find literature appropriate to their needs. All reviews begin with summaries of the contents, stated audiences, and goals of each guide. Reviews also include subjective comments on the strengths and weaknesses of each guide. Finally, this bibliography includes recommendations of guides and combinations of guides judged most useful for a range of purposes. 

Project LIFE, 1963-1975. Final Report.

ERIC Educational Resources Information Center

Pfau, Glenn S.

Presented is the final report on Project Life (Language Improvement to Facilitate Education), a 12-year (1963-75) project which developed filmstrips and supplementary materials for teaching language to deaf children. General overview and historical review sections include information on project goals and objectives, administration agencies and…

25 CFR 23.22 - Purpose of tribal government grants.

Code of Federal Regulations, 2013 CFR

2013-04-01

... assistance, including homemaker and home counselors, protective day care and afterschool care, recreational activities, respite care, and employment support services with the goal of strengthening Indian families and contributing to family stability; (4) Home improvement programs with the primary emphasis on preventing the...

25 CFR 23.22 - Purpose of tribal government grants.

Code of Federal Regulations, 2011 CFR

2011-04-01

... assistance, including homemaker and home counselors, protective day care and afterschool care, recreational activities, respite care, and employment support services with the goal of strengthening Indian families and contributing to family stability; (4) Home improvement programs with the primary emphasis on preventing the...

25 CFR 23.22 - Purpose of tribal government grants.

Code of Federal Regulations, 2012 CFR

2012-04-01

... assistance, including homemaker and home counselors, protective day care and afterschool care, recreational activities, respite care, and employment support services with the goal of strengthening Indian families and contributing to family stability; (4) Home improvement programs with the primary emphasis on preventing the...

25 CFR 23.22 - Purpose of tribal government grants.

Code of Federal Regulations, 2014 CFR

2014-04-01

... assistance, including homemaker and home counselors, protective day care and afterschool care, recreational activities, respite care, and employment support services with the goal of strengthening Indian families and contributing to family stability; (4) Home improvement programs with the primary emphasis on preventing the...

Quality Management: Survey of Federal Organizations

DTIC Science & Technology

1992-10-01

Deming, Armand Feigenbaum, Kaoru Ishikawa , and J. M. Juran. For purposes of our survey, quality improvement efforts which have the same basic goals and...Feigenbaum, Kaoru Ishikawa , and J.M. Juran. Even though this approach may have different names, it most often includes the following five concepts

Damage to ITS, traffic control and roadway lighting equipment from transient surge and lightning strikes.

DOT National Transportation Integrated Search

2016-11-01

The goal of this project was to collect the knowledge needed for the FDOT to either confirm or : improve the adequacy of the FDOTs existing minimum standards for lightning/surge protection, : including devices used and installation procedures. The...

A Cultural Assessment of Tripler Regional Medical Center.

DTIC Science & Technology

1997-05-15

add value to the beneficiaries. The path Tripler Regional Medical Center has chosen to achieve the level of service quality required to sustain or grow...employing TQM management methods. The goals of this training include improvement in management, service quality , and in employee satisfaction, among

Artificial Intelligence Applications to High-Technology Training.

ERIC Educational Resources Information Center

Dede, Christopher

1987-01-01

Discusses the use of artificial intelligence to improve occupational instruction in complex subjects with high performance goals, such as those required for high-technology jobs. Highlights include intelligent computer assisted instruction, examples in space technology training, intelligent simulation environments, and the need for adult training…

Intercity passenger rail : Amtrak faces challenges in improving its financial condition : statement of Phyllis F. Scheinberg

DOT National Transportation Integrated Search

1999-10-28

The Rail Passenger Service Act of 1970 created Amtrak as the nation's intercity passenger railroad. The act, as amended, gave Amtrak a number of goals, including providing modern, efficient intercity passenger rail service; giving Americans an altern...

Four Sides to Every Story: Creating Effective Multimedia Business Simulations.

ERIC Educational Resources Information Center

Graham, William; Legere, Sylvie M.

1998-01-01

Discusses the goal-based design concepts used to build a CD-ROM-based course for senior executives at Andersen Consulting. Topics include quality management; continuous improvement; problem-centered learning; video storytelling; feedback; multimedia learning environments; course organization; and possible future applications. (Author/LRW)

Improving Conditions for Principal Effectiveness: Policy Implications of Research on Effective Principals.

ERIC Educational Resources Information Center

Manasse, A. Lorri

This paper reviews principal effectiveness research and suggests measures that might promote effective principalship. The first section discusses principals' behavior patterns and conditions bearing on their effectiveness. Topics examined include role ambiguity, goal setting behavior, leadership and initiative, management behaviors, instructional…

Pulling Together

ERIC Educational Resources Information Center

Daresh, John; Lynch, Jane

2011-01-01

Schools today require many individuals to work together to attain learning goals since no school functions without broad, active involvement of all community members. In addition, successful school improvement efforts operate well when there is a coherent vision for student achievement. While principals are aware of the need to include disparate…

23 CFR 924.13 - Evaluation.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Ensure the accuracy and currency of the safety data; (ii) Identify factors that affect the priority of... HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HIGHWAY SAFETY HIGHWAY SAFETY IMPROVEMENT PROGRAM... reaching the performance goals identified in § 924.9(a)(3)(ii)(G). (2) Include a process to evaluate the...

This Good-Health Regimen Keeps Employes Fit--And School Budgets Trim.

ERIC Educational Resources Information Center

Collingwood, Thomas R.

1984-01-01

The Dallas Independent School District's staff stress reduction and health awareness program is described. The program features medical screening, fitness assessment, goal setting, exercise and nutrition prescriptions, health education, exercise classes, motivation, and feedback. Benefits reported include significantly improved health and attitude…

Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services.

PubMed

Silver, Julie K; Raj, Vishwa S; Fu, Jack B; Wisotzky, Eric M; Smith, Sean Robinson; Kirch, Rebecca A

2015-12-01

Palliative care and rehabilitation practitioners are important collaborative referral sources for each other who can work together to improve the lives of cancer patients, survivors, and caregivers by improving both quality of care and quality of life. Cancer rehabilitation and palliative care involve the delivery of important but underutilized medical services to oncology patients by interdisciplinary teams. These subspecialties are similar in many respects, including their focus on improving cancer-related symptoms or cancer treatment-related side effects, improving health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision-making. They also aim to improve healthcare efficiencies and minimize costs by means such as reducing hospital lengths of stay and unanticipated readmissions. Although their goals are often aligned, different specialized skills and approaches are used in the delivery of care. For example, while each specialty prioritizes goal-concordant care through identification of patient and family preferences and values, palliative care teams typically focus extensively on using patient and family communication to determine their goals of care, while also tending to comfort issues such as symptom management and spiritual concerns. Rehabilitation clinicians may tend to focus more specifically on functional issues such as identifying and treating deficits in physical, psychological, or cognitive impairments and any resulting disability and negative impact on quality of life. Additionally, although palliative care and rehabilitation practitioners are trained to diagnose and treat medically complex patients, rehabilitation clinicians also treat many patients with a single impairment and a low symptom burden. In these cases, the goal is often cure of the underlying neurologic or musculoskeletal condition. This report defines and describes cancer rehabilitation and palliative care, delineates their respective roles in comprehensive oncology care, and highlights how these services can contribute complementary components of essential quality care. An understanding of how cancer rehabilitation and palliative care are aligned in goal setting, but distinct in approach may help facilitate earlier integration of both into the oncology care continuum-supporting efforts to improve physical, psychological, cognitive, functional, and quality of life outcomes in patients and survivors.

Subjective Experiences of the Benefits and Key Elements of a Cognitive Behavioral Intervention Focused on Community Work Outcomes in Persons With Mental Illness.

PubMed

Kukla, Marina; Strasburger, Amy M; Salyers, Michelle P; Rattray, Nicholas A; Lysaker, Paul H

2017-01-01

New research suggests that group-based cognitive behavioral therapy (CBT) may help improve employment outcomes in persons with mental illness, yet the effects and potential key elements facilitating change in such interventions are unclear. Using a mixed methods approach, this study examined the perspectives of persons with mental illness after participating in a pilot study of the "CBT for Work Success" intervention. Findings demonstrate that participants valued the intervention and perceived that it assisted them in achieving work goals. Therapeutic effects included improved self-efficacy, work motivation, enhanced sense of self as workers, and increased beliefs that work success is attainable. CBT for Work Success elements perceived to be important in facilitating work goals included cognitive restructuring, behavioral coping strategies, problem solving work barriers, meaningful reflection on oneself as a worker, and important factors associated with the group process. The authors discuss the implications of these findings and future research directions.

Operationally Responsive Space: Creating Responsive Space for America

DTIC Science & Technology

2008-06-20

programs. Items identified for improvement include: 1 ) Fractured management and accounting , 2 ) Satellite availability, 3) Facilities (Processing...enveloped by our three output tiers. The three tiers: • Tier 1 is an immediate response taking minutes to days. • Tier 2 is a mid term response taking...needs to improve. 2 . Develop a philosophy. 3. Set a direction with specific goals (Fuchs 1 -7). The Department of Space should follow these

Purchasing population health: aligning financial incentives to improve health outcomes.

PubMed

Kindig, D A

1999-01-01

To review the concept of population health, including its definition, measurement, and determinants, and to suggest an approach for aligning financial incentives toward this goal. DATA SOURCE, STUDY DESIGN, DATA EXTRACTION: Literature review, policy analysis The article presents the argument that a major reason for our slow progress toward health outcome improvement is that there is no operational definition of population health and that financial incentives are not aligned to this goal. Current attempts at process measures as indicators of quality or outcome are not adequate for the task. It is suggested that some measure of health-adjusted life expectancy be adopted for this purpose, and that integrated delivery systems and other agents responsible for nonmedical determinants be rewarded for improvement in this measure. This will require the development of an investment portfolio across the determinants of health based on relative marginal return to health, with horizontal integration strategies across sectoral boundaries. A 20-year three-phase development strategy is proposed, including components of research and acceptance, integrated health system implementation, and cross-sectoral integration. The U.S. health care system is a $1 trillion industry without a definition of its product. Until population outcome measures are developed and rewarded for, we will not solve the twenty-first century challenge of maximizing health outcome improvement for the resources available.

Purchasing population health: aligning financial incentives to improve health outcomes.

PubMed

Kindig, D A

1998-06-01

To review the concept of population health, including its definition, measurement, and determinants, and to suggest an approach for aligning financial incentives toward this goal. DATA SOURCE, STUDY DESIGN, DATA EXTRACTION. Literature review, policy analysis The article presents the argument that a major reason for our slow progress toward health outcome improvement is that there is no operational definition of population health and that financial incentives are not aligned to this goal. Current attempts at process measures as indicators of quality or outcome are not adequate for the task. It is suggested that some measure of health-adjusted life expectancy be adopted for this purpose, and that integrated delivery systems and other agents responsible for nonmedical determinants be rewarded for improvement in this measure. This will require the development of an investment portfolio across the determinants of health based on relative marginal return to health, with horizontal integration strategies across sectoral boundaries. A 20-year three-phase development strategy is proposed, including components of research and acceptance, integrated health system implementation, and cross-sectoral integration. The U.S. healthcare system is a $1 trillion industry without a definition of its product. Until population outcome measures are developed and rewarded for, we will not solve the twenty-first century challenge of maximizing health outcome improvement for the resources available.

An Example of How to Supplement Goal Setting to Promote Behavior Change for Families Using Motivational Interviewing.

PubMed

Draxten, Michelle; Flattum, Colleen; Fulkerson, Jayne

2016-10-01

The purpose of this study was to describe the components and use of motivational interviewing (MI) within a behavior change intervention to promote healthful eating and family meals and prevent childhood obesity. The Healthy Home Offerings via the Mealtime Environment (HOME) Plus intervention was part of a two-arm randomized-controlled trial and included 81 families (children 8-12 years old and their parents) in the intervention condition. The intervention included 10 monthly, 2-hour group sessions and 5 bimonthly motivational/goal-setting phone calls. Data were collected for intervention families only at each of the goal-setting calls and a behavior change assessment was administered at the 10th/final group session. Descriptive statistics were used to analyze the MI call data and behavior assessment. Overall group attendance was high (68% attending ≥7 sessions). Motivational/goal-setting phone calls were well accepted by parents, with an 87% average completion rate. More than 85% of the time, families reported meeting their chosen goal between calls. Families completing the behavioral assessment reported the most change in having family meals more often and improving home food healthfulness. Researchers should use a combination of delivery methods using MI when implementing behavior change programs for families to promote goal setting and healthful eating within pediatric obesity interventions.

Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review.

PubMed

Myers, Jeff; Cosby, Roxanne; Gzik, Danusia; Harle, Ingrid; Harrold, Deb; Incardona, Nadia; Walton, Tara

2018-01-01

Advance care planning and goals of care discussions involve the exploration of what is most important to a person, including their values and beliefs in preparation for health-care decision-making. Advance care planning conversations focus on planning for future health care, ensuring that an incapable person's wishes are known and can guide the person's substitute decision maker for future decision-making. Goals of care discussions focus on preparing for current decision-making by ensuring the person's goals guide this process. To provide evidence regarding tools and/or practices available for use by health-care providers to effectively facilitate advance care planning conversations and/or goals of care discussions. A systematic review was conducted focusing on guidelines, randomized trials, comparative studies, and noncomparative studies. Databases searched included MEDLINE, EMBASE, and the proceedings of the International Advance Care Planning Conference and the American Society of Clinical Oncology Palliative Care Symposium. Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.

Balancing measures or a balanced accounting of improvement impact: a qualitative analysis of individual and focus group interviews with improvement experts in Scotland.

PubMed

Toma, Madalina; Dreischulte, Tobias; Gray, Nicola M; Campbell, Diane; Guthrie, Bruce

2018-07-01

As quality improvement (QI) programmes have become progressively larger scale, the risks of implementation having unintended consequences are increasingly recognised. More routine use of balancing measures to monitor unintended consequences has been proposed to evaluate overall effectiveness, but in practice published improvement interventions hardly ever report identification or measurement of consequences other than intended goals of improvement. We conducted 15 semistructured interviews and two focus groups with 24 improvement experts to explore the current understanding of balancing measures in QI and inform a more balanced accounting of the overall impact of improvement interventions. Data were analysed iteratively using the framework approach. Participants described the consequences of improvement in terms of desirability/undesirability and the extent to which they were expected/unexpected when planning improvement. Four types of consequences were defined: expected desirable consequences ( goals ); expected undesirable consequences ( trade-offs ); unexpected undesirable consequences ( unpleasant surprises ); and unexpected desirable consequences ( pleasant surprises ). Unexpected consequences were considered important but rarely measured in existing programmes, and an improvement pause to take stock after implementation would allow these to be more actively identified and managed. A balanced accounting of all consequences of improvement interventions can facilitate staff engagement and reduce resistance to change, but has to be offset against the cost of additional data collection. Improvement measurement is usually focused on measuring intended goals , with minimal use of balancing measures which when used, typically monitor trade-offs expected before implementation. This paper proposes that improvers and leaders should seek a balanced accounting of all consequences of improvement across the life of an improvement programme, including deliberately pausing after implementation to identify and quantitatively or qualitatively evaluate any pleasant or unpleasant surprises. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Themes in the literature related to cardiovascular disease risk reduction.

PubMed

Cohen, Shannon Munro; Kataoka-Yahiro, Merle

2009-01-01

This article aimed to identify themes in the literature related to patient-healthcare provider beliefs, barriers to adherence, and interventions pertaining to cardiovascular disease risk reduction. Twenty quantitative and qualitative primary research studies including 2 meta-analyses published between 1995 and 2008 were analyzed for themes and practice implications to synthesize existing research on cardiovascular disease risk reduction. Databases searched included EBSCO, CINAHL, MEDLINE, ScienceDirect, HealthSource, and PsychLit using the search terms patient- provider adherence, adherence and shared decision making, adherence and decision support, patient- provider goal setting, and cardiovascular disease risk reduction. The emergent themes found in this literature review included (1) complex medication regimens; (2) risk perception, quality of life, and competing priorities; (3) motivation for change; (4) provider clinical inertia; and (5) goal setting, feedback, and reminders. Studies reporting the highest rates of adherence to cardiovascular disease risk reduction recommendations incorporated patient-provider goal setting and decision support, self-management techniques, and personalized printed communication. Goal setting in cardiovascular disease risk reduction is a relatively unexplored area and is an important component of shared decision making and adherence to cardiovascular disease health recommendations. The following review will address the 5 themes identified in more detail and provide a basis for improved clinical practice.

Setting goals, not just roles: Improving teamwork through goal-focused debriefing.

PubMed

Gardner, Aimee K; Kosemund, Matthew; Hogg, Deborah; Heymann, Abraham; Martinez, Joseph

2017-02-01

The role of goal setting within post-simulation debriefing is not well known. This study sought to examine how inclusion of group-level goals, individual-level goals, or no goals in the debriefing process impacts teamwork. Students participated in two high-fidelity team training scenarios. Between scenarios, teams were assigned to one of three debriefing groups: jointly creating five teamwork goals for the group to achieve (group-level goals); independently creating five teamwork goals for each individual to attain (individual-level goals); or no goals. Paired-samples t tests and one-way ANOVA with post-hoc Tukey tests were used to examine performance improvements and differences between groups. 86 MS3s participated in the training program across 22 groups. Percentage of items achieved on the teamwork tool from first to second scenario were 61.7±20.4 to 60.2±8.8 (no goals; ns), 59.8±14.0 to 76.8±7.0 (individual goals; p<0.01), and 62.5±9.5 to 67.0±10.0 (group goals; ns). Performance improvement in the individual goals group was significantly higher than the no goals group (p<0.05). Debriefing facilitators should encourage learners to focus on creating and achieving personal goals contributing to teamwork. Copyright © 2016 Elsevier Inc. All rights reserved.

Shared decision making within goal setting in rehabilitation settings: A systematic review.

PubMed

Rose, Alice; Rosewilliam, Sheeba; Soundy, Andrew

2017-01-01

To map out and synthesise literature that considers the extent of shared decision-making (SDM) within goal-setting in rehabilitation settings and explore participants' views of this approach within goal-setting. Four databases were systematically searched between January 2005-September 2015. All articles addressing SDM within goal-setting involving adult rehabilitation patients were included. The literature was critically appraised followed by a thematic synthesis. The search output identified 3129 studies and 15 articles met the inclusion criteria. Themes that emerged related to methods of SDM within goal-setting, participants' views on SDM, perceived benefits of SDM, barriers and facilitators to using SDM and suggestions to improve involvement of patients resulting in a better process of goal-setting. The literature showed various levels of patient involvement existing within goal-setting however few teams adopted an entirely patient-centred approach. However, since the review has identified clear value to consider SDM within goal-setting for rehabilitation, further research is required and practice should consider educating both clinicians and patients about this approach. To enhance the use of SDM within goal-setting in rehabilitation it is likely clinicians and patients will require further education on this approach. For clinicians this could commence during their training at undergraduate level. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Social, economic, and political factors in progress towards improving child survival in developing nations.

PubMed

Lykens, Kristine; Singh, Karan P; Ndukwe, Elewichi; Bae, Sejong

2009-01-01

Child mortality is a persistent health problem faced by developing nations. In 2000 the United Nations (UN) established a set of high priority goals to address global problems of poverty and health, the Millennium Development Goals, which address extreme poverty, hunger, primary education, child mortality, maternal health, infectious diseases, environmental sustainability, and partnerships for development. Goal 4 aims to reduce by two thirds, between 2000 and 2015, the under-five mortality rate in developing countries. In sub-Saharan Africa from 2000 to 2006 these rates have only been reduced from 167 per 1,000 live births to 157, and 27 nations in this region have made no progress towards the goal. A country-specific database was developed from the UN Millennium Development Goal tracking project and other international sources which include age distribution, under-nutrition, per capita income, government expenditures on health, external resources for health, civil liberties, and political rights. A multiple regression analysis examined the extent to which these factors explain the variance in child mortality rates in developing countries. Nutrition, external resources, and per capita income were shown to be significant factors in child survivability. Policy options include developed countries' renewed commitment of resources, and developing nations' commitments towards governance, development, equity, and transparency.

Preparing the Principal to Drive the Goals of Education for All: A Conceptual Case Developmental Model

ERIC Educational Resources Information Center

Hutton, Disraeli M.

2014-01-01

The Education for All (EFA) goals, established for countries to improve educational performance, are most challenging for many developing countries. Notwithstanding the challenges, each country must implement suitable programme intervention in order to accomplish these goals. Goal 6 calls for the overall improvement of the education product, which…

Psychometric properties of the Global Operative Assessment of Laparoscopic Skills (GOALS) using item response theory.

PubMed

Watanabe, Yusuke; Madani, Amin; Ito, Yoichi M; Bilgic, Elif; McKendy, Katherine M; Feldman, Liane S; Fried, Gerald M; Vassiliou, Melina C

2017-02-01

The extent to which each item assessed using the Global Operative Assessment of Laparoscopic Skills (GOALS) contributes to the total score remains unknown. The purpose of this study was to evaluate the level of difficulty and discriminative ability of each of the 5 GOALS items using item response theory (IRT). A total of 396 GOALS assessments for a variety of laparoscopic procedures over a 12-year time period were included. Threshold parameters of item difficulty and discrimination power were estimated for each item using IRT. The higher slope parameters seen with "bimanual dexterity" and "efficiency" are indicative of greater discriminative ability than "depth perception", "tissue handling", and "autonomy". IRT psychometric analysis indicates that the 5 GOALS items do not demonstrate uniform difficulty and discriminative power, suggesting that they should not be scored equally. "Bimanual dexterity" and "efficiency" seem to have stronger discrimination. Weighted scores based on these findings could improve the accuracy of assessing individual laparoscopic skills. Copyright © 2016 Elsevier Inc. All rights reserved.

Genome Consortium for Active Teaching: Meeting the Goals of BIO2010

PubMed Central

Ledbetter, Mary Lee S.; Hoopes, Laura L.M.; Eckdahl, Todd T.; Heyer, Laurie J.; Rosenwald, Anne; Fowlks, Edison; Tonidandel, Scott; Bucholtz, Brooke; Gottfried, Gail

2007-01-01

The Genome Consortium for Active Teaching (GCAT) facilitates the use of modern genomics methods in undergraduate education. Initially focused on microarray technology, but with an eye toward diversification, GCAT is a community working to improve the education of tomorrow's life science professionals. GCAT participants have access to affordable microarrays, microarray scanners, free software for data analysis, and faculty workshops. Microarrays provided by GCAT have been used by 141 faculty on 134 campuses, including 21 faculty that serve large numbers of underrepresented minority students. An estimated 9480 undergraduates a year will have access to microarrays by 2009 as a direct result of GCAT faculty workshops. Gains for students include significantly improved comprehension of topics in functional genomics and increased interest in research. Faculty reported improved access to new technology and gains in understanding thanks to their involvement with GCAT. GCAT's network of supportive colleagues encourages faculty to explore genomics through student research and to learn a new and complex method with their undergraduates. GCAT is meeting important goals of BIO2010 by making research methods accessible to undergraduates, training faculty in genomics and bioinformatics, integrating mathematics into the biology curriculum, and increasing participation by underrepresented minority students. PMID:17548873

Genome Consortium for Active Teaching: meeting the goals of BIO2010.

PubMed

Campbell, A Malcolm; Ledbetter, Mary Lee S; Hoopes, Laura L M; Eckdahl, Todd T; Heyer, Laurie J; Rosenwald, Anne; Fowlks, Edison; Tonidandel, Scott; Bucholtz, Brooke; Gottfried, Gail

2007-01-01

The Genome Consortium for Active Teaching (GCAT) facilitates the use of modern genomics methods in undergraduate education. Initially focused on microarray technology, but with an eye toward diversification, GCAT is a community working to improve the education of tomorrow's life science professionals. GCAT participants have access to affordable microarrays, microarray scanners, free software for data analysis, and faculty workshops. Microarrays provided by GCAT have been used by 141 faculty on 134 campuses, including 21 faculty that serve large numbers of underrepresented minority students. An estimated 9480 undergraduates a year will have access to microarrays by 2009 as a direct result of GCAT faculty workshops. Gains for students include significantly improved comprehension of topics in functional genomics and increased interest in research. Faculty reported improved access to new technology and gains in understanding thanks to their involvement with GCAT. GCAT's network of supportive colleagues encourages faculty to explore genomics through student research and to learn a new and complex method with their undergraduates. GCAT is meeting important goals of BIO2010 by making research methods accessible to undergraduates, training faculty in genomics and bioinformatics, integrating mathematics into the biology curriculum, and increasing participation by underrepresented minority students.

Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependence

PubMed Central

Collins, Susan E.; Grazioli, Véronique S.; Torres, Nicole I.; Taylor, Emily M.; Jones, Connor B.; Hoffman, Gail E.; Haelsig, Laura; Zhu, Mengdan D.; Hatsukami, Alyssa S.; Koker, Molly J.; Herndon, Patrick; Greenleaf, Shawna M.; Dean, Parker E.

2015-01-01

Most treatment programs for alcohol dependence have prioritized alcohol abstinence as the primary treatment goal. However, abstinence-based goals are not always considered desirable or attainable by more severely affected populations, such as chronically homeless people with alcohol dependence. Because these individuals comprise a multimorbid and high-utilizing population, they are in need of more focused research attention that elucidates their preferred treatment goals. The aim of this secondary study was therefore to qualitatively and quantitatively document participant-generated treatment goals. Participants were currently or formerly chronically homeless individuals (N=31) with alcohol dependence who participated in a pilot of extended-release naltrexone and harm-reduction counseling. Throughout the treatment period, study interventionists elicited participants’ goals and recorded them on an open-ended grid. In subsequent weeks, progress towards and achievement of goals was obtained via self-report and recorded by study interventionists. Conventional content analysis was performed to classify participant-generated treatment goals. Representation of the three top categories remained stable over the course of treatment. In the order of their frequency, they included drinking-related goals, quality-of-life goals and health-related goals. Within the category of drinking-related goals, participants consistently endorsed reducing drinking and alcohol-related consequences ahead of abstinence-based goals. Quantitative analyses indicated participants generated an increasing number of goals over the course of treatment. Proportions of goals achieved and progressed toward kept pace with this increase. Findings confirmed hypotheses that chronically homeless people with alcohol dependence can independently generate and achieve treatment goals toward alcohol harm reduction and quality-of-life improvement. PMID:25697724

Poland: Changing the Whole System at Once

ERIC Educational Resources Information Center

Handke, Miroslaw

2015-01-01

Polish education reforms begun in 1999 have helped dramatically raise that nation's performance on international examinations. Broad goals set by Poland's education ministry included improving the overall education level of Polish citizens, equity, and implementing national standards with local autonomy. As part of the new reforms, Poland required…

Closing the Reference Interview: Implications for Policy and Practice.

ERIC Educational Resources Information Center

Nolan, Christopher W.

1992-01-01

Discusses reasons why patrons or librarians terminate the reference interview, including the content of the interview, interpersonal dynamics, and institutional or policy factors. Goals and objectives of the person terminating the interview are considered, and guidelines for policy development and performance improvement are offered. (30…

Scientists' Views about Communication Training

ERIC Educational Resources Information Center

Besley, John C.; Dudo, Anthony; Storksdieck, Martin

2015-01-01

This study assesses how scientists think about science communication training based on the argument that such training represents an important tool in improving the quality of interactions between scientists and the public. It specifically focuses on training related to five goals, including views about training to make science messages…

Home Visitation--A Chance for Counseling

ERIC Educational Resources Information Center

Crosen, Roger L.

1976-01-01

Some ideas for improving the effectiveness of home visitation of students by vocational agriculture instructors include: planning for the visit, getting to know the student, assessing the home situation for influencing factors, using home responsibilities for plant and animal care as learning experiences, and considering life goals. (MS)

Technology and Education: A Feminist Perspective.

ERIC Educational Resources Information Center

Rothschild, Joan

1989-01-01

Examines content of courses that focus on women and technology. Discusses the problems arising from the attempt to mainstream feminist scholarship on technology into the curriculum. Argues that a feminist framework is essential to achieving the dual goals of including women in the professions and improving the professions. (KO)

38 CFR 21.70 - Vocational rehabilitation.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Improving the veteran's potential to participate in a program of services designed to achieve a vocational... vocational goal; (2) Provide services needed to qualify for suitable employment; (3) Enable the veteran to...) The services that are needed for the accomplishment of the purposes of Chapter 31, including such...

Social Studies Course of Study.

ERIC Educational Resources Information Center

Miller, John E.; Murphy, Terrence A.

This K-12 sequential course of study is the result of one school district's efforts to improve continuity in the social studies curriculum. Following an introduction and statement of philosophy, the program is organized around four basic educational areas--knowledge, application, valuing, and participation. Specific program goals include promoting…

ElderSmile: A Comprehensive Approach to Improving Oral Health for Seniors

PubMed Central

Northridge, Mary E.; De La Cruz, Leydis D.; Vaughan, Roger D.; O'Neil-Dunne, Jarlath; Lamster, Ira B.

2009-01-01

Societal changes, including the aging of the US population and the lack of routine dental service coverage under Medicare, have left many seniors unable to afford any dental care whatsoever, let alone the most advanced treatments.1 In 2004, the Columbia University College of Dental Medicine and its partners instituted the ElderSmile program in the largely impoverished communities of Harlem and Washington Heights/Inwood in New York City. The long-term goal of this program is to improve access to and delivery of oral health care for seniors; the short-term goal is to establish and operate a network of prevention centers surrounding a limited number of treatment centers. Preliminary results indicate substantial unmet dental needs in this largely Hispanic and Black elderly population. PMID:19276459

Evaluation of Pharmacists' Work in a Physician-Pharmacist Collaborative Model for the Management of Hypertension.

PubMed

Isetts, Brian J; Buffington, Daniel E; Carter, Barry L; Smith, Marie; Polgreen, Linnea A; James, Paul A

2016-04-01

Physician-pharmacist collaborative models have been shown to improve the care of patients with numerous chronic medical conditions. Team-based health care using integrated clinical pharmacists provides one opportunity to improve quality in health care systems that use population-based financing. In November 2015, the Centers for Medicare and Medicaid Services (CMS) requested that the relative value of pharmacists' work in team-based care needs to be established. Thus the objective of this study was to describe the components of pharmacists' work in the management of hypertension with a physician-pharmacist collaborative model. Descriptive analysis of the components of pharmacists' work in the Collaboration Among Pharmacists and Physicians to Improve Outcomes Now (CAPTION) study, a prospective, cluster randomized trial. This analysis was intended to provide policymakers with data and information, using the CAPTION study model, on the time and intensity of pharmacists' work to understand pharmacists' relative value contributions in the context of CMS financing and population management aims. The CAPTION trial was conducted in 32 community-based medical offices in 15 U.S. states and included 390 patients with multiple cardiovascular risk factors. Blood pressure was measured by trained study coordinators in each office, and patients were included in the study if they had uncontrolled blood pressure. Included patients were randomized to a 9-month intervention, a 24-month intervention, or usual care. The goal of the pharmacist intervention was to improve blood pressure control and resolve drug therapy problems impeding progress toward blood pressure goals. This intervention included medical record review, a structured assessment with the patient, collaboration to achieve goals of therapy, and patient follow-up. The two intervention arms (9 and 24 mo) were identical the first 9 months, and that time frame is the focus of this workload evaluation. Pharmacists completed study encounter forms for every patient encounter and estimated time spent in pre-visit, face-to-face care, and post-visit activities. Among the 390 patients, there were 2811 encounters with pharmacists that involved 3.44 hours/patient for face-to-face care visits plus 1.55 hours/patient for pre-visit and post-visit work. Intensity of work was reflected in interventions to resolve drug therapy problems with patients (43% of encounters) and with physicians (1169 recommendations, of which physicians accepted 1153 [98.6%]), resulting in improvement of patients' blood pressure goals achieved (from 0% at baseline to 43% at 9 months based on the primary study end point). Pharmacists provided extensive interventions to patients with hypertension. This analysis provides a framework for health systems, provider groups, and payers to measure pharmacists' work in value-based financing and population management. © 2016 Pharmacotherapy Publications, Inc.

Evaluation of Pharmacists’ Work in a Physician-Pharmacist Collaborative Model for the Management of Hypertension

PubMed Central

Isetts, Brian J.; Buffington, Daniel E.; Carter, Barry L.; Smith, Marie; Polgreen, Linnea A.; James, Paul A.

2016-01-01

Study Objective Physician-pharmacist collaborative models have been shown to improve the care of patients with numerous chronic medical conditions. Team-based health care using integrated clinical pharmacists provides one opportunity to improve quality in health care systems that use population-based financing. In November 2015, the Centers for Medicare and Medicaid Services (CMS) requested that the relative value of pharmacists’ work in team-based care needs to be established. Thus, the objective of this study was to describe the components of pharmacists’ work in the management of hypertension with a physician-pharmacist collaborative model. Design Descriptive analysis of the components of pharmacists’ work in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) study, a prospective, cluster randomized trial. Measurements and Main Results This analysis was intended to provide policymakers with data and information, using the CAPTION study model, on the time and intensity of pharmacists’ work to understand pharmacists’ relative value contributions in the context of CMS financing and population management aims. The CAPTION trial was conducted in 32 community-based medical offices in 15 U.S. states and included 390 patients with multiple cardiovascular risk factors. Blood pressure was measured by trained study coordinators in each office, and patients were included in the study if they had uncontrolled blood pressure. Included patients were randomized to a 9-month intervention, a 24-month intervention, or usual care. The goal of the pharmacist intervention was to improve blood pressure control and resolve drug therapy problems impeding progress toward blood pressure goals. This intervention included medical record review, a structured assessment with the patient, collaboration to achieve goals of therapy, and patient follow-up. The two intervention arms (9 months and 24 months) were identical the first 9 months, and that time frame is the focus of this workload evaluation. Pharmacists completed study encounter forms for every patient encounter and estimated time spent in pre-visit, face-to-face care, and post-visit activities. Among the 390 patients, there were 2,811 encounters with pharmacists that involved 3.44 hours/patient for face-to-face care visits plus 1.55 hours/patient for pre-visit and post-visit work. Intensity of work was reflected in interventions to resolve drug therapy problems with patients (43% of encounters) and with physicians (1,169 recommendations, of which physicians accepted 1,153 [98.6%]), resulting in improvement of patients’ blood pressure goals achieved (from 0% at baseline to 43% at 9 months based on the primary study endpoint). Conclusion Pharmacists provided extensive interventions to patients with hypertension. This analysis provides a framework for health systems, provider groups, and payers to measure pharmacists’ work in value-based financing and population management. PMID:26893135

Evaluating Practice-Based Learning and Improvement: Efforts to Improve Acceptance of Portfolios

PubMed Central

Fragneto, Regina Y.; DiLorenzo, Amy Noel; Schell, Randall M.; Bowe, Edwin A.

2010-01-01

Introduction The Accreditation Council for Graduate Medical Education (ACGME) recommends resident portfolios as 1 method for assessing competence in practice-based learning and improvement. In July 2005, when anesthesiology residents in our department were required to start a portfolio, the residents and their faculty advisors did not readily accept this new requirement. Intensive education efforts addressing the goals and importance of portfolios were undertaken. We hypothesized that these educational efforts improved acceptance of the portfolio and retrospectively audited the portfolio evaluation forms completed by faculty advisors. Methods Intensive education about the goals and importance of portfolios began in January 2006, including presentations at departmental conferences and one-on-one education sessions. Faculty advisors were instructed to evaluate each resident's portfolio and complete a review form. We retrospectively collected data to determine the percentage of review forms completed by faculty. The portfolio reviews also assessed the percentage of 10 required portfolio components residents had completed. Results Portfolio review forms were completed by faculty advisors for 13% (5/38) of residents during the first advisor-advisee meeting in December 2005. Initiation of intensive education efforts significantly improved compliance, with review forms completed for 68% (26/38) of residents in May 2006 (P < .0001) and 95% (36/38) in December 2006 (P < .0001). Residents also significantly improved the completeness of portfolios between May and December of 2006. Discussion Portfolios are considered a best methods technique by the ACGME for evaluation of practice-based learning and improvment. We have found that intensive education about the goals and importance of portfolios can enhance acceptance of this evaluation tool, resulting in improved compliance in completion and evaluation of portfolios. PMID:22132291

Evaluating practice-based learning and improvement: efforts to improve acceptance of portfolios.

PubMed

Fragneto, Regina Y; Dilorenzo, Amy Noel; Schell, Randall M; Bowe, Edwin A

2010-12-01

The Accreditation Council for Graduate Medical Education (ACGME) recommends resident portfolios as 1 method for assessing competence in practice-based learning and improvement. In July 2005, when anesthesiology residents in our department were required to start a portfolio, the residents and their faculty advisors did not readily accept this new requirement. Intensive education efforts addressing the goals and importance of portfolios were undertaken. We hypothesized that these educational efforts improved acceptance of the portfolio and retrospectively audited the portfolio evaluation forms completed by faculty advisors. Intensive education about the goals and importance of portfolios began in January 2006, including presentations at departmental conferences and one-on-one education sessions. Faculty advisors were instructed to evaluate each resident's portfolio and complete a review form. We retrospectively collected data to determine the percentage of review forms completed by faculty. The portfolio reviews also assessed the percentage of 10 required portfolio components residents had completed. Portfolio review forms were completed by faculty advisors for 13% (5/38) of residents during the first advisor-advisee meeting in December 2005. Initiation of intensive education efforts significantly improved compliance, with review forms completed for 68% (26/38) of residents in May 2006 (P < .0001) and 95% (36/38) in December 2006 (P < .0001). Residents also significantly improved the completeness of portfolios between May and December of 2006. Portfolios are considered a best methods technique by the ACGME for evaluation of practice-based learning and improvment. We have found that intensive education about the goals and importance of portfolios can enhance acceptance of this evaluation tool, resulting in improved compliance in completion and evaluation of portfolios.

Summary of laser speckle photogrammetry for HOST

NASA Technical Reports Server (NTRS)

Pollack, Frank G.

1986-01-01

High temperature static strain measurement capability is important for the success of the HOST program. As part of the NASA Lewis effort to develop the technology for improved hot-section durability, the HOST instrumentation program has, as a major goal, the development of methods for measuring strain at high temperature. Development work includes both improvements in resistance strain-gauge technology and, as an alternative approach, the development of optical techniques for high temperature strain measurement.

Reading and Writing a Better World. A Response to the Education for All (EFA) Global Monitoring Report 2008, from an Adult Literacy Perspective (Including Numeracy)

ERIC Educational Resources Information Center

Eldred, Jan

2008-01-01

The six EFA goals help to shape policies and priorities especially in developing countries; they can be seen as discrete targets or as a cohesive collection of complimentary developmental areas to improve learning for people of all ages and stages. The paper argues that the cohesion, success and impact of the EFA would be improved enormously if…

American Recovery and Reinvestment Act - Improper Planning of the Administrative Buildings Project at Camp Lejeune, Norlh Carolina

DTIC Science & Technology

2011-09-30

the project was for “routine maintenance and repair and improvements to non-historic buildings and structures in the Camp Lejeune Complex...and cost overruns; and (5) program goals are achieved, including specific program outcomes and improved results on broader economic indicators. 1...Department of the Navy received approximately $1.2 billion in Recovery Act funds for Operations and Maintenance ; Military Construction; and Research

Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting.

PubMed

Smith, Lorraine; Bosnic-Anticevich, Sinthia Z; Mitchell, Bernadette; Saini, Bandana; Krass, Ines; Armour, Carol

2007-04-01

Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings.

The Bleeder's Digest: A Campus Blood Collection Reference Manual.

ERIC Educational Resources Information Center

Bean, Melissa; And Others

This manual was written for students and blood donor recruiters interested in starting a campus blood program or in improving an already existing blood program. Contents include discussions of the reasons for blood programs, goals, elements of successful programs, organization of student committees, and comprehensive planning for annual campus and…

Does Higher Education Improve Student Scientific Reasoning Skills?

ERIC Educational Resources Information Center

Ding, Lin; Wei, Xin; Mollohan, Katherine

2016-01-01

An ultimate goal of higher education is to prepare our future workers with needed knowledge and skills. This includes cultivating students to become proficient reasoners who can utilize proper scientific reasoning to devise causal inferences from observations. Conventionally, students with more years of higher education are expected to have a…

78 FR 54873 - Notice of Intent To Prepare an Environmental Impact Statement for Multiple Projects in Support of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-06

... standards, life safety, sustainability, and energy efficiency, and Anti-Terrorism and Force Protection (AT.../FP and life safety standards, improve space utilization, and meet sustainability goals. The... public services for DC residents, to include public housing, education, or public recreation services...

What Governors Need To Know about Education Reform.

ERIC Educational Resources Information Center

Higginbotham, Marla, Ed.

This book offers 24 perspectives from educators, students, advocates, journalists, policymakers, and citizens on education reform and the importance of improving America's schools and school systems. Articles include the following: (1) "What Only a Governor Can Do" (Lamar Alexander); (2) "Governors and the National Education Goals" (Carroll A.…

Use of glucose oxidase to improve refrigerated dough quality

USDA-ARS?s Scientific Manuscript database

Refrigerated dough encompasses a wide range of products including bread, rolls, pastries and pizza crust and is a very popular choice for consumers. Two of the largest problems that occur during refrigerated dough storage are dough syruping and loss of dough strength. The goal of this study was to e...

Learning Competition and Business Restructuring in the Enlarging EU

ERIC Educational Resources Information Center

Schienstock, Gerd

2004-01-01

The growing importance of learning as the key competition criterion obliges companies to undertake holistic and integrated restructuring to maintain or improve their market position. Such a renewal approach includes a focus on innovation as a strategic goal, intelligent use of modern ICT, development of decentralised organisation forms,…

Electrification of the freight train network from the Ports of Los Angeles and Long Beach to the Inland Empire.

DOT National Transportation Integrated Search

2008-05-01

The goal of this project was to evaluate the benefits of electrifying the freight railroads connecting the Ports of Los Angeles and Long Beach with the Inland Empire. These benefits include significant reduction in air pollution, and improvements in ...

Towards the Goal of Full Employment: Trends, Obstacles and Policies.

ERIC Educational Resources Information Center

Richards, Peter

Expanding upon a report presented to the International Labor Organization (ILO), this book documents the current world employment situation, including how it has fallen short, how current economic policies interact with world employment, and how improvements can be made. Chapter one, "The Commitment to Full Employment," describes how the…

National Research Priorities for Tertiary Education and Training: 2011-13

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

The objective of a national government-funded research program for tertiary education and training is to support the achievement of major social and economic goals. These include increased opportunities for participation in the labour market, improvements in productivity and enhanced social inclusion. In essence, the overarching lens is to…

ReflectED: Evaluation Report and Executive Summary

ERIC Educational Resources Information Center

Motteram, Gary; Choudry, Sophina; Kalambouka, Afroditi; Hutcheson, Graeme; Barton, Hutcheson

2016-01-01

The ReflectED programme was developed by Rosendale Primary School to improve pupils' metacognition--their ability to think about and manage their own learning. This includes the skills of setting and monitoring goals, assessing progress, and identifying personal strengths and challenges. ReflectED consists of 28, weekly, half-hour lessons, which…

Aligning K-12 and Postsecondary Career Pathways with Workforce Needs

ERIC Educational Resources Information Center

Zinth, Jennifer

2015-01-01

Since 2013, states have witnessed significant legislative activity related to secondary- and postsecondary-level career/technical education (CTE). One key goal of much recent policymaking activity has been to improve alignment between high school and postsecondary CTE programs, including by developing state or regional structures to design career…

Improving Business-IT Alignment through Business Architecture

ERIC Educational Resources Information Center

Li, Chingmei

2010-01-01

The business and Information Technology (IT) alignment issue has become one of the Top-10 IT management issues since 1980. IT has continually strived to achieve alignment with business goals and objectives. These IT efforts include ERP implementation to benefit from the best practices; data center consolidation and server virtualization to keep…

Methodologies For Evaluating The Impact On Safety Of Intelligent Vehicle Highway Systems

DOT National Transportation Integrated Search

1994-01-01

THE IVHS PROGRAM INCLUDES A WIDE VARIETY OF TYPES OF SYSTEMS ALL OF WHICH ARE INTENDED TO IMPROVE SOME ASPECT OF HIGHWAY TRAVEL. AS THESE SYSTEMS EVOLVE, IT IS IMPORTANT TO KNOW IF THEY ARE ACCOMPLISHING THEIR DESIGN GOALS; AND IT IS ALSO IMPORTANT T...

The Effectiveness of L2 Pronunciation Instruction: A Narrative Review

ERIC Educational Resources Information Center

Thomson, Ron I.; Derwing, Tracey M.

2015-01-01

Research on the efficacy of second language (L2) pronunciation instruction has produced mixed results, despite reports of significant improvement in many studies. Possible explanations for divergent outcomes include learner individual differences, goals and foci of instruction, type and duration of instructional input, and assessment procedures.…

Improving the School Food Environment

PubMed Central

CULLEN, KAREN W.; HARTSTEIN, JILL; REYNOLDS, KIM D.; VU, MAIHAN; RESNICOW, KEN; GREENE, NATASHA; WHITE, MAMIE A.

2009-01-01

Our objective for this study was to examine the feasibility of instituting environmental changes during a 6-week pilot in school foodservice programs, with long-term goals of improving dietary quality and preventing obesity and type 2 diabetes in youth. Participants included students and staff from six middle schools in three states. Formative assessment with students and school staff was conducted in the spring of 2003 to inform the development of school foodservice policy changes. Thirteen potential policy goals were delineated. These formed the basis for the environmental change pilot intervention implemented during the winter/spring of 2004. Questionnaires were used to assess the extent to which the 13 foodservice goals were achieved. Success was defined as achieving 75% of goals not met at baseline. Daily data were collected on goal achievement using the schools’ daily food production and sales records. Qualitative data were also collected after the pilot study to obtain feedback from students and staff. Formative research with staff and students identified potential environmental changes. Most schools made substantial changes in the National School Lunch Program meal and snack bar/a la carte offerings. Vending goals were least likely to be achieved. Only one school did not meet the 75% goal achievement objective. Based on the objective data as well as qualitative feedback from student focus groups and interviews with students and school staff, healthful school foodservice changes in the cafeteria and snack bar can be implemented and were acceptable to the staff and students. Implementing longer-term and more ambitious changes and assessing cost issues and the potential enduring impact of these changes on student dietary change and disease risk reduction merits investigation. PMID:17324667

Goal setting for health behavior change: evidence from an obesity intervention for rural low-income women.

PubMed

Ries, A V; Blackman, L T; Page, R A; Gizlice, Z; Benedict, S; Barnes, K; Kelsey, K; Carter-Edwards, L

2014-01-01

Rural, minority populations are disproportionately affected by overweight and obesity and may benefit from lifestyle modification programs that are tailored to meet their unique needs. Obesity interventions commonly use goal setting as a behavior change strategy; however, few have investigated the specific contribution of goal setting to behavior change and/or identified the mechanisms by which goal setting may have an impact on behavior change. Furthermore, studies have not examined goal setting processes among racial/ethnic minorities. Using data from an obesity intervention for predominately minority women in rural North Carolina, this study sought to examine whether intervention participation resulted in working on goals and using goal setting strategies which in turn affected health behavior outcomes. It also examined racial/ethnic group differences in working on goals and use of goal setting strategies. Data came from a community-based participatory research project to address obesity among low-income, predominately minority women in rural North Carolina. A quasi-experimental intervention design was used. Participants included 485 women aged 18 years and over. Intervention participants (n=208) received health information and goal setting support through group meetings and tailored newsletters. Comparison participants (n = 277) received newsletters on topics unrelated to obesity. Surveys assessed physical activity, fruit and vegetable intake, goal-related stage of change, and use of goal setting strategies. Chi squared statistics were used to assess intervention group differences in changes in goal-related stage of change and use of goal setting strategies as well as racial/ethnic group differences in stage of change and use of goal setting strategies at baseline. The causal steps approach of Baron and Kenny was used to assess mediation. Intervention compared to comparison participants were more likely to move from contemplation to action/maintenance for the goals of improving diet (58% intervention, 44% comparison, p= 0.04) and physical activity (56% intervention, 31% comparison, p ≤ 0.0001). Intervention group differences were not found for moving from precontemplation to a higher category. At baseline, black compared to white participants were more likely to be working on the goals of getting a better education (p < 0.0001), owning a home (p < 0.01), starting a business (p < 0.0001), and improving job skills (p <0.05). For whites only, intervention participants were more likely than comparison participants to move from contemplation to action/maintenance for the goal of improving diet ( p< 0.05). For both blacks (p < 0.05) and whites (p < 0.0001), intervention participants were more likely than comparison participants to move from contemplation to action/maintenance for the goal of increasing physical activity. For all participants, progression in stages of change mediated the intervention effect on physical activity, but not fruit and vegetable intake. The intervention did not reveal an impact on use of goal setting strategies. In this sample of low-income, rural women, the intervention's goal setting component influenced behavior change for participants who were contemplating lifestyle changes at baseline. Racial/ethnic group differences in goal setting indicate the need to gain greater understanding of individual, social, and environmental factors that may uniquely have an impact on goal setting, and the importance of tailoring obesity intervention strategies for optimal, sustainable behavior change.

My Quest, an Intervention Using Text Messaging to Improve Dietary and Physical Activity Behaviors and Promote Weight Loss in Low-Income Women.

PubMed

Griffin, Jamie B; Struempler, Barb; Funderburk, Katie; Parmer, Sondra M; Tran, Cecilia; Wadsworth, Danielle D

2018-01-01

To evaluate changes in dietary and physical activity behaviors and weight after implementation of a 12-week text messaging initiative (My Quest). The researchers conducted a 1-group, pre- to posttest study design to determine changes after implementation of a text messaging initiative developed using the tenets of the Social Cognitive Theory. A total of 55 Alabama counties (84% rural) with high rates of poverty, overweight/obesity, and chronic diseases. Convenience sample of low-income, primarily overweight/obese women (n = 104). Short texts (n = 2-3/d) provided health tips, reminders, and goal-setting prompts. Weekly electronic newsletters provided tips and recipes. Participant self-monitored body weight weekly. Outcomes included goal setting, self-efficacy, behavioral and environmental factors, self-monitoring, and body weight; data collection occurred through text message response and online surveys. Analyses were conducted using McNemar test (dichotomous data), Wilcoxon signed rank test (ordinal data), or paired t test (continuous data). Participants significantly (P < .05) improved dietary and physical activity behaviors and food environment; increased dietary and physical activity goal setting; and reduced body weight. A low-cost, text messaging initiative particularly targeting women residing in rural communities with high rates of poverty and obesity can promote weight loss and improve dietary and physical activity behaviors. Future studies may include a control group and social support component such as group text messaging. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Cross-country analysis of strategies for achieving progress towards global goals for women’s and children’s health

PubMed Central

Ahmed, Syed Masud; Rawal, Lal B; Chowdhury, Sadia A; Murray, John; Arscott-Mills, Sharon; Jack, Susan; Hinton, Rachael; Alam, Prima M

2016-01-01

Abstract Objective To identify how 10 low- and middle-income countries achieved accelerated progress, ahead of comparable countries, towards meeting millennium development goals 4 and 5A to reduce child and maternal mortality. Methods We synthesized findings from multistakeholder dialogues and country policy reports conducted previously for the Success Factors studies in 10 countries: Bangladesh, Cambodia, China, Egypt, Ethiopia, the Lao People's Democratic Republic, Nepal, Peru, Rwanda and Viet Nam. A framework approach was used to analyse and synthesize the data from the country reports, resulting in descriptive or explanatory conclusions by theme. Findings Successful policy and programme approaches were categorized in four strategic areas: leadership and multistakeholder partnerships; health sector; sectors outside health; and accountability for resources and results. Consistent and coordinated inputs across sectors, based on high-impact interventions, were assessed. Within the health sector, key policy and programme strategies included defining standards, collecting and using data, improving financial protection, and improving the availability and quality of services. Outside the health sector, strategies included investing in girls’ education, water, sanitation and hygiene, poverty reduction, nutrition and food security, and infrastructure development. Countries improved accountability by strengthening and using data systems for planning and evaluating progress. Conclusion Reducing maternal and child mortality in the 10 fast-track countries can be linked to consistent and coordinated policy and programme inputs across health and other sectors. The approaches used by successful countries have relevance to other countries looking to scale-up or accelerate progress towards the sustainable development goals. PMID:27147765

Evaluation of an Integrated Telemonitoring Surveillance System in Patients with Coronary Heart Disease.

PubMed

Ammenwerth, E; Woess, S; Baumgartner, C; Fetz, B; van der Heidt, A; Kastner, P; Modre-Osprian, R; Welte, S; Poelzl, G

2015-01-01

Cardiovascular diseases are the most frequent cause of death in industrialized countries. Non-adherence with prescribed medication and recommended lifestyle changes significantly increases the risk of major cardiovascular events. The telemonitoring programme MyCor (Myokardinfarkt und Koronarstent Programm in Tirol) is a multi-modal intervention programme to improve lifestyle and medication management of patients with coronary heart disease (CHD). It includes patient education, self-monitoring with goal-setting and feedback, and regular clinical visits. We evaluated the MyCor telemonitoring programme regarding technical feasibility, user acceptance, patient adherence, change in health status, and change in quality of life. A 4½-month study was conducted with two telemonitoring phases and one interim phase. The study comprised patient surveys, standardized assessment of quality of life using the MacNew questionnaire at study entry and after 4 and 18 weeks, analysis of adherence to medication and physical activity during the two telemonitoring phases, and analysis of reached goals regarding health conditions during the telemonitoring phases. Twenty-five patients (mean age: 63 years) participated in the study. Patients showed a high acceptance of the MyCor telemonitoring programme. Patients reported feelings of self-control, motivation for lifestyle changes, and improved quality of life. Adherence to daily measurements was high with 86% and 77% in the two telemonitoring phases. Adherence to medication was also high with up to 87% and 80%. Pre-defined goals for physical activity were reached in up to 86% and 73% of days, respectively. Quality of life improved from 5.5 at study entry to 6.3 at the end (p< 0.01; MacNew questionnaire). Reductions in blood pressure and heart rate or an improvement in reaching defined goals could not be observed. The MyCor telemonitoring programme Tirol for CHD patients has a high rate of acceptance among included patients. Critical evaluation revealed subjective benefits regarding quality of life and health status as well as high adherence rates to medication and lifestyle changes. Achieving long-term adherence and verifying clinical outcomes, however, remains an open issue. Our findings will promote further studies, addressing different strategies for an optimal mix of patient education, telemonitoring, feedback, and clinical follow-ups.

Black Walnut at the Hardwood Tree Improvement and Regeneration Center (HTIRC)

Treesearch

Keith Woeste

2002-01-01

Black walnut research at the Hardwood Tree Improvement and Regenation Center (HTIRC) is focused on genetic improvement but our ultimate goal is much broader. Simply put, our goal is more and better black walnut for the Central Hardwoods Region (CHR). To reach this goal, our research has to be both very basic and practical, long and short term. If landowners are to make...

Gastroenterologists' Perceptions Regarding Ulcerative Colitis and Its Management: Results from a Large-Scale Survey.

PubMed

Lasch, Karen; Liu, Stephen; Ursos, Lyann; Mody, Reema; King-Concialdi, Kristen; DiBonaventura, Marco; Leberman, Julie; Dubinsky, Marla

2016-10-01

Misperceptions about ulcerative colitis (UC) may influence management strategies and limit opportunities for improving patient outcomes. This study assessed physicians' perceptions of UC, concepts of disease severity and remission, and treatment goals. Gastroenterologists who typically treated ≥10 adults with UC per month were recruited for a large-scale, web-based survey. Participants were asked about their perceptions of UC (often vs. Crohn's disease [CD]), treatment goals, and medication use. Response data were evaluated via descriptive statistics and univariate and multivariable analyses. Gastroenterologists (N = 500) with a mean of 16.5 years (standard deviation, 8.7 years) in practice participated. In comparison to CD, survey respondents perceived UC as being easier to diagnose, having better treatment outcomes, and being associated with later prescribing of biologics. Treatment goals commonly considered to have the greatest importance included quality of life improvement (31.2% of respondents), maintenance of clinical remission (17.4%), and mucosal healing (17.4%). When respondents evaluated the performance of medication classes in achieving these goals, biologics were rated significantly higher than all other classes (P < 0.05). However, the most common drivers for the initiation of biologic therapy were the development of steroid refractoriness (66.8%) and steroid dependency (65.8%). Medication class use by UC severity was generally consistent with the traditional step-up approach to UC therapy, with biologics being used most commonly for severe UC. These results suggest a possible disparity between treatment goals and therapeutic management in UC. An increased awareness of general UC perceptions is an important step toward a better overall understanding of the disease and, ultimately, toward improved management aligned with treatment goals. This study was sponsored by the American Gastroenterological Association (AGA), and the design and conduct of the study as well as article processing charges and the open access fee for this publication were funded by Takeda Pharmaceuticals International, Inc. (TPI).

Soft Tissue Surgery for Adults With Nonfunctional, Spastic Hands Following Central Nervous System Lesions: A Retrospective Study.

PubMed

Gatin, Laure; Schnitzler, Alexis; Calé, Fabien; Genêt, Guillaume; Denormandie, Philippe; Genêt, François

2017-12-01

Soft tissue surgery for upper extremity contractures can improve hygiene, pain, and appearance in adults with central nervous system lesions. The goal of such interventions is highly individual; thus, goal attainment scaling (GAS; a method of scoring the extent to which patient's individual goals are achieved [5 levels] in the course of intervention and using T score values) is pertinent to evaluate outcome. The objective of this study was to assess the effect of soft tissue surgery for upper extremity muscle contractures in patients with central nervous system lesions using GAS. Retrospective data from 70 interventions were included (63 patients; 23 women). The mean age was 51.3 ± 16.2 years (range, 24.2-87.0 years). The primary goal was to improve hygiene (n = 58), pain (n = 10), or appearance (n = 2). The etiologies were stroke (n = 35), traumatic brain injury (n = 16), cerebral anoxia (n = 4), neurodegenerative disease (n = 6), and cerebral palsy (n = 2). The GAS score was calculated before surgery and 3 months after surgery. The T score (which took into account the weight of each goal) was 52.3 at 3 months (38.5 before surgery), corresponding to a "better than expected" outcome. The mean of the differences of the GAS score for each goal before and after surgery increased by 1.27 for hygiene, 1.06 for pain, and 1.00 for appearance. Soft tissue surgery can safely and effectively improve hygiene, pain, and appearance in adults with cerebral damage. The preoperative evaluation should be multidisciplinary. The GAS is a useful tool to assess the effectiveness of orthopedic surgery for these patients. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Linked sustainability challenges and trade-offs among fisheries, aquaculture and agriculture.

PubMed

Blanchard, Julia L; Watson, Reg A; Fulton, Elizabeth A; Cottrell, Richard S; Nash, Kirsty L; Bryndum-Buchholz, Andrea; Büchner, Matthias; Carozza, David A; Cheung, William W L; Elliott, Joshua; Davidson, Lindsay N K; Dulvy, Nicholas K; Dunne, John P; Eddy, Tyler D; Galbraith, Eric; Lotze, Heike K; Maury, Olivier; Müller, Christoph; Tittensor, Derek P; Jennings, Simon

2017-09-01

Fisheries and aquaculture make a crucial contribution to global food security, nutrition and livelihoods. However, the UN Sustainable Development Goals separate marine and terrestrial food production sectors and ecosystems. To sustainably meet increasing global demands for fish, the interlinkages among goals within and across fisheries, aquaculture and agriculture sectors must be recognized and addressed along with their changing nature. Here, we assess and highlight development challenges for fisheries-dependent countries based on analyses of interactions and trade-offs between goals focusing on food, biodiversity and climate change. We demonstrate that some countries are likely to face double jeopardies in both fisheries and agriculture sectors under climate change. The strategies to mitigate these risks will be context-dependent, and will need to directly address the trade-offs among Sustainable Development Goals, such as halting biodiversity loss and reducing poverty. Countries with low adaptive capacity but increasing demand for food require greater support and capacity building to transition towards reconciling trade-offs. Necessary actions are context-dependent and include effective governance, improved management and conservation, maximizing societal and environmental benefits from trade, increased equitability of distribution and innovation in food production, including continued development of low input and low impact aquaculture.

Life Goals Increase Self-regulation Among Male Patients with Alcohol Use Disorder.

PubMed

Won, Sung-Doo; Kim, Im-Yel

2018-01-24

Alcohol use disorder (AUD) has been conceptualized as a chronic self-regulation failure. The aim of this study was to examine the most probable pathways related to self-regulation among patients with AUD. In this study, a hypothetical model was proposed that focused on the relationship between risk factors (extrinsic life goals, emotion dysregulation) and protective factors (intrinsic life goals, self-control, and abstinence self-efficacy). Male patients with AUD (N = 188) were recruited from alcohol centers of four psychiatric hospitals between March 2015 and September 2015. All participants completed psychological assessments, including the Future Oriented Goals Scale (FOGS), the Alcohol Abstinence Self-Efficacy Scale (AASE), the Brief Self-Control Scale (BSCS), and the Difficulties in Emotion Regulation Scale (DERS) as well as sociodemographic characteristics. The final model was found to be a good fit to data. In testing indirect effects, it was shown that intrinsic life goals via emotion dysregulation, self-control, and alcohol abstinence self-efficacy decreased alcohol self-regulation failure. On the other hand, extrinsic life goals via these factors increased alcohol self-regulation failure. Conclusions/Importance: These results suggest that intrinsic goals might indirectly be the important and protective factors for AUD. Moreover, the findings implicate that self-regulation through goal setting may be necessary to alleviate symptoms and improve function among patients with AUD.

Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome.

PubMed

Merritt, Russell J; Cohran, Valeria; Raphael, Bram P; Sentongo, Timothy; Volpert, Diana; Warner, Brad W; Goday, Praveen S

2017-11-01

Intestinal failure is a rare, debilitating condition that presents both acute and chronic medical management challenges. The condition is incompatible with life in the absence of the safe application of specialized and individualized medical therapy that includes surgery, medical equipment, nutritional products, and standard nursing care. Intestinal rehabilitation programs are best suited to provide such complex care with the goal of achieving enteral autonomy and oral feeding with or without intestinal transplantation. These programs almost all include pediatric surgeons, pediatric gastroenterologists, specialized nurses, and dietitians; many also include a variety of other medical and allied medical specialists. Intestinal rehabilitation programs provide integrated interdisciplinary care, more discussion of patient management by involved specialists, continuity of care through various treatment interventions, close follow-up of outpatients, improved patient and family education, earlier treatment of complications, and learning from the accumulated patient databases. Quality assurance and research collaboration among centers are also goals of many of these programs. The combined and coordinated talents and skills of multiple types of health care practitioners have the potential to ameliorate the impact of intestinal failure and improve health outcomes and quality of life.

Small Business Management Volume IV: Final Report. An Adult Education Program. Development, Demonstration and Evaluation of Management Education Programs for Small Business Entrepreneurs, Including Minorities.

ERIC Educational Resources Information Center

Persons, Edgar A.; Swanson, Gordon I.

The purpose of the small business management program is to help families improve the effectiveness of their business operation and enable them to reach family and business goals. Similar to a successful program in farm management education operational in Minnesota since 1952, the program includes classroom instruction, small group instruction,…

Intelligent Sensors for Integrated Systems Health Management (ISHM)

NASA Technical Reports Server (NTRS)

Schmalzel, John L.

2008-01-01

IEEE 1451 Smart Sensors contribute to a number of ISHM goals including cost reduction achieved through: a) Improved configuration management (TEDS); and b) Plug-and-play re-configuration. Intelligent Sensors are adaptation of Smart Sensors to include ISHM algorithms; this offers further benefits: a) Sensor validation. b) Confidence assessment of measurement, and c) Distributed ISHM processing. Space-qualified intelligent sensors are possible a) Size, mass, power constraints. b) Bus structure/protocol.

A regional-scale Ocean Health Index for Brazil.

PubMed

Elfes, Cristiane T; Longo, Catherine; Halpern, Benjamin S; Hardy, Darren; Scarborough, Courtney; Best, Benjamin D; Pinheiro, Tiago; Dutra, Guilherme F

2014-01-01

Brazil has one of the largest and fastest growing economies and one of the largest coastlines in the world, making human use and enjoyment of coastal and marine resources of fundamental importance to the country. Integrated assessments of ocean health are needed to understand the condition of a range of benefits that humans derive from marine systems and to evaluate where attention should be focused to improve the health of these systems. Here we describe the first such assessment for Brazil at both national and state levels. We applied the Ocean Health Index framework, which evaluates ten public goals for healthy oceans. Despite refinements of input data and model formulations, the national score of 60 (out of 100) was highly congruent with the previous global assessment for Brazil of 62. Variability in scores among coastal states was most striking for goals related to mariculture, protected areas, tourism, and clean waters. Extractive goals, including Food Provision, received low scores relative to habitat-related goals, such as Biodiversity. This study demonstrates the applicability of the Ocean Health Index at a regional scale, and its usefulness in highlighting existing data and knowledge gaps and identifying key policy and management recommendations. To improve Brazil's ocean health, this study suggests that future actions should focus on: enhancing fisheries management, expanding marine protected areas, and monitoring coastal habitats.

Millennium Development Goal 5 and adolescents: looking back, moving forward

PubMed Central

Vogel, Joshua P; Pileggi-Castro, Cynthia; Chandra-Mouli, Venkatraman; Pileggi, Vicky Nogueira; Souza, João Paulo; Chou, Doris; Say, Lale

2015-01-01

Since the Millennium Declaration in 2000, unprecedented progress has been made in the reduction of global maternal mortality. Millennium Development Goal 5 (MDG 5; improving maternal health) includes two primary targets, 5A and 5B. Target 5A aimed for a 75% reduction in the global maternal mortality ratio (MMR), and 5B aimed to achieve universal access to reproductive health. Globally, maternal mortality since 1990 has nearly halved and access to reproductive health services in developing countries has substantially improved. In setting goals and targets for the post-MDG era, the global maternal health community has recognised that ultimate goal of ending preventable maternal mortality is now within reach. The new target of a global MMR of <70 deaths per 100 000 live births by 2030 is ambitious, yet achievable and to reach this target a significantly increased effort to promote and ensure universal, equitable access to reproductive, maternal and newborn services for all women and adolescents will be required. In this article, as we reflect on patterns, trends and determinants of maternal mortality, morbidity and other key MDG5 indicators among adolescents, we aim to highlight the importance of promoting and protecting the sexual and reproductive health and rights of adolescents as part of renewed global efforts to end preventable maternal mortality. PMID:25613967

Evaluation of the nutrition counselling component of a fitness programme for children with disabilities.

PubMed

Fragala-Pinkham, Maria A; Bradford, Laura; Haley, Stephen M

2006-01-01

To describe and evaluate the nutrition counselling component of a fitness programme for children with disabilities. Twenty-eight children with disabilities, ages 6-14 years, participated in a 16-week comprehensive fitness programme consisting of twice weekly exercise sessions, nutrition counselling and physical activity promotion education sessions. Nutrition sessions consisted of three individual and two group sessions. Individual nutrition goals were developed for each child using 3-day food intake diaries and parent interview. Body Mass Index (BMI) and progress towards nutrition goals were documented. No significant BMI changes were recorded for the entire group (n=28) or a sub-group with a goal to decrease BMI (n=8). Most of the children made improvements in individual goals indicating improvements in healthy eating habits. This included eating the daily recommended amount of servings of each food group, trying new foods and limiting foods containing saturated and trans fats, sodium and sugar. Short-term changes were noted in eating habits and behaviours during the 16-week fitness programme, although the effects did not influence overall BMI during the 16-week programme. Children with disabilities are at nutritional risk, and long-term follow-up is needed to determine if initial changes in parent-reported child eating behaviours will impact long-term nutrition, BMI and overall health.

Improving oncology nurses' communication skills for difficult conversations.

PubMed

Baer, Linda; Weinstein, Elizabeth

2013-06-01

When oncology nurses have strong communication skills, they play a pivotal role in influencing patient satisfaction, adherence to plans of care, and overall clinical outcomes. However, research studies indicate that nurses tend to keep communication with patients and families at a superficial, nontherapeutic level. Processes for teaching goals-of-care communication skills and for implementing skills into clinical practice are not clearly defined. Nurses at a large comprehensive cancer center recognized the need for help with this skill set and sought out communication experts to assist in providing the needed education. An educational project was developed to improve therapeutic communication skills in oncology nurses during goals-of-care discussions and giving bad news. The program was tailored to nurses and social workers providing care to patients in a busy, urban, academic, outpatient oncology setting. Program topics included exploring the patient's world, eliciting hopes and concerns, and dealing with conflict about goals. Sharing and discussing specific difficult questions and scenarios were encouraged throughout the program. The program was well attended and well received by oncology nurses and social workers. Participants expressed interest in the continuation of communication programs to further enhance skills.

Incremental planning to control a blackboard-based problem solver

NASA Technical Reports Server (NTRS)

Durfee, E. H.; Lesser, V. R.

1987-01-01

To control problem solving activity, a planner must resolve uncertainty about which specific long-term goals (solutions) to pursue and about which sequences of actions will best achieve those goals. A planner is described that abstracts the problem solving state to recognize possible competing and compatible solutions and to roughly predict the importance and expense of developing these solutions. With this information, the planner plans sequences of problem solving activities that most efficiently resolve its uncertainty about which of the possible solutions to work toward. The planner only details actions for the near future because the results of these actions will influence how (and whether) a plan should be pursued. As problem solving proceeds, the planner adds new details to the plan incrementally, and monitors and repairs the plan to insure it achieves its goals whenever possible. Through experiments, researchers illustrate how these new mechanisms significantly improve problem solving decisions and reduce overall computation. They briefly discuss current research directions, including how these mechanisms can improve a problem solver's real-time response and can enhance cooperation in a distributed problem solving network.

An Integrated Approach Is Needed for Ecosystem Based Fisheries Management: Insights from Ecosystem-Level Management Strategy Evaluation

PubMed Central

Fulton, Elizabeth A.; Smith, Anthony D. M.; Smith, David C.; Johnson, Penelope

2014-01-01

An ecosystem approach is widely seen as a desirable goal for fisheries management but there is little consensus on what strategies or measures are needed to achieve it. Management strategy evaluation (MSE) is a tool that has been widely used to develop and test single species fisheries management strategies and is now being extended to support ecosystem based fisheries management (EBFM). We describe the application of MSE to investigate alternative strategies for achieving EBFM goals for a complex multispecies fishery in southeastern Australia. The study was undertaken as part of a stakeholder driven process to review and improve the ecological, economic and social performance of the fishery. An integrated management strategy, involving combinations of measures including quotas, gear controls and spatial management, performed best against a wide range of objectives and this strategy was subsequently adopted in the fishery, leading to marked improvements in performance. Although particular to one fishery, the conclusion that an integrated package of measures outperforms single focus measures we argue is likely to apply widely in fisheries that aim to achieve EBFM goals. PMID:24454722

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

PubMed

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

2016-11-01

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

QUEST/Ada (Query Utility Environment for Software Testing of Ada): The development of a prgram analysis environment for Ada, task 1, phase 2

NASA Technical Reports Server (NTRS)

Brown, David B.

1990-01-01

The results of research and development efforts are described for Task one, Phase two of a general project entitled The Development of a Program Analysis Environment for Ada. The scope of this task includes the design and development of a prototype system for testing Ada software modules at the unit level. The system is called Query Utility Environment for Software Testing of Ada (QUEST/Ada). The prototype for condition coverage provides a platform that implements expert system interaction with program testing. The expert system can modify data in the instrument source code in order to achieve coverage goals. Given this initial prototype, it is possible to evaluate the rule base in order to develop improved rules for test case generation. The goals of Phase two are the following: (1) to continue to develop and improve the current user interface to support the other goals of this research effort (i.e., those related to improved testing efficiency and increased code reliable); (2) to develop and empirically evaluate a succession of alternative rule bases for the test case generator such that the expert system achieves coverage in a more efficient manner; and (3) to extend the concepts of the current test environment to address the issues of Ada concurrency.

Unique Systems Analysis Task 7, Advanced Subsonic Technologies Evaluation Analysis

NASA Technical Reports Server (NTRS)

Eisenberg, Joseph D. (Technical Monitor); Bettner, J. L.; Stratton, S.

2004-01-01

To retain a preeminent U.S. position in the aircraft industry, aircraft passenger mile costs must be reduced while at the same time, meeting anticipated more stringent environmental regulations. A significant portion of these improvements will come from the propulsion system. A technology evaluation and system analysis was accomplished under this task, including areas such as aerodynamics and materials and improved methods for obtaining low noise and emissions. Previous subsonic evaluation analyses have identified key technologies in selected components for propulsion systems for year 2015 and beyond. Based on the current economic and competitive environment, it is clear that studies with nearer turn focus that have a direct impact on the propulsion industry s next generation product are required. This study will emphasize the year 2005 entry into service time period. The objective of this study was to determine which technologies and materials offer the greatest opportunities for improving propulsion systems. The goals are twofold. The first goal is to determine an acceptable compromise between the thermodynamic operating conditions for A) best performance, and B) acceptable noise and chemical emissions. The second goal is the evaluation of performance, weight and cost of advanced materials and concepts on the direct operating cost of an advanced regional transport of comparable technology level.

Are hospital quality improvement and public accountability compatible?

PubMed

Panzer, R J

1994-07-01

The goals of public accountability and quality improvement are compatible in theory but not necessarily in practice. Both concepts emphasize the customer. However, those working toward these two goals design systems with quite different roles and relationships between the providers and consumers of health care. Superficial interactions obstruct meaningful dialogue about how to build a better system meeting both sets of goals. Current practices of public accountability and quality improvement have fundamentally different paradigms concerning the roles and responsibilities of those who provide and those who consume health care. There are at least three ways to improve the current relationship between public accountability and quality improvement. First, optimizing the design and performance of each effort would be an improvement since the goals are highly compatible. Neither ideal currently meets its own expectations, creating distrust among the proponents of each when reality falls short. Second, the two efforts could be coordinated through joint community-level planning and sharing. Finally and optimally, the two concepts could be made part of the same community-level cooperative system, an approach that offers the greatest opportunity for achieving shared goals.

NASA/DOE automotive Stirling engine project: Overview 1986

NASA Technical Reports Server (NTRS)

Beremand, D. G.; Shaltens, R. K.

1986-01-01

The DOE/NASA Automotive Stirling Engine Project is reviewed and its technical progress and status are presented. Key technologies in materials, seals, and piston rings are progressing well. Seven first-generation engines, and modifications thereto, have accumulated over 15,000 hr of test time, including 1100hr of in-vehicle testing. Results indicate good progress toward the program goals. The first second-generation engine is now undergoing initial testing. It is expected that the program goal of a 30-percent improvement in fuel economy will be achieved in tests of a second-generation engine in a Celebrity vehicle.

DOE/NASA automotive Stirling engine project - Overview 86

NASA Technical Reports Server (NTRS)

Beremand, D. G.; Shaltens, R. K.

1986-01-01

The DOE/NASA Automotive Stirling Engine Project is reviewed and its technical progress and status are presented. Key technologies in materials, seals, and piston rings are progressing well. Seven first-generation engines, and modifications thereto, have accumulated over 15,000 hr of test time, including 1100 hr of in-vehicle testing. Results indicate good progress toward the program goals. The first second-generation engine is now undergoing initial testing. It is expected that the program goal of a 30-percent improvement in fuel economy will be achieved in tests of a second-generation engine in a Celebrity vehicle.

Energy access and living standards: some observations on recent trends

NASA Astrophysics Data System (ADS)

Rao, Narasimha D.; Pachauri, Shonali

2017-02-01

A subset of Sustainable Development Goals pertains to improving people’s living standards at home. These include the provision of access to electricity, clean cooking energy, improved water and sanitation. We examine historical progress in energy access in relation to other living standards. We assess regional patterns in the pace of progress and relative priority accorded to these different services. Countries in sub-Saharan Africa would have to undergo unprecedented rates of improvement in energy access in order to achieve the goal of universal electrification by 2030. World over, access to clean cooking fuels and sanitation facilities consistently lag improved water and electricity access by a large margin. These two deprivations are more concentrated among poor countries, and poor people in middle income countries. They are also correlated to health risks faced disproportionately by women. However, some Asian countries have been able to achieve faster progress in electrification at lower income levels compared to industrialized countries’ earlier efforts. These examples offer hope that future efforts need not be constrained by historical rates of progress.

An evaluation of the Kinect-Ed presentation, a motivating nutrition and cooking intervention for young adolescents in grades 6-8.

PubMed

Santarossa, Sara; Ciccone, Jillian; Woodruff, Sarah J

2015-09-01

Recently, public health messaging has included having more family meals and involving young adolescents (YAs) with meal preparation to improve healthful diets and family dinner frequency (FDF). Kinect-Ed, a motivational nutrition education presentation was created to encourage YAs (grades 6-8) to help with meal preparation and ultimately improve FDF. The purpose of this study was to evaluate the Kinect-Ed presentation, with the goals of the presentation being to improve self-efficacy for cooking (SE), food preparation techniques (TECH), food preparation frequency (PREP), family meal attitudes and behaviours, and ultimately increase FDF. A sample of YAs (n = 219) from Southern Ontario, Canada, completed pre- and postpresentation surveys, measuring FDF, PREP, SE, and TECH. Kinect-Ed successfully improved participants' FDF (p < 0.01), PREP (p < 0.01), SE (p < 0.01), and TECH (<0.01). Overall, goals of the presentation were met. Encouraging YAs to help prepare meals and get involved in the kitchen may reduce the time needed from parents to prepare meals, and, in turn, allow more time for frequent family dinners.

Integration of Palliative Care in the Context of Rapid Response

PubMed Central

Nelson, Judith E.; Mathews, Kusum S.; Weissman, David E.; Brasel, Karen J.; Campbell, Margaret; Curtis, J. Randall; Frontera, Jennifer A.; Gabriel, Michelle; Hays, Ross M.; Mosenthal, Anne C.; Mulkerin, Colleen; Puntillo, Kathleen A.; Ray, Daniel E.; Weiss, Stefanie P.; Bassett, Rick; Boss, Renee D.; Lustbader, Dana R.

2015-01-01

Rapid response teams (RRTs) can effectively foster discussions about appropriate goals of care and address other emergent palliative care needs of patients and families facing life-threatening illness on hospital wards. In this article, The Improving Palliative Care in the ICU (IPAL-ICU) Project brings together interdisciplinary expertise and existing data to address the following: special challenges for providing palliative care in the rapid response setting, knowledge and skills needed by RRTs for delivery of high-quality palliative care, and strategies for improving the integration of palliative care with rapid response critical care. We discuss key components of communication with patients, families, and primary clinicians to develop a goal-directed treatment approach during a rapid response event. We also highlight the need for RRT expertise to initiate symptom relief. Strategies including specific clinician training and system initiatives are then recommended for RRT care improvement. We conclude by suggesting that as evaluation of their impact on other outcomes continues, performance by RRTs in meeting palliative care needs of patients and families should also be measured and improved. PMID:25644909

A practice-based approach to the 2012 position statement of the American Diabetes Association and the European Association for the Study of Diabetes.

PubMed

Schwartz, Stanley S

2013-07-01

The position statement on the management of hyperglycemia in patients with type 2 diabetes mellitus issued in 2012 by the American Diabetes Association and the European Association for the Study of Diabetes contains significant improvements over the 2009 version, including an emphasis on patient-centered care, enhanced strategies for lifestyle modification, a focus on comprehensive cardiovascular risk reduction, and increased pharmacotherapy choices. As diabetes management evolves over time, further improvements may be made in future consensus statements, including a focus on prevention and early treatment and improved glycemic control in all patients, including those with comorbidities. These goals will be achievable by waning use of therapies known to cause hypoglycemia and weight gain and the increased use of therapies that do not carry these risks.

Theory of constraints for publicly funded health systems.

PubMed

Sadat, Somayeh; Carter, Michael W; Golden, Brian

2013-03-01

Originally developed in the context of publicly traded for-profit companies, theory of constraints (TOC) improves system performance through leveraging the constraint(s). While the theory seems to be a natural fit for resource-constrained publicly funded health systems, there is a lack of literature addressing the modifications required to adopt TOC and define the goal and performance measures. This paper develops a system dynamics representation of the classical TOC's system-wide goal and performance measures for publicly traded for-profit companies, which forms the basis for developing a similar model for publicly funded health systems. The model is then expanded to include some of the factors that affect system performance, providing a framework to apply TOC's process of ongoing improvement in publicly funded health systems. Future research is required to more accurately define the factors affecting system performance and populate the model with evidence-based estimates for various parameters in order to use the model to guide TOC's process of ongoing improvement.

An academic-health service partnership in nursing: lessons from the field.

PubMed

Granger, Bradi B; Prvu-Bettger, Janet; Aucoin, Julia; Fuchs, Mary Ann; Mitchell, Pamela H; Holditch-Davis, Diane; Roth, Deborah; Califf, Robert M; Gilliss, Catherine L

2012-03-01

To describe the development of an academic-health services partnership undertaken to improve use of evidence in clinical practice. Academic health science schools and health service settings share common elements of their missions: to educate, participate in research, and excel in healthcare delivery, but differences in the business models, incentives, and approaches to problem solving can lead to differences in priorities. Thus, academic and health service settings do not naturally align their leadership structures or work processes. We established a common commitment to accelerate the appropriate use of evidence in clinical practice and created an organizational structure to optimize opportunities for partnering that would leverage shared resources to achieve our goal. A jointly governed and funded institute integrated existing activities from the academic and service sectors. Additional resources included clinical staff and student training and mentoring, a pilot research grant-funding program, and support to access existing data. Emergent developments include an appreciation for a wider range of investigative methodologies and cross-disciplinary teams with skills to integrate research in daily practice and improve patient outcomes. By developing an integrated leadership structure and commitment to shared goals, we developed a framework for integrating academic and health service resources, leveraging additional resources, and forming a mutually beneficial partnership to improve clinical outcomes for patients. Structurally integrated academic-health service partnerships result in improved evidence-based patient care delivery and in a stronger foundation for generating new clinical knowledge, thus improving patient outcomes. © 2012 Sigma Theta Tau International.

Web Applications for Patient Communication.

PubMed

Lewis, Kristopher; Reicher, Murray A

2016-12-01

Communication between imaging professionals and patients can help achieve many goals, including improved patient understanding of imaging-related diagnostic and treatment options, better compliance with appropriate imaging screening procedures, and improved efficiency of service. The explosive growth of out-of-pocket consumer spending on health care has heightened health care shopping, thus making patient communication an important goal of any imaging practice or health care organization. Furthermore, the Merit-Based Incentive Payment System introduced by CMS will publicly disclose physicians' quality ratings, which are in part dependent on patient engagement. The authors summarize the rationale for web communication with patients, the range of content that should be considered, and the technology options. The aim is to help imaging providers develop organized patient communication strategic and implementation plans. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Review of Strategies to Enhance Outcomes for Patients with Type 2 Diabetes: Payers' Perspective

PubMed Central

Greenapple, Rhonda

2011-01-01

Background Diabetes and its clinical consequences exact a great toll on patients and on society in terms of its effects on morbidity and mortality and its staggering economic impact. Objective To review various programs and strategies that aim at enhancing adherence to antihyperglycemic therapy and suggest the best approach to improving patient outcomes and reducing healthcare costs. Discussion Treatment goals for patients with diabetes have been defined, and multiple safe and effective medications are available. Nevertheless, the majority of patients with diabetes fail to achieve treatment goals, because of difficulty with adherence to medication regimens and lifestyle modifications, and because of economic barriers. This article discusses various initiatives developed to improve patient outcomes, including consumer-driven health plans and wellness and prevention programs. Furthermore, economic incentives to patients, such as value-based insurance design, may increase adherence; nevertheless, evidence suggests that such programs alone provide only modest gains. Primary providers in disease management programs can include nurses, case managers, or pharmacists. Supportive interventions across several modalities have been shown to be effective. Conclusion An approach that uses a combination of strategies designed to impact patients' health-related behaviors across a variety of modalities may help to improve outcomes and reduce costs. Additional novel, innovative interdisciplinary initiatives are necessary to effect meaningful change that can facilitate improved health outcomes for patients with diabetes and maximize cost-effectiveness approaches for payers. PMID:25126364

Daily Goals Formulation and Enhanced Visualization of Mechanical Ventilation Variance Improves Mechanical Ventilation Score.

PubMed

Walsh, Brian K; Smallwood, Craig; Rettig, Jordan; Kacmarek, Robert M; Thompson, John; Arnold, John H

2017-03-01

The systematic implementation of evidence-based practice through the use of guidelines, checklists, and protocols mitigates the risks associated with mechanical ventilation, yet variation in practice remains prevalent. Recent advances in software and hardware have allowed for the development and deployment of an enhanced visualization tool that identifies mechanical ventilation goal variance. Our aim was to assess the utility of daily goal establishment and a computer-aided visualization of variance. This study was composed of 3 phases: a retrospective observational phase (baseline) followed by 2 prospective sequential interventions. Phase I intervention comprised daily goal establishment of mechanical ventilation. Phase II intervention was the setting and monitoring of daily goals of mechanical ventilation with a web-based data visualization system (T3). A single score of mechanical ventilation was developed to evaluate the outcome. The baseline phase evaluated 130 subjects, phase I enrolled 31 subjects, and phase II enrolled 36 subjects. There were no differences in demographic characteristics between cohorts. A total of 171 verbalizations of goals of mechanical ventilation were completed in phase I. The use of T3 increased by 87% from phase I. Mechanical ventilation score improved by 8.4% in phase I and 11.3% in phase II from baseline ( P = .032). The largest effect was in the low risk V T category, with a 40.3% improvement from baseline in phase I, which was maintained at 39% improvement from baseline in phase II ( P = .01). mechanical ventilation score was 9% higher on average in those who survived. Daily goal formation and computer-enhanced visualization of mechanical ventilation variance were associated with an improvement in goal attainment by evidence of an improved mechanical ventilation score. Further research is needed to determine whether improvements in mechanical ventilation score through a targeted, process-oriented intervention will lead to improved patient outcomes. (ClinicalTrials.gov registration NCT02184208.). Copyright © 2017 by Daedalus Enterprises.

The effects of social concern goals on the value of learning and on the intentions of medical students to change their majors

PubMed Central

Park, Soowon; Cho, Seunghee; Lee, Jun-Young

2017-01-01

ABSTRACT Background: In the process of developing a professional medical expertise, goals can become a psychological impetus and act as a source of retaining an individual’s persistency. Therefore, the goals of medical students should be considered when designing a curriculum for health professions. Purpose: The purpose of this study was to examine relative effects of goal categories on the value of learning and intention to change one’s major. Method: Data were obtained from the Korea Education Longitudinal Study, which included 1938 representative Korean college freshmen majoring in medicine, engineering, natural science and humanities. They answered a survey questionnaire about goal categories (i.e., social concern, affiliation, self-growth, leisure, wealth, and fame), the value of learning, and intention to change one's major. Results: For medical students, social concern goals were positively related to the value of learning and negatively related to the intention to change one's major. Social concern goals decreased the intention to change one's major directly, and also indirectly through increased value of learning. Conclusion: Providing context for enhancing medical students’ social concern goals is necessary in a medical training curriculum, not only for the students’ professional development but also for improving society. Abbreviations: GCT: Goal contents theory GPA: Grade point average KELS: Korea education longitudinal study SDLA: Self-directed learning abilities SDT: Self-determination theory PMID:28580860

The effects of social concern goals on the value of learning and on the intentions of medical students to change their majors.

PubMed

Park, Soowon; Cho, Seunghee; Lee, Jun-Young

2017-01-01

In the process of developing a professional medical expertise, goals can become a psychological impetus and act as a source of retaining an individual's persistency. Therefore, the goals of medical students should be considered when designing a curriculum for health professions. The purpose of this study was to examine relative effects of goal categories on the value of learning and intention to change one's major. Data were obtained from the Korea Education Longitudinal Study, which included 1938 representative Korean college freshmen majoring in medicine, engineering, natural science and humanities. They answered a survey questionnaire about goal categories (i.e., social concern, affiliation, self-growth, leisure, wealth, and fame), the value of learning, and intention to change one's major. For medical students, social concern goals were positively related to the value of learning and negatively related to the intention to change one's major. Social concern goals decreased the intention to change one's major directly, and also indirectly through increased value of learning. Providing context for enhancing medical students' social concern goals is necessary in a medical training curriculum, not only for the students' professional development but also for improving society. GCT: Goal contents theory GPA: Grade point average KELS: Korea education longitudinal study SDLA: Self-directed learning abilities SDT: Self-determination theory.

Improving Closing Task Completion in a Drugstore

ERIC Educational Resources Information Center

Fante, Rhiannon; Davis, Ora L.; Kempt, Vivian

2013-01-01

A within-subject ABAB reversal design was utilized to investigate the effects of graphic feedback and goal setting on employee closing task completion. Goal setting was contingent upon baseline performance and graphic feedback was posted weekly. It was found that goal setting and graphic feedback improved employee closing task completion.…

Clinical Pharmacology in Sleep Medicine

PubMed Central

Proctor, Ashley; Bianchi, Matt T.

2012-01-01

The basic treatment goals of pharmacological therapies in sleep medicine are to improve waking function by either improving sleep or by increasing energy during wakefulness. Stimulants to improve waking function include amphetamine derivatives, modafinil, and caffeine. Sleep aids encompass several classes, from benzodiazepine hypnotics to over-the-counter antihistamines. Other medications used in sleep medicine include those initially used in other disorders, such as epilepsy, Parkinson's disease, and psychiatric disorders. As these medications are prescribed or encountered by providers in diverse fields of medicine, it is important to recognize the distribution of adverse effects, drug interaction profiles, metabolism, and cytochrome substrate activity. In this paper, we review the pharmacological armamentarium in the field of sleep medicine to provide a framework for risk-benefit considerations in clinical practice. PMID:23213564

SEARCH: Study of Environmental Arctic Change--A System-scale, Cross-disciplinary Arctic Research Program

NASA Astrophysics Data System (ADS)

Shnoro, R. S.; Eicken, H.; Francis, J. A.; Scambos, T. A.; Schuur, E. A.; Straneo, F.; Wiggins, H. V.

2013-12-01

SEARCH is an interdisciplinary, interagency program that works with academic and government agency scientists and stakeholders to plan, conduct, and synthesize studies of Arctic change. Over the past three years, SEARCH has developed a new vision and mission, a set of prioritized cross-disciplinary 5-year goals, an integrated set of activities, and an organizational structure. The vision of SEARCH is to provide scientific understanding of arctic environmental change to help society understand and respond to a rapidly changing Arctic. SEARCH's 5-year science goals include: 1. Improve understanding, advance prediction, and explore consequences of changing Arctic sea ice. 2. Document and understand how degradation of near-surface permafrost will affect Arctic and global systems. 3. Improve predictions of future land-ice loss and impacts on sea level. 4. Analyze societal and policy implications of Arctic environmental change. Action Teams organized around each of the 5-year goals will serve as standing groups responsible for implementing specific goal activities. Members will be drawn from academia, different agencies and stakeholders, with a range of disciplinary backgrounds and perspectives. 'Arctic Futures 2050' scenarios tasks will describe plausible future states of the arctic system based on recent trajectories and projected changes. These scenarios will combine a range of data including climate model output, paleo-data, results from data synthesis and systems modeling, as well as expert scientific and traditional knowledge. Current activities include: - Arctic Observing Network (AON) - coordinating a system of atmospheric, land- and ocean-based environmental monitoring capabilities that will significantly advance our observations of arctic environmental conditions. - Arctic Sea Ice Outlook - an international effort that provides monthly summer reports synthesizing community estimates of the expected sea ice minimum. A newly-launched Sea Ice Prediction Network will create a network of scientists and stakeholders to generate, assess and communicate Arctic seasonal sea ice forecasts. - Collaboration with the Interagency Arctic Research Policy Committee (IARPC) to implement mutual science goals. SEARCH is sponsored by 8 U.S. agencies, including: the National Science Foundation, the National Oceanic and Atmospheric Administration, the National Aeronautics and Space Administration, the Department of Defense, the Department of Energy, the Department of the Interior, the Smithsonian Institution, and the U.S. Department of Agriculture. The U.S. Arctic Research Commission participates as an observer. For more information: http://www.arcus.org/search.

Conceptual Model of Climate Change Impacts at LANL

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

Dewart, Jean Marie

Goal 9 of the LANL FY15 Site Sustainability Plan (LANL 2014a) addresses Climate Change Adaptation. As part of Goal 9, the plan reviews many of the individual programs the Laboratory has initiated over the past 20 years to address climate change impacts to LANL (e.g. Wildland Fire Management Plan, Forest Management Plan, etc.). However, at that time, LANL did not yet have a comprehensive approach to climate change adaptation. To fill this gap, the FY15 Work Plan for the LANL Long Term Strategy for Environmental Stewardship and Sustainability (LANL 2015) included a goal of (1) establishing a comprehensive conceptual modelmore » of climate change impacts at LANL and (2) establishing specific climate change indices to measure climate change and impacts at Los Alamos. Establishing a conceptual model of climate change impacts will demonstrate that the Laboratory is addressing climate change impacts in a comprehensive manner. This paper fulfills the requirement of goal 1. The establishment of specific indices of climate change at Los Alamos (goal 2), will improve our ability to determine climate change vulnerabilities and assess risk. Future work will include prioritizing risks, evaluating options/technologies/costs, and where appropriate, taking actions. To develop a comprehensive conceptual model of climate change impacts, we selected the framework provided in the National Oceanic and Atmospheric Administration (NOAA) Climate Resilience Toolkit (http://toolkit.climate.gov/).« less

Mobile mammography: An evaluation of organizational, process, and information systems challenges.

PubMed

Browder, Casey; Eberth, Jan M; Schooley, Benjamin; Porter, Nancy R

2015-03-01

The purpose of this case study was to evaluate the information systems, personnel, and processes involved in mobile mammography settings, and offer recommendations to improve efficiency and satisfaction among patients and staff. Data includes on-site observations, interviews, and an electronic medical record review of a hospital who offers both mobile and fixed facility mammography services to their community. The optimal expectations for the process of mobile mammography from multiple perspectives were defined as (1) patient receives mammogram the day of their visit, (2) patient has efficient intake process with little wait time, (3) follow-up is completed and timely, (4) site contact and van staff are satisfied with van visit and choose to schedule future visits, and (5) the MMU is able to assess its performance and set goals for improvement. Challenges that prevent the realization of those expectations include a low patient pre-registration rate, difficulty obtaining required physician orders, frequent information system downtime/Internet connectivity issues, ill-defined organizational communication/roles, insufficient site host/patient education, and disparate organizational and information systems. Our recommendations include employing a dedicated mobile mammography team for end-to-end oversight, mitigating for system connectivity issues, allowing for patient self-referrals, integrating scheduling and registration processes, and a focused approach to educating site hosts and respective patients about expectations for the day of the visit. The MMU is an important community resource; we recommend simple process improvements and information flow improvements to further enable the MMU׳s goals. Copyright © 2015 Elsevier Inc. All rights reserved.

A systematic review evaluating the impact of paid home carer training, supervision, and other interventions on the health and well-being of older home care clients.

PubMed

Cooper, Claudia; Cenko, Blerta; Dow, Briony; Rapaport, Penny

2017-04-01

Interventions to support and skill paid home carers and managers could potentially improve health and well-being of older home care clients. This is the first systematic review of interventions to improve how home carers and home care agencies deliver care to older people, with regard to clients' health and well-being and paid carers' well-being, job satisfaction, and retention. We reviewed 10/731 papers found in the electronic search (to January 2016) fitting predetermined criteria, assessed quality using a checklist, and synthesized data using quantitative and qualitative techniques. Ten papers described eight interventions. The six quantitative evaluations used diverse outcomes that precluded meta-analysis. In the only quantitative study (a cluster Randomized Controlled Trial), rated higher quality, setting meaningful goals, carer training, and supervision improved client health-related quality of life. The interventions that improved client outcomes comprised training with additional implementation, such as regular supervision and promoted care focused around clients' needs and goals. In our qualitative synthesis of four studies, intervention elements carers valued were greater flexibility to work to a needs-based rather than a task-based model, learning more about clients, and improved communication with management and other workers. There is a dearth of evidence regarding effective strategies to improve how home care is delivered to older clients, particularly those with dementia. More research in this sector including feasibility testing of the first home care intervention trials to include health and life quality outcomes for clients with more severe dementia is now needed.

From "Bildung" to Entrepreneurship: Trends in Education Policy in Sweden

ERIC Educational Resources Information Center

Ringarp, Johanna

2013-01-01

The European Union would like to improve its efforts to promote entrepreneurship within the Union. More new companies and more entrepreneurs are needed to increase the Union's competitiveness. In order to achieve this goal, the education sectors of the member countries must be reformulated to include entrepreneurship in their education programmes.…

Improving the Use of Technology in Schools: What We Are Learning. Research Bulletin #1.

ERIC Educational Resources Information Center

Center for the Study of Educational Technology, St. Paul, MN.

This bulletin summarizes six studies on the integration of technology into education. Information provided for each study includes the background or the problem statement, study goals, methodology, conclusions, and recommendations. The first three studies focus on the impact of technology on education: "The Effect of Computer Use and Student…

Woodland Wisdom: Tribal Colleges Take Action to Improve Community Health Across America.

ERIC Educational Resources Information Center

Tribal College Journal, 2001

2001-01-01

Describes the Woodlands Wisdom Project, a collaborative effort of six tribal colleges and the University of Minnesota that addresses the special health and nutrition issues faced by Native Americans, who suffer from a high incidence diet-related diseases. The project's goals include creating more American Indian dieticians and developing new…

Energy efficient engine component development and integration program

NASA Technical Reports Server (NTRS)

1982-01-01

The development of the technology to improve energy efficiency of propulsion systems for subsonic commercial aircrafts was examined. Goals established include: (1) fuel consumption, reduction in flight propulsion system; (2) direct operation cost; (3) noise, with provision for engine growth corresponding to future engine application; and (4) emissions, EPA new engine standards.

A Study of Faculty Racial Diversity in Business Schools: Perceptions of Business Deans

ERIC Educational Resources Information Center

Moshiri, Farrokh; Cardon, Peter Wilson

2016-01-01

For decades, business schools in the United States have attempted to increase faculty diversity. The goals and benefits of increasing faculty diversity include improved educational outcomes, social justice, and economic competitiveness. While Association to Advance Collegiate Schools of Business data shows that a gender gap still exists in…

Effective Charter Schools and Charter School Systems

ERIC Educational Resources Information Center

Lawton, Stephen B.

2009-01-01

The purpose of this synthesis of the literature on charter school effectiveness is to develop a research agenda on the topic and to propose action that will lead to improved performance of charter schools. To accomplish these goals, background information is first provided including: a definition of charter schools; statistics on charter schools;…

Technologies, Democracy and Digital Citizenship: Examining Australian Policy Intersections and the Implications for School Leadership

ERIC Educational Resources Information Center

Moyle, Kathryn

2014-01-01

There are intersections that can occur between the respective peak Australian school education policy agendas. These policies include the use of technologies in classrooms to improve teaching and learning as promoted through the "Melbourne Declaration on Educational Goals for Young Australians" and the "Australian Curriculum";…

High School Mathematics: State-Level Curriculum Standards and Graduation Requirements

ERIC Educational Resources Information Center

Reys, Barbara J.; Dingman, Shannon; Nevels, Nevels; Teuscher, Dawn

2007-01-01

In a continuing effort to improve student-learning opportunities in mathematics, state departments of education have focused on articulating standards or learning goals at all levels, including high school mathematics. A review of K-8 mathematics curriculum standards (many of which have been published since 2002) compiled by staff from the Center…

33 CFR 385.8 - Goals and purposes of the Comprehensive Everglades Restoration Plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ecosystem while providing for other water-related needs of the region, including water supply and flood protection. (b) The Corps of Engineers, the South Florida Water Management District, and other non-Federal... of the loss of fresh water from, and the improvement of the environment of the South Florida...

Traffic management centers : the state-of-the-practice : task A : final working paper for design of support systems for advanced traffic management systems

DOT National Transportation Integrated Search

1999-02-01

The goal of the Federal Highway Administration (FHWA) Expert Systems for Crash Data Collection Program was to use expert system technology to improve the accuracy and consistency of police-reported data. The program included the development and evalu...

Internal Branding: Using Performance Technology To Create an Organization Focused on Customer Value.

ERIC Educational Resources Information Center

Tosti, Donald T.; Stotz, Rodger

2000-01-01

Presents a performance technology approach to revenue enhancement, with the goal of improving customer retention through building customer value. Topics include internal branding, a way to make sure that what the company delivers matches what's promised in the advertising; product versus service brands; and customer satisfaction, including…

Teaching to Learn: Analyzing the Experiences of First-Time Physics Learning Assistants

ERIC Educational Resources Information Center

Gray, Kara Elizabeth

2013-01-01

The Colorado Learning Assistant (LA) Model has demonstrated that it is successful in helping to meet multiple goals including enhancing student learning in LA-supported courses, increasing conceptual understanding of physics among LAs, and improving the teaching practices of former LAs in K-12 schools. The research reported here investigated the…

Semiannual Report to Congress, October 1, 2002-March 31, 2003.

ERIC Educational Resources Information Center

Office of Inspector General (ED), Washington, DC.

This semiannual report to Congress by the Office of Inspector General (OIG), U.S. Department of Education, covers the actions of the OIG from October 1, 2002, through March 31, 2003. The report discusses four goals of the President's Management Agenda: (1) improved financial performance: includes information on financial statement audits,…

Navigating the Shift to Intensive Principal Preparation in Illinois: Policy Brief

ERIC Educational Resources Information Center

White, Bradford R.; Pareja, Amber Stitziel; Hart, Holly; Huynh, Michelle Hanh; Klostermann, Brenda K.; Holt, Janet K.

2016-01-01

In 2010, Illinois became one of the first states to legislatively require a complete redesign of all its principal preparation programs, with the goal of advancing statewide school improvement through strengthening school leadership. This effort was ambitious and sweeping, calling for radical shifts in previous practice, including: (1) A targeted…

A Study of College Professors' Perceptions of International Students in STEM Classrooms at a Technical University

ERIC Educational Resources Information Center

Abendschein, Barbara Feeney

2017-01-01

This study investigated the perceptions of STEM professors at a Southeastern technical college about the international students in their undergraduate classrooms, including impact on the learning environment, academic abilities and proficiency in meeting course goals, contribution to class activities and recommendations for improved preparation.…

Case Studies of the Urban Mathematics Collaborative Project: Program Report 91-3.

ERIC Educational Resources Information Center

Popkewitz, Thomas S.; Myrdal, Sigurjon

The Urban Mathematics Collaborative (UMC) project has the goal of contributing to the improvement of mathematics education in the inner-city schools by identifying models to enhance the professional lives of teachers and encouraging the entry of high school mathematics teachers into a larger mathematics community including mathematicians from…

The Role of School Culture in Improving Student Achievement in POS

ERIC Educational Resources Information Center

Sundell, Kirsten; Castellano, Marisa; Overman, Laura T.; Aliaga, Oscar A.

2012-01-01

Over the past five years, the National Research Center for Career and Technical Education (NRCCTE) has sponsored five research studies of Programs of Study (POS)--including three ongoing longitudinal projects--with the goal of informing the field about how and under what conditions POS impact student engagement, achievement, and transition to…

Into the Vortex: Support for Public Education Goes on a Downward Spiral.

ERIC Educational Resources Information Center

Hilliard, Asa G., III

1996-01-01

Discusses current support, or lack of support, for public education. Topics include conflict over national educational goals and minimal budgetary support; a historical look at the conflict over publicly supported education; low academic performance; and school vouchers, choice, and the idea of competition to help improve schools. (LRW)

"On Course" for Supporting Expanded Participation and Improving Scientific Reasoning in Undergraduate Thesis Writing

ERIC Educational Resources Information Center

Dowd, Jason E.; Roy, Christopher P.; Thompson, Robert J., Jr.; Reynolds, Julie A.

2015-01-01

The Department of Chemistry at Duke University has endeavored to expand participation in undergraduate honors thesis research while maintaining the quality of the learning experience. Accomplishing this goal has been constrained by limited departmental resources (including faculty time) and increased diversity in students' preparation to engage in…

34 CFR 607.8 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2010 CFR

2010-07-01

... development plan must include the following: (1) An analysis of the strengths, weaknesses, and significant...) Measurable objectives related to reaching each goal and timeframes for achieving the objectives. (4) Methods...-year plan for improving its services to Indian students, increasing the rates at which Indian secondary...

34 CFR 606.8 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2010 CFR

2010-07-01

... comprehensive development plan must include the following: (1) An analysis of the strengths, weaknesses, and...) Measurable objectives related to reaching each goal and timeframes for achieving the objectives. (4) Methods... proposed project. (5) Its five year plan to improve its services to Hispanic and other low-income students...

34 CFR 606.8 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2012 CFR

2012-07-01

... comprehensive development plan must include the following: (1) An analysis of the strengths, weaknesses, and...) Measurable objectives related to reaching each goal and timeframes for achieving the objectives. (4) Methods... proposed project. (5) Its five year plan to improve its services to Hispanic and other low-income students...

34 CFR 607.8 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2013 CFR

2013-07-01

... development plan must include the following: (1) An analysis of the strengths, weaknesses, and significant...) Measurable objectives related to reaching each goal and timeframes for achieving the objectives. (4) Methods...-year plan for improving its services to Indian students, increasing the rates at which Indian secondary...

34 CFR 606.8 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2011 CFR

2011-07-01

... comprehensive development plan must include the following: (1) An analysis of the strengths, weaknesses, and...) Measurable objectives related to reaching each goal and timeframes for achieving the objectives. (4) Methods... proposed project. (5) Its five year plan to improve its services to Hispanic and other low-income students...

34 CFR 607.8 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2014 CFR

2014-07-01

... development plan must include the following: (1) An analysis of the strengths, weaknesses, and significant...) Measurable objectives related to reaching each goal and timeframes for achieving the objectives. (4) Methods...-year plan for improving its services to Indian students, increasing the rates at which Indian secondary...

34 CFR 606.8 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2014 CFR

2014-07-01

... comprehensive development plan must include the following: (1) An analysis of the strengths, weaknesses, and...) Measurable objectives related to reaching each goal and timeframes for achieving the objectives. (4) Methods... proposed project. (5) Its five year plan to improve its services to Hispanic and other low-income students...

34 CFR 607.8 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2011 CFR

2011-07-01

... development plan must include the following: (1) An analysis of the strengths, weaknesses, and significant...) Measurable objectives related to reaching each goal and timeframes for achieving the objectives. (4) Methods...-year plan for improving its services to Indian students, increasing the rates at which Indian secondary...

34 CFR 606.8 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2013 CFR

2013-07-01

... comprehensive development plan must include the following: (1) An analysis of the strengths, weaknesses, and...) Measurable objectives related to reaching each goal and timeframes for achieving the objectives. (4) Methods... proposed project. (5) Its five year plan to improve its services to Hispanic and other low-income students...

34 CFR 607.8 - What is a comprehensive development plan and what must it contain?

Code of Federal Regulations, 2012 CFR

2012-07-01

... development plan must include the following: (1) An analysis of the strengths, weaknesses, and significant...) Measurable objectives related to reaching each goal and timeframes for achieving the objectives. (4) Methods...-year plan for improving its services to Indian students, increasing the rates at which Indian secondary...

Multi-perspective observations of NO2 over the Denver area during DISCOVER-AQ: Insights for future monitoring

EPA Science Inventory

The final deployment in the DISCOVER-AQ1 series of air quality field campaigns focused on the Northern Front Range of Colorado including the Denver Metropolitan Area in July-August 2014. The overarching goal of these campaigns was to improve the interpretation of satellite observ...

The Secondary School Mathematics Curriculum Improvement Study Goals-The Subject Matter-Accomplishments

ERIC Educational Resources Information Center

Fehr, Howard F.

1970-01-01

Describes an experimental study attempting to construct a unified school mathematics curriculum for grades seven through twelve. Study was initiated in 1965 and is to be a six-year study. The total program includes, in the following order, syllabus writing, conferences, writing of experimental textbook, education of classroom teachers, pilot class…

Maintenance Procedure Display: Head Mounted Display (HMD) Evaluations

NASA Technical Reports Server (NTRS)

Whitmore, Milrian; Litaker, Harry L., Jr.; Solem, Jody A.; Holden, Kritina L.; Hoffman, Ronald R.

2007-01-01

A viewgraph presentation describing maintenance procedures for head mounted displays is shown. The topics include: 1) Study Goals; 2) Near Eye Displays (HMDs); 3) Design; 4) Phase I-Evaluation Methods; 5) Phase 1 Results; 6) Improved HMD Mounting; 7) Phase 2 -Evaluation Methods; 8) Phase 2 Preliminary Results; and 9) Next Steps.

Improving component interoperability and reusability with the java connection framework (JCF): overview and application to the ages-w environmental model

USDA-ARS?s Scientific Manuscript database

Environmental modeling framework (EMF) design goals are multi-dimensional and often include many aspects of general software framework development. Many functional capabilities offered by current EMFs are closely related to interoperability and reuse aspects. For example, an EMF needs to support dev...

Olympic Sports Coaching Education: An International Coach's Perspective

ERIC Educational Resources Information Center

Kiosoglous, Cameron

2016-01-01

The profession of high performance sports coaching is a complex process focused on performance improvement with the goal of producing international sporting success. Rising demand for top-level coaches has been matched with the increasing amount of resources allocated to producing world-class performances. This includes creating and sustaining a…

HIPAA Readiness Collaborative in Hawaii.

PubMed

Chun, Marva; Forbes, Susan; Gose, Steven; Kumabe, Brenda; Loo, Jeffrey; Nichols, Lorraine; Rosa, Luis; Sherrill, Laura; Turner, Jim

2002-01-01

The vision of Hawaii's HIPAA Readiness Collaborative (HRC) effort is to realize the positive potential of HIPAA through a collaborative process that engages the entire healthcare delivery system. Goals include reducing the cost of healthcare through streamlining, reducing the cost of HIPAA implementation for HRC participants, and improving the interoperability between facilities through use of standard technologies.

Evidence-based nursing leadership: Evaluation of a Joint Academic-Service Journal Club.

PubMed

Duffy, Joanne R; Thompson, Diane; Hobbs, Terry; Niemeyer-Hackett, Nancy Lee; Elpers, Susan

2011-10-01

This article describes the importance of evidence-based nursing leadership in the development and evaluation of a joint academic-service nursing leadership journal club. The use of scientific evidence and the embracing of an environment of continuous learning are essential to quality practice; however, nursing leadership has been slow to apply evidence-based practice to their own work. A noontime monthly meeting schedule, incentivized by lunch, was organized as a nursing leadership journal club. Articles were selected and reviewed monthly, and the process was formally evaluated using a written evaluation at the end of year 1. Eighteen articles were appraised by the group with 6 topics identified. Positive results included increased knowledge, competence of the leader, and attainment of goals. Recommendations include revision of goals, plans to share leadership of the group, development of a rigorous evaluation of outcomes, and dissemination of findings. The journal club was valuable in increasing awareness of nursing leadership research, promoting leadership development, and improving competence in the performance of research appraisals. Process improvement and further study are needed to increase understanding regarding the benefits of leadership journal clubs.

Development of New Treatments for Prostate Cancer

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

DiPaola, R. S.; Abate-Shen, C.; Hait, W. N.

2005-02-01

The Dean and Betty Gallo Prostate Cancer Center (GPCC) was established with the goal of eradicating prostate cancer and improving the lives of men at risk for the disease through research, treatment, education and prevention. GPCC was founded in the memory of Dean Gallo, a beloved New Jersey Congressman who died tragically of prostate cancer diagnosed at an advanced stage. GPCC unites a team of outstanding researchers and clinicians who are committed to high-quality basic research, translation of innovative research to the clinic, exceptional patient care, and improving public education and awareness of prostate cancer. GPCC is a center ofmore » excellence of The Cancer Institute of New Jersey, which is the only NCI-designated comprehensive cancer center in the state. GPCC efforts are now integrated well as part of our Prostate Program at CINJ, in which Dr. Robert DiPaola and Dr. Cory Abate-Shen are co-leaders. The Prostate Program unites 19 investigators from 10 academic departments who have broad and complementary expertise in prostate cancer research. The overall goal and unifying theme is to elucidate basic mechanisms of prostate growth and oncogenesis, with the ultimate goal of promoting new and effective strategies for the eradication of prostate cancer. Members' wide range of research interests collectively optimize the chances of providing new insights into normal prostate biology and unraveling the molecular pathophysiology of prostate cancer. Cell culture and powerful animal models developed by program members recapitulate the various stages of prostate cancer progression, including prostatic intraepithelial neoplasia, adenocarcinoma, androgen-independence, invasion and metastases. These models promise to further strengthen an already robust program of investigator-initiated therapeutic clinical trials, including studies adopted by national cooperative groups. Efforts to translate laboratory results into clinical studies of early detection and chemoprevention are underway. The specific goals of this program are: (1) To investigate the molecular mechanisms underlying normal prostate growth and differentiation and elucidate the molecular mechanisms underlying prostate oncogenesis. (2) To build on fundamental knowledge to develop effective therapeutic approaches for the treatment of prostate cancer. (3) To improve the control of prostate cancer through early detection, chemoprevention, and outreach and education. This new disease-based program is structured to improve interdisciplinary interactions and translational results. Already, through the dynamic leadership of Drs. Cory Abate-Shen and Robert DiPaola, new investigators were attracted to the field, new collaborations engendered, and numerous investigator-initiated trials implemented. Progress in GPCC and the program overall has been outstanding. The Center has success in uniting investigators with broad and complementary expertise in prostate cancer research. The overall goal and unifying theme is to elucidate basic mechanisms of prostate growth and oncogenesis, with the ultimate goal of promoting new and effective strategies for the eradication of prostate cancer in patients and populations at risk. Members wide range of research interests collectively optimize the chances of providing new insights into normal prostate biology and unraveling the molecular pathophysiology of prostate cancer. Studies in cell culture and powerful animal models developed recapitulate the various stages of prostate cancer progression, including prostatic intraepithelial neoplasia, adenocarcinoma, androgen-independence, invasion and metastases. These models promise to further strengthen an already robust program of investigator-initiated therapeutic clinical trials, including studies adopted by national cooperative groups. Efforts to translate laboratory results into clinical studies of early detection and chemoprevention are underway.« less

Fidelity to a behavioral intervention to improve goals of care decisions for nursing home residents with advanced dementia.

PubMed

Hanson, Laura C; Song, Mi-Kyung; Zimmerman, Sheryl; Gilliam, Robin; Rosemond, Cherie; Chisholm, Latarsha; Lin, Feng-Chang

2016-12-01

Ensuring fidelity to a behavioral intervention implemented in nursing homes requires awareness of the unique considerations of this setting for research. The purpose of this article is to describe the goals of care cluster-randomized trial and the methods used to monitor and promote fidelity to a goals of care decision aid intervention delivered in nursing homes. The cluster randomized trial tested whether a decision aid for goals of care in advanced dementia could improve (1) the quality of communication and decision-making, (2) the quality of palliative care, and (3) the quality of dying for nursing home residents with advanced dementia. In 11 intervention nursing homes, family decision-makers for residents with advanced dementia received a two-component intervention: viewing a video decision aid about goals of care choices and then participating in a structured decision-making discussion with the nursing home care plan team, ideally within 3 months after the decision aid was viewed. Following guidelines from the National Institutes of Health Behavior Change Consortium, fidelity was assessed in study design, in nursing home staff training for intervention implementation, and in monitoring and receipt of the intervention. We also monitored the content and timing of goals of care discussions. Investigators enrolled 151 family decision-maker/resident dyads in intervention sites; of those, 136 (90%) received both components of the intervention, and 92%-99% of discussions addressed each of four recommended content areas-health status, goals of care, choice of a goal, and treatment planning. A total of 94 (69%) of the discussions between family decision-makers and the nursing home care team were completed within 3 months. The methods we used for intervention fidelity allowed nursing home staff to implement a goals of care decision aid intervention for advanced dementia. Key supports for implementation included design features that aligned with nursing home practice, efficient staff training, and a structured guide for goals of care discussions between family decision-makers and staff. These approaches may be used to promote fidelity to behavioral interventions in future clinical trials. © The Author(s) 2016.

Expressing and amplifying positive emotions facilitate goal attainment in workplace interactions.

PubMed

Wong, Elena; Tschan, Franziska; Messerli, Laurence; Semmer, Norbert K

2013-01-01

Expressing emotions has social functions; it provides information, affects social interactions, and shapes relationships with others. Expressing positive emotions could be a strategic tool for improving goal attainment during social interactions at work. Such effects have been found in research on social contagion, impression management, and emotion work. However, expressing emotions one does not feel entails the risk of being perceived as inauthentic. This risk may well be worth taking when the emotions felt are negative, as expressing negative emotions usually has negative effects. When experiencing positive emotions, however, expressing them authentically promises benefits, and the advantage of amplifying them is not so obvious. We postulated that expressing, and amplifying, positive emotions would foster goal attainment in social interactions at work, particularly when dealing with superiors. Analyses are based on 494 interactions involving the pursuit of a goal by 113 employes. Multilevel analyses, including polynomial analyses, show that authentic display of positive emotions supported goal attainment throughout. However, amplifying felt positive emotions promoted goal attainment only in interactions with superiors, but not with colleagues. Results are discussed with regard to the importance of hierarchy for detecting, and interpreting, signs of strategic display of positive emotions.

Expressing and Amplifying Positive Emotions Facilitate Goal Attainment in Workplace Interactions

PubMed Central

Wong, Elena; Tschan, Franziska; Messerli, Laurence; Semmer, Norbert K.

2013-01-01

Expressing emotions has social functions; it provides information, affects social interactions, and shapes relationships with others. Expressing positive emotions could be a strategic tool for improving goal attainment during social interactions at work. Such effects have been found in research on social contagion, impression management, and emotion work. However, expressing emotions one does not feel entails the risk of being perceived as inauthentic. This risk may well be worth taking when the emotions felt are negative, as expressing negative emotions usually has negative effects. When experiencing positive emotions, however, expressing them authentically promises benefits, and the advantage of amplifying them is not so obvious. We postulated that expressing, and amplifying, positive emotions would foster goal attainment in social interactions at work, particularly when dealing with superiors. Analyses are based on 494 interactions involving the pursuit of a goal by 113 employes. Multilevel analyses, including polynomial analyses, show that authentic display of positive emotions supported goal attainment throughout. However, amplifying felt positive emotions promoted goal attainment only in interactions with superiors, but not with colleagues. Results are discussed with regard to the importance of hierarchy for detecting, and interpreting, signs of strategic display of positive emotions. PMID:23675358

Drivers of Dashboard Development (3-D): A Curricular Continuous Quality Improvement Approach.

PubMed

Shroyer, A Laurie; Lu, Wei-Hsin; Chandran, Latha

2016-04-01

Undergraduate medical education (UME) programs are seeking systematic ways to monitor and manage their educational performance metrics and document their achievement of external goals (e.g., Liaison Committee on Medical Education [LCME] accreditation requirements) and internal objectives (institution-specific metrics). In other continuous quality improvement (CQI) settings, summary dashboard reports have been used to evaluate and improve performance. The Stony Brook University School of Medicine UME leadership team developed and implemented summary dashboard performance reports in 2009 to document LCME standards/criteria compliance, evaluate medical student performance, and identify progress in attaining institutional curricular goals and objectives. Key performance indicators (KPIs) and benchmarks were established and have been routinely monitored as part of the novel Drivers of Dashboard Development (3-D) approach to curricular CQI. The systematic 3-D approach has had positive CQI impacts. Substantial improvements over time have been documented in KPIs including timeliness of clerkship grades, midclerkship feedback, student mistreatment policy awareness, and student satisfaction. Stakeholder feedback indicates that the dashboards have provided useful information guiding data-driven curricular changes, such as integrating clinician-scientists as lecturers in basic science courses to clarify the clinical relevance of specific topics. Gaining stakeholder acceptance of the 3-D approach required clear communication of preestablished targets and annual meetings with department leaders and course/clerkship directors. The 3-D approach may be considered by UME programs as a template for providing faculty and leadership with a CQI framework to establish shared goals, document compliance, report accomplishments, enrich communications, facilitate decisions, and improve performance.

Goal setting, using goal attainment scaling, as a method to identify patient selected items for measuring arm function.

PubMed

Ashford, Stephen; Jackson, Diana; Turner-Stokes, Lynne

2015-03-01

Following stroke or brain injury, goals for rehabilitation of the hemiparetic upper limb include restoring active function if there is return of motor control or, if none is possible, improving passive function, and facilitating care for the limb. To inform development of a new patient reported outcome measure (PROM) of active and passive function in the hemiparetic upper limb, the Arm Activity measure, we examined functional goals for the upper limb, identified during goal setting for spasticity intervention (physical therapy and concomitant botulinum toxin A interventions). Using secondary analysis of a prospective observational cohort study, functional goals determined between patients, their carers and the clinical team were assigned into categories by two raters. Goal category identification, followed by assignment of goals to a category, was undertaken and then confirmed by a second reviewer. Participants comprised nine males and seven females of mean (SD) age 54.5 (15.7) years and their carers. Fifteen had sustained a stroke and one a traumatic brain injury. Goals were used to identify five categories: passive function, active function, symptoms, cosmesis and impairment. Two passive function items not previously identified by a previous systematic review were identified. Analysis of goals important to patients and carers revealed items for inclusion in a new measure of arm function and provide a useful alternative method to involve patients and carers in standardised measure development. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Horses for courses? A qualitative exploration of goals formulated in mental health settings by young people, parents, and clinicians.

PubMed

Jacob, Jenna; Edbrooke-Childs, Julian; Holley, Simone; Law, Duncan; Wolpert, Miranda

2016-04-01

This research sought to explore and categorise goals set by children and young people, parents/caregivers and jointly by a combination of children/young people, parents/caregivers and/or clinicians within mental health settings across the United Kingdom. Using a dataset of 441 goals formed at the outset of 180 treatment episodes (2007-2010) from UK child mental health services using the Goal-Based Outcomes tool, a grounded theory approach was taken, which built on previous research into child-rated goals to develop frameworks for parent and joint goal data which were then compared with the child goal data. A total of 19 subthemes and four overarching themes were identified for parent goals. A total of 19 subthemes in five overarching themes were identified for joint goals. These were compared with 25 subthemes and three overarching themes for child goals. A comparison of subthemes between parent, child and joint goals demonstrated many consistencies, but also differences. Most commonly rated goals from children focused on coping with specific difficulties, personal growth and independence. Parent goals focused mainly on managing specific difficulties, parent-specific goals and improving self or life. Jointly negotiated goals focused on parent-specific goals, self-confidence and understanding, hopes for the future and managing specific problems. The results suggest that goals may capture areas not captured by other normed outcome measures. In particular, goals may capture higher order, underlying factors, such as confidence, resilience, coping, and parenting factors that may not be explored by other measures. The differences across perspectives also link to existing literature suggesting a different focus on treatment based on perspectives and highlights the potential importance when jointly agreeing goals of ensuring the voice of the child/young person is heard and included in goal setting. © The Author(s) 2015.

Goal Setting and Task Performance: 1969-1980

DTIC Science & Technology

1980-06-01

self - esteem showed greater performance improvement than individuals with low self - esteem ...There was no self - esteem effect when instrumentality was high. When self - esteem was low , typists who perceived high goal instrumentality showed greater...performance improvement than M. 49 those with low goal instrumentality; when self - esteem was high, there was no instrumentality effect.

Identification of Pediatric Oral Health Core Competencies through Interprofessional Education and Practice.

PubMed

Hallas, D; Fernandez, J B; Herman, N G; Moursi, A

2015-01-01

Over the past seven years, the Department of Pediatric Dentistry at New York University College of Dentistry (NYUCD) and the Advanced Practice: Pediatrics and the Pediatric Nurse Practitioner (PNP) program at New York University College of Nursing (NYUCN) have engaged in a program of formal educational activities with the specific goals of advancing interprofessional education, evidence-based practice, and interprofessional strategies to improve the oral-systemic health of infants and young children. Mentoring interprofessional students in all health care professions to collaboratively assess, analyze, and care-manage patients demands that faculty reflect on current practices and determine ways to enhance the curriculum to include evidence-based scholarly activities, opportunities for interprofessional education and practice, and interprofessional socialization. Through the processes of interprofessional education and practice, the pediatric nursing and dental faculty identified interprofessional performance and affective oral health core competencies for all dental and pediatric primary care providers. Students demonstrated achievement of interprofessional core competencies, after completing the interprofessional educational clinical practice activities at Head Start programs that included interprofessional evidence-based collaborative practice, case analyses, and presentations with scholarly discussions that explored ways to improve the oral health of diverse pediatric populations. The goal of improving the oral health of all children begins with interprofessional education that lays the foundations for interprofessional practice.

Identification of Pediatric Oral Health Core Competencies through Interprofessional Education and Practice

PubMed Central

Hallas, D.; Fernandez, J. B.; Herman, N. G.; Moursi, A.

2015-01-01

Over the past seven years, the Department of Pediatric Dentistry at New York University College of Dentistry (NYUCD) and the Advanced Practice: Pediatrics and the Pediatric Nurse Practitioner (PNP) program at New York University College of Nursing (NYUCN) have engaged in a program of formal educational activities with the specific goals of advancing interprofessional education, evidence-based practice, and interprofessional strategies to improve the oral-systemic health of infants and young children. Mentoring interprofessional students in all health care professions to collaboratively assess, analyze, and care-manage patients demands that faculty reflect on current practices and determine ways to enhance the curriculum to include evidence-based scholarly activities, opportunities for interprofessional education and practice, and interprofessional socialization. Through the processes of interprofessional education and practice, the pediatric nursing and dental faculty identified interprofessional performance and affective oral health core competencies for all dental and pediatric primary care providers. Students demonstrated achievement of interprofessional core competencies, after completing the interprofessional educational clinical practice activities at Head Start programs that included interprofessional evidence-based collaborative practice, case analyses, and presentations with scholarly discussions that explored ways to improve the oral health of diverse pediatric populations. The goal of improving the oral health of all children begins with interprofessional education that lays the foundations for interprofessional practice. PMID:25653873

Just-in-Time Feedback in Diet and Physical Activity Interventions: Systematic Review and Practical Design Framework

PubMed Central

Robertson, Michael C; Dunton, Genevieve Fridlund; Kerr, Jacqueline; Haffey, Meghan E; Burnett, Taylor; Basen-Engquist, Karen; Hicklen, Rachel S

2018-01-01

Background The integration of body-worn sensors with mobile devices presents a tremendous opportunity to improve just-in-time behavioral interventions by enhancing bidirectional communication between investigators and their participants. This approach can be used to deliver supportive feedback at critical moments to optimize the attainment of health behavior goals. Objective The goals of this systematic review were to summarize data on the content characteristics of feedback messaging used in diet and physical activity (PA) interventions and to develop a practical framework for designing just-in-time feedback for behavioral interventions. Methods Interventions that included just-in-time feedback on PA, sedentary behavior, or dietary intake were eligible for inclusion. Feedback content and efficacy data were synthesized descriptively. Results The review included 31 studies (15/31, 48%, targeting PA or sedentary behavior only; 13/31, 42%, targeting diet and PA; and 3/31, 10%, targeting diet only). All studies used just-in-time feedback, 30 (97%, 30/31) used personalized feedback, and 24 (78%, 24/31) used goal-oriented feedback, but only 5 (16%, 5/31) used actionable feedback. Of the 9 studies that tested the efficacy of providing feedback to promote behavior change, 4 reported significant improvements in health behavior. In 3 of these 4 studies, feedback was continuously available, goal-oriented, or actionable. Conclusions Feedback that was continuously available, personalized, and actionable relative to a known behavioral objective was prominent in intervention studies with significant behavior change outcomes. Future research should determine whether all or some of these characteristics are needed to optimize the effect of feedback in just-in-time interventions. PMID:29567638

Innovation in Diabetes Care: Improving Consumption of Healthy Food Through a “Chef Coaching” Program: A Case Report

PubMed Central

Dill, Diana; Abrahamson, Martin J.; Pojednic, Rachele M.; Phillips, Edward M.

2014-01-01

Nutrition therapy as part of lifestyle care is recommended for people with type 2 diabetes. However, most people with diabetes do not follow this guideline. Changing eating habits involves obtaining knowledge and building practical skills such as shopping, meal preparation, and food storage. Just as fitness coaches use their specific knowledge base in fitness to enhance the effectiveness of their coaching, credentialed chefs trained as health coaches might combine their culinary expertise with coaching in order to improve clients' food choices and lifestyles. This report documents the case of a 55-year-old white male physician, single and living alone, who was recently diagnosed with type 2 diabetes and reported chronic stress, sedentary behavior, and unhealthy eating habits. He participated in a chef coaching program of 8 weekly one-on-one 30-minute coaching sessions via Skype delivered by a chef trained as a health coach. During the first five meetings, the patient's goals were primarily culinary; however, with his success in accomplishing these goals, the patient progressed and expanded his goals to include other lifestyle domains, specifically exercise and work-life balance. At the end of the program, the patient had improved both his nutritional and exercise habits, his confidence in further self-care improvement, and his health parameters such as HgA1c (8.8% to 6.7%; normal <6.5%). We conclude that chef coaching has the potential to help people with diabetes improve their practical culinary skills and implement them so that they eat better and, further, has the potential to help them improve their overall self-care. We intend to further develop chef coaching and assess its potential as we learn from its implementation. PMID:25568831

Root Cause Analysis and Subsequent Intervention to Improve First Dose Antibiotic Turnaround Time for Hospitalized Pediatric Patients

PubMed Central

Dee, Abigail A.; Kelly, Brian; Hampp, Christian

2010-01-01

OBJECTIVE Antibiotic timing is used as a quality standard for hospital accreditation and is an important quality measure. The study aim was to identify barriers in the process of first dose antibiotic administration on the pediatric floors at a tertiary healthcare center and carry out and test an intervention to improve turnaround time to less than one hour. METHODS We conducted a quasi-experimental pre-post study of hospitalized pediatric patients up to 18 years of age initiated on intravenous antibiotics. Every order for a first dose intravenous antibiotic was assessed on all pediatric floors (10/2008). Orders that did not meet the overall turnaround time goal of ≤ 1 hour were identified. A root cause analysis (RCA) was performed to identify reasons for delayed antibiotic administration. Barriers identified in the RCA were used to develop interventions (03/2009) to improve compliance, and the proportion of orders that met the goal was compared pre- (10/2008–02/2009) and post-intervention (04/2009–05/2009). RESULTS During the pre-intervention assessment period, 32 out of 46 total physician orders for a first dose intravenous antibiotic did not meet the one-hour overall turnaround goal. A main reason for delay was failure to label antibiotic orders as first dose. We designed an intervention that included antibiotic audits and individualized feedback to prescribers. The mean ± SD time from the written physician order to drug administration was 228 ± 58 minutes; timing improved to 55 ± 4 minutes after the intervention. The proportion of antibiotics administered within one hour improved from 42.2% to 63% (p=0.0015). CONCLUSIONS We identified system barriers associated with delayed antibiotic administration. Antibiotic timing was improved after continued surveillance and individualized feedback to providers. PMID:22477810

Innovation in diabetes care: improving consumption of healthy food through a "chef coaching" program: a case report.

PubMed

Polak, Rani; Dill, Diana; Abrahamson, Martin J; Pojednic, Rachele M; Phillips, Edward M

2014-11-01

Nutrition therapy as part of lifestyle care is recommended for people with type 2 diabetes. However, most people with diabetes do not follow this guideline. Changing eating habits involves obtaining knowledge and building practical skills such as shopping, meal preparation, and food storage. Just as fitness coaches use their specific knowledge base in fitness to enhance the effectiveness of their coaching, credentialed chefs trained as health coaches might combine their culinary expertise with coaching in order to improve clients' food choices and lifestyles. This report documents the case of a 55-year-old white male physician, single and living alone, who was recently diagnosed with type 2 diabetes and reported chronic stress, sedentary behavior, and unhealthy eating habits. He participated in a chef coaching program of 8 weekly one-on-one 30-minute coaching sessions via Skype delivered by a chef trained as a health coach. During the first five meetings, the patient's goals were primarily culinary; however, with his success in accomplishing these goals, the patient progressed and expanded his goals to include other lifestyle domains, specifically exercise and work-life balance. At the end of the program, the patient had improved both his nutritional and exercise habits, his confidence in further self-care improvement, and his health parameters such as HgA1c (8.8% to 6.7%; normal <6.5%). We conclude that chef coaching has the potential to help people with diabetes improve their practical culinary skills and implement them so that they eat better and, further, has the potential to help them improve their overall self-care. We intend to further develop chef coaching and assess its potential as we learn from its implementation.

Depicting individual responses to physical therapist led chronic pain self-management support with pain science education and exercise in primary health care: multiple case studies.

PubMed

Miller, Jordan; MacDermid, Joy C; Richardson, Julie; Walton, David M; Gross, Anita

2017-01-01

Previous evidence suggests self-management programs for people with chronic pain improve knowledge and self-efficacy, but result in small to negligible changes in function. The purpose of this multiple case studies design was to describe the unique responses of six participants to a new self-management program aimed at improving function, to detail each component of the program, and to explore potential explanations for the varied trajectories of each of the participants. Six participants who had been experiencing chronic pain for at least 5 years were included. All participants were enrolled 6 weeks of ChrOnic pain self-ManageMent support with pain science EducatioN and exercise (COMMENCE). Participants completed an assessment at baseline, 7 weeks (1-week follow-up), and 18 weeks (12-week follow-up). Each participant had a unique initial presentation and goals. Assessments included: function as measured by the Short Musculoskeletal Function Assessment - Dysfunction Index, how much participants are bothered by functional difficulties, pain intensity, fatigue, pain interference, cognitive and psychological factors associated with pain and disability, pain neurophysiology, self-efficacy, satisfaction, and perceived change. The self-management program was 6-weeks in length, consisting of one individual visit and one group visit per week. The program incorporated three novel elements not commonly included in self-management programs: pain neurophysiology education, individualized exercises determined by the participants' goals, and additional cognitive behavioural approaches. Participants were all satisfied with self-management support received. Change in function was variable ranging from 59% improvement to 17% decline. Two potential explanations for variances in response, attendance and social context, are discussed. Several challenges were identified by participants as barriers to attendance. A primary care self-management intervention including pain education and individualized exercise has potential to improve function for some people with chronic pain, although strategies to improve adherence and reduce barriers to participation may be needed to optimize the impact.

Image-guided urologic surgery: intraoperative optical imaging and tissue interrogation (Conference Presentation)

NASA Astrophysics Data System (ADS)

Liao, Joseph C.

2017-02-01

Emerging optical imaging technologies can be integrated in the operating room environment during minimally invasive and open urologic surgery, including oncologic surgery of the bladder, prostate, and kidney. These technologies include macroscopic fluorescence imaging that provides contrast enhancement between normal and diseased tissue and microscopic imaging that provides tissue characterization. Optical imaging technologies that have reached the clinical arena in urologic surgery are reviewed, including photodynamic diagnosis, near infrared fluorescence imaging, optical coherence tomography, and confocal laser endomicroscopy. Molecular imaging represents an exciting future arena in conjugating cancer-specific contrast agents to fluorophores to improve the specificity of disease detection. Ongoing efforts are underway to translate optimal targeting agents and imaging modalities, with the goal to improve cancer-specific and functional outcomes.

Tool Efficiency Analysis model research in SEMI industry

NASA Astrophysics Data System (ADS)

Lei, Ma; Nana, Zhang; Zhongqiu, Zhang

2018-06-01

One of the key goals in SEMI industry is to improve equipment through put and ensure equipment production efficiency maximization. This paper is based on SEMI standards in semiconductor equipment control, defines the transaction rules between different tool states, and presents a TEA system model which is to analysis tool performance automatically based on finite state machine. The system was applied to fab tools and verified its effectiveness successfully, and obtained the parameter values used to measure the equipment performance, also including the advices of improvement.

NASA Johnson Space Center: Total quality partnership

NASA Technical Reports Server (NTRS)

Harlan, Charlie; Boyd, Alfred A.

1992-01-01

The development of and benefits realized from a joint NASA, support contractor continuous improvement process at the Johnson Space Center (JSC) is traced. The joint effort described is the Safety, Reliability, and Quality Assurance Directorate relationship with its three support contractors which began in early 1990. The Continuous Improvement effort started in early 1990 with an initiative to document and simplify numerous engineering change evaluation processes. This effort quickly grew in scope and intensity to include process improvement teams, improvement methodologies, awareness, and training. By early 1991, the support contractor had teams in place and functioning, program goals established and a cultural change effort underway. In mid-l991 it became apparent that a major redirection was needed to counter a growing sense of frustration and dissatisfaction from teams and managers. Sources of frustration were isolated to insufficient joint participation on teams, and to a poorly defined vision. Over the next year, the effort was transformed to a truly joint process. The presentation covers the steps taken to define vision, values, goals, and priorities and to form a joint Steering Committee and joint process improvement teams. The most recent assessment against the President's award criteria is presented as a summary of progress. Small, but important improvement results have already demonstrated the value of the joint effort.

Reducing perceived barriers to nursing homes data entry in the advancing excellence campaign: the role of LANEs (Local Area Networks for Excellence).

PubMed

Bakerjian, Debra; Bonner, Alice; Benner, Carol; Caswell, Cheryl; Weintraub, Alissa; Koren, Mary Jane

2011-09-01

Advancing Excellence (AE) is a coalition-based campaign concerned with how society cares for its elderly and disabled citizens. The purpose of this project was to work with a small group of volunteer nursing homes and with local quality improvement networks called LANEs (Local Area Networks for Excellence) in 6 states in a learning collaborative. The purpose of the collaborative was to determine effective ways for LANEs to address and mitigate perceived barriers to nursing home data entry in the national Advancing Excellence campaign and to test methods by which local quality improvement networks could support nursing homes as they enter data on the AE Web site. A semistructured telephone survey of nursing homes was conducted in 6 states. Participants included LANEs from California, Georgia, Massachusetts, Michigan, Oklahoma, and Washington. Facility characteristics were obtained from a series of questions during the telephone interview. Three states (GA, MA, OK) piloted a new spreadsheet and process for entering data on staff turnover, and 3 states (CA, MI, WA) piloted a new spreadsheet and process for entering data on consistent assignment. Many of the nursing homes we contacted had not entered data for organizational goals on the national Web site, but all were able to do so with telephone assistance from the LANE. Eighty-five percent of nursing homes said they would be able to collect information on advance directives if tools (eg, spreadsheets) were provided. Over 40% of nursing homes, including for-profit homes, were willing to have staff and residents/families enter satisfaction data directly on an independent Web site. Nursing homes were able to convey concerns and questions about the process of goal entry, and offer suggestions to the LANEs during semistructured telephone interviews. The 6 LANEs discussed nursing home responses on their regularly scheduled calls, and useful strategies were shared across states. Nursing homes reported that they are using Advancing Excellence target setting and goal entry to improve care, and that they would use new tools such as those for measuring satisfaction, consistent assignment, and advance directives. Having LANE members contact nursing homes directly by telephone engaged the nursing homes in providing valuable feedback on new Advancing Excellence goals and data entry. It also provided an opportunity to clarify issues related to the campaign and ongoing quality improvement efforts, including culture change. Published by Elsevier Inc.

Setting Goals for Achievement in Physical Education Settings

ERIC Educational Resources Information Center

Baghurst, Timothy; Tapps, Tyler; Kensinger, Weston

2015-01-01

Goal setting has been shown to improve student performance, motivation, and task completion in academic settings. Although goal setting is utilized by many education professionals to help students set realistic and proper goals, physical educators may not be using goal setting effectively. Without incorporating all three types of goals and…

Rehabilitation of executive functioning with training in attention regulation applied to individually defined goals: a pilot study bridging theory, assessment, and treatment.

PubMed

Novakovic-Agopian, Tatjana; Chen, Anthony J-W; Rome, Scott; Abrams, Gary; Castelli, Holli; Rossi, Annemarie; McKim, Ryan; Hills, Nancy; D'Esposito, Mark

2011-01-01

To assess feasibility and effects of training in goal-oriented attentional self-regulation for patients with brain injury and chronic executive dysfunction. Sixteen individuals with chronic brain injury and mild to moderate executive dysfunction. Participants were divided into 2 groups: one group completed goal-oriented attentional self-regulation training during the first 5 weeks, followed by a brief (2-hour) educational instruction session as a control midway through the second 5 weeks; the other group participated in reverse order. Neuropsychological and functional performance assessed at baseline and at weeks 5 and 10. Participants found training in goal-oriented attentional self-regulation engaging, incorporated some trained strategies into daily life, and reported subjective improvements in personal functioning. At week 5, participants who completed goals training significantly improved on tests of attention and executive function and had fewer functional task failures, while performance did not change after educational instruction. At week 10, participants who crossed over from educational instruction to goals training also significantly improved on attention and executive function tests. Participants who crossed from goals training to educational instruction maintained their week 5 gains. Training in goal-oriented attentional self-regulation is theoretically driven and feasible in a research setting. Pilot results suggest improvements in cognitive and functional domains targeted by the intervention.

Goal-setting in diabetes self-management: A systematic review and meta-analysis examining content and effectiveness of goal-setting interventions.

PubMed

Fredrix, Milou; McSharry, Jenny; Flannery, Caragh; Dinneen, Sean; Byrne, Molly

2018-03-02

Goal-setting is recommended and widely used within diabetes self-management programmes. However, empirical evidence around its effectiveness lacks clarity. This review aims to evaluate the effectiveness of goal-setting interventions on diabetes outcomes and to determine which behaviour change techniques (BCTs) are frequently used within these interventions. A systematic search identified 14 studies, describing 12 interventions targeting diabetic-control which incorporated goal-setting as the main intervention strategy. Study characteristics, outcome measures and effect sizes of the included studies were extracted and checked by two authors. The BCT taxonomy v1 was used to identify intervention content. Meta-analyses were conducted to assess intervention effects on the primary outcome of average blood glucose levels (HbA1c) and on body-weight. Psycho-social and behavioural outcomes were summarised in narrative syntheses. Significant post-intervention improvements in HbA1C were found (-.22, 95% CI, -.40, -.04) across studies. No other main effects were identified. The BCT 'goal-setting (behaviour)' was most frequently implemented and was identified in 84% of the interventions. Goal-setting interventions appear to be associated with reduced HbA1C levels. However, the low numbers of studies identified and the risk biases across studies suggest more research is needed to further explore goal-setting BCTs in diabetes self-management.

Goal setting: an integral component of effective diabetes care.

PubMed

Miller, Carla K; Bauman, Jennifer

2014-08-01

Goal setting is a widely used behavior change tool in diabetes education and training. Prior research found specific relatively difficult but attainable goals set within a specific timeframe improved performance in sports and at the workplace. However, the impact of goal setting in diabetes self-care has not received extensive attention. This review examined the mechanisms underlying behavioral change according to goal setting theory and evaluated the impact of goal setting in diabetes intervention studies. Eight studies were identified, which incorporated goal setting as the primary strategy to promote behavioral change in individual, group-based, and primary care settings among patients with type 2 diabetes. Improvements in diabetes-related self-efficacy, dietary intake, physical activity, and A1c were observed in some but not all studies. More systematic research is needed to determine the conditions and behaviors for which goal setting is most effective. Initial recommendations for using goal setting in diabetes patient encounters are offered.

Algorithm improvement program nuclide identification algorithm scoring criteria and scoring application.

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

Enghauser, Michael

2016-02-01

The goal of the Domestic Nuclear Detection Office (DNDO) Algorithm Improvement Program (AIP) is to facilitate gamma-radiation detector nuclide identification algorithm development, improvement, and validation. Accordingly, scoring criteria have been developed to objectively assess the performance of nuclide identification algorithms. In addition, a Microsoft Excel spreadsheet application for automated nuclide identification scoring has been developed. This report provides an overview of the equations, nuclide weighting factors, nuclide equivalencies, and configuration weighting factors used by the application for scoring nuclide identification algorithm performance. Furthermore, this report presents a general overview of the nuclide identification algorithm scoring application including illustrative examples.

Emerging CFD Capabilities and Outlook: A NASA Langley Perspective

NASA Technical Reports Server (NTRS)

Biedron, Robert T.; Pao, S. Paul; Thomas, James L.

2004-01-01

COMSAC goals include increasing the acceptance of CFD as a viable tool for S&C predictions, as well as to focus CFD development and improvement towards the needs of the S&C community. We view this as a symbiotic relationship, with increasing improvement of CFD promoting increasing acceptance by the S&C community, and increasing acceptance spurring further improvements. In this presentation we want to provide an overview for the non CFD expert of current CFD strengths and weaknesses, as well as to highlight a few emerging capabilities that we feel will lead toward increased usefulness in S&C applications.

Understanding and benchmarking health service achievement of policy goals for chronic disease

PubMed Central

2012-01-01

Background Key challenges in benchmarking health service achievement of policy goals in areas such as chronic disease are: 1) developing indicators and understanding how policy goals might work as indicators of service performance; 2) developing methods for economically collecting and reporting stakeholder perceptions; 3) combining and sharing data about the performance of organizations; 4) interpreting outcome measures; 5) obtaining actionable benchmarking information. This study aimed to explore how a new Boolean-based small-N method from the social sciences—Qualitative Comparative Analysis or QCA—could contribute to meeting these internationally shared challenges. Methods A ‘multi-value QCA’ (MVQCA) analysis was conducted of data from 24 senior staff at 17 randomly selected services for chronic disease, who provided perceptions of 1) whether government health services were improving their achievement of a set of statewide policy goals for chronic disease and 2) the efficacy of state health office actions in influencing this improvement. The analysis produced summaries of configurations of perceived service improvements. Results Most respondents observed improvements in most areas but uniformly good improvements across services were not perceived as happening (regardless of whether respondents identified a state health office contribution to that improvement). The sentinel policy goal of using evidence to develop service practice was not achieved at all in four services and appears to be reliant on other kinds of service improvements happening. Conclusions The QCA method suggested theoretically plausible findings and an approach that with further development could help meet the five benchmarking challenges. In particular, it suggests that achievement of one policy goal may be reliant on achievement of another goal in complex ways that the literature has not yet fully accommodated but which could help prioritize policy goals. The weaknesses of QCA can be found wherever traditional big-N statistical methods are needed and possible, and in its more complex and therefore difficult to empirically validate findings. It should be considered a potentially valuable adjunct method for benchmarking complex health policy goals such as those for chronic disease. PMID:23020943

Interventions to Support Integrated Psychological Care and Holistic Health Outcomes in Paediatrics.

PubMed

Shafran, Roz; Bennett, Sophie D; McKenzie Smith, Mhairi

2017-08-16

There are strong calls from many national and international bodies for there to be a 'holistic' and integrated approach to the understanding and management of psychological and physical health needs. Such holistic approaches are characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease. Holistic approaches can impact on mental and physical health and are cost-effective. Several psychological interventions have demonstrated efficacy in improving holistic health outcomes, for example Cognitive Behaviour Therapy, Behavioural Therapies and Problem Solving Therapies. They have shown to impact upon a wide range of outcomes, including psychological distress, pain, physical health, medication adherence, and family outcomes. There is increasing recognition that the holistic goals of the child and family should be prioritised, and that interventions and outcomes should reflect these goals. A focus on holistic goals in therapy can be achieved through a combination of personalised goal-based outcomes in addition to symptom-based measures.

Impacts of Climate Change on Biofuels Production

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

Melillo, Jerry M.

2014-04-30

The overall goal of this research project was to improve and use our biogeochemistry model, TEM, to simulate the effects of climate change and other environmental changes on the production of biofuel feedstocks. We used the improved version of TEM that is coupled with the economic model, EPPA, a part of MIT’s Earth System Model, to explore how alternative uses of land, including land for biofuels production, can help society meet proposed climate targets. During the course of this project, we have made refinements to TEM that include development of a more mechanistic plant module, with improved ecohydrology and considerationmore » of plant-water relations, and a more detailed treatment of soil nitrogen dynamics, especially processes that add or remove nitrogen from ecosystems. We have documented our changes to TEM and used the model to explore the effects on production in land ecosystems, including changes in biofuels production.« less

Progresses and challenges of utilizing traditional birth attendants in maternal and child health in Nigeria.

PubMed

Amutah-Onukagha, Ndidiamaka; Rodriguez, Monica; Opara, Ijeoma; Gardner, Michelle; Assan, Maame Araba; Hammond, Rodney; Plata, Jesus; Pierre, Kimberly; Farag, Ehsan

2017-01-01

Despite advances in modern healthcare, Traditional Birth Attendants (TBA) have continued to be heavily utilized in rural communities in Nigeria. Major disparities in maternal health care in Nigeria remain present despite the goal of the United Nations Millennium Development Goal to reduce maternal mortality by 2015. The objective of this study is to review the contribution of TBAs in the birthing process in Nigeria, and to examine barriers and opportunities for utilizing TBAs in improving maternal and child health outcomes in Nigeria. A literature review of two major electronic databases was conducted using the PRISMA framework to identify English language studies conducted between 2006 and 2016. Inclusion criteria included articles that examined the role of traditional birth attendants as a factor influencing maternal health in Nigeria. The value of TBAs has not been fully examined as few studies have aimed to examine its potential role in reducing maternal mortality with proper training. Eight manuscripts that were examined highlighted the role of TBAs in maternal health including outcomes of utilizing trained versus non-trained TBAs. Specific areas of training for TBAs that were identified and recommended in review including: recognizing delivery complications, community support for TBA practices through policy, evaluation of TBA training programs and increasing collaboration between healthcare facilities and TBAs. Policies focused on improving access to health services and importantly, formal health education training to TBAs, are required to improve maternal health outcomes and underserved communities.

The Bremerton enrollment capacity model: an enrollment capacity model supporting the military health system optimization plan.

PubMed

Helmers, S

2001-12-01

The Department of Defense has launched several initiatives to improve efficiency and quality of care in the military health system. The goal of empaneling 1,300 to 1,500 patients per primary care manager did not correlate well with Naval Hospital Bremerton's experience and did not accurately account for military-specific requirements. The Bremerton Model Task Force was chartered to assess current business practices, identify areas for improvement, and develop a capacity model reflecting military readiness and residency training requirements. Methods included a 12-month review of patient visits and staff surveys of how providers spent their day, with time-and-motion analysis to verify assumptions. Our capacity results (average, 791 enrollees per primary care manager) demonstrated that objective measures at the local level do not support enrollment to Department of Defense-specified levels. Significant changes in "corporate culture" are necessary to accomplish the military health system goals.

Innovative Trajectory Designs to meet Exploration Challenges

NASA Technical Reports Server (NTRS)

Folta, David C.

2006-01-01

This document is a viewgraph presentation of the conference paper. Missions incorporated into NASA's Vision for Space Exploration include many different destinations and regions; are challenging to plan; and need new and innovative trajectory design methods to enable them. By combining proven methods with chaos dynamics, exploration goals that require maximum payload mass or minimum duration can be achieved. The implementation of these innovative methods, such as weak stability boundaries, has altered NASA's approach to meet exploration challenges and is described to show how exploration goals may be met in the next decade. With knowledge that various perturbations play a significant role, the mission designer must rely on both traditional design strategies as well as these innovative methods. Over the past decades, improvements have been made that would at first glance seem dramatic. This paper provides a brief narrative on how a fundamental shift has occurred and how chaos dynamics improve the design of exploration missions with complex constraints.

Performance goals on simulators boost resident motivation and skills laboratory attendance.

PubMed

Stefanidis, Dimitrios; Acker, Christina E; Greene, Frederick L

2010-01-01

To assess the impact of setting simulator training goals on resident motivation and skills laboratory attendance. Residents followed a proficiency-based laparoscopic curriculum on the 5 Fundamentals of Laparoscopic Surgery and 9 virtual reality tasks. Training goals consisted of the average expert performance on each task + 2 SD (mandatory) and best expert performance (optional). Residents rated the impact of the training goals on their motivation on a 20-point visual analog scale. Performance and attendance data were analyzed and correlated (Spearman's). Data are reported as medians (range). General Surgery residency program at a regional referral Academic Medical Center. General surgery residents (n = 15). During the first 5 months of the curriculum, weekly attendance rate was 51% (range, 8-96). After 153 (range, 21-412) repetitions, resident speed improved by 97% (range, 18-230), errors improved by 17% (range, 0-24), and motion efficiency by 59% (range, 26-114) compared with their baseline. Nine (60%) residents achieved proficiency in 7 (range, 3-14) and the best goals in 3.5 (range, 1-9) tasks; the other 6 residents had attendance rates <30%. Residents rated the impact of setting performance goals on their motivation as 15 (range, 1-18) and setting a best goal as 13 (range, 1-18). Motivation ratings correlated positively with attendance rates, number of repetitions, performance improvement, and achievement of proficiency and best goals (r = 0.59-0.75; p < 0.05) but negatively with postgraduate year (PGY) (-0.67; p = 0.02). Setting training goals on simulators are associated with improved resident motivation to participate in a simulator curriculum. While more stringent goals may potentiate this effect, they have a limited impact on senior residents. Further research is needed to investigate ways to improve skills laboratory attendance. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Goal Fluency, Pessimism and Disengagement in Depression

PubMed Central

Dickson, Joanne M.; Moberly, Nicholas J.; O’Dea, Christian; Field, Matt

2016-01-01

Despite the development of prominent theoretical models of goal motivation and its importance in daily life, research has rarely examined goal dysregulation processes in clinical depression. Here we aimed to investigate problematic aspects of goal regulation in clinically depressed adults, relative to controls. Depressed participants (n = 42) were recruited from two Improving Access to Psychological Therapy clinics in north-west England. Control participants (n = 51) were recruited from the same region. Participants generated personal approach goals (e.g., improve my marathon time) and avoidance goals (e.g., avoid getting upset over little things) and completed self-report measures of goal attainment likelihood and depressive symptoms. Participants also completed a measure of ease of disengagement from unattainable goals and re-engagement with new goals. Compared to controls, depressed participants reported fewer approach goals (but not more avoidance goals), rated their approach goal (rewarding) outcomes as less likely to happen and avoidance goal (threatening) outcomes as more likely to happen. Depressed participants also reported greater ease of disengagement from unattainable goals and more difficulty re-engaging with new goals than controls. Our findings extend current knowledge of the psychopathology of depression from a goal regulation perspective, suggesting that pessimism around goal pursuit accompanies fewer approach goal pursuits and a general tendency to disengage when difficulties are encountered. PMID:27902708

U.S. Virgin Islands Transportation Petroleum Reduction Plan

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

Johnson, C.

2011-09-01

This NREL technical report determines a way for USVI to meet its petroleum reduction goal in the transportation sector. It does so first by estimating current petroleum use and key statistics and characteristics of USVI transportation. It then breaks the goal down into subordinate goals and estimates the petroleum impacts of these goals with a wedge analysis. These goals focus on reducing vehicle miles, improving fuel economy, improving traffic flow, using electric vehicles, using biodiesel and renewable diesel, and using 10% ethanol in gasoline. The final section of the report suggests specific projects to achieve the goals, and ranks themore » projects according to cost, petroleum reduction, time frame, and popularity.« less

Improving School Climate in an Urban Junior High School.

ERIC Educational Resources Information Center

Lawson, Robert C.

The problem of poor school climate in an eighth- and ninth-grade center was addressed by the implementation of a school climate improvement project. The following are the primary goals of this practicum: (1) improve school attendance; (2) reduce out-of-school suspensions; and (3) improve student and teacher morale. To address these goals, a…

What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review.

PubMed

Yuan, Beibei; Målqvist, Mats; Trygg, Nadja; Qian, Xu; Ng, Nawi; Thomsen, Sarah

2014-06-21

The deadline for achieving Millennium Development Goals 4 and 5 is approaching, but inequalities between disadvantaged and other populations is a significant barrier for progress towards achieving these goals. This systematic review aims to collect evidence about the differential effects of interventions on different sociodemographic groups in order to identify interventions that were effective in reducing maternal or child health inequalities. We searched the PubMed, EMBASE and other relevant databases. The reference lists of included reviews were also screened to find more eligible studies. We included experimental or observational studies that assessed the effects of interventions on maternal and child health, but only studies that report quantitative inequality outcomes were finally included for analysis. 22 articles about the effectiveness of interventions on equity in maternal and child health were finally included. These studies covered five kinds of interventions: immunization campaigns, nutrition supplement programs, health care provision improvement interventions, demand side interventions, and mixed interventions. The outcome indicators covered all MDG 4 and three MDG 5 outcomes. None of the included studies looked at equity in maternal mortality, adolescent birth rate and unmet need for family planning. The included studies reported inequalities based on gender, income, education level or comprehensive socioeconomic status. Stronger or moderate evidence showed that all kinds of the included interventions may be more effective in improving maternal or child health for those from disadvantaged groups. Studies about the effectiveness of interventions on equity in maternal or child health are limited. The limited evidence showed that the interventions that were effective in reducing inequity included the improvement of health care delivery by outreach methods, using human resources in local areas or provided at the community level nearest to residents and the provision of financial or knowledge support to demand side.

Structural Analysis in a Conceptual Design Framework

NASA Technical Reports Server (NTRS)

Padula, Sharon L.; Robinson, Jay H.; Eldred, Lloyd B.

2012-01-01

Supersonic aircraft designers must shape the outer mold line of the aircraft to improve multiple objectives, such as mission performance, cruise efficiency, and sonic-boom signatures. Conceptual designers have demonstrated an ability to assess these objectives for a large number of candidate designs. Other critical objectives and constraints, such as weight, fuel volume, aeroelastic effects, and structural soundness, are more difficult to address during the conceptual design process. The present research adds both static structural analysis and sizing to an existing conceptual design framework. The ultimate goal is to include structural analysis in the multidisciplinary optimization of a supersonic aircraft. Progress towards that goal is discussed and demonstrated.

Effectiveness of coaching for enhancing the health of menopausal Japanese women.

PubMed

Fujimoto, Kaoru

2017-01-01

We conducted and evaluated a coaching intervention aimed at encouraging menopausal women's engagement in goal-oriented actions, self-efficacy enhancement, menopausal symptom alleviation, and quality of life improvement. The study was a randomized controlled trial comprising women aged 40-60 who were not receiving hormone therapy. The intervention group received leaflets and three monthly coaching sessions. Instruments included the Simplified Menopausal Index, Medical Outcome Study 36-Item Short Form Health Survey, and goal achievement scale. Participants were measured preintervention, immediately postintervention, and three months postintervention. A 3-month coaching intervention to enhance menopausal women's health increased their self-efficacy. This effect was not maintained 3 months postintervention.

Triple therapy for age-related macular degeneration.

PubMed

Augustin, Albert

2009-06-01

Choroidal neovascularization is a hallmark sign of wet age-related macular degeneration (AMD) but it is not an isolated feature. Several processes are likely to contribute to the fibrotic scarring and vision loss that accompanies progressive disease. In a case series, a triple therapy approach to wet AMD was based on the goals of halting choroidal neovascularization, controlling the inflammatory response, and modifying proliferative factors. To address each of these goals, respectively, patients received photodynamic therapy, bevacizumab, and the steroid dexamethasone. The encouraging rate of response, including significant improvements in visual acuity, is consistent with the combined activities of these agents and provides the basis for more definitive studies.

Learning to think strategically.

PubMed

1994-01-01

Strategic thinking focuses on issues that directly affect the ability of a family planning program to attract and retain clients. This issue of "The Family Planning Manager" outlines the five steps of strategic thinking in family planning administration: 1) define the organization's mission and strategic goals; 2) identify opportunities for improving quality, expanding access, and increasing demand; 3) evaluate each option in terms of its compatibility with the organization's goals; 4) select an option; and 5) transform strategies into action. Also included in this issue is a 20-question test designed to permit readers to assess their "strategic thinking quotient" and a list of sample questions to guide a strategic analysis.

Electrical Anomalies Observed During DC3

NASA Technical Reports Server (NTRS)

Lang, Timothy J.; Rutledge, Steven A.; Dolan, Brenda; Krehbiel, Paul; Rison, William; Lindsey, Daniel T.; Lyons, Walt

2013-01-01

The primary scientific goals of DC3 involved improving our understanding of the chemical impacts of thunderstorms and their anvils. However, the Colorado domain provided opportunities to study other interesting phenomena, including the potential impacts of smoke ingestion on convection and thunderstorms, electrification processes in smoke plumes and pyrocumulonimbus clouds, and the production of sprites by unconventional thunderstorm.

Basic Electricity/Electronics (Industrial Arts). Vocational Education Curriculum Guide. Bulletin 1724.

ERIC Educational Resources Information Center

Louisiana State Dept. of Education, Baton Rouge. Div. of Vocational Education.

This curriculum guide is designed to assist industrial arts teachers, counselors, and administrators in improving instruction in the areas of electricity and basic electronics. Included in the first part of the guide are a course flow chart, a course description, a discussion of target grade levels and prerequisites, course goals and objectives,…

The Rhetoric and Reality of Aid: Promoting Educational Technology in Egypt

ERIC Educational Resources Information Center

Warschauer, Mark

2004-01-01

This paper examines a US foreign aid project to promote use of new technologies in Egyptian education. Though the project sought to improve teaching and learning, an examination of implementation indicates how goals of Westernization ended up taking precedence. These included a focus on bringing Egyptian educators to the US and on showcasing US…

Examining How Professional Development Impacted Teachers and Students of U.S. History Courses

ERIC Educational Resources Information Center

Duffield, Stacy; Wageman, Justin; Hodge, Angela

2013-01-01

A causal-comparative, mixed methods design was used to study a partnership between a university and school district formed with the goal of improving history teachers' United States history content knowledge to raise student engagement and achievement. Data were collected from middle and high school history teachers including teacher interviews,…

Combustion of Nitramine Propellants

DTIC Science & Technology

1983-03-01

through development of a comprehensive analytical model. The ultimate goals are to enable prediction of deflagration rate over a wide pressure range...superior in burn rate prediction , both simple models fail in correlating existing temperature- sensitivity data. (2) In the second part, a...auxiliary condition to enable independent burn rate prediction ; improved melt phase model including decomposition-gas bubbles; model for far-field

The Florida Community College System: A Strategic Plan for the Millennium, 1998-2003.

ERIC Educational Resources Information Center

Florida State Board of Community Colleges, Tallahassee.

This report describes the 1998-2003 strategic plan of the Florida Community College System (FCCS). The plan's goals include: (1) enrolling 45% of high school graduates in community colleges by expanding partnerships with K-12 schools and improving child-care and transportation alternatives; (2) meeting the challenge of the Florida Chamber of…

A High School Program in Human Ecology: Helping Everyone Live Productively. Student Handbook.

ERIC Educational Resources Information Center

Brandywine School District, Claymont, DE.

The program's goal is to provide high school students an opportunity to become an active force in the advancement of the human condition and to develop positive attitudes to improve their effectiveness in dealing with their environment. The student handbook consists of eight chapters, including an introduction to the program in chapter I. Chapter…

The Conferences for Undergraduate Women in Physics

NASA Astrophysics Data System (ADS)

Blessing, Susan

2014-03-01

The APS Conferences for Undergraduate Women in Physics (CUWiP) are the continuation of a grass-roots collaborative effort that began 2006. The goals of the conferences are to increase retention and improve career outcomes of undergraduate women in physics. I will discuss the conferences, including organization and participant response, and encourage participation--of both students and institutions.

The role of yogurt in improving the quality of the American diet and meeting dietary guidelines

USDA-ARS?s Scientific Manuscript database

The Dietary Guidelines for Americans (DGA) recommend 3 daily servings of lowfat or nonfat dairy products, however, two-thirds of Americans do not meet that goal. Including lowfat or nonfat yogurt as part of an overall healthful diet can be a positive step towards meeting the DGA. Yogurt contains cal...

Brief Report of Preliminary Outcomes of an Emotion Regulation Intervention for Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Thomson, Kendra; Burnham Riosa, Priscilla; Weiss, Jonathan A.

2015-01-01

Children with autism spectrum disorder (ASD) often present with comorbid psychopathology including problems with emotion regulation. The goal of the present research was to investigate the feasibility of a multicomponent manualized cognitive behavior therapy treatment program for improving emotion regulation in youth with ASD 8-12 years of age.…

Adaptation and Validation of the Spanish Version of the Leisure Assessment Inventory

ERIC Educational Resources Information Center

Badia, Marta; Orgaz-Baz, M. Begona; Verdugo, Miguel-Angel; Martinez-Aguirre, M. Magdalena; Longo-Araujo-de-Melo, Egmar; Ullan-de-la-Fuente, Ana M.

2012-01-01

"Participation"--defined as engagement in life situations, including leisure and recreational activities--is associated with the improvement of people with disabilities' quality of life. Several specific instruments assess leisure, but none of them has been adapted to the Spanish context. The goal of this study is to adapt and validate the Spanish…

Harnessing the Environmental Professional Expertise of Engineering Students--The Course: "Environmental Management Systems in the Industry"

ERIC Educational Resources Information Center

Ben-Zvi-Assaraf, Orit; Ayal, Nitzan

2010-01-01

More and more technical universities now advocate integrating sustainability in higher education and including it as a strategic goal for improving education's quality and relevance to society. This study examines 30 fourth-year chemical engineering students, graduates of a university course designed to combine their terminological domain with…

Reconceptualizing a More Inclusive Faculty Engagement Model: Including and Engaging Part-Time Faculty at Community Colleges

ERIC Educational Resources Information Center

Thirolf, Kathryn Q.

2017-01-01

Because of the importance of faculty engagement to achieve our nationwide student completion goals, this paper comprehensively and critically reviews the conceptualizations of faculty and employee engagement in the extant literature. This review is a means to develop an improved, more inclusive, faculty engagement framework. It is a framework that…

Transforming Elementary Science Teacher Education by Bridging Formal and Informal Science Education in an Innovative Science Methods Course

ERIC Educational Resources Information Center

Riedinger, Kelly; Marbach-Ad, Gili; McGinnis, J. Randy; Hestness, Emily; Pease, Rebecca

2011-01-01

We investigated curricular and pedagogical innovations in an undergraduate science methods course for elementary education majors at the University of Maryland. The goals of the innovative elementary science methods course included: improving students' attitudes toward and views of science and science teaching, to model innovative science teaching…

A Framework for Developing and Testing Financial Capability Education Programs Targeted to Elementary Schools

ERIC Educational Resources Information Center

Collins, J. Michael; Odders-White, Elizabeth

2015-01-01

Concerns about consumers' ability to manage their finances have triggered a range of proposals, including interventions aimed at elementary school students. The goal of these approaches is to improve lifelong economic decision making, but the evidence supporting their efficacy is thin. In this article, the authors discuss the trend toward…

The Instructional Technology Support Center at MTSU: Integrating Technology into K-12 and University Classrooms.

ERIC Educational Resources Information Center

Schmidt, Constance R.

The Instructional Technology Support Center (ITSC) provides training and support for the use of instructional technology by K-12 teachers and Middle Tennessee State University (MTSU) faculty. The goals of the ITSC include: training pre-service and in-service teachers in the use of instructional technology; improving MTSU teaching through expanded…

Challenging and Supporting the First-Year Student: A Handbook for Improving the First Year of College

ERIC Educational Resources Information Center

Upcraft, M. Lee, Ed.; Gardner, John N., Ed.; Barefoot, Betsy O., Ed.

2004-01-01

An authoritative, comprehensive guide to the first year of college, this book includes the most current information about the policies, strategies, programs, and services designed to help first-year students make a successful transition to college and fulfill their educational and personal goals. Following the introduction, "The First Year of…

Power/Energy (Industrial Arts). Vocational Education Curriculum Guide. Bulletin 1723.

ERIC Educational Resources Information Center

Louisiana State Dept. of Education, Baton Rouge. Div. of Vocational Education.

This curriculum guide is designed to assist industrial arts practitioners in improving instruction in the areas of energy and power technology. Included in the first part of the guide are a course flow chart, a course description, a discussion of target grade levels and prerequisites, course goals and objectives, an introduction, and a course…

An Investigation of Turkish Middle School Science Teachers' Pedagogical Orientations towards Direct and Inquiry Instructional Approaches

ERIC Educational Resources Information Center

Sahingoz, Selcuk

2017-01-01

One of the most important goals of science education is preparing effective science teachers which includes the development of a science pedagogical orientation. Helping in-service science teachers improve their orientations toward science teaching begins with identifying their current orientations. While there are many aspects of an effective…

A Regional-Scale Ocean Health Index for Brazil

PubMed Central

Elfes, Cristiane T.; Longo, Catherine; Halpern, Benjamin S.; Hardy, Darren; Scarborough, Courtney; Best, Benjamin D.; Pinheiro, Tiago; Dutra, Guilherme F.

2014-01-01

Brazil has one of the largest and fastest growing economies and one of the largest coastlines in the world, making human use and enjoyment of coastal and marine resources of fundamental importance to the country. Integrated assessments of ocean health are needed to understand the condition of a range of benefits that humans derive from marine systems and to evaluate where attention should be focused to improve the health of these systems. Here we describe the first such assessment for Brazil at both national and state levels. We applied the Ocean Health Index framework, which evaluates ten public goals for healthy oceans. Despite refinements of input data and model formulations, the national score of 60 (out of 100) was highly congruent with the previous global assessment for Brazil of 62. Variability in scores among coastal states was most striking for goals related to mariculture, protected areas, tourism, and clean waters. Extractive goals, including Food Provision, received low scores relative to habitat-related goals, such as Biodiversity. This study demonstrates the applicability of the Ocean Health Index at a regional scale, and its usefulness in highlighting existing data and knowledge gaps and identifying key policy and management recommendations. To improve Brazil's ocean health, this study suggests that future actions should focus on: enhancing fisheries management, expanding marine protected areas, and monitoring coastal habitats. PMID:24695103

Smart Sensor Demonstration Payload

NASA Technical Reports Server (NTRS)

Schmalzel, John; Bracey, Andrew; Rawls, Stephen; Morris, Jon; Turowski, Mark; Franzl, Richard; Figueroa, Fernando

2010-01-01

Sensors are a critical element to any monitoring, control, and evaluation processes such as those needed to support ground based testing for rocket engine test. Sensor applications involve tens to thousands of sensors; their reliable performance is critical to achieving overall system goals. Many figures of merit are used to describe and evaluate sensor characteristics; for example, sensitivity and linearity. In addition, sensor selection must satisfy many trade-offs among system engineering (SE) requirements to best integrate sensors into complex systems [1]. These SE trades include the familiar constraints of power, signal conditioning, cabling, reliability, and mass, and now include considerations such as spectrum allocation and interference for wireless sensors. Our group at NASA s John C. Stennis Space Center (SSC) works in the broad area of integrated systems health management (ISHM). Core ISHM technologies include smart and intelligent sensors, anomaly detection, root cause analysis, prognosis, and interfaces to operators and other system elements [2]. Sensor technologies are the base fabric that feed data and health information to higher layers. Cost-effective operation of the complement of test stands benefits from technologies and methodologies that contribute to reductions in labor costs, improvements in efficiency, reductions in turn-around times, improved reliability, and other measures. ISHM is an active area of development at SSC because it offers the potential to achieve many of those operational goals [3-5].

Evaluation and management of the patient with difficult-to-control or resistant hypertension.

PubMed

Viera, Anthony J; Hinderliter, Alan L

2009-05-15

High blood pressure is often difficult to control. Resistant hypertension is blood pressure above goal despite adherence to a combination of at least three antihypertensive medications of different classes, optimally dosed and usually including a diuretic. The approach to blood pressure that is apparently difficult to control begins with an assessment of the patient's adherence to the management plan, including lifestyle modifications and medications. White-coat hypertension may need to be ruled out. Suboptimal therapy is the most common reason for failure to reach the blood pressure goal. Once-daily fixed-dose combination pills may improve control through the synergism of antihypertensive agents from different classes and improved adherence. Truly drug-resistant hypertension is commonly caused by chronic kidney disease, obstructive sleep apnea, or hyperaldosteronism, all of which can lead to fluid retention. Higher doses of diuretics (or a change to a loop diuretic) are usually needed. Other strategies include adding an alpha blocker, alpha-beta blocker, clonidine, or an aldosterone antagonist (e.g., spironolactone). Particularly in patients with diabetes or renal disease, combining a long-acting nondihydropyridine with a dihydropyridine calcium channel . blocker can also be considered. Obesity, heavy alcohol intake, high levels of dietary sodium, and interfering substances (especially nonsteroidal anti-inflammatory drugs) contribute to hypertension that is resistant or difficult to control.

Recent Cycle Time Reduction at Langley Research Center

NASA Technical Reports Server (NTRS)

Kegelman, Jerome T.

2000-01-01

The NASA Langley Research Center (LaRC) has been engaged in an effort to reduce wind tunnel test cycle time in support of Agency goals and to satisfy the wind tunnel testing needs of the commercial and military aerospace communities. LaRC has established the Wind Tunnel Enterprise (WTE), with goals of reducing wind tunnel test cycle time by an order of magnitude by 2002, and by two orders of magnitude by 2010. The WTE also plans to meet customer expectations for schedule integrity, as well as data accuracy and quality assurance. The WTE has made progress towards these goals over the last year with a focused effort on technological developments balanced by attention to process improvements. This paper presents a summary of several of the WTE activities over the last year that are related to test cycle time reductions at the Center. Reducing wind tunnel test cycle time, defined here as the time between the freezing of loft lines and delivery of test data, requires that the relationship between high productivity and data quality assurance be considered. The efforts have focused on all of the drivers for test cycle time reduction, including process centered improvements, facility upgrades, technological improvements to enhance facility readiness and productivity, as well as advanced measurement techniques. The application of internet tools and computer modeling of facilities to allow a virtual presence of the customer team is also presented.

The balanced scorecard--measures that drive performance.

PubMed

Kaplan, R S; Norton, D P

1992-01-01

Frustrated by the inadequacies of traditional performance measurement systems, some managers have abandoned financial measures like return on equity and earnings per share. "Make operational improvements and the numbers will follow," the argument goes. But managers do not want to choose between financial and operational measures. Executives want a balanced presentation of measures that allow them to view the company from several perspectives simultaneously. During a year-long research project with 12 companies at the leading edge of performance measurement, the authors developed a "balanced scorecard," a new performance measurement system that gives top managers a fast but comprehensive view of the business. The balanced scorecard includes financial measures that tell the results of actions already taken. And it complements those financial measures with three sets of operational measures having to do with customer satisfaction, internal processes, and the organization's ability to learn and improve--the activities that drive future financial performance. Managers can create a balanced scorecard by translating their company's strategy and mission statements into specific goals and measures. To create the part of the scorecard that focuses on the customer perspective, for example, executives at Electronic Circuits Inc. established general goals for customer performance: get standard products to market sooner, improve customers' time-to-market, become customers' supplier of choice through partnerships, and develop innovative products tailored to customer needs. Managers translated these elements of strategy into four specific goals and identified a measure for each.

Health in All Policies in South Australia—Did It Promote and Enact an Equity Perspective?

PubMed Central

Harris, Elizabeth; Baum, Fran; Delany-Crowe, Toni; MacDougall, Colin

2017-01-01

Mobilising cross-sectoral action is helpful in addressing the range of social determinants that contribute to health inequities. The South Australian Health in All Policies (SA HiAP) approach was implemented from 2007 to stimulate cross-sector policy activity to address the social determinants of health to improve population wellbeing and reduce health inequities. This paper presents selected findings from a five year multi-methods research study of the SA HiAP approach and draws on data collected during interviews, observation, case studies, and document analysis. The analysis shows that SA HiAP had dual goals of facilitating joined-up government for co-benefits (process focus); and addressing social determinants of health and inequities through cross-sectoral policy activity (outcomes focus). Government agencies readily understood HiAP as providing tools for improving the process of intersectoral policy development, while the more distal outcome-focused intent of improving equity was not well understood and gained less traction. While some early rhetorical support existed for progressing an equity agenda through SA HiAP, subsequent economic pressures resulted in the government narrowing its priorities to economic goals. The paper concludes that SA HiAP’s initial intentions to address equity were only partially enacted and little was done to reduce inequities. Emerging opportunities in SA, and internationally, including the UN Sustainable Development Goals, may revive interest in addressing equity. PMID:29068400

Setting Single or Multiple Goals for Diet and Physical Activity Behaviors Improves Cardiovascular Disease Risk Factors in Adults With Type 2 Diabetes: A Pragmatic Pilot Randomized Trial.

PubMed

Swoboda, Christine M; Miller, Carla K; Wills, Celia E

2016-08-01

The purpose of this study was to evaluate a 4-month telephone-based goal-setting and decision support intervention among adults with type 2 diabetes mellitus (T2DM) and multiple risk factors for cardiovascular disease (CVD). A randomized pretest-posttest control group design was employed. Overweight or obese adults aged 40 to 75 years with T2DM and ≥1 additional CVD risk factor were provided with individualized CVD risk information. At baseline and each biweekly telephone call, the multiple-goal group self-selected both diet- and physical activity-related goals, the single goal group set a single goal, and the control group received information about community health resources. Dietary intake was assessed via a food frequency questionnaire, physical activity via questionnaire, and A1C and blood lipids via fasting fingerstick sample. Between-group differences for clinical (ie, A1C, blood pressure, and blood lipids), physical activity, and dietary variables were evaluated using Kruskal-Wallis, Mann-Whitney U, analysis of variance, and t tests. From pre- to postintervention, the single-goal group demonstrated significant improvement in systolic blood pressure and intake of servings of fruits, vegetables, and refined grains (all P < .05). The multiple-goal group reported significant reduction in percent energy from total, saturated, monounsaturated, and trans fat intake and significant increase in leisure time walking (all P < .05). A multiple-goal approach over 4 months can improve dietary and physical activity outcomes, while a single-goal approach may facilitate improvement in one behavioral domain. Additional research is needed to evaluate maintenance of the achieved changes. © 2016 The Author(s).

Improving Transfer of Learning: An Innovative Comentoring Program to Enhance Workplace Implementation After an Occupational Therapy Course on Autism Spectrum Disorders.

PubMed

Ashburner, Jill; Ziviani, Jenny; Rodger, Sylvia; Hinder, Elizabeth A; Cartmill, Linda; White, Jessica; Vickerstaff, Sandy

2015-01-01

Research suggests that learning gained through training is infrequently implemented in the workplace. A short-term postcourse comentoring program was developed with the aim of facilitating workplace implementation of learning after a 3-day course for occupational therapists. The program was evaluated for usefulness, successes, challenges, recommended improvements, and associations with changes in self-rated knowledge and confidence. Two months after the course, 42 participants completed an evaluation of the comentoring program with closed- and open-ended questions addressing usefulness, successes, challenges, pairing preferences, and recommendations. They also completed a record on whether or not they had worked on goals nominated in their comentoring contract. Before and 2 months after the course, they completed a self-rated questionnaire on knowledge and confidence. The comentoring program was recommended by 80% of participants. Benefits included opportunities for information and resource sharing, debriefing, problem solving, reassurance, and implementation of ideas. Ninety-five percent of participants worked on some or all their comentoring goals. Although there were significant improvements in knowledge (P < 0.001) and confidence (P < 0.001), the total comentoring evaluation score was not significantly associated with these changes. It is therefore possible that these improvements related to the course itself rather than the comentoring program. Challenges related to time, scheduling, distance, and pairing of comentors. Reported benefits of the program included enhanced psychosocial support and prompting to trial newly learned strategies. Effectiveness may be improved by setting aside time for comentoring in the workplace and better matching of comentors.

EXTENDING THE FLOOR AND THE CEILING FOR ASSESSMENT OF PHYSICAL FUNCTION

PubMed Central

Fries, James F.; Lingala, Bharathi; Siemons, Liseth; Glas, Cees A. W.; Cella, David; Hussain, Yusra N; Bruce, Bonnie; Krishnan, Eswar

2014-01-01

Objective The objective of the current study was to improve the assessment of physical function by improving the precision of assessment at the floor (extremely poor function) and at the ceiling (extremely good health) of the health continuum. Methods Under the NIH PROMIS program, we developed new physical function floor and ceiling items to supplement the existing item bank. Using item response theory (IRT) and the standard PROMIS methodology, we developed 30 floor items and 26 ceiling items and administered them during a 12-month prospective observational study of 737 individuals at the extremes of health status. Change over time was compared across anchor instruments and across items by means of effect sizes. Using the observed changes in scores, we back-calculated sample size requirements for the new and comparison measures. Results We studied 444 subjects with chronic illness and/or extreme age, and 293 generally fit subjects including athletes in training. IRT analyses confirmed that the new floor and ceiling items outperformed reference items (p<0.001). The estimated post-hoc sample size requirements were reduced by a factor of two to four at the floor and a factor of two at the ceiling. Conclusion Extending the range of physical function measurement can substantially improve measurement quality, can reduce sample size requirements and improve research efficiency. The paradigm shift from Disability to Physical Function includes the entire spectrum of physical function, signals improvement in the conceptual base of outcome assessment, and may be transformative as medical goals more closely approach societal goals for health. PMID:24782194

Breastfeeding Support in a Community Pharmacy: Improving Access through the Well Babies at Walgreens Program.

PubMed

Lenell, Amy; Friesen, Carol A; Hormuth, Laura

2015-11-01

Well Babies at Walgreens is a unique community-based corporate partnership program that offers breastfeeding support by a lactation professional in a private room at the pharmacy. Walgreens is a community pharmacy chain with more than 8000 locations in the United States, Puerto Rico, and the US Virgin Islands. The primary goal of Well Babies is to support breastfeeding women using a model that is expandable to other Walgreens pharmacy sites. The Well Babies program offers drop-in services, with a professional consultation by a lactation consultant and baby weight check, if desired. Well Babies creators are developing a business plan for Walgreens and a toolkit that would help other stores implement the program. An additional goal is to improve continuity of care for breastfeeding by engaging pharmacists as vital members of the health care team. Offering breastfeeding support at a pharmacy improves access and encourages support persons to attend while simultaneously allowing the family to complete other errands. This initiative included education for pharmacists to improve the recommendations they make for breastfeeding mothers and to improve awareness among pharmacists of the benefits associated with breastfeeding and the need to preserve the breastfeeding relationship. The first drop-in location opened in April 2012. Grant funding from the US Centers for Disease Control and Prevention, awarded to the Indiana State Department of Health, made it possible to open a second drop-in location in June 2013. Future plans include developing an employee lactation program and expanding Well Babies at Walgreens at other store locations. © The Author(s) 2015.

Health care reform 2010: a fresh view on tort reform.

PubMed

Stimson, C J; Dmochowski, Roger; Penson, David F

2010-11-01

We reviewed the state of medical malpractice tort reform in the context of a new political climate and the current debate over comprehensive health care reform. Specifically we asked whether medical malpractice tort reform is necessary, and evaluated the strengths and weaknesses of contemporary reform proposals. The medical, legal and public policy literature related to medical malpractice tort reform was reviewed and synthesized. We include a primer for understanding the current structure of medical malpractice law, identify the goals of the current system and analyze whether these goals are presently being met. Finally, we describe and evaluate the strengths and weaknesses of the current reform proposals including caps on damages, safe harbors and health care courts. Medical malpractice tort law is designed to improve health care quality and appropriately compensate patients for medical malpractice injuries, but is failing on both fronts. Of the 3 proposed remedies, caps on damages do little to advance the quality and compensatory goals, while safe harbors and health care courts represent important advancements in tort reform. Tort reform should be included in the current health policy debate because the current medical malpractice system is not adequately achieving the basic goals of tort law. While safe harbors and health care courts both represent reasonable remedies, health care courts may be preferred because they do not rely on jury determination in the absence of strong medical evidence. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

A goal management intervention for polyarthritis patients: rationale and design of a randomized controlled trial.

PubMed

Arends, Roos Y; Bode, Christina; Taal, Erik; Van de Laar, Mart A F J

2013-08-13

A health promotion intervention was developed for inflammatory arthritis patients, based on goal management. Elevated levels of depression and anxiety symptoms, which indicate maladjustment, are found in such patients. Other indicators of adaptation to chronic disease are positive affect, purpose in life and social participation. The new intervention focuses on to improving adaptation by increasing psychological and social well-being and decreasing symptoms of affective disorders. Content includes how patients can cope with activities and life goals that are threatened or have become impossible to attain due to arthritis. The four goal management strategies used are: goal maintenance, goal adjustment, goal disengagement and reengagement. Ability to use various goal management strategies, coping versatility and self-efficacy are hypothesized to mediate the intervention's effect on primary and secondary outcomes. The primary outcome is depressive symptoms. Secondary outcomes are anxiety symptoms, positive affect, purpose in life, social participation, pain, fatigue and physical functioning. A cost-effectiveness analysis and stakeholders' analysis are planned. The protocol-based psycho-educational program consists of six group-based meetings and homework assignments, led by a trained nurse. Participants are introduced to goal management strategies and learn to use these strategies to cope with threatened personal goals. Four general hospitals participate in a randomized controlled trial with one intervention group and a waiting list control condition. The purpose of this study is to evaluate the effectiveness of a goal management intervention. The study has a holistic focus as both the absence of psychological distress and presence of well-being are assessed. In the intervention, applicable goal management competencies are learned that assist people in their choice of behaviors to sustain and enhance their quality of life. Nederlands Trial Register = NTR3606, registration date 11-09-2012.

Residents' perspectives on the final year of medical school

PubMed Central

Obrien, Bridget; Niehaus, Brian; Teherani, Arianne; Young, John Q.

2012-01-01

Objectives To characterize junior residents’ perspectives on the purpose, value, and potential improvement of the final year of medical school. Methods Eighteen interviews were conducted with junior residents who graduated from nine different medical schools and who were in internal medicine, surgery, and psychiatry programs at one institution in the United States. Interview transcripts were coded and analyzed inductively for themes. Results Participants’ descriptions of the purpose of their recently completed final year of medical school contained three primary themes: residency-related purposes, interest- or need-based purposes, and transitional purposes. Participants commented on the most valued aspects of the final year. Themes included opportunities to: prepare for residency; assume a higher level of responsibility in patient care; pursue experiences of interest that added breadth of knowledge, skills and perspective; develop and/or clarify career plans; and enjoy a period of respite. Suggestions for improvement included enhancing the learning value of clinical electives, augmenting specific curricular content, and making the final year more purposeful and better aligned with career goals. Conclusions The final year of medical school is a critical part of medical education for most learners, but careful attention is needed to ensure that the year is developmentally robust. Medical educators can facilitate this by creating structures to help students define personal and professional goals, identify opportunities to work toward these goals, and monitor progress so that the value of the final year is optimized and not exclusively focused on residency preparation. PMID:28029642

Enabling the Future: Linking Science and Technology to Societal Goals. A Report.

ERIC Educational Resources Information Center

Carnegie Commission on Science, Technology, and Government, New York, NY.

This report seeks ways to improve the knowledge, understanding, and information available to the federal government on the long-term nature of the science and technology (S&T) enterprise as it relates to societal goals. The recommendations focus on a few key issues: improving the national capacity to define and revise long-term S&T goals; linking…

Nonpharmacologic treatments in psychodermatology.

PubMed

Fried, Richard G

2002-01-01

The author believes that psychocutaneous medicine has indeed come of age and is being incorporated into mainstream medical practice. Patients presenting to dermatologists today are more sophisticated and are frequently dissatisfied with traditional medical therapies. They actively seek alternative approaches and adjuncts to standard treatments. In contrast to many other "alternative" (or) "holistic" treatments offered through non-medical venues, dermatologists can assure their patients that controlled studies support the efficacy of psychocutaneous techniques in improving many dermatologic conditions. Psoriasis, rosacea, herpes simplex, body dysmorphic disorder, acne, eczema, urticaria, neurotic excoriations, excoriated acne, trichotillomania, dysesthetic syndromes, and delusions parasitosis are included in this incomplete list. The author believes it is helpful for both the patient and therapist to define concrete and realistic goals for psychocutaneous intervention. Concrete observable or measurable goals can help the patient and clinician gauge therapeutic progress and success. Specifically, goals can include reduction in pruritus (rating severity from 1-10), decreased scratching activity, decreased plaque extent or thickness, decreased number of urticarial plaques, decreased flushing, decreased anxiety, decreased anger, decreased social embarrassment, decreased social withdrawal, and improved sleep. More global goals can include an improved sense of well-being, increased sense of control, and enhanced acceptance of some of the inevitable aspects of a given skin disease. Cure should never be a goal, because most disorders amenable to psychocutaneous techniques are chronic in nature; thus, cure as an endpoint would only lead to disappointment. The author encourages dermatologists to align themselves with what he euphemistically calls "a skin-emotion specialist." The skin-emotion specialist may be a psychiatrist, psychologist, social worker, biofeedback therapist, or other mental health or behavioral specialist. Patients are more likely to accept a referral to a "skin-emotion specialist," because this term destigmatizes psychologic interventions. Incorporating these techniques and specialists into a clinical practice will expand therapeutic horizons and improve the quality of life of many of the patients afflicted with chronic skin disease. A final caveat must be offered about attempting to make prognostic statements regarding the likelihood of therapeutic success. Although all patients can potentially benefit from psychocutaneous interventions, those with severe psychopathology and poor pretreatment functional status are likely to be more difficult to treat and to achieve less optimal outcomes. Patients with personality disorders such as borderline, narcissistic, and schizotypal disorders, and patients with any active psychotic process certainly constitute a more resistant and difficult population with whom therapeutic success is less likely. These patients, however, are often the ones in the greatest subjective distress and certainly can profit from any of the described interventions. Quoting W. Mitchell Sams, Jr., "although the physician is a scientist and clinician, he or she is and must be something more. A doctor is a caretaker of the patient's person--a professional advisor, guiding the patient through some of life's most difficult journeys. Only the clergy share this responsibility with us." This commitment is and must always be the guiding force in the provision of comprehensive and compatient patient care.

The Advanced Gamma-Ray Imaging System (AGIS)

NASA Astrophysics Data System (ADS)

Otte, Nepomuk

The Advanced Gamma-ray Imaging System (AGIS) is a concept for the next generation of imag-ing atmospheric Cherenkov telescope arrays. It has the goal of providing an order of magnitude increase in sensitivity for Very High Energy Gamma-ray ( 100 GeV to 100 TeV) astronomy compared to currently operating arrays such as CANGAROO, HESS, MAGIC, and VERITAS. After an overview of the science such an array would enable, we discuss the development of the components of the telescope system that are required to achieve the sensitivity goal. AGIS stresses improvements in several areas of IACT technology including component reliability as well as exploring cost reduction possibilities in order to achieve its goal. We discuss alterna-tives for the telescopes and positioners: a novel Schwarzschild-Couder telescope offering a wide field of view with a relatively smaller plate scale, and possibilities for rapid slewing in order to address the search for and/or study of Gamma-ray Bursts in the VHE gamma-ray regime. We also discuss options for a high pixel count camera system providing the necessary finer solid angle per pixel and possibilities for a fast topological trigger that would offer improved realtime background rejection and lower energy thresholds.

Building capacity in social service agencies to employ peer providers.

PubMed

Gates, Lauren B; Mandiberg, James M; Akabas, Sheila H

2010-01-01

While there is evidence that peer providers are valuable to service delivery teams, the agencies where they work face difficulties in fulfilling the potential of including peers on staff effectively. The purpose of this article is to report findings of a pilot test of a workplace strategy that promoted inclusion of peer providers at social service agencies by building organizational capacity to support people with mental health conditions in peer provider roles. The strategy included training, goal setting and ongoing consultation. Seventy-one peer, non-peer and supervisory staff participated from 6 agencies over a one year period. Goal attainment scaling and data from in-depth interviews about perceptions of differences in the ways in which staff are supported, administered prior to and after the consultation period, were used to assess strategy impact. Most frequently staff set goals to respond to role conflict or a lack of support. Staff that met or exceeded their goals utilized the formal structure of consultation to improve communication among themselves, had leadership that sanctioned changes and felt that their participation was of value to the organization and contributed to their individual development. Strategy participation promoted inclusion by initiating changes to policies and practices that devalued the peer provider role, increased skill sets, and formalized lines of communication for sharing information and understanding related to peer providers. Findings demonstrate that a strategy of training, goal setting and consultation can positively affect perceptions of inclusion, and promote implementation of practices associated with inclusive workplaces.

Applied Operations Research: Augmented Reality in an Industrial Environment

NASA Technical Reports Server (NTRS)

Cole, Stuart K.

2015-01-01

Augmented reality is the application of computer generated data or graphics onto a real world view. Its use provides the operator additional information or a heightened situational awareness. While advancements have been made in automation and diagnostics of high value critical equipment to improve readiness, reliability and maintenance, the need for assisting and support to Operations and Maintenance staff persists. AR can improve the human machine interface where computer capabilities maximize the human experience and analysis capabilities. NASA operates multiple facilities with complex ground based HVCE in support of national aerodynamics and space exploration, and the need exists to improve operational support and close a gap related to capability sustainment where key and experienced staff consistently rotate work assignments and reach their expiration of term of service. The initiation of an AR capability to augment and improve human abilities and training experience in the industrial environment requires planning and establishment of a goal and objectives for the systems and specific applications. This paper explored use of AR in support of Operation staff in real time operation of HVCE and its maintenance. The results identified include identification of specific goal and objectives, challenges related to availability and computer system infrastructure.

Combined Goal Management Training and Mindfulness meditation improve executive functions and decision-making performance in abstinent polysubstance abusers.

PubMed

Alfonso, José P; Caracuel, Alfonso; Delgado-Pastor, Luis C; Verdejo-García, Antonio

2011-08-01

The clinical relevance of neuropsychological deficits in addicted individuals has fostered interest in treatment strategies aimed to effectively target executive and decision-making dysfunction. One of the best-validated interventions for executive dysfunction is Goal Management Training (GMT) (Robertson et al., 2005), an interactive program aimed at improving participants' organization and ability to achieve goals. Mindfulness-based meditation can complement GMT training in order to improve attentional scanning and "reading" of emotional signals involved in adaptive decision-making. In this pilot study we investigated the efficacy of a 7-week program including GMT+Mindfulness (GMT+MF), as compared to standard treatment alone (STx), for reducing executive and decision-making deficits in an outpatient sample of alcohol and polysubstance abusers. Eighteen participants were enrolled in the GMT+MF group, whereas 16 participants formed the STx group; both groups were matched for relevant demographic and clinical variables, and pre-treatment degree of executive dysfunction. Results showed that the individuals enrolled in GMT+MF significantly improved their performance on neuropsychological measures of working memory (Letter Number Sequencing), response inhibition (Stroop) and decision-making (Iowa Gambling Task) after the treatment; whereas individuals enrolled in STx alone failed to show significant changes. These preliminary results indicate that the GMT+MF intervention may be effective in reducing executive and decision-making deficits in polysubstance abusers, and they support future randomized controlled studies aimed at examining the extent to which these improvements may generalize to every day functioning and may affect the capacity of addicted individuals to achieve and maintain abstinence. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Use of patient ethnography to support quality improvement in benign prostatic hyperplasia.

PubMed

Kaplan, A L; Klein, M P; Tan, H J; Setlur, N P; Agarwal, N; Steinberg, K; Saigal, C S

2014-12-01

Patient-centeredness is a primary aim of quality improvement (QI) but optimal strategies to achieve that goal remain elusive. Benign prostatic hyperplasia (BPH) is one of the commonest urologic diagnoses and significantly affects quality of life. Patient ethnography is an emerging qualitative method of observation and dynamic interviews to understand the context through which the patient experiences care. We implemented patient ethnography to support our QI infrastructure and improve patient-centeredness in BPH. Little is known about how to measure whether processes of care are patient-centered. We did not know whether the care processes our patients experienced provided value from their perspective. We sought to discover previously unrecognized components of care that patients perceived to be of low value. Our primary goal was to develop QI initiatives that targeted low-value themes identified in the ethnography. Our secondary goal was a rapid rollout of three targeted initiatives. We used a 4-step patient ethnography: (1) created detailed process maps to define phases of care, (2) interviewed patients, (3) synthesized transcript data in focus groups using the Crawford Slip method, and (4) targeted undesirable components of care for QI. Semi-structured interviews with seven representative patients identified low-value themes. Focus groups, comprised of primary care physicians, case coordinators, nurses, and urologists, evaluated the interview transcripts and generated improvement opportunities prioritized based on feasibility, patient value, scalability, and innovation. We used affinity mapping and priority matrix techniques to prioritize QI opportunities. We identified five low-value themes from the patient interviews and developed corresponding QI opportunities. These included issues surrounding the referral and consultation process as well as postoperative care, especially home urinary catheter maintenance. Six months after completing the ethnography three of five targeted improvement opportunities had been implemented. Copyright © 2014 Elsevier Inc. All rights reserved.

Developing a Practice-Based Learning and Improvement Curriculum for an Academic General Surgery Residency

PubMed Central

O'Connor, Erin S.; Mahvi, David M.; Foley, Eugene F.; Lund, Dennis; McDonald, Robert

2010-01-01

Background Program Directors in Surgery are now facing the challenge of incorporating the ACGME's practice-based learning and improvement (PBLI) competency into residency curriculum. We introduced a comprehensive PBLI experience for PG2 residents designed to integrate specific competency goals (quality improvement, clinical thinking, and self-directed learning) within the context of residents’ clinical practice. Study Design Fourteen PG2 residents participated in a three-week PBLI curriculum consisting of three components: Complex Clinical Decision Making (CCDM), Individual Learning Plan, and Quality Improvement (QI). To assess how effectively the curriculum addressed these three competencies, residents rated their understanding of PBLI by answering a 12-question written survey given pre- and post-rotation. Resident satisfaction was assessed through standard post-rotation evaluations. Results Analysis of the pre and post rotation surveys from the fourteen participants showed an increase in all measured elements, including knowledge of PBLI (p<0.001), ability to assess learning needs (p<0.001) and set learning goals (p<0.001), understanding of QI concepts (p=0.001), and experience with QI projects (p<0.001). Fourteen QI projects were developed. Although many residents found the creation of measurable learning goals to be challenging, the process of identifying strengths and weaknesses enhanced the resident's self-understanding, and contributed to overall satisfaction with the rotation. Conclusions The initial implementation of our PBLI curriculum demonstrated that residents report personal progress in their clinical decision making, self-directed learning, and familiarity with quality improvement. This comprehensive PBLI curriculum was accepted by surgical residents as a valuable part of their training. We are encouraged to continue a clinically-grounded PBLI experience for PG2 residents. PMID:20347732

A conceptual persistent healthcare quality improvement process for software development management.

PubMed

Lin, Jen-Chiun; Su, Mei-Ju; Cheng, Po-Hsun; Weng, Yung-Chien; Chen, Sao-Jie; Lai, Jin-Shin; Lai, Feipei

2007-01-01

This paper illustrates a sustained conceptual service quality improvement process for the management of software development within a healthcare enterprise. Our proposed process is revised from Niland's healthcare quality information system (HQIS). This process includes functions to survey the satisfaction of system functions, describe the operation bylaws on-line, and provide on-demand training. To achieve these goals, we integrate five information systems in National Taiwan University Hospital, including healthcare information systems, health quality information system, requirement management system, executive information system, and digital learning system, to form a full Deming cycle. A preliminary user satisfaction survey showed that our outpatient information system scored an average of 71.31 in 2006.

Revolutionary opportunities for materials and structures study

NASA Technical Reports Server (NTRS)

Schweiger, F. A.

1987-01-01

The revolutionary opportunities for materials and structures study was performed to provide Government and Industry focus for advanced materials technology. Both subsonic and supersonic engine studies and aircraft fuel burn and DOC evaluation are examined. Year 2010 goal materials were used in the advanced engine studies. These goal materials and improved component aero yielded subsonic fuel burn and DOC improvements of 13.4 percent and 5 percent, respectively and supersonic fuel burn and DOC improvements of 21.5 percent and 18 percent, respectively. Conclusions are that the supersonic study engine yielded fuel burn and DOC improvements well beyond the program goals; therefore, it is appropriate that advanced material programs be considered.

A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery.

PubMed

Magruder, J Trent; Crawford, Todd C; Harness, Herbert Lynn; Grimm, Joshua C; Suarez-Pierre, Alejandro; Wierschke, Chad; Biewer, Jim; Hogue, Charles; Whitman, Glenn R; Shah, Ashish S; Barodka, Viachaslau

2017-01-01

We sought to determine whether a pilot goal-directed perfusion initiative could reduce the incidence of acute kidney injury after cardiac surgery. On the basis of the available literature, we identified goals to achieve during cardiopulmonary bypass (including maintenance of oxygen delivery >300 mL O2/min/m 2 and reduction in vasopressor use) that were combined into a goal-directed perfusion initiative and implemented as a quality improvement measure in patients undergoing cardiac surgery at Johns Hopkins during 2015. Goal-directed perfusion initiative patients were matched to controls who underwent cardiac surgery between 2010 and 2015 using propensity scoring across 15 variables. The primary and secondary outcomes were the incidence of acute kidney injury and the mean increase in serum creatinine within the first 72 hours after cardiac surgery. We used the goal-directed perfusion initiative in 88 patients and matched these to 88 control patients who were similar across all variables, including mean age (61 years in controls vs 64 years in goal-directed perfusion initiative patients, P = .12) and preoperative glomerular filtration rate (90 vs 83 mL/min, P = .34). Controls received more phenylephrine on cardiopulmonary bypass (mean 2.1 vs 1.4 mg, P < .001) and had lower nadir oxygen delivery (mean 241 vs 301 mL O2/min/m 2 , P < .001). Acute kidney injury incidence was 23.9% in controls and 9.1% in goal-directed perfusion initiative patients (P = .008); incidences of acute kidney injury stage 1, 2, and 3 were 19.3%, 3.4%, and 1.1% in controls, and 5.7%, 3.4%, and 0% in goal-directed perfusion initiative patients, respectively. Control patients exhibited a larger median percent increase in creatinine from baseline (27% vs 10%, P < .001). The goal-directed perfusion initiative was associated with reduced acute kidney injury incidence after cardiac surgery in this pilot study. Copyright © 2016. Published by Elsevier Inc.

Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis

PubMed Central

2011-01-01

Background School closure was employed as a non-pharmaceutical intervention against pandemic 2009 H1N1, particularly during the first wave. More than 700 schools in the United States were closed. However, closure decisions reflected significant variation in rationales, decision triggers, and authority for closure. This variability presents the opportunity for improved efficiency and decision-making. Methods We identified media reports relating to school closure as a response to 2009 H1N1 by monitoring high-profile sources and searching Lexis-Nexis and Google news alerts, and reviewed reports for key themes. News stories were supplemented by observing conference calls and meetings with health department and school officials, and by discussions with decision-makers and community members. Results There was significant variation in the stated goal of closure decision, including limiting community spread of the virus, protecting particularly vulnerable students, and responding to staff shortages or student absenteeism. Because the goal of closure is relevant to its timing, nature, and duration, unclear rationales for closure can challenge its effectiveness. There was also significant variation in the decision-making authority to close schools in different jurisdictions, which, in some instances, was reflected in open disagreement between school and public health officials. Finally, decision-makers did not appear to expect the level of scientific uncertainty encountered early in the pandemic, and they often expressed significant frustration over changing CDC guidance. Conclusions The use of school closure as a public health response to epidemic disease can be improved by ensuring that officials clarify the goals of closure and tailor closure decisions to those goals. Additionally, authority to close schools should be clarified in advance, and decision-makers should expect to encounter uncertainty disease emergencies unfold and plan accordingly. PMID:21284865

Older patients with schizophrenia: challenges in the coming decades.

PubMed

Palmer, B W; Heaton, S C; Jeste, D V

1999-09-01

The number and proportion of older adults with schizophrenia will increase considerably in the coming decades. Although a vast literature on schizophrenia among younger adults exists, much less is known about late-life schizophrenia and its treatment. The authors describe two potential scenarios for 2011, the year that the first baby boomers will turn 65. To ensure that the more favorable scenario becomes a reality, the authors suggest four goals: decrease medical comorbidity and mortality among younger patients with schizophrenia and improve their access to health care so that they can live longer and more productive lives; improve our understanding of the neurobiological and psychosocial factors underlying late-life schizophrenia, as well as the health care and social service needs of such patients; develop more effective and safer pharmacologic, psychosocial, and cognitive behavioral treatments; and improve rehabilitation of older people with schizophrenia. Specific strategies to foster these goals include establishing a consortium for studies of late-life schizophrenia; conducting multicenter studies of treatment effectiveness; and forming interdisciplinary collaborations among researchers, clinicians, government and industry representatives, and patient advocacy groups.

Genome editing in plants: Advancing crop transformation and overview of tools.

PubMed

Shah, Tariq; Andleeb, Tayyaba; Lateef, Sadia; Noor, Mehmood Ali

2018-05-07

Genome manipulation technology is one of emerging field which brings real revolution in genetic engineering and biotechnology. Targeted editing of genomes pave path to address a wide range of goals not only to improve quality and productivity of crops but also permit to investigate the fundamental roots of biological systems. These goals includes creation of plants with valued compositional properties and with characters that confer resistance to numerous biotic and abiotic stresses. Numerous novel genome editing systems have been introduced during the past few years; these comprise zinc finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeats/Cas9 (CRISPR/Cas9). Genome editing technique is consistent for improving average yield to achieve the growing demands of the world's existing food famine and to launch a feasible and environmentally safe agriculture scheme, to more specific, productive, cost-effective and eco-friendly. These exciting novel methods, concisely reviewed herein, have verified themselves as efficient and reliable tools for the genetic improvement of plants. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Expert meeting on Child Growth and Micronutrient Deficiencies--New Initiatives for Developing Countries to Achieve Millennium Development Goals: executive summary report.

PubMed

Usfar, Avita A; Achadi, Endang L; Martorell, Reynaldo; Hadi, Hamam; Thaha, Razak; Jus'at, Idrus; Atmarita; Martianto, Drajat; Ridwan, Hardinsyah; Soekirman

2009-01-01

Undernutrition in early childhood has long-term physical and intellectual consequences. Improving child growth should start before the age of two years and be an integrated effort between all sectors, covering all aspects such as diet and nutrient intake, disease reduction, optimum child care, and improved environmental sanitation. To discuss these issues, the Indonesian Danone Institute Foundation organized an expert meeting on Child Growth and Micronutrient Deficiencies: New Initiatives for Developing Countries to Achieve Millennium Development Goals. The objective of the meeting was to have a retrospective view on child growth: lessons learned from programs to overcome under-nutrition in the developed countries and to relate the situation to the Indonesian context, as well as to discuss implications for future programs. Recommendations derived from the meeting include focus intervention on the window of opportunity group, re-activation of the Integrated Health Post at the village level, improvement of infant and young child feeding, expand food fortification intervention programs, strengthen supplementation programs with multi-micronutrient, and strengthening public and private partnership on food related programs.

Preconceptional Nutrition Interventions for Adolescent Girls and Adult Women: Global Guidelines and Gaps in Evidence and Policy with Emphasis on Micronutrients.

PubMed

De-Regil, Luz M; Harding, Kimberly B; Roche, Marion L

2016-07-01

Much of the global nutrition efforts in recent years have been focused on improving the nutritional status of children during the window of the first 1000 d of life, from conception to 2 y of age. However, as the world transitions from the Millennium Development Goals to the Sustainable Development Goals, women's and adolescent girls' overall health and well-being are being placed at the center of the global agenda. It is also increasingly recognized that a woman's nutritional status before pregnancy affects maternal and child outcomes and thus needs to be improved to ensure optimal outcomes. This article reviews the global picture of preconception nutrition in women and girls, including some of the key factors that influence women's outcomes, as well as their children's outcomes, if they do become pregnant. This article describes the current global guidelines on preconceptional nutrition interventions for girls and women; highlights related gaps in evidence, guidelines, and policy; and discusses research to forward the agenda of improving women's and girls' preconceptional nutrition. © 2016 American Society for Nutrition.

Centering the voices of international students in family studies and family therapy graduate programs.

PubMed

McDowell, Teresa; Fang, Shi-Ruei; Kosutic, Iva; Griggs, Julie

2012-06-01

In this article, we report the results of a survey that accessed the perceptions of family studies and family therapy international master's and doctoral students across the United States. Our goals included giving collective voice to the experience of international students and gathering their suggestions for improving programs. Themes that emerged from responses to open- and closed-ended questions included feeling (mis)understood and (de)valued; forming personal connections and experiencing marginalization; the importance of including international perspectives in curricula; considering the relevance/transferability of knowledge; and attending to barriers to learning. Based on the results, we share suggestions for improving family studies and family therapy graduate programs relative to program planning, curricula revision, teaching strategies, and faculty development. © 2012 American Association for Marriage and Family Therapy.

Small Aircraft Transportation System (SATS): A Collaborative Effort Between Nebraska EPSCoR and NASA Langley Research Center

NASA Technical Reports Server (NTRS)

2000-01-01

Implementing SATS in Nebraska will require a number of changes, both technical and administrative. SATS will require major improvements in the infrastructure of Nebraska airports. Improving airport infrastructure so that it can accommodate SATS is first and most obvious goal. A second goal is to make airports financially sustainable over the long term with limited federal assistance. A third goal, closely related to the second, is to link the implementation of SATS with anticipated local economic growth. This can leverage local funds without tax increases, enhance the equity of the finance approach, improve planning of facility size, and reduce long-term per unit cost. Many of these goals are national issues, and presumably federal policy will determine how these goals are addressed. This study examines several financing options and discusses their ease of application to Nebraska's airports.

Motivations for conserving urban biodiversity.

PubMed

Dearborn, Donald C; Kark, Salit

2010-04-01

In a time of increasing urbanization, the fundamental value of conserving urban biodiversity remains controversial. How much of a fixed budget should be spent on conservation in urban versus nonurban landscapes? The answer should depend on the goals that drive our conservation actions, yet proponents of urban conservation often fail to specify the motivation for protecting urban biodiversity. This is an important shortcoming on several fronts, including a missed opportunity to make a stronger appeal to those who believe conservation biology should focus exclusively on more natural, wilder landscapes. We argue that urban areas do offer an important venue for conservation biology, but that we must become better at choosing and articulating our goals. We explored seven possible motivations for urban biodiversity conservation: preserving local biodiversity, creating stepping stones to nonurban habitat, understanding and facilitating responses to environmental change, conducting environmental education, providing ecosystem services, fulfilling ethical responsibilities, and improving human well-being. To attain all these goals, challenges must be faced that are common to the urban environment, such as localized pollution, disruption of ecosystem structure, and limited availability of land. There are, however, also challenges specific only to particular goals, meaning that different goals will require different approaches and actions. This highlights the importance of specifying the motivations behind urban biodiversity conservation. If the goals are unknown, progress cannot be assessed.

Priming patient safety: A middle-range theory of safety goal priming via safety culture communication.

PubMed

Groves, Patricia S; Bunch, Jacinda L

2018-05-18

The aim of this paper is discussion of a new middle-range theory of patient safety goal priming via safety culture communication. Bedside nurses are key to safe care, but there is little theory about how organizations can influence nursing behavior through safety culture to improve patient safety outcomes. We theorize patient safety goal priming via safety culture communication may support organizations in this endeavor. According to this theory, hospital safety culture communication activates a previously held patient safety goal and increases the perceived value of actions nurses can take to achieve that goal. Nurses subsequently prioritize and are motivated to perform tasks and risk assessment related to achieving patient safety. These efforts continue until nurses mitigate or ameliorate identified risks and hazards during the patient care encounter. Critically, this process requires nurses to have a previously held safety goal associated with a repertoire of appropriate actions. This theory suggests undergraduate educators should foster an outcomes focus emphasizing the connections between nursing interventions and safety outcomes, hospitals should strategically structure patient safety primes into communicative activities, and organizations should support professional development including new skills and the latest evidence supporting nursing practice for patient safety. © 2018 John Wiley & Sons Ltd.

Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis.

PubMed

Misra-Hebert, Anita D; Hu, Bo; Taksler, Glen; Zimmerman, Robert; Rothberg, Michael B

2016-08-01

Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse. To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management and for attaining goals. Retrospective cohort study using insurance claims linked with electronic medical record data from January 2008-December 2012. Employee patients with diabetes covered by the organization's self-funded insurance and propensity-matched non-employee patient comparison group with diabetes and commercial insurance. Financial incentives for employer-sponsored disease management program participation and achieving goals. Change in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL), systolic blood pressure (SBP), and weight. A total of 1092 employees with diabetes were matched to non-employee patients. With increasing incentives, employee program participation increased (7 % in 2009 to 50 % in 2012, p < 0.001). Longitudinal mixed modeling demonstrated improved diabetes and cardiovascular risk factor control in employees vs. non-employees [HbA1c yearly change -0.05 employees vs. 0.00 non-employees, difference in change (DIC) p <0.001]. In their first participation year, employees had larger declines in HbA1c and weight vs. non-employees (0.33 vs. 0.14, DIC p = 0.04) and (2.3 kg vs. 0.1 kg, DIC p < 0.001), respectively. Analysis of employee cohorts corresponding with incentive offerings showed that fixed incentives (years 1 and 2) or incentives tied to goals (years 3 and 4) were not significantly associated with HbA1c reductions compared to non-employees. For each employee cohort offered incentives, SBP and LDL also did not significantly differ in employees compared with non-employees (DIC p > 0.05). Financial incentives were associated with employee participation in disease management and improved cardiovascular risk factors over 5 years. Improvements occurred primarily in the first year of participation. The relative impact of specific incentives could not be discerned.

Impacts of dairy diagnostic teams on herd performance.

PubMed

Weinand, D; Conlin, B J

2003-05-01

This study evaluated impacts of educational diagnostic teams of consultants used to transfer technology to dairy farms. Herd management performance changes were measured by comparing Dairy Herd Improvement data from 38 project farms to data from herds that were geographical contemporaries. The value of focused goals for effecting change was also assessed. Interviews provided producers' perception of project outcomes and insight on organization and conduct of dairy diagnostic teams. Changes observed in project herds were small compared with controls with tendencies for increased herd size and improved milk production per cow. Focused goals had greater impacts on increasing herd size, milk per cow, first lactation peak milk, reducing age at first calving, and percentages of cows with subclinical mastitis. Time, money, facility limitations, labor, and alternative priorities were the most cited constraints to implementing changes. Satisfaction scores of producers were significantly related to the degree that team recommendations were followed. Improved attitudes, quality of life, and financial well-being were benefits listed by a majority of producers from participation in the project. If similar projects were to be offered, 83% said they would participate again, and 69% indicated they would pay at least some of the costs. Project farms served as demonstration farms for 1930 other producers in their respective locales, resulting in a multiplier effect of original advice given by consultant teams. Suggestions by farmer participants for improvements in dairy diagnostic teams included needs for at least some unbiased team members, more frequent meetings, more follow-up on recommendations, and consistency of recommendations with family goals.

Evolution of an academic-public library partnership.

PubMed

Engeszer, Robert J; Olmstadt, William; Daley, Jan; Norfolk, Monique; Krekeler, Kara; Rogers, Monica; Colditz, Graham; Anwuri, Victoria V; Morris, Scott; Voorhees, Mychal; McDonald, Brenda; Bernstein, Jackie; Schoening, Paul; Williams, Lee

2016-01-01

A partnership to improve access to health information via an urban public library system was established in St. Louis, Missouri, in 2011. A multiyear project was outlined that included an information needs assessment, a training class for public library staff, information kiosks at library branches for delivering printed consumer health materials, and a series of health-related programming. The partnership evolved to include social service and community organizations to carry out project goals and establish a sustainable program that met the health and wellness interests of the community.

Daily goal progress is facilitated by spousal support and promotes psychological, physical, and relational well-being throughout adulthood

PubMed Central

Jakubiak, Brittany K.; Feeney, Brooke C.

2016-01-01

In two daily-diary studies, we tested the consequences and precursors of daily goal progress throughout the adult lifespan. Attachment theory posits that exploration—including the pursuit of autonomous goals—promotes well-being across the lifespan and is facilitated by support from close others. For both young-adult newlyweds (Study 1) and married couples in late adulthood (Study 2), daily independent goal progress predicted same-day and next-day improvements in psychological, physical, and relational well-being. Specifically, when participants made more progress on their goals than usual on one day, they reported increases in positive affect, sleep quality, and relationship quality, and decreased physical symptoms, the following day (as well as concurrently). Additionally, spousal support (i.e., availability, encouragement, and noninterference) enabled same-day and next-day goal progress. Mediational analyses showed indirect links between spousal support and well-being through goal progress. Some effects were moderated by attachment orientation in the newlywed sample; individuals with greater insecure attachment benefited most from goal progress, and spousal support enabled goal progress most strongly for individuals with less anxious attachment. Overall, these results support and extend attachment theoretical propositions regarding the importance of the exploration system across the adult lifespan. They contribute to existing literature by demonstrating wide-ranging consequences of successful exploration for well-being and by providing evidence for the importance of both exploration and support for exploration into late adulthood. PMID:27560610

Enabling physical activity participation for children and youth with disabilities following a goal-directed, family-centred intervention.

PubMed

Willis, Claire; Nyquist, Astrid; Jahnsen, Reidun; Elliott, Catherine; Ullenhag, Anna

2018-06-01

There is a paucity of research demonstrating the optimisation and maintenance of participation outcomes following physical activity interventions for children and youth with disabilities. To evaluate changes in physical activity participation in children with disabilities following a goal-directed, family-centred intervention at a healthsports centre, and to identify factors influencing participation following the intervention. A mixed methods pre-test post-test cohort design was applied. Recruitment occurred over a 12 month period during standard clinical service provision. The Canadian Occupational Performance Measure (COPM) was administered to children and parents pre (T1) and post-intervention (T2), and at 12 weeks follow-up (T3). Goal Attainment Scaling (GAS) was applied to assess outcomes at 12 weeks follow-up (T2-T3). Qualitative inquiry described barriers to goal attainment at T3. Ninety two children with a range of disabilities (mean age 11.1yr; 49 males) were included in the study. Statistically significant and clinically meaningful improvements in parent ratings of COPM performance and satisfaction of participation goals were observed following intervention. Ratings at 12 weeks follow-up remained significantly higher than baseline, and 32% of children attained their COPM-derived GAS goal. Environmental factors were the most frequent barrier to goal attainment following intervention. These results provide preliminary evidence for goal-directed, family-centred interventions to optimise physical activity participation outcomes for children with disabilities. Copyright © 2018 Elsevier Ltd. All rights reserved.

Feasibility of Using Qualitative Interviews to Explore Patients' Treatment Goals: Experience from Dermatology.

PubMed

Blome, Christine; von Usslar, Kathrin; Augustin, Matthias

2016-06-01

Qualitative interviews are used to assess understandability and content validity of patient-reported outcomes. However, the common approach of asking patients to paraphrase items may not be sufficient to completely reveal item content as understood by patients. We used qualitative interviews to elicit more detailed information about patients' understanding of treatment goal items for the Patient Benefit Index 2.0 (PBI 2.0). This questionnaire measures patient-relevant benefit from treatments for skin diseases by assessing goal importance prior to and goal attainment after treatment. We interviewed 16 patients with psoriasis, atopic dermatitis, leg ulcers, and vitiligo. Patients were asked to elaborate in detail on their understanding of 15 treatment goal items. Subsequently, they were asked to suggest changes in item wording and to name missing treatment goals. Interview transcripts were analyzed according to an adapted approach of content analysis. The task was easy for the patients to understand, and they shared detailed information on what each goal meant to them. Results of the content analysis induced a range of revisions of the PBI 2.0 items, including changes in wording (four items) and item order (two items). Four items were deleted because they were found to be redundant or irrelevant, and one item was added to the list of treatment goals. Asking patients to elaborate on their item understanding in qualitative interviews provided detailed insight into item content and understandability. This method has helped considerably to improve feasibility and content validity of the PBI 2.0.

Bernese motive and goal inventory in exercise and sport: Validation of an updated version of the questionnaire.

PubMed

Schmid, Julia; Gut, Vanessa; Conzelmann, Achim; Sudeck, Gorden

2018-01-01

Target group-specific intervention strategies are often called for in order to effectively promote exercise and sport. Currently, motives and goals are rarely included systematically in the design of interventions, despite the key role they play in well-being and adherence to exercise. The Bernese motive and goal inventory (BMZI) allows an individual diagnosis of motives and goals in exercise and sport in people in middle adulthood. The purpose of the present study was to elaborate on the original BMZI and to modify the questionnaire in order to improve its psychometric properties. The study is based on data from two samples (sample A: 448 employees of companies and authorities; sample B: 853 patients of a medical rehabilitation programme). We applied confirmatory factor analysis and exploratory structural equation modelling. Overall, both the original and the updated BMZI had an acceptable to good validity and a good reliability. However, the revised questionnaire had slightly better reliability. The updated BMZI consists of 23 items and covers the following motives and goals: Body/Appearance, Contact, Competition/Performance, Aesthetics, Distraction/Catharsis, Fitness and Health. It is recommended as an economical inventory for the individual diagnosis of important psychological conditions for exercise and sport.

The BioDyn facility on ISS: Advancing biomaterial production in microgravity for commercial applications

NASA Astrophysics Data System (ADS)

Myers, Niki; Wessling, Francis; Deuser, Mark; Anderson, C. D.; Lewis, Marian

1999-01-01

The primary goals of the BioDyn program are to foster use of the microgravity environment for commercial production of bio-materials from cells, and to develop services and processes for obtaining these materials through space processing. The scope of products includes commercial bio-molecules such as cytokines, other cell growth regulatory proteins, hormones, monoclonal antibodies and enzymes; transplantable cells or tissues which can be improved by low-G processes, or which cannot be obtained through standard processes in earth gravity; agriculture biotechnology products from plant cells; microencapsulation for diabetes treatment; and factors regulating cellular aging. To facilitate BioDyn's commercial science driven goals, hardware designed for ISS incorporates the flexibility for interchange between the different ISS facilities including the glovebox, various thermal units and centrifuges. By providing a permanent research facility, ISS is the critical space-based platform required by scientists for carrying out the long-term experiments necessary for developing bio-molecules and tissues using several cell culture modalities including suspension and anchorage-dependent cell types.

Response to intervention: are the Emperor's clothes really new?

PubMed

Carreker, Suzanne; Malatesha Joshi, R

2010-11-01

With the reauthorization of the Individuals with Disabilities Education Act in 2004, Response to Intervention (RTI) was officially introduced. Unlike the discrepancy model, which determines eligibility in special education with a discrepancy between achievement and ability, RTI was designed to provide intensive instruction to students in the general classroom as soon as difficulties in acquiring requisite reading skills are detected. The proposed goals of RTI include the improvement of reading achievement and the identification of students with learning disabilities (LD). Although RTI holds promise for the former goal when certain conditions are met, the latter goal is more elusive. The Component Model of Reading (CMR) is described in the current paper as an alternative to the discrepancy model and RTI. CMR, which consists of three domains, evaluates a poor reader's performance multidimensionally, so the most appropriate instruction for the reader can be designed to ensure reading success. Empirical evidence of CMR is presented.

Who are the PDCO?

PubMed

Dempsey, E M; Connolly, K

2014-02-01

In January 2007, the Paediatric Regulation entered into force and established the Paediatric Committee (PDCO) within the European Medicines Agency. The goal of the PDCO is to improve the health of the children of Europe by increasing high-quality research for medicinal products and promoting the development and authorization of such medicines at the EU level. A major function of the PDCO is to formulate and authorize Paediatric Investigation Plans and Paediatric Use Marketing Authorisations. The EU's Seventh Framework Programme for Research has facilitated the establishment of consortia whose ultimate goal is to answer important clinical questions involving medicines commonly used "off-label", in children. The benefits of these consortia include enhanced collaboration amongst paediatricians, scientists and small to medium enterprises whose ultimate goal is to obtain an authorization for a new indication or formulation for use in the paediatric population. It will be interesting in a number of years time to measure the success of this very important European initiative.

Is Decoupling GDP Growth from Environmental Impact Possible?

PubMed

Ward, James D; Sutton, Paul C; Werner, Adrian D; Costanza, Robert; Mohr, Steve H; Simmons, Craig T

2016-01-01

The argument that human society can decouple economic growth-defined as growth in Gross Domestic Product (GDP)-from growth in environmental impacts is appealing. If such decoupling is possible, it means that GDP growth is a sustainable societal goal. Here we show that the decoupling concept can be interpreted using an easily understood model of economic growth and environmental impact. The simple model is compared to historical data and modelled projections to demonstrate that growth in GDP ultimately cannot be decoupled from growth in material and energy use. It is therefore misleading to develop growth-oriented policy around the expectation that decoupling is possible. We also note that GDP is increasingly seen as a poor proxy for societal wellbeing. GDP growth is therefore a questionable societal goal. Society can sustainably improve wellbeing, including the wellbeing of its natural assets, but only by discarding GDP growth as the goal in favor of more comprehensive measures of societal wellbeing.

The impact of goal setting and goal orientation on performance during a clerkship surgical skills training program.

PubMed

Gardner, Aimee K; Diesen, Diana L; Hogg, Deborah; Huerta, Sergio

2016-02-01

The purpose of this study was to integrate relevant goal-setting theory and to identify if trainees' goal orientations have an impact on the assigned goals-performance relationship. Trainees attended 1 of the 3 goal-training activities (do your best, performance, or learning goals) for knot tying (KT) and camera navigation (CN) during the 3rd-year clerkship rotation. Questionnaires and pretests and/or post-tests were completed. One twenty-seven 3rd-year medical students (age: 25 ± 2.6; 54% women) participated in the training program. Pretraining to post-training performance changes were significant for all groups on both tasks (P < .01), but the increase was significantly greater (P < .01) for the learning goals group (do your best: KTΔ = 2.14, CNΔ = 1.69; performance: KTΔ = 2.49, CNΔ = 2.24; learning: KTΔ = 3.04 CNΔ = 2.76). Correlations between goal orientations and improvement were examined, revealing a unique role of goal orientation for performance improvement. These data indicate that consideration of goal type and trainee goal orientation must be considered during curriculum development to maximize educational value. Copyright © 2016 Elsevier Inc. All rights reserved.

Early Childhood Education in Pakistan: An International Slogan Waiting for National Attention

ERIC Educational Resources Information Center

Ahmad, Mumtaz

2011-01-01

The World Conference on Education for All (1990) stated that learning begins at birth. The Dakar Framework for Action (2000) included the expansion and improvement of early childhood care and education as the first of six global goals. A number of countries have launched a variety of efforts to meet their global commitment to the development of…

System for Collecting, Analyzing, and Using Information on Institutional Consumer Protection Practices: Accreditation User Guide. Improving The Consumer Protection Function in Postsecondary Education.

ERIC Educational Resources Information Center

Jung, Steven M.; And Others

This accreditation user guide describes: (1) a set of institutional conditions, policies, and practices that are potentially abusive to students, and (2) a system for collecting, analyzing, and using quantitative data on these conditions, policies, and practices. Possible uses include: (1) setting consumer protection standards and goals that…

Prescribed fire applications in Forest and Woodlands: Integration of models and field studies to guide fire use

Treesearch

Kevin C. Ryan; Eric Rigolot; Francisco C. Rego; Herminio Botelho; Jose A. Vega; Paulo M. Fernandes; Tatiana M. Sofronova

2010-01-01

Globally prescribed burning is widely used for agro-forestry, restoration, and conservation to modify species composition and stand structure. Commonly stated goals of prescribed burns include to reduce hazardous fuels, improve species’ habitat, reduce the potential for severe fires in the wildland urban interface or protect municipal watersheds. Treatments may focus...

Generation of American elm trees with tolerance to Dutch elm disease through controlled crosses and selection

Treesearch

James M. Slavicek; Kathleen S. Knight

2012-01-01

The goal of our research and development efforts is to generate new and/or improved selections of the American elm (Ulmus americana L.) with tolerance/resistance to Dutch elm disease (DED). The approaches we are taking for this effort include: 1) controlled breeding using known DED -tolerant selections, 2) controlled breeding using DED-tolerant...

Environmental Literacy Comparison between Students Taught in Eco-Schools and Ordinary Schools in the Madeira Island Region of Portugal

ERIC Educational Resources Information Center

Spinola, H.

2015-01-01

The main goal of environmental education is to improve environmental literacy, including not just more knowledge but also a better attitude toward the environment and a higher prevalence of pro-environmental behaviours. The Eco-School Program is considered the world largest environmental education program for schools, but it keeps growing without…

Education That Works: An Action Plan for the Education of Minorities. Report Summary.

ERIC Educational Resources Information Center

Massachusetts Inst. of Technology, Cambridge. Quality Education for Minorities Project.

This report summarizes the major points of a plan for improving the education of minority students in the United States. The following sections are included in this report: (1) "A Common Future"; (2) "A New Foundation"; (3) "Where We Start"; (4) "Our Goals for the Year 2000"; (5) "Recommended Strategies for Achieving Quality Education for…

National Forum on Building Relationships for Educational Excellence in Corrections Proceedings (Crystal City, Virginia, October 22-23, 1984).

ERIC Educational Resources Information Center

Office of Vocational and Adult Education (ED), Washington, DC.

This document contains the proceedings of an annual conference of corrections officials who gathered in order to build relationships for improving correctional education. Papers in the document include the following: (1) opening general session remarks and conference goals by John K. Wu, Deputy Assistant Secretary, Office of Vocational and Adult…

The conferences for undergraduate women in physics

NASA Astrophysics Data System (ADS)

Blessing, Susan K.

2015-12-01

The American Physical Society Conferences for Undergraduate Women in Physics are the continuation of a grassroots collaborative effort that began in 2006. The goals of the conferences are to increase retention and improve career outcomes of undergraduate women in physics. I describe the conferences, including organization and participant response, and encourage other countries to host similar programs for their undergraduate women.

Impact of Explicit Vocabulary Instruction on Writing Achievement of Upper-Intermediate EFL Learners

ERIC Educational Resources Information Center

Solati-Dehkordi, Seyed Amir; Salehi, Hadi

2016-01-01

Studying explicit vocabulary instruction effects on improving L2 learners' writing skill and their short and long-term retention is the purpose of the present study. To achieve the mentioned goal, a fill-in-the-blank test including 36 single words and 60 lexical phrases were administrated to 30 female upper-intermediate EFL learners. The EFL…

How Are School Leaders and Teachers Allocating Their Time in the Intensive Partnership Sites? Working Paper WR-1041-1-BMGF

ERIC Educational Resources Information Center

Chambers, Jay; de los Reyes, Iliana Brodziak; Wang, Antonia; O'Neil, Caitlin

2014-01-01

The goal of the Intensive Partnership (IP) initiative is to improve student success by transforming how teachers are recruited, developed, assigned, rewarded, and retained. RAND and American Institutes for Research (AIR) have been studying the seven IP sites (including three districts and four charter management organizations--CMOs) since the…

Listening to Early Career Teachers: How Can Elementary Mathematics Methods Courses Better Prepare Them to Utilize Standards-Based Practices in Their Classrooms?

ERIC Educational Resources Information Center

Coester, Lee Anne

2010-01-01

This study was designed to gather input from early career elementary teachers with the goal of finding ways to improve elementary mathematics methods courses. Multiple areas were explored including the degree to which respondents' elementary mathematics methods course focused on the NCTM Process Standards, the teachers' current standards-based…

Raise Your Child's Social IQ: Stepping Stones to People Skills for Kids.

ERIC Educational Resources Information Center

Cohen, Cathi

Noting that children with poor peer relationships are at risk for later problems and that social skills can improve with coaching, this book shows parents how they can teach their children a variety of social skills. The book is divided into 10 chapters, each addressing a particular skill or set of skills. Each chapter includes goals that equip…

Reading Fluency and Students with Reading Disabilities: How Fast Is Fast Enough to Promote Reading Comprehension?

ERIC Educational Resources Information Center

O'Connor, Rollanda E.

2018-01-01

The goal of improving reading rate and fluency is to positively impact reading comprehension; however, it is unclear how fast students with learning disabilities (LD) need to read to reap this benefit. The purpose of this research was to identify the point of diminishing return for students who were dysfluent readers. Participants included 337…

Word Watcher's Handbook, Including a Deletionary of the Most Abused and Misused Words.

ERIC Educational Resources Information Center

Martin, Phyllis

The goal of this handbook of English usage and pronunciation is to save the job seeker from possible rejection, to improve the job holder's chances for promotion, to inspire the student to master the language, and to help everyone to avoid making errors in everyday conversation. Part one of the volume provides a "deletionary," a listing of words…

William H. Taft High School Project HOLA 1984-1985. O.E.A. Evaluation Report.

ERIC Educational Resources Information Center

New York City Board of Education, Brooklyn. Office of Educational Assessment.

In 1984-85, Project HOLA was in its second year of funding at William H. Taft High School in the Bronx, New York. HOLA serves Spanish-speaking students of limited English proficiency (LEP). Project goals include speedy acquisition of English skills, orientation to life in America, maintenance and improvement of Spanish skills and cultural…

Into Adolescence: Actions for Wellpower. A Curriculum for Grades 5-8. Contemporary Health Series.

ERIC Educational Resources Information Center

Waters, Mae; Hocker, Anita

This module on wellness includes eight lessons, and is oriented toward middle school students in grades 5-8. Students choose partners to support them in achieving their goals for improving health in several areas. In lesson 1, health and wellness are defined. Students are introduced to a wellness continuum and the physical, mental/emotional, and…

Setting the Direction: The Role of the Principal in Developing an Effective, Inclusive School

ERIC Educational Resources Information Center

Waldron, Nancy L.; McLeskey, James; Redd, Lacy

2011-01-01

Many schools are currently faced with the difficult task of including increasing numbers of students with disabilities and improving academic outcomes for these and other students who struggle to learn academic content. Recent research has shown that the principal is the key to ensuring that a school meets both of these goals and is both inclusive…

Quantum Engineering of States in Heterostructure-based Detectors for Enhance Performance

DTIC Science & Technology

2017-05-26

excited carrier contribution in these heterostructure- based photodetectors has been reduced by using phonon-assisted transitions to design structures ...experimental investigations of nanostructure- based electronic and optoelectronic structures with the goal of facilitating major improvements in the performance...nanostructures. Quantum engineering of nano- structures is emphasized. Related quantum- based structures – including those with spontaneous polarizations are

Identification of Priority Forests in the Upper Mississippi River System: A Summary

Treesearch

Jason Rohweder; Theresa Heyer; Samuel Osinde; Darrell Zastrow; Steve Westin; Al Todd

2007-01-01

The goal of the Upper Mississippi Forest Partnership is to improve water quality and migratory bird habitat by restoring and enhancing forests in the six-state watershed. This document summarizes the results of a GIS analysis that identified forests where allocation of resources would make the most difference. Also included in this document are case studies that...

The Role of the Dorsal Anterior Cingulate in Evaluating Behavior for Achieving Gains and Avoiding Losses

ERIC Educational Resources Information Center

Magno, Elena; Simoes-Franklin, Cristina; Robertson, Ian H.; Garavan, Hugh

2009-01-01

Effective goal-directed behavior relies on a network of regions including anterior cingulate cortex and ventral striatum to learn from negative outcomes in order to improve performance. We employed fMRI to determine if this frontal-striatal system is also involved in instances of behavior that do not presume negative circumstances. Participants…

Career Development Partnership. A Program Linking Parents, Students, Schools. A Guide to Implementation.

ERIC Educational Resources Information Center

Myers, Edward J.; And Others

A program was developed for parent involvement in career education of students at the elementary, junior high, and senior high levels. The goal of the program is to make parents aware of the important role they play in the career development processes of their children. Topics dealt with include the following: (1) improvement of communication…

Inlet Flow Control and Prediction Technologies for Embedded Propulsion Systems

NASA Technical Reports Server (NTRS)

McMillan, Michelle L.; Mackie, Scott A.; Gissen, Abe; Vukasinovic, Bojan; Lakebrink, Matthew T.; Glezer, Ari; Mani, Mori; Mace, James L.

2011-01-01

Fail-safe, hybrid, flow control (HFC) is a promising technology for meeting high-speed cruise efficiency, low-noise signature, and reduced fuel-burn goals for future, Hybrid-Wing-Body (HWB) aircraft with embedded engines. This report details the development of HFC technology that enables improved inlet performance in HWB vehicles with highly integrated inlets and embedded engines without adversely affecting vehicle performance. In addition, new test techniques for evaluating Boundary-Layer-Ingesting (BLI)-inlet flow-control technologies developed and demonstrated through this program are documented, including the ability to generate a BLI-like inlet-entrance flow in a direct-connect, wind-tunnel facility, as well as, the use of D-optimal, statistically designed experiments to optimize test efficiency and enable interpretation of results. Validated improvements in numerical analysis tools and methods accomplished through this program are also documented, including Reynolds-Averaged Navier-Stokes CFD simulations of steady-state flow physics for baseline, BLI-inlet diffuser flow, as well as, that created by flow-control devices. Finally, numerical methods were employed in a ground-breaking attempt to directly simulate dynamic distortion. The advances in inlet technologies and prediction tools will help to meet and exceed "N+2" project goals for future HWB aircraft.

[The new Blood Law and new principles of transfusion therapy].

PubMed

Takahashi, Koki

2005-01-01

The new Blood Law for Self-sufficiency, Stable Supply of Safe Blood Products and Other Transfusion-related Rules was enacted in July 2003. In terms of the safety of blood products, improvement of screening tests and the introduction of the viral nucleic acid amplification test to shorten the so-called window period have markedly reduced the incidence of blood-borne virus transmission, although they cannot completely protect against transfusion-associated adverse reactions. Even with increasing blood safety, there remains an iatrogenic risk of ABO-mismatched transfusions without proper management systems and standard operation procedures. Fresh frozen plasma and plasma derivatives have been and continue to be used much more in Japan compared with the international standard. As a result, the shortage of domestic blood products remains an obstacle to achieving self-sufficiency. The goal of the new law is to provide safe transfusion therapy and achieve self-sufficiency in all blood products including plasma derivatives such as albumin solutions. To reach this goal medical professionals should recognize the necessity for safe and appropriate transfusions and establish new principles for improved transfusion therapy, including standard indications, safe operation procedure guidelines, and a 24-hour management system in each hospital.

Challenges in Achieving Food Security in India

PubMed Central

Upadhyay, R Prakash; Palanivel, C

2011-01-01

First Millennium Development Goal states the target of “Halving hunger by 2015”. Sadly, the recent statistics for India present a very gloomy picture. India currently has the largest number of undernourished people in the world and this is in spite of the fact that it has made substantial progress in health determinants over the past decades and ranks second worldwide in farm output. The causes of existing food insecurity can be better viewed under three concepts namely the: ‘traditional concept’ which includes factors such as unavailability of food and poor purchasing capacity; ‘socio-demographic concept’ which includes illiteracy, unemployment, overcrowding, poor environmental conditions and gender bias; ‘politico-developmental concept’ comprising of factors such as lack of intersectoral coordination and political will, poorly monitored nutritional programmes and inadequate public food distribution system. If the Millennium Development Goal is to be achieved by 2015, efforts to improve food and nutrition security have to increase considerably. Priority has to be assigned to agriculture and rural development along with promoting women empowerment, ensuring sustainable employment and improving environmental conditions (water, sanitation and hygiene). As the problem is multi-factorial, so the solution needs to be multi-sectoral. PMID:23113100

Developing a Continuous Quality Improvement Assessment Using a Patient-Centered Approach in Optimizing Systemic Lupus Erythematosus Disease Control.

PubMed

Updyke, Katelyn Mariko; Urso, Brittany; Beg, Shazia; Solomon, James

2017-10-09

Systemic lupus erythematosus (SLE) is a multi-organ, autoimmune disease in which patients lose self-tolerance and develop immune complexes which deposit systemically causing multi-organ damage and inflammation. Patients often experience unpredictable flares of symptoms with poorly identified triggers. Literature suggests exogenous exposures may contribute to flares in symptoms. An online pilot survey was marketed globally through social media to self-reported SLE patients with the goal to identify specific subpopulations who are susceptible to disease state changes based on analyzed exogenous factors. The pilot survey was promoted for two weeks, 80 respondents fully completed the survey and were included in statistical analysis. Descriptive statistical analysis was performed on de-identified patient surveys and compared to previous literature studies reporting known or theorized triggers in the SLE disease state. The pilot survey identified similar exogenous triggers compared to previous literature, including antibiotics, increasing beef intake, and metal implants. The goal of the pilot survey is to utilize similar questions to develop a detailed internet-based patient interactive form that can be edited and time stamped as a method to promote continuous quality improvement assessments. The ultimate objective of the platform is to interact with SLE patients from across the globe longitudinally to optimize disease control and improve quality of care by allowing them to avoid harmful triggers.

Developing a Continuous Quality Improvement Assessment Using a Patient-Centered Approach in Optimizing Systemic Lupus Erythematosus Disease Control

PubMed Central

Urso, Brittany; Beg, Shazia; Solomon, James

2017-01-01

Systemic lupus erythematosus (SLE) is a multi-organ, autoimmune disease in which patients lose self-tolerance and develop immune complexes which deposit systemically causing multi-organ damage and inflammation. Patients often experience unpredictable flares of symptoms with poorly identified triggers. Literature suggests exogenous exposures may contribute to flares in symptoms. An online pilot survey was marketed globally through social media to self-reported SLE patients with the goal to identify specific subpopulations who are susceptible to disease state changes based on analyzed exogenous factors. The pilot survey was promoted for two weeks, 80 respondents fully completed the survey and were included in statistical analysis. Descriptive statistical analysis was performed on de-identified patient surveys and compared to previous literature studies reporting known or theorized triggers in the SLE disease state. The pilot survey identified similar exogenous triggers compared to previous literature, including antibiotics, increasing beef intake, and metal implants. The goal of the pilot survey is to utilize similar questions to develop a detailed internet-based patient interactive form that can be edited and time stamped as a method to promote continuous quality improvement assessments. The ultimate objective of the platform is to interact with SLE patients from across the globe longitudinally to optimize disease control and improve quality of care by allowing them to avoid harmful triggers. PMID:29226052

Use of Standardized Assessment Tools to Improve the Effectiveness of Palliative Care Rounds: A Quality Improvement Initiative.

PubMed

Spaner, Donna; Caraiscos, Valerie B; Muystra, Christina; Furman, Margaret Lynn; Zaltz-Dubin, Jodi; Wharton, Marilyn; Whitehead, Katherine

Optimal care for patients in the palliative care setting requires effective clinical teamwork. Communication may be challenging for health-care workers from different disciplines. Daily rounds are one way for clinical teams to share information and develop care plans for patients. The objective of this initiative was to improve the structure and process of daily palliative care rounds by incorporating the use of standardized tools and improved documentation into the meeting. We chose a quality improvement (QI) approach to address this initiative. Our aims were to increase the use of assessment tools when discussing patient care in rounds and to improve the documentation and accessibility of important information in the health record, including goals of care. This QI initiative used a preintervention and postintervention comparison of the outcome measures of interest. The initiative was tested in a palliative care unit (PCU) over a 22-month period from April 2014 to January 2016. Participants were clinical staff in the PCU. Data collected after the completion of several plan-do-study-act cycles showed increased use and incorporation of the Edmonton Symptom Assessment System and Palliative Performance Scale into patient care discussions as well as improvement in inclusion of goals of care into the patient plan of care. Our findings demonstrate that the effectiveness of daily palliative care rounds can be improved by incorporating the use of standard assessment tools and changes into the meeting structure to better focus and direct patient care discussions.

The ReACH Collaborative--improving quality home care.

PubMed

Boyce, Patricia Simino; Pace, Karen B; Lauder, Bonnie; Solomon, Debra A

2007-08-01

Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71). In summary, home health care is a significant and growing sector of the health care system that provides care to millions of vulnerable patients. There seems little doubt that home health agencies want to focus on quality of care issues and provide optimal care to home-based patients. Furthermore, there is a growing awareness of the value for adapting innovative, effective models for improving the culture of home care practice. This awareness stems from the notion that some agencies see quality improvement activities as a way for them to distinguish themselves not only to regulators and customers, but also to meet the cultural and transformational needs to remain viable in a constantly evolving and competitive health care industry.

Economic Benefits of Improved Information on Worldwide Crop Production: An Optimal Decision Model of Production and Distribution with Application to Wheat, Corn, and Soybeans

NASA Technical Reports Server (NTRS)

Andrews, J.

1977-01-01

An optimal decision model of crop production, trade, and storage was developed for use in estimating the economic consequences of improved forecasts and estimates of worldwide crop production. The model extends earlier distribution benefits models to include production effects as well. Application to improved information systems meeting the goals set in the large area crop inventory experiment (LACIE) indicates annual benefits to the United States of $200 to $250 million for wheat, $50 to $100 million for corn, and $6 to $11 million for soybeans, using conservative assumptions on expected LANDSAT system performance.

Task three: Report: STDN Antenna and preamplifier cost tradeoff study. [combinations of antennas and preamplifiers for several communication environments

NASA Technical Reports Server (NTRS)

1973-01-01

The general goal of this task, STDN Antenna and Preamplifier G/T Study, was to determine cost-effective combinations of antennas and preamplifiers for several sets of conditions for frequency, antenna elevation angle, and rain. The output of the study includes design curves and tables which indicate the best choice of antenna size and preamplifier type to provide a given G/T performance. The report indicates how to evaluate the cost effectiveness of proposed improvements to a given station. Certain parametric variations are presented to emphasize the improvement available by reducing RF losses and improving the antenna feed.

Algorithm Improvement Program Nuclide Identification Algorithm Scoring Criteria And Scoring Application - DNDO.

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

Enghauser, Michael

2015-02-01

The goal of the Domestic Nuclear Detection Office (DNDO) Algorithm Improvement Program (AIP) is to facilitate gamma-radiation detector nuclide identification algorithm development, improvement, and validation. Accordingly, scoring criteria have been developed to objectively assess the performance of nuclide identification algorithms. In addition, a Microsoft Excel spreadsheet application for automated nuclide identification scoring has been developed. This report provides an overview of the equations, nuclide weighting factors, nuclide equivalencies, and configuration weighting factors used by the application for scoring nuclide identification algorithm performance. Furthermore, this report presents a general overview of the nuclide identification algorithm scoring application including illustrative examples.

Teaching Students to Attain Annual Transition Goals Using the Take Action Goal Attainment Lessons

ERIC Educational Resources Information Center

Martin, Jodie D.; Martin, James E.; Osmani, Kimberly J.

2014-01-01

This study used the Take Action goal attainment lesson package and assistive technology to teach nine high school students with mild to moderate disabilities to attain annual transition goals. The Take Action lessons increased students' goal attainment knowledge, and this knowledge generalized to improved Plan Organizers, and slightly increased…

Automotive Stirling engine development program - Overview and status report

NASA Technical Reports Server (NTRS)

Nightingale, N. P.

1983-01-01

The current status of the automotive-Stirling-engine development program being undertaken by DOE and NASA Lewis is reviewed. The program goals and the reference-engine design are explained, and the modifications introduced to improve performance and lower manufacturing costs are discussed and illustrated, including part-power optimization; increased operating temperature (from 720 to 820 C); 45.4-kg weight reduction; elimination of Co and reduction of Cr used; and improved seals, ceramic components, and high-temperature alloys. The test program, some difficulties encountered, and results after 2042 h are summarized.

Systems Engineering Education Development(SEED)Case Study

NASA Technical Reports Server (NTRS)

Bagg, Thomas C., III; Brumfield, Mark D.; Jamison, Donald E.; Granata, Raymond L.; Casey, Carolyn A.

2003-01-01

The Systems Engineering Development Program (SEED) was initiated to help Goddard resolve a Systems Engineering skill shortage. The chronology of events and the experiences of the pilot program are outlined to describe the development of the present program. The program goals are included in order to give a focus on what the developers saw as the program drivers. Lessons learned from a pilot program were incorporated into the present program. This program is constantly learning from its past efforts and looks for continuous improvement. We list several future ideas for improvement and change.

A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery After Surgery program.

PubMed

Phan, T D; D'Souza, B; Rattray, M J; Johnston, M J; Cowie, B S

2014-11-01

There is continued controversy regarding the benefits of goal-directed fluid therapy, with earlier studies showing marked improvement in morbidity and length-of-stay that have not been replicated more recently. The aim of this study was to compare patient outcomes in elective colorectal surgery patients having goal-directed versus restrictive fluid therapy. Inclusion criteria included suitability for an Enhanced Recovery After Surgery care pathway and patients with an American Society of Anesthesiologists Physical Status score of 1 to 3. Patients were intraoperatively randomised to either restrictive or Doppler-guided goal-directed fluid therapy. The primary outcome was length-of-stay; secondary outcomes included complication rate, change in haemodynamic variables and fluid volumes. Compared to restrictive therapy, goal-directed therapy resulted in a greater volume of intraoperative fluid, 2115 (interquartile range 1350 to 2560) ml versus 1500 (1200 to 2000) ml, P=0.008, and was associated with an increase in Doppler-derived stroke volume index from beginning to end of surgery, 43.7 (16.3) to 54.2 (21.1) ml/m(2), P <0.001, in the latter group. Length-of-stay was similar, 6.5 (5 to 9) versus 6 (4 to 9) days, P=0.421. The number of patients with any complication (minor or major) was similar; 0% (30) versus 52% (26), P=0.42, or major complications, 1 (2%) versus 4 (8%), P=0.36, respectively. The increased perioperative fluid volumes and increased stroke volumes at the end of surgery in patients receiving goal-directed therapy did not translate to a significant difference in length-of-stay and we did not observe a difference in the number of patients experiencing minor or major complications.

Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients: A Randomized Clinical Trial.

PubMed

Cavalcanti, Alexandre B; Bozza, Fernando Augusto; Machado, Flavia R; Salluh, Jorge I F; Campagnucci, Valquiria Pelisser; Vendramim, Patricia; Guimaraes, Helio Penna; Normilio-Silva, Karina; Damiani, Lucas Petri; Romano, Edson; Carrara, Fernanda; Lubarino Diniz de Souza, Juliana; Silva, Aline Reis; Ramos, Grazielle Viana; Teixeira, Cassiano; Brandão da Silva, Nilton; Chang, Chung-Chou H; Angus, Derek C; Berwanger, Otavio

2016-04-12

The effectiveness of checklists, daily goal assessments, and clinician prompts as quality improvement interventions in intensive care units (ICUs) is uncertain. To determine whether a multifaceted quality improvement intervention reduces the mortality of critically ill adults. This study had 2 phases. Phase 1 was an observational study to assess baseline data on work climate, care processes, and clinical outcomes, conducted between August 2013 and March 2014 in 118 Brazilian ICUs. Phase 2 was a cluster randomized trial conducted between April and November 2014 with the same ICUs. The first 60 admissions of longer than 48 hours per ICU were enrolled in each phase. Intensive care units were randomized to a quality improvement intervention, including a daily checklist and goal setting during multidisciplinary rounds with follow-up clinician prompting for 11 care processes, or to routine care. In-hospital mortality truncated at 60 days (primary outcome) was analyzed using a random-effects logistic regression model, adjusted for patients' severity and the ICU's baseline standardized mortality ratio. Exploratory secondary outcomes included adherence to care processes, safety climate, and clinical events. A total of 6877 patients (mean age, 59.7 years; 3218 [46.8%] women) were enrolled in the baseline (observational) phase and 6761 (mean age, 59.6 years; 3098 [45.8%] women) in the randomized phase, with 3327 patients enrolled in ICUs (n = 59) assigned to the intervention group and 3434 patients in ICUs (n = 59) assigned to routine care. There was no significant difference in in-hospital mortality between the intervention group and the usual care group, with 1096 deaths (32.9%) and 1196 deaths (34.8%), respectively (odds ratio, 1.02; 95% CI, 0.82-1.26; P = .88). Among 20 prespecified secondary outcomes not adjusted for multiple comparisons, 6 were significantly improved in the intervention group (use of low tidal volumes, avoidance of heavy sedation, use of central venous catheters, use of urinary catheters, perception of team work, and perception of patient safety climate), whereas there were no significant differences between the intervention group and the control group for 14 outcomes (ICU mortality, central line-associated bloodstream infection, ventilator-associated pneumonia, urinary tract infection, mean ventilator-free days, mean ICU length of stay, mean hospital length of stay, bed elevation to ≥30°, venous thromboembolism prophylaxis, diet administration, job satisfaction, stress reduction, perception of management, and perception of working conditions). Among critically ill patients treated in ICUs in Brazil, implementation of a multifaceted quality improvement intervention with daily checklists, goal setting, and clinician prompting did not reduce in-hospital mortality. clinicaltrials.gov Identifier: NCT01785966.

The development of a patient-specific method for physiotherapy goal setting: a user-centered design.

PubMed

Stevens, Anita; Köke, Albère; van der Weijden, Trudy; Beurskens, Anna

2018-08-01

To deliver client-centered care, physiotherapists need to identify the patients' individual treatment goals. However, practical tools for involving patients in goal setting are lacking. The purpose of this study was to improve the frequently used Patient-Specific Complaints instrument in Dutch physiotherapy, and to develop it into a feasible method to improve physiotherapy goal setting. An iterative user-centered design was conducted in co-creation with the physiotherapists and patients, in three phases. Their needs and preferences were identified by means of group meetings and questionnaires. The new method was tested in several field tests in physiotherapy practices. Four main objectives for improvement were formulated: clear instructions for the administration procedure, targeted use across the physiotherapy process, client-activating communication skills, and a client-centered attitude of the physiotherapist. A theoretical goal-setting framework and elements of shared decision making were integrated into the new-called, Patient-Specific Goal-setting method, together with a practical training course. The user-centered approach resulted in a goal-setting method that is fully integrated in the physiotherapy process. The new goal-setting method contributes to a more structured approach to goal setting and enables patient participation and goal-oriented physiotherapy. Before large-scale implementation, its feasibility in physiotherapy practice needs to be investigated. Implications for rehabilitation Involving patients and physiotherapists in the development and testing of a goal-setting method, increases the likelihood of its feasibility in practice. The integration of a goal-setting method into the physiotherapy process offers the opportunity to focus more fully on the patient's goals. Patients should be informed about the aim of every step of the goal-setting process in order to increase their awareness and involvement. Training physiotherapists to use a patient-specific method for goal setting is crucial for a correct application.

First-order error budgeting for LUVOIR mission

NASA Astrophysics Data System (ADS)

Lightsey, Paul A.; Knight, J. Scott; Feinberg, Lee D.; Bolcar, Matthew R.; Shaklan, Stuart B.

2017-09-01

Future large astronomical telescopes in space will have architectures that will have complex and demanding requirements to meet the science goals. The Large UV/Optical/IR Surveyor (LUVOIR) mission concept being assessed by the NASA/Goddard Space Flight Center is expected to be 9 to 15 meters in diameter, have a segmented primary mirror and be diffraction limited at a wavelength of 500 nanometers. The optical stability is expected to be in the picometer range for minutes to hours. Architecture studies to support the NASA Science and Technology Definition teams (STDTs) are underway to evaluate systems performance improvements to meet the science goals. To help define the technology needs and assess performance, a first order error budget has been developed. Like the JWST error budget, the error budget includes the active, adaptive and passive elements in spatial and temporal domains. JWST performance is scaled using first order approximations where appropriate and includes technical advances in telescope control.

Conducted electrical weapons within healthcare: a comprehensive use of force model.

PubMed

Ho, Jeffrey D; Williams, Martin F; Coplen, Michael J

2014-01-01

Healthcare settings are experiencing increased amounts of violent activity that are challenging to the health care security profession. There is difficulty in addressing this issue completely. Some of this difficulty is because of factors that include inexperienced and untrained clinicians and administrators that are often the decision-makers in the health care setting. As part of an effective solution, we propose that a security plan, including a comprehensive use of force program incorporating conducted electrical weapons, is a necessary and best-practice goal. This paper outlines the background of the problem and discusses the challenges we encountered in reaching this goal as well as the benefits we have discovered along the way. This paper will be beneficial to any healthcare security professional that is interested in enhancing or improving their current health care security use of force model to further counter the increasing violent activity in their respective healthcare setting.

Energy Efficient Engine Flight Propulsion System Preliminary Analysis and Design Report

NASA Technical Reports Server (NTRS)

Bisset, J. W.; Howe, D. C.

1983-01-01

The final design and analysis of the flight propulsion system is presented. This system is the conceptual study engine defined to meet the performance, economic and environmental goals established for the Energy Efficient Engine Program. The design effort included a final definition of the engine, major components, internal subsystems, and nacelle. Various analytical representations and results from component technology programs are used to verify aerodynamic and structural design concepts and to predict performance. Specific design goals and specifications, reflecting future commercial aircraft propulsion system requirements for the mid-1980's, are detailed by NASA and used as guidelines during engine definition. Information is also included which details salient results from a separate study to define a turbofan propulsion system, known as the maximum efficiency engine, which reoptimized the advanced fuel saving technologies for improved fuel economy and direct operating costs relative to the flight propulsion system.

Drug Coverage Surveys for Neglected Tropical Diseases: 10 Years of Field Experience

PubMed Central

Worrell, Caitlin; Mathieu, Els

2012-01-01

Mass drug administration is one of the public health strategies recommended by the World Health Organization for the control and elimination of seven neglected tropical diseases (NTDs). Because adequate coverage is vital to achieve program goals, periodically conducting surveys to validate reported coverage to guide NTD programs is recommended. Over the past decade, the Centers for Disease Control and Prevention (CDC) and collaborators conducted more than 30 two-stage cluster household surveys across three continents. The questionnaires gathered coverage data and information relevant to improving NTD programs including NTD-related attitudes and practices. From the 37 coverage survey estimates obtained in those surveys, 73.3% indicated an over reporting of coverage, including all three that assessed school-based distributions. It took an average of 1 week to conduct a survey. Our experiences led us to conclude that coverage surveys are useful and feasible tools to ensure NTD elimination and control goals are reached. PMID:22855750

Minority University Research and Education Division (MURED) Update

NASA Technical Reports Server (NTRS)

Malone, John

2000-01-01

Program priorities include: (1) Expand and advance NASA's scientific and technological base by building on prior year's efforts in research and academic infrastructure; (2) Increase exposure to NASA's unique mission and facilities by developing closer relationships with NASA Strategic Enterprises; (3) Increase involvement in competitive peer review and merit selection processes; (4) Contribute significantly to the Agency's strategic goals and objectives; (5) Create systemic and sustainable change through partnerships and programs that enhance research and education programs; (6) Prepare faculty and students at HBCU's for NASA-related fields and increase number of students that enter and successfully complete degrees in NASA-related fields; (7) Establish measurable program goals and objectives; and (8) Improve financial management performance.

Tackling the Global Challenge: Humanitarian Catastrophes

PubMed Central

Iserson, Kenneth V.

2014-01-01

“Humanitarian catastrophes,” conflicts and calamities generating both widespread human suffering and destructive events, require a wide range of emergency resources. This paper answers a number of questions that humanitarian catastrophes generate: Why and how do the most-developed countries—those with the resources, capabilities, and willingness to help—intervene in specific types of disasters? What ethical and legal guidelines shape our interventions? How well do we achieve our goals? It then suggests a number of changes to improve humanitarian responses, including better NGO-government cooperation, increased research on the best disaster response methods, clarification of the criteria and roles for humanitarian (military) interventions, and development of post-2015 Millennium Development Goals with more accurate progress measures. PMID:24672618

Progresses and challenges of utilizing traditional birth attendants in maternal and child health in Nigeria

PubMed Central

Amutah-Onukagha, Ndidiamaka; Rodriguez, Monica; Opara, Ijeoma; Gardner, Michelle; Assan, Maame Araba; Hammond, Rodney; Plata, Jesus; Pierre, Kimberly; Farag, Ehsan

2017-01-01

Background and Objectives: Despite advances in modern healthcare, Traditional Birth Attendants (TBA) have continued to be heavily utilized in rural communities in Nigeria. Major disparities in maternal health care in Nigeria remain present despite the goal of the United Nations Millennium Development Goal to reduce maternal mortality by 2015. The objective of this study is to review the contribution of TBAs in the birthing process in Nigeria, and to examine barriers and opportunities for utilizing TBAs in improving maternal and child health outcomes in Nigeria. Methods: A literature review of two major electronic databases was conducted using the PRISMA framework to identify English language studies conducted between 2006 and 2016. Inclusion criteria included articles that examined the role of traditional birth attendants as a factor influencing maternal health in Nigeria. Results: The value of TBAs has not been fully examined as few studies have aimed to examine its potential role in reducing maternal mortality with proper training. Eight manuscripts that were examined highlighted the role of TBAs in maternal health including outcomes of utilizing trained versus non-trained TBAs. Conclusion and Global Health Implications: Specific areas of training for TBAs that were identified and recommended in review including: recognizing delivery complications, community support for TBA practices through policy, evaluation of TBA training programs and increasing collaboration between healthcare facilities and TBAs. Policies focused on improving access to health services and importantly, formal health education training to TBAs, are required to improve maternal health outcomes and underserved communities. PMID:29367889

Student Achievement Goal Setting: Using Data to Improve Teaching and Learning

ERIC Educational Resources Information Center

Stronge, James H.; Grant, Leslie W.

2009-01-01

The first book in the James H. Stronge Research-to-Practice series focuses on improving student achievement through academic goal setting. It offers the tools and plan of action to use performance data to improve instructional practice and increase student achievement. The book is divided into three parts: (1) How Student Achievement Data Can Be…

Effect of a Counseling Session Bolstered by Text Messaging on Self-Selected Health Behaviors in College Students: A Preliminary Randomized Controlled Trial.

PubMed

Sandrick, Janice; Tracy, Doreen; Eliasson, Arn; Roth, Ashley; Bartel, Jeffrey; Simko, Melanie; Bowman, Tracy; Harouse-Bell, Karen; Kashani, Mariam; Vernalis, Marina

2017-05-17

The college experience is often the first time when young adults live independently and make their own lifestyle choices. These choices affect dietary behaviors, exercise habits, techniques to deal with stress, and decisions on sleep time, all of which direct the trajectory of future health. There is a need for effective strategies that will encourage healthy lifestyle choices in young adults attending college. This preliminary randomized controlled trial tested the effect of coaching and text messages (short message service, SMS) on self-selected health behaviors in the domains of diet, exercise, stress, and sleep. A second analysis measured the ripple effect of the intervention on health behaviors not specifically selected as a goal by participants. Full-time students aged 18-30 years were recruited by word of mouth and campuswide advertisements (flyers, posters, mailings, university website) at a small university in western Pennsylvania from January to May 2015. Exclusions included pregnancy, eating disorders, chronic medical diagnoses, and prescription medications other than birth control. Of 60 participants, 30 were randomized to receive a single face-to-face meeting with a health coach to review results of behavioral questionnaires and to set a health behavior goal for the 8-week study period. The face-to-face meeting was followed by SMS text messages designed to encourage achievement of the behavioral goal. A total of 30 control subjects underwent the same health and behavioral assessments at intake and program end but did not receive coaching or SMS text messages. The texting app showed that 87.31% (2187/2505) of messages were viewed by intervention participants. Furthermore, 28 of the 30 intervention participants and all 30 control participants provided outcome data. Among intervention participants, 22 of 30 (73%) showed improvement in health behavior goal attainment, with the whole group (n=30) showing a mean improvement of 88% (95% CI 39-136). Mean improvement in any behavioral domains was not seen in the control group. Intervention participants also increased their exercise significantly compared with controls, regardless of their self-selected goal category. The increased exercise was paralleled by significantly lower fasting glucose levels. The health coaching session plus tailored SMS text messages improved self-selected health behaviors with a modest ripple effect to include unselected health behaviors. Clinicaltrials.gov NCT02476604; https://clinicaltrials.gov/ct2/show/NCT02476604 (Archived by WebCite at http://www.webcitation.org/6qAAryS5t). ©Janice Sandrick, Doreen Tracy, Arn Eliasson, Ashley Roth, Jeffrey Bartel, Melanie Simko, Tracy Bowman, Karen Harouse-Bell, Mariam Kashani, Marina Vernalis. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 17.05.2017.

[Indicators monitoring the process of specialized nutritional support. Grupo de Nutrición de la SEFH].

PubMed

Sirvent, Mariola; Victoria Calvo, María; Sagalés, María; Rodríguez-Penin, Isaura; Cervera, Mercedes; Piñeiro, Guadalupe; García-Rodicio, Sonsoles; Gomis, Pilar; Caba, Isabel; Vazquez, Amparo; Gomez, María E; Pedraza, Luis

2013-01-01

To identify and develop monitoring indicators of the process of specialized nutritional support that will allow measuring the level of adherence to the established practice standards. Those practice standards considered to be key elements of the process were selected to develop performance indicators. The construction of these indicators combined the scientific evidence with expert opinion. Key goals were identified within each standard provided that its consecution would allow increasing the achievement of the standard. Particular improvement initiatives associated to each key goal were generated. Lastly, monitoring indicators were defined allowing undertaking a follow-up of the implementation of the improvement initiatives or either to assess the level of achievement of the key goals identified. Nineteen practice standards were selected representative of the critical points of the process. The strategic map for each standard has been defined, with the identification of 43 key goals. In order to achieve these key goals, a portfolio of improvements has been generated comprising 56 actions. Finally, 44 monitoring indicators have been defined grouped into three categories: 1. Numeric: they assess the level of goal achievement; 2. Dichotomic (yes/no): they inform on the execution of the improvement actions; 3. Results of the practice audits. We have made available monitoring indicators that allow assessing the level of adherence to the practice standards of the process of specialized nutritional support and the impact of the implementation of improvement actions within this process. Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.

The feasibility of meta-cognitive strategy training in acute inpatient stroke rehabilitation: case report.

PubMed

Skidmore, Elizabeth R; Holm, Margo B; Whyte, Ellen M; Dew, Mary Amanda; Dawson, Deirdre; Becker, James T

2011-04-01

Meta-cognitive strategy training may be used to augment inpatient rehabilitation to promote active engagement and subsequent benefit for individuals with cognitive impairments after stroke. We examined the feasibility of administering a form of meta-cognitive strategy training, Cognitive Orientation to daily Occupational Performance (CO-OP), during inpatient rehabilitation. We trained an individual with cognitive impairments after right hemisphere stroke to identify performance problems, set self-selected goals, develop plans to address goals, and evaluate performance improvements. To assess feasibility, we examined the number of meta-cognitive training sessions attended, the number of self-selected goals, and changes in goal-related performance. We also examined changes in rehabilitation engagement and disability. The participant used the meta-cognitive strategy to set eight goals addressing physically oriented, instrumental, and work-related activities. Mean improvement in Canadian Occupational Performance Measure Performance Scale scores was 6.1. Pittsburgh Rehabilitation Participation Scale scores (measuring rehabilitation engagement) improved from 3.2 at admission to 4.9 at discharge. Functional Independence Measure scores (measuring disability) improved from 68 at admission, to 97 at discharge. Performance Assessment of Self-Care Skills scores improved from 1.1 at admission to 2.9 at discharge. The results indicate that meta-cognitive strategy training was feasible during inpatient rehabilitation and warrants further evaluation to determine its effectiveness.

What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial

PubMed Central

Sharma, Anjana E.; Willard-Grace, Rachel; Hessler, Danielle; Bodenheimer, Thomas; Thom, David H.

2016-01-01

PURPOSE Health coaching is effective for chronic disease self-management in the primary care safety-net setting, but little is known about the persistence of its benefits. We conducted an observational study evaluating the maintenance of improved cardiovascular risk factors following a health coaching intervention. METHODS We performed a naturalistic follow-up to the Health Coaching in Primary Care Study, a 12-month randomized controlled trial (RCT) comparing health coaching to usual care for patients with uncontrolled diabetes, hypertension, or hyperlipidemia. Participants were followed up 24 months from RCT baseline. The primary outcome was the proportion at goal for at least 1 measure (hemoglobin A1c, systolic blood pressure, or LDL cholesterol) that had been above goal at enrollment; secondary outcomes included each individual clinical goal. Chi-square tests and paired t-tests compared dichotomous and continuous measures. RESULTS 290 of 441 participants (65.8%) participated at both 12 and 24 months. The proportion of patients in the coaching arm of the RCT who achieved the primary outcome dropped only slightly from 47.1% at 12 to 45.9% at 24 months (P = .80). The proportion at goal for hemoglobin A1c dropped from 53.4% to 36.2% (P = .03). All other clinical metrics had small, nonsignificant changes between 12 and 24 months. CONCLUSIONS Results support the conclusion that most improved clinical outcomes persisted 1 year after the completion of the health coaching intervention. PMID:27184989

What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial.

PubMed

Sharma, Anjana E; Willard-Grace, Rachel; Hessler, Danielle; Bodenheimer, Thomas; Thom, David H

2016-05-01

Health coaching is effective for chronic disease self-management in the primary care safety-net setting, but little is known about the persistence of its benefits. We conducted an observational study evaluating the maintenance of improved cardiovascular risk factors following a health coaching intervention. We performed a naturalistic follow-up to the Health Coaching in Primary Care Study, a 12-month randomized controlled trial (RCT) comparing health coaching to usual care for patients with uncontrolled diabetes, hypertension, or hyperlipidemia. Participants were followed up 24 months from RCT baseline. The primary outcome was the proportion at goal for at least 1 measure (hemoglobin A1c, systolic blood pressure, or LDL cholesterol) that had been above goal at enrollment; secondary outcomes included each individual clinical goal. Chi-square tests and paired t-tests compared dichotomous and continuous measures. 290 of 441 participants (65.8%) participated at both 12 and 24 months. The proportion of patients in the coaching arm of the RCT who achieved the primary outcome dropped only slightly from 47.1% at 12 to 45.9% at 24 months (P = .80). The proportion at goal for hemoglobin A1c dropped from 53.4% to 36.2% (P = .03). All other clinical metrics had small, nonsignificant changes between 12 and 24 months. Results support the conclusion that most improved clinical outcomes persisted 1 year after the completion of the health coaching intervention. © 2016 Annals of Family Medicine, Inc.

Rehabilitation of Executive Functions in a Real-Life Setting: Goal Management Training Applied to a Person with Schizophrenia

PubMed Central

Levaux, M.-N.; Larøi, F.; Malmedier, M.; Offerlin-Meyer, I.; Danion, J.-M.; Van der Linden, M.

2012-01-01

The aim was to assess the efficacy of a modified version of Goal Management Training (GMT) in a person with schizophrenia who had difficulties in attaining the final goal for new and multitasking daily-life situations. GMT is designed to improve abilities in establishing goal-directed plans and carrying them out effectively. Beneficial effects of GMT were measured for several clinical questionnaires, laboratory tasks, and three real-life situations: meal preparation (trained, familiar); washing (nontrained, familiar); meeting preparation (nontrained, unfamiliar). The results revealed improvement in planning and on trained laboratory and meal preparation tasks and a generalization of GMT effects on nontrained laboratory and everyday tasks. Self-esteem also improved. Finally, a two-year followup indicated the durability of the beneficial effects. PMID:23094177

Can paying for results help to achieve the Millennium Development Goals? Overview of the effectiveness of results-based financing.

PubMed

Oxman, Andrew D; Fretheim, Atle

2009-05-01

Results-based financing and pay-for-performance refer to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. Results-based financing is widely advocated for achieving health goals, including the Millennium Development Goals. We undertook an overview of systematic reviews of the effectiveness of RBF. We searched the Cochrane Library, EMBASE, and MEDLINE (up to August 2007). We also searched for related articles in PubMed, checked the reference lists of retrieved articles, and contacted key informants. We included reviews with a methods section that addressed the effects of any results-based financing in the health sector targeted at patients, providers, organizations, or governments. We summarized the characteristics and findings of each review using a structured format. We found 12 systematic reviews that met our inclusion criteria. Based on the findings of these reviews, financial incentives targeting recipients of health care and individual healthcare professionals are effective in the short run for simple and distinct, well-defined behavioral goals. There is less evidence that financial incentives can sustain long-term changes. Conditional cash transfers to poor and disadvantaged groups in Latin America are effective at increasing the uptake of some preventive services. There is otherwise very limited evidence of the effects of results-based financing in low- or middle-income countries. Results-based financing can have undesirable effects, including motivating unintended behaviors, distortions (ignoring important tasks that are not rewarded with incentives), gaming (improving or cheating on reporting rather than improving performance), widening the resource gap between rich and poor, and dependency on financial incentives. There is limited evidence of the effectiveness of results-based financing and almost no evidence of the cost-effectiveness of results-based financing. Based on the available evidence and likely mechanisms through which financial incentives work, they are more likely to influence discrete individual behaviors in the short run and less likely to create sustained changes. © 2009 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Assessment, treatment goals and interventions for oedema/lymphoedema in palliative care.

PubMed

Cobbe, Sinead; Real, Shirley; Slattery, Sinead

2017-03-16

Little is known about the treatment of oedema in palliative care patients. To outline the assessment, goals, and interventions for patients with oedema. A 6-month chart review of a specialist physiotherapy-led oedema service was carried out. Of the sample group (n=63), 28.6% of patients had lymphoedema, 15.9% had non-lymphatic oedema, 46% had mixed oedema and 9.8% had lymphorrhoea; 58 patients (92%) had cancer. The most common interventions were providing education (100%, n=63), using compression garments (58%, n=37), bandaging (51%, n=32), exercise (38%, n=24), lymphatic massage and kinesio-taping (35%, n=22 each). Treatment regime differed depending on the type of oedema present. Treatment goals were pragmatic: the most common were to maintain skin quality (54%, n=34), reduce limb volume (52%, n=32), and improve quality of life (48%, n=30). Palliative care oedema can be treated using manual methods, including compression and massage. Goals differ from other oedema populations. Research is hampered by lack of suitable measures to record skin changes and quality of life.

Process evaluation results from the HEALTHY nutrition intervention to modify the total school food environment

PubMed Central

Volpe, S. L.; Hall, W. J.; Steckler, A.; Schneider, M.; Thompson, D.; Mobley, C.; Pham, T.; El ghormli, L.

2013-01-01

The process evaluation of HEALTHY, a large multi-center trial to decrease type 2 diabetes mellitus in middle school children, monitored the implementation of the intervention to ascertain the extent that components were delivered and received as intended. The purpose of this article is to report the process evaluation findings concerning the extent to which the HEALTHY nutrition intervention was implemented during the HEALTHY trial. Overall, the observed fidelity of implementing nutrition strategies improved from baseline to the end of the study. By the last semester, all but two nutrition process evaluation goals were met. The most challenging goal to implement was serving high fiber foods, including grain-based foods and legumes. The easiest goals to implement were lowering the fat content of foods offered and offering healthier beverages. The most challenging barriers experienced by research dietitians and food service staff were costs, availability of foods and student acceptance. Forming strong relationships between the research dietitians and food service staff was identified as a key strategy to meet HEALTHY nutrition goals. PMID:24107856

Building Energy Simulation Test for Existing Homes (BESTEST-EX) (Presentation)

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

Judkoff, R.; Neymark, J.; Polly, B.

2011-12-01

This presentation discusses the goals of NREL Analysis Accuracy R&D; BESTEST-EX goals; what BESTEST-EX is; how it works; 'Building Physics' cases; 'Building Physics' reference results; 'utility bill calibration' cases; limitations and potential future work. Goals of NREL Analysis Accuracy R&D are: (1) Provide industry with the tools and technical information needed to improve the accuracy and consistency of analysis methods; (2) Reduce the risks associated with purchasing, financing, and selling energy efficiency upgrades; and (3) Enhance software and input collection methods considering impacts on accuracy, cost, and time of energy assessments. BESTEST-EX Goals are: (1) Test software predictions of retrofitmore » energy savings in existing homes; (2) Ensure building physics calculations and utility bill calibration procedures perform up to a minimum standard; and (3) Quantify impact of uncertainties in input audit data and occupant behavior. BESTEST-EX is a repeatable procedure that tests how well audit software predictions compare to the current state of the art in building energy simulation. There is no direct truth standard. However, reference software have been subjected to validation testing, including comparisons with empirical data.« less

Swarm intelligence: when uncertainty meets conflict.

PubMed

Conradt, Larissa; List, Christian; Roper, Timothy J

2013-11-01

Good decision making is important for the survival and fitness of stakeholders, but decisions usually involve uncertainty and conflict. We know surprisingly little about profitable decision-making strategies in conflict situations. On the one hand, sharing decisions with others can pool information and decrease uncertainty (swarm intelligence). On the other hand, sharing decisions can hand influence to individuals whose goals conflict. Thus, when should an animal share decisions with others? Using a theoretical model, we show that, contrary to intuition, decision sharing by animals with conflicting goals often increases individual gains as well as decision accuracy. Thus, conflict-far from hampering effective decision making-can improve decision outcomes for all stakeholders, as long as they share large-scale goals. In contrast, decisions shared by animals without conflict were often surprisingly poor. The underlying mechanism is that animals with conflicting goals are less correlated in individual choice errors. These results provide a strong argument in the interest of all stakeholders for not excluding other (e.g., minority) factions from collective decisions. The observed benefits of including diverse factions among the decision makers could also be relevant to human collective decision making.

The use of a daily goals sheet to improve communication in the paediatric intensive care unit.

PubMed

Phipps, Lorri M; Thomas, Neal J

2007-10-01

To assess the impact of the implementation of a daily goals sheet upon nursing perception of communication in an academic, tertiary care paediatric intensive care unit (PICU). Prospective, longitudinal, before-and-after intervention surveys. University affiliated 12-bed PICU. Bedside nurses. A questionnaire was administered to PICU nurses addressing their perception of communication. Following this questionnaire, the use of a daily goals sheet was instituted. A second questionnaire was administered one year later. Mann-Whitney Rank Sum Test was used to compare differences of the graded outcome variables. The primary outcome was the perception of communication taken from a nursing perspective. Eighty-five percent of nurses felt the daily goals sheet led to improved communication between physicians and nurses in the PICU. All questions related to communication demonstrated a positive influence of the goals sheet, with the perception of the PICU staff working as a team reaching statistical significance (p=0.05). The perception of the care of one surgical service being attending physician directed also significantly improved after the institution of the goals sheet (p=0.04). The institution of a daily goals sheet led to an improvement in nursing perception of communication. Future studies are required to determine if this change in process has a demonstrable effect on health care outcomes of critically ill children, or whether this tool can have the same beneficial effects in other academic and non-academic PICUs.

Improving Metabolic and Cardiovascular Health at an Early Psychosis Intervention Program in Vancouver, Canada

PubMed Central

Fredrikson, Diane H.; Boyda, Heidi N.; Tse, Lurdes; Whitney, Zachary; Pattison, Mark A.; Ott, Fred J.; Hansen, Laura; Barr, Alasdair M.

2014-01-01

Psychotic disorders most commonly appear during the late teenage years and early adulthood. A focused and rapid clinical response by an integrated health team can help to improve the quality of life of the patient, leading to a better long-term prognosis. The Vancouver Coastal Health early psychosis intervention program covers a catchment area of approximately 800,000 people in the cities of Vancouver and Richmond, Canada. The program provides a multidisciplinary approach to supporting patients under the age of 30 who have recently experienced first-break psychosis. The program addresses the needs of the treatment environment, medication, and psychological therapies. A critical part of this support includes a program to specifically improve patients’ physical health. Physical health needs are addressed through a two-pronged, parallel approach. Patients receive routine metabolic health assessments during their first year in the program, where standard metabolic parameters are recorded. Based on the results of clinical interviews and laboratory tests, specific actionable interventions are recommended. The second key strategy is a program that promotes healthy lifestyle goal development. Patients work closely with occupational therapists to develop goals to improve cardiometabolic health. These programs are supported by an active research environment, where patients are able to engage in studies with a focus on improving their physical health. These studies include a longitudinal evaluation of the effects of integrated health coaching on maintaining cardiometabolic health in patients recently admitted to the program, as well as a clinical study that evaluates the effects of low versus higher metabolic risk antipsychotic drugs on central adiposity. An additional pharmacogenomic study is helping to identify genetic variants that may predict cardiometabolic changes following treatment with antipsychotic drugs. PMID:25249985

A patient centered care plan in the EHR: improving collaboration and engagement.

PubMed

Chunchu, Kavitha; Mauksch, Larry; Charles, Carol; Ross, Valerie; Pauwels, Judith

2012-09-01

Patients attempting to manage their chronic conditions require ongoing support in changing and adopting self-management behaviors. However, patient values, health goals, and action plans are not well represented in the electronic health record (EHR) impeding the ability of the team (MA and providers) to provide respectful, ongoing self-management support. We evaluated whether a team approach to using an EHR based patient centered care plan (PCCP) improved collaborative self-management planning. An experimental, prospective cohort study was conducted in a family medicine residency clinic. The experimental group included 7 physicians and a medical assistant who received 2 hr of PCCP training. The control group consisted of 7 physicians and a medical assistant. EHR charts were analyzed for evidence of 8 behavior change elements. Follow-up interviews with experimental group patients and physicians and the medical assistant assessed their experiences. We found that PCCP charts had more documented behavior change elements than control charts in all 8 domains (p < .001). Experimental group physicians valued the PCCP model and suggested ways to improve its use. Patient feedback demonstrated support for the model. A PCCP can help team members to engage patients with chronic illnesses in goal setting and action planning to support self-management. An EHR design that stores patient values, health goals, and action plans may strengthen continuity and quality of care between patients and primary care team members. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Tropospheric Airborne Meteorological Data Reporting (TAMDAR) Sensor Development

NASA Technical Reports Server (NTRS)

Daniels, Taumi S.; Tsoucalas, George; Anderson, Mark; Mulally, Daniel; Moninger, William; Mamrosh, Richard

2004-01-01

One of the recommendations of the National Aviation Weather Program Council was to expand and institutionalize the generation, dissemination, and use of automated pilot reports (PIREPS) to the full spectrum of the aviation community, including general aviation. In response to this and other similar recommendations, NASA initiated cooperative research into the development of an electronic pilot reporting capability (Daniels 2002). The ultimate goal is to develop a small low-cost sensor, collect useful meteorological observations below 25,000 ft., downlink the data in near real time, and use the data to improve weather forecasts. Primary users of the data include pilots, who are one targeted audience for the improved weather information that will result from the TAMDAR data. The weather data will be disseminated and used to improve aviation safety by providing pilots with enhanced weather situational awareness. In addition, the data will be used to improve the accuracy and timeliness of weather forecasts. Other users include air traffic controllers, flight service stations, and airline weather centers. Additionally, the meteorological data collected by TAMDAR is expected to have a significant positive impact on forecast accuracy for ground based applications.

Improving fatigue and depression in individuals with multiple sclerosis using telephone-administered physical activity counseling.

PubMed

Turner, Aaron P; Hartoonian, Narineh; Sloan, Alicia P; Benich, Marisa; Kivlahan, Daniel R; Hughes, Christina; Hughes, Abbey J; Haselkorn, Jodie K

2016-04-01

To evaluate the impact of a physical activity intervention consisting of telephone counseling with home-based monitoring to improve fatigue and depression in individuals with multiple sclerosis (MS). Single-blind randomized controlled trial. Sixty-four individuals with MS received either telephone counseling (N = 31), or self-directed physical activity education (N = 33). The education condition (EC) consisted of advice to increase physical activity and a DVD with examples of in-home exercises for multiple physical ability levels. The telephone counseling condition (TC) included EC as well as mailed graphic feedback, 6 telephone counseling sessions using principles of motivational interviewing, and telehealth home monitoring to track progress on physical activity goals. Booster sessions were provided when participants indicated they did not meet their goals. Assessment was conducted at baseline, 3-month, and 6-month follow-up. TC participants reported significantly reduced fatigue (d = -.70), reduced depression (d = -.72) and increased physical activity (d = .92) relative to EC participants. Of individuals receiving TC, 33.3% experienced clinically significant improvement in fatigue (vs. 18.2% in EC) and 53.3% experienced clinically significant improvement in depression (vs. 9.1% in EC). Improvements in physical activity mediated improvements in fatigue with a similar trend for depression. TC was highly feasible (participants completed 99.5% of schedule telephone sessions) and well tolerated (100% rated it highly successful). Telephone-based counseling with home monitoring is a promising modality to improve physical activity and treat fatigue and depression. (c) 2016 APA, all rights reserved).

A brief educational intervention to teach residents shared decision making in the intensive care unit.

PubMed

Yuen, Jacqueline K; Mehta, Sonal S; Roberts, Jordan E; Cooke, Joseph T; Reid, M Carrington

2013-05-01

Effective communication is essential for shared decision making with families of critically ill patients in the intensive care unit (ICU), yet there is limited evidence on effective strategies to teach these skills. The study's objective was to pilot test an educational intervention to teach internal medicine interns skills in discussing goals of care and treatment decisions with families of critically ill patients using the shared decision making framework. The intervention consisted of a PowerPoint online module followed by a four-hour workshop implemented at a retreat for medicine interns training at an urban, academic medical center. Participants (N=33) completed post-intervention questionnaires that included self-assessed skills learned, an open-ended question on the most important learning points from the workshop, and retrospective pre- and post-workshop comfort level with ICU communication skills. Participants rated their satisfaction with the workshop. Twenty-nine interns (88%) completed the questionnaires. Important self-assessed communication skills learned reflect key components of shared decision making, which include assessing the family's understanding of the patient's condition (endorsed by 100%) and obtaining an understanding of the patient/family's perspectives, values, and goals (100%). Interns reported significant improvement in their comfort level with ICU communication skills (pre 3.26, post 3.73 on a five-point scale, p=0.004). Overall satisfaction with the intervention was high (mean 4.45 on a five-point scale). The findings suggest that a brief intervention designed to teach residents communication skills in conducting goals of care and treatment discussions in the ICU is feasible and can improve their comfort level with these conversations.

Solar thermal program summary. Volume 1: Overview, fiscal year 1988

NASA Astrophysics Data System (ADS)

1989-02-01

The goal of the solar thermal program is to improve overall solar thermal systems performance and provide cost-effective energy options that are strategically secure and environmentally benign. Major research activities include energy collection technology, energy conversion technology, and systems and applications technology for both CR and DR systems. This research is being conducted through research laboratories in close coordination with the solar thermal industry, utilities companies, and universities. The Solar Thermal Technology Program is pursuing the development of critical components and subsystems for improved energy collection and conversion devices. This development follows two basic paths: for CR systems, critical components include stretched membrane heliostats, direct absorption receivers (DARs), and transport subsystems for molten salt heat transfer fluids. These components offer the potential for a significant reduction in system costs; and for DR systems, critical components include stretched membrane dishes, reflux receivers, and Stirling engines. These components will significantly increase system reliability and efficiency, which will reduce costs. The major thrust of the program is to provide electric power. However, there is an increasing interest in the use of concentrated solar energy for applications such as detoxifying hazardous wastes and developing high-value transportable fuels. These potential uses of highly concentrated solar energy still require additional experiments to prove concept feasibility. The program goal of economically competitive energy reduction from solar thermal systems is being cooperatively addressed by industry and government.

Health and Academic Achievement: Cumulative Effects of Health Assets on Standardized Test Scores Among Urban Youth in the United States*

PubMed Central

Ickovics, Jeannette R.; Carroll-Scott, Amy; Peters, Susan M.; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

2014-01-01

Background The Institute of Medicine (2012) concluded that we must “strengthen schools as the heart of health.” To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement, and (2) examine cumulative effects of these assets on academic achievement. Methods Participants include 940 students (grades 5 and 6) from 12 schools randomly selected from an urban district. Data include physical assessments, fitness testing, surveys, and district records. Fourteen health indicators were gathered including physical health (eg, body mass index [BMI]), health behaviors (eg, meeting recommendations for fruit/vegetable consumption), family environment (eg, family meals), and psychological well-being (eg, sleep quality). Data were collected 3-6 months prior to standardized testing. Results On average, students reported 7.1 health assets out of 14. Those with more health assets were more likely to be at goal for standardized tests (reading/writing/mathematics), and students with the most health assets were 2.2 times more likely to achieve goal compared with students with the fewest health assets (both p < .001). Conclusions Schools that utilize nontraditional instructional strategies to improve student health may also improve academic achievement, closing equity gaps in both health and academic achievement. PMID:24320151

Development of improved pyroelectric detectors; Literature survey of pyroelectric materials and their characteristics

NASA Technical Reports Server (NTRS)

Weiner, S.; Beerman, H. P.

1971-01-01

The object of this program is to improve the detectivity of the pyroelectric detector with the ultimate goal of operation at or near the temperature-noise limit. Two general areas of investigation are undertaken. The first is to improve responsivity through the use of new materials. The second is directed toward reduction of noise and will be effected with improved field effect transistor characteristics, and improved electroding of the pyroelectric material. The search for new materials has begun with a review of the literature on pyroelectric materials in several languages. The compiled data includes an extensive list of references. From this, several materials have already been selected for investigation. FETs are being obtained from various manufacturers, evaluated, and selected units will be tested with pyroelectric elements as complete detectors.

Personal and social factors that influence pro-environmental concern and behaviour: a review.

PubMed

Gifford, Robert; Nilsson, Andreas

2014-06-01

We review the personal and social influences on pro-environmental concern and behaviour, with an emphasis on recent research. The number of these influences suggests that understanding pro-environmental concern and behaviour is far more complex than previously thought. The influences are grouped into 18 personal and social factors. The personal factors include childhood experience, knowledge and education, personality and self-construal, sense of control, values, political and world views, goals, felt responsibility, cognitive biases, place attachment, age, gender and chosen activities. The social factors include religion, urban-rural differences, norms, social class, proximity to problematic environmental sites and cultural and ethnic variations We also recognize that pro-environmental behaviour often is undertaken based on none of the above influences, but because individuals have non-environmental goals such as to save money or to improve their health. Finally, environmental outcomes that are a result of these influences undoubtedly are determined by combinations of the 18 categories. Therefore, a primary goal of researchers now should be to learn more about how these many influences moderate and mediate one another to determine pro-environmental behaviour. © 2014 International Union of Psychological Science.

AMOEBA 2.0: A physics-first approach to biomolecular simulations

NASA Astrophysics Data System (ADS)

Rackers, Joshua; Ponder, Jay

The goal of the AMOEBA force field project is to use classical physics to understand and predict the nature of interactions between biological molecules. While making significant advances over the past decade, the ultimate goal of predicting binding energies with ``chemical accuracy'' remains elusive. The primary source of this inaccuracy comes from the physics of how molecules interact at short range. For example, despite AMOEBA's advanced treatment of electrostatics, the force field dramatically overpredicts the electrostatic energy of DNA stacking interactions. AMOEBA 2.0 works to correct these errors by including simple, first principles physics-based terms to account for the quantum mechanical nature of these short-range molecular interactions. We have added a charge penetration term that considerably improves the description of electrostatic interactions at short range. We are reformulating the polarization term of AMOEBA in terms of basic physics assertions. And we are reevaluating the van der Waals term to match ab initio energy decompositions. These additions and changes promise to make AMOEBA more predictive. By including more physical detail of the important short-range interactions of biological molecules, we hope to move closer to the ultimate goal of true predictive power.

The Aerosol/Cloud/Ecosystems Mission (ACE)

NASA Technical Reports Server (NTRS)

Schoeberl, Mark

2008-01-01

The goals and measurement strategy of the Aerosol/Cloud/Ecosystems Mission (ACE) are described. ACE will help to answer fundamental science questions associated with aerosols, clouds, air quality and global ocean ecosystems. Specifically, the goals of ACE are: 1) to quantify aerosol-cloud interactions and to assess the impact of aerosols on the hydrological cycle and 2) determine Ocean Carbon Cycling and other ocean biological processes. It is expected that ACE will: narrow the uncertainty in aerosol-cloud-precipitation interaction and quantify the role of aerosols in climate change; measure the ocean ecosystem changes and precisely quantify ocean carbon uptake; and, improve air quality forecasting by determining the height and type of aerosols being transported long distances. Overviews are provided of the aerosol-cloud community measurement strategy, aerosol and cloud observations over South Asia, and ocean biology research goals. Instruments used in the measurement strategy of the ACE mission are also highlighted, including: multi-beam lidar, multiwavelength high spectra resolution lidar, the ocean color instrument (ORCA)--a spectroradiometer for ocean remote sensing, dual frequency cloud radar and high- and low-frequency micron-wave radiometer. Future steps for the ACE mission include refining measurement requirements and carrying out additional instrument and payload studies.

Curriculum reform and evolution: Innovative content and processes at one US medical school.

PubMed

Fischel, Janet E; Olvet, Doreen M; Iuli, Richard J; Lu, Wei-Hsin; Chandran, Latha

2018-03-11

Curriculum reform in medical schools continues to be an ever-present and challenging activity in medical education. This paper describes one school's experiences with specific curricular innovations that were developed or adapted and targeted to meet a clear set of curricular goals during the curriculum reform process. Those goals included: (a) promoting active learning and learner engagement; (b) establishing early professional identity; and (c) developing physician competencies in an integrated and contextual manner while allowing for individualized learning experiences for the millennial student. Six specific innovations championed by the school are described in detail. These included Themes in Medical Education, Translational Pillars, Stony Brook Teaching Families, Transition Courses, Educational Continuous Quality Improvement Processes, and our Career Advising Program. Development of the ideas and design of the innovations were done by faculty and student teams. We discuss successes and ongoing challenges with these innovations which are currently in the fourth year of implementation. Our curriculum reform has emphasized the iterative process of curriculum building. Based on our experience, we discuss general and practical guidelines for curriculum innovation in its three phases: setting the stage, implementation, and monitoring for the achievement of intended goals.

Motivation related to work: A century of progress.

PubMed

Kanfer, Ruth; Frese, Michael; Johnson, Russell E

2017-03-01

Work motivation is a topic of crucial importance to the success of organizations and societies and the well-being of individuals. We organize the work motivation literature over the last century using a meta-framework that clusters theories, findings, and advances in the field according to their primary focus on (a) motives, traits, and motivation orientations (content); (b) features of the job, work role, and broader environment (context); or (c) the mechanisms and processes involved in choice and striving (process). Our integrative review reveals major achievements in the field, including more precise mapping of the psychological inputs and operations involved in motivation and broadened conceptions of the work environment. Cross-cutting trends over the last century include the primacy of goals, the importance of goal striving processes, and a more nuanced conceptualization of work motivation as a dynamic, goal-directed, resource allocation process that unfolds over the related variables of time, experience, and place. Across the field, advances in methodology and measurement have improved the match between theory and research. Ten promising directions for future research are described and field experiments are suggested as a useful means of bridging the research-practice gap. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Patient-focused goal planning process and outcome after spinal cord injury rehabilitation: quantitative and qualitative audit.

PubMed

Byrnes, Michelle; Beilby, Janet; Ray, Patricia; McLennan, Renee; Ker, John; Schug, Stephan

2012-12-01

To evaluate the process and outcome of a multidisciplinary inpatient goal planning rehabilitation programme on physical, social and psychological functioning for patients with spinal cord injury. Clinical audit: quantitative and qualitative analyses. Specialist spinal injury unit, Perth, Australia. Consecutive series of 100 newly injured spinal cord injury inpatients. MAIN MEASURE(S): The Needs Assessment Checklist (NAC), patient-focused goal planning questionnaire and goal planning progress form. The clinical audit of 100 spinal cord injured patients revealed that 547 goal planning meetings were held with 8531 goals stipulated in total. Seventy-five per cent of the goals set at the first goal planning meeting were achieved by the second meeting and the rate of goal achievements at subsequent goal planning meetings dropped to 56%. Based on quantitative analysis of physical, social and psychological functioning, the 100 spinal cord injury patients improved significantly from baseline to discharge. Furthermore, qualitative analysis revealed benefits consistently reported by spinal cord injury patients of the goal planning rehabilitation programme in improvements to their physical, social and psychological adjustment to injury. The findings of this clinical audit underpin the need for patient-focused goal planning rehabilitation programmes which are tailored to the individual's needs and involve a comprehensive multidisciplinary team.

Improving Communication About Serious Illness in Primary Care: A Review.

PubMed

Lakin, Joshua R; Block, Susan D; Billings, J Andrew; Koritsanszky, Luca A; Cunningham, Rebecca; Wichmann, Lisa; Harvey, Doreen; Lamey, Jan; Bernacki, Rachelle E

2016-09-01

The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satisfaction, and lower health care costs; however, the role of primary care clinicians in driving conversations about goals and priorities in serious illness is not well defined. To present a review of a structured search of the evidence base about communication in serious illness in primary care. MEDLINE was searched, via PubMed, on January 19, 2016, finding 911 articles; 126 articles were reviewed and selected titles were added from bibliography searches. Review of the literature informed 2 major topic areas: the role of primary care in communication about serious illness and clinician barriers and system failures that interfere with effective communication. Literature regarding the role that primary care plays in communication focused primarily on the ambiguity about whether primary care clinicians or specialists are responsible for initiating conversations, the benefits of primary care clinicians and specialists conducting conversations, and the quantity and quality of discussions. Timely and effective communication about serious illness in primary care is hampered by key clinician barriers, which include deficits in knowledge, skills, and attitudes; discomfort with prognostication; and lack of clarity about the appropriate timing and initiation of conversations. Finally, system failures in coordination, documentation, feedback, and quality improvement contribute to lack of conversations. Clinician and system barriers will challenge primary care clinicians and institutions to meet the needs of patients with serious illness. Ensuring that conversations about goals and values occur at the appropriate time for seriously ill patients will require improved training, validation, and dissemination of patient selection tools, systems for conducting and revisiting conversations, accessible documentation, and incentives for measurement, feedback, and continuous improvement.