Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs.

PubMed

Phillips, Erica; Harris, Christina; Lee, Wei Wei; Pincavage, Amber T; Ouchida, Karin; Miller, Rachel K; Chaudhry, Saima; Arora, Vineet M

2017-06-01

While there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern. The 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country. Nationwide survey. All internal medicine program directors registered with APDIM. Descriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs. Of the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year-End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff. Most internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.

Evaluating handoffs in the context of a communication framework.

PubMed

Hasan, Hani; Ali, Fadwa; Barker, Paul; Treat, Robert; Peschman, Jacob; Mohorek, Matthew; Redlich, Philip; Webb, Travis

2017-03-01

The implementation of mandated restrictions in resident duty hours has led to increased handoffs for patient care and thus more opportunities for errors during transitions of care. Much of the current handoff literature is empiric, with experts recommending the study of handoffs within an established framework. A prospective, single-institution study was conducted evaluating the process of handoffs for the care of surgical patients in the context of a published communication framework. Evaluation tools for the source, receiver, and observer were developed to identify factors impacting the handoff process, and inter-rater correlations were assessed. Data analysis was generated with Pearson/Spearman correlations and multivariate linear regressions. Rater consistency was assessed with intraclass correlations. A total of 126 handoffs were observed. Evaluations were completed by 1 observer (N = 126), 2 observers (N = 23), 2 receivers (N = 39), 1 receiver (N = 82), and 1 source (N = 78). An average (±standard deviation) service handoff included 9.2 (±4.6) patients, lasted 9.1 (±5.4) minutes, and had 4.7 (±3.4) distractions recorded by the observer. The source and receiver(s) recognized distractions in >67% of handoffs, with the most common internal and external distractions being fatigue (60% of handoffs) and extraneous staff entering/exiting the room (31%), respectively. Teams with more patients spent less time per individual patient handoff (r = -0.298; P = .001). Statistically significant intraclass correlations (P ≤ .05) were moderate between observers (r ≥ 0.4) but not receivers (r < 0.4). Intraclass correlation values between different types of raters were inconsistent (P > .05). The quality of the handoff process was affected negatively by presence of active electronic devices (β = -0.565; P = .005), number of teaching discussions (β = -0.417; P = .048), and a sense of hierarchy between source and receiver (β = -0.309; P = .002). Studying the handoff process within an established framework highlights factors that impair communication. Internal and external distractions are common during handoffs and along with the working relationship between the source and receiver impact the quality of the handoff process. This information allows further study and targeted interventions of the handoff process to improve overall effectiveness and patient safety of the handoff. Copyright © 2016 Elsevier Inc. All rights reserved.

An Improved Call Admission Control Mechanism with Prioritized Handoff Queuing Scheme for BWA Networks

NASA Astrophysics Data System (ADS)

Chowdhury, Prasun; Saha Misra, Iti

2014-10-01

Nowadays, due to increased demand for using the Broadband Wireless Access (BWA) networks in a satisfactory manner a promised Quality of Service (QoS) is required to manage the seamless transmission of the heterogeneous handoff calls. To this end, this paper proposes an improved Call Admission Control (CAC) mechanism with prioritized handoff queuing scheme that aims to reduce dropping probability of handoff calls. Handoff calls are queued when no bandwidth is available even after the allowable bandwidth degradation of the ongoing calls and get admitted into the network when an ongoing call is terminated with a higher priority than the newly originated call. An analytical Markov model for the proposed CAC mechanism is developed to analyze various performance parameters. Analytical results show that our proposed CAC with handoff queuing scheme prioritizes the handoff calls effectively and reduces dropping probability of the system by 78.57% for real-time traffic without degrading the number of failed new call attempts. This results in the increased bandwidth utilization of the network.

Use of Failure Mode and Effects Analysis to Improve Emergency Department Handoff Processes.

PubMed

Sorrentino, Patricia

2016-01-01

The purpose of this article is to describe a quality improvement process using failure mode and effects analysis (FMEA) to evaluate systems handoff communication processes, improve emergency department (ED) throughput and reduce crowding through development of a standardized handoff, and, ultimately, improve patient safety. Risk of patient harm through ineffective communication during handoff transitions is a major reason for breakdown of systems. Complexities of ED processes put patient safety at risk. An increased incidence of submitted patient safety event reports for handoff communication failures between the ED and inpatient units solidified a decision to implement the use of FMEA to identify handoff failures to mitigate patient harm through redesign. The clinical nurse specialist implemented an FMEA. Handoff failure themes were created from deidentified retrospective reviews. Weekly meetings were held over a 3-month period to identify failure modes and determine cause and effect on the process. A functional block diagram process map tool was used to illustrate handoff processes. An FMEA grid was used to list failure modes and assign a risk priority number to quantify results. Multiple areas with actionable failures were identified. A majority of causes for high-priority failure modes were specific to communications. Findings demonstrate the complexity of transition and handoff processes. The FMEA served to identify and evaluate risk of handoff failures and provide a framework for process improvement. A focus on mentoring nurses to quality handoff processes so that it becomes habitual practice is crucial to safe patient transitions. Standardizing content and hardwiring within the system are best practice. The clinical nurse specialist is prepared to provide strong leadership to drive and implement system-wide quality projects.

A Novel Process Audit for Standardized Perioperative Handoff Protocols.

PubMed

Pallekonda, Vinay; Scholl, Adam T; McKelvey, George M; Amhaz, Hassan; Essa, Deanna; Narreddy, Spurthy; Tan, Jens; Templonuevo, Mark; Ramirez, Sasha; Petrovic, Michelle A

2017-11-01

A perioperative handoff protocol provides a standardized delivery of communication during a handoff that occurs from the operating room to the postanestheisa care unit or ICU. The protocol's success is dependent, in part, on its continued proper use over time. A novel process audit was developed to help ensure that a perioperative handoff protocol is used accurately and appropriately over time. The Audit Observation Form is used for the Audit Phase of the process audit, while the Audit Averages Form is used for the Data Analysis Phase. Employing minimal resources and using quantitative methods, the process audit provides the necessary means to evaluate the proper execution of any perioperative handoff protocol. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Development, implementation and evaluation of a patient handoff tool to improve safety in orthopaedic surgery.

PubMed

Gagnier, Joel J; Derosier, Joseph M; Maratt, Joseph D; Hake, Mark E; Bagian, James P

2016-06-01

To develop, implement and test the effect of a handoff tool for orthopaedic trauma residents that reduces adverse events associated with the omission of critical information and the transfer of erroneous information. Components of this project included a literature review, resident surveys and observations, checklist development and refinement, implementation and evaluation of impact on adverse events through a chart review of a prospective cohort compared with a historical control group. Large teaching hospital. Findings of a literature review were presented to orthopaedic residents, epidemiologists, orthopaedic surgeons and patient safety experts in face-to-face meetings, during which we developed and refined the contents of a resident handoff tool. The tool was tested in an orthopaedic trauma service and its impact on adverse events was evaluated through a chart review. The handoff tool was developed and refined during the face-to-face meetings and a pilot implementation. Adverse event data were collected on 127 patients (n = 67 baseline period; n = 60 test period). A handoff tool for use by orthopaedic residents. Adverse events in patients handed off by orthopaedic trauma residents. After controlling for age, gender and comorbidities, testing resulted in fewer events per person (25-27% reduction; P < 0.10). Preliminary evidence suggests that our resident handoff tool may contribute to a decrease in adverse events in orthopaedic patients. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Face-to-face handoff: improving transfer to the pediatric intensive care unit after cardiac surgery.

PubMed

Vergales, Jeffrey; Addison, Nancy; Vendittelli, Analise; Nicholson, Evelyn; Carver, D Jeannean; Stemland, Christopher; Hoke, Tracey; Gangemi, James

2015-01-01

The goal was to develop and implement a comprehensive, primarily face-to-face handoff process that begins in the operating room and concludes at the bedside in the intensive care unit (ICU) for pediatric patients undergoing congenital heart surgery. Involving all stakeholders in the planning phase, the framework of the handoff system encompassed a combination of a formalized handoff tool, focused process steps that occurred prior to patient arrival in the ICU, and an emphasis on face-to-face communication at the conclusion of the handoff. The final process was evaluated by the use of observer checklists to examine quality metrics and timing for all patients admitted to the ICU following cardiac surgery. The process was found to improve how various providers view the efficiency of handoff, the ease of asking questions at each step, and the overall capability to improve patient care regardless of overall surgical complexity. © 2014 by the American College of Medical Quality.

Decreasing handoff-related care failures in children's hospitals.

PubMed

Bigham, Michael T; Logsdon, Tina R; Manicone, Paul E; Landrigan, Christopher P; Hayes, Leslie W; Randall, Kelly H; Grover, Purva; Collins, Susan B; Ramirez, Dana E; O'Guin, Crystal D; Williams, Catherine I; Warnick, Robin J; Sharek, Paul J

2014-08-01

Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures. Twenty-three children's hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction. Twenty-three children's hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P < .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P < .05]; clear transition of responsibility from 92% to 96% [P < .05]; and minimized interruptions and distractions from 84% to 90% [P < .05]) as did overall satisfaction with the handoff (from 55% to 70% [P < .05]). Implementation of a standardized evidence-based handoff process across 23 children's hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction. Copyright © 2014 by the American Academy of Pediatrics.

Simulation-based education with deliberate practice may improve intraoperative handoff skills: a pilot study.

PubMed

Pukenas, Erin W; Dodson, Gregory; Deal, Edward R; Gratz, Irwin; Allen, Elaine; Burden, Amanda R

2014-11-01

To examine the results of simulation-based education with deliberate practice on the acquisition of handoff skills by studying resident intraoperative handoff communication performances. Preinvention and postintervention pilot study. Simulated operating room of a university-affiliated hospital. Resident handoff performances during 27 encounters simulating elective surgery were studied. Ten residents (CA-1, CA-2, and CA-3) participated in a one-day simulation-based handoff course. Each resident repeated simulated handoffs to deliberately practice with an intraoperative handoff checklist. One year later, 7 of the 10 residents participated in simulated intraoperative handoffs. All handoffs were videotaped and later scored for accuracy by trained raters. A handoff assessment tool was used to characterize the type and frequency of communication failures. The percentage of handoff errors and omissions were compared before simulation and postsimulation-based education with deliberate practice and at one year following the course. Initially, the overall communication failure rate, defined as the percentage of handoff omissions plus errors, was 29.7%. After deliberate practice with the intraoperative handoff checklist, the communication failure rate decreased to 16.8%, and decreased further to 13.2% one year after the course. Simulation-based education using deliberate practice may result in improved intraoperative handoff communication and retention of skills at one year. Copyright © 2014 Elsevier Inc. All rights reserved.

A Delphi study to identify the core components of nurse to nurse handoff.

PubMed

O'Rourke, Jennifer; Abraham, Joanna; Riesenberg, Lee Ann; Matson, Jeff; Lopez, Karen Dunn

2018-03-08

The aim of this study was to identify the core components of nurse-nurse handoffs. Patient handoffs involve a process of passing information, responsibility and control from one caregiver to the next during care transitions. Around the globe, ineffective handoffs have serious consequences resulting in wrong treatments, delays in diagnosis, longer stays, medication errors, patient falls and patient deaths. To date, the core components of nurse-nurse handoff have not been identified. This lack of identification is a significant gap in moving towards a standardized approach for nurse-nurse handoff. Mixed methods design using the Delphi technique. From May 2016 - October 2016, using a series of iterative steps, a panel of handoff experts gave feedback on the nurse-nurse handoff core components and the content in each component to be passed from one nurse to the next during a typical unit-based shift handoff. Consensus was defined as 80% agreement or higher. After three rounds of participant review, 17 handoff experts with backgrounds in clinical nursing practice, academia and handoff research came to consensus on the core components of handoff: patient summary, action plan and nurse-nurse synthesis. This is the first study to identify the core components of nurse-nurse handoff. Subsequent testing of the core components will involve evaluating the handoff approach in a simulated and then actual patient care environment. Our long-term goal is to improve patient safety outcomes by validating an evidence-based handoff framework and handoff curriculum for pre-licensure nursing programmes that strengthen the quality of their handoff communication as they enter clinical practice. © 2018 John Wiley & Sons Ltd.

Research on nursing handoffs for medical and surgical settings: an integrative review.

PubMed

Staggers, Nancy; Blaz, Jacquelyn W

2013-02-01

To synthesize outcomes from research on handoffs to guide future computerization of the process on medical and surgical units. Handoffs can create important information gaps, omissions and errors in patient care. Authors call for the computerization of handoffs; however, a synthesis of the literature is not yet available that might guide computerization. PubMed, CINAHL, Cochrane, PsycINFO, Scopus and a handoff database from Cohen and Hilligoss. Integrative literature review. This integrative review included studies from 1980-March 2011 in peer-reviewed journals. Exclusions were studies outside medical and surgical units, handoff education and nurses' perceptions. The search strategy yielded a total of 247 references; 81 were retrieved, read and rated for relevance and research quality. A set of 30 articles met relevance criteria. Studies about handoff functions and rituals are saturated topics. Verbal handoffs serve important functions beyond information transfer and should be retained. Greater consideration is needed on analysing handoffs from a patient-centred perspective. Handoff methods should be highly tailored to nurses and their contextual needs. The current preference for bedside handoffs is not supported by available evidence. The specific handoff structure for all units may be less important than having a structure for contextually based handoffs. Research on pertinent information content for contextually based handoffs is an urgent need. Without it, handoff computerization is not likely to be successful. Researchers need to use more sophisticated experimental research designs, control for individual and unit differences and improve sampling frames. © 2012 Blackwell Publishing Ltd.

Handoffs causing patient harm: a survey of medical and surgical house staff.

PubMed

Kitch, Barrett T; Cooper, Jeffrey B; Zapol, Warren M; Marder, Jessica E; Karson, Andrew; Hutter, Matt; Campbell, Eric G

2008-10-01

Communication lapses at the time of patient handoffs are believed to be common, and yet the frequency with which patients are harmed as a result of problematic handoffs is unknown. Resident physicians were surveyed about their handoffpractices and the frequency with which they perceive problems with handoffs lead to patient harm. A survey was conducted in 2006 of all resident physicians in internal medicine and general surgery at Massachusetts General Hospital (MGH) concerning the quality and effects of handoffs during their most recent inpatient rotations. Surveys were sent to 238 eligible residents; 161 responses were obtained (response rate, 67.6%). Fifty-nine percent of residents reported that one or more patients had been harmed during their most recent clinical rotation because of problematic handoffs, and 12% reported that this harm had been major. Overall quality of handoffs was reported to be fair or poor by 31% of residents. A minority of residents (26%) reported that handoffs usually or always took place in a quiet setting, and 37% reported that one or more interruptions during the receipt of handoffs occurred either most of the time or always. Although handoffs have long been recognized as potentially hazardous, further scrutiny of handoffs has followed recent reports that handoffs are often marked by missing, incomplete, or inaccurate information and are associated with adverse events. In this study, reports of harm to patients from problematic handoffs were common among residents in internal medicine and general surgery. Many best-practice recommendations for handoffs are not observed, although the extent to which improvement of these practices could reduce patient harm is not known. MGH has recently launched a handoff-safety educational program, along with other interventions designed to improve the safety and effectiveness of handoffs, for its house staff and clinical leadership.

Comparative evaluation of the content and structure of communication using two handoff tools: implications for patient safety.

PubMed

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

2014-04-01

Handoffs vary in their structure and content, raising concerns regarding standardization. We conducted a comparative evaluation of the nature and patterns of communication on 2 functionally similar but conceptually different handoff tools: Subjective, Objective, Assessment and Plan, based on a patient problem-based format, and Handoff Intervention Tool (HAND-IT), based on a body system-based format. A nonrandomized pre-post prospective intervention study supported by audio recordings and observations of 82 resident handoffs was conducted in a medical intensive care unit. Qualitative analysis was complemented with exploratory sequential pattern analysis techniques to capture the characteristics and types of communication events (CEs) and breakdowns. Use of HAND-IT led to fewer communication breakdowns (F1,80 = 45.66: P < .0001), greater number of CEs (t40 = 4.56; P < .001), with more ideal CEs than Subjective, Objective, Assessment and Plan (t40 = 9.27; P < .001). In addition, the use of HAND-IT was characterized by more request-response CE transitions. The HAND-IT's body system-based structure afforded physicians the ability to better organize and comprehend patient information and led to an interactive and streamlined communication, with limited external input. Our results also emphasize the importance of information organization using a medical knowledge hierarchical format for fostering effective communication. Copyright © 2014 Elsevier Inc. All rights reserved.

Making good better: implementing a standardized handoff in pediatric transport.

PubMed

Weingart, Caroline; Herstich, Tracey; Baker, Pam; Garrett, M Lynne; Bird, Michael; Billock, James; Schwartz, Hamilton P; Bigham, Michael T

2013-01-01

Failures in communication lead to adverse events in healthcare. Handoffs, defined as the transfer of information, responsibility, and authority from one provider to another, have been identified as a cause of communication failure compromising patient safety. Locally, there was dissatisfaction among caregivers working on the general care and intensive care units regarding the quality of information received from the pediatric transport team for transferred patients. Using the Model for Improvement, a quality improvement team was engaged to lead this improvement effort. The team developed a standardized and scripted transport handoff process that incorporated parental input. The primary measure was provider satisfaction (reported as overall handoff score, OHS). Secondary outcomes included the use of components outlined by the Joint Commission's guidelines for safe handoff. Data were collected using a Likert-style survey and collated using Microsoft Excel. Baseline measures of OHS were 81.5 ± 19.4 (mean±SD) with an interval analysis showing no improvement (81.6±17.4, P=0.99). Further modifications were made to both education and process with an improved OHS (88.8±11.1, P<0.05). Certain specific handoff components showed the greatest improvement according to caregivers. This practical, low-cost quality-improvement project may help others improve handoff communication and provide safe, high-quality care. Copyright © 2013 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Characterizing Physician Listening Behavior During Hospitalist Handoffs using the HEAR Checklist

PubMed Central

Greenstein, Elizabeth A.; Arora, Vineet M.; Staisiunas, Paul G.; Banerjee, Stacy S.; Farnan, Jeanne M.

2015-01-01

Background The increasing fragmentation of healthcare has resulted in more patient handoffs. Many professional groups, including the Accreditation Council on Graduate Medical Education and the Society of Hospital Medicine, have made recommendations for safe and effective handoffs. Despite the two-way nature of handoff communication, the focus of these efforts has largely been on the person giving information. Objective To observe and characterize the listening behaviors of handoff receivers during hospitalist handoffs. Design Prospective observational study of shift change and service change handoffs on a non-teaching hospitalist service at a single academic tertiary care institution. Measurements The “HEAR Checklist”, a novel tool created based on review of effective listening behaviors, was used by third party observers to characterize active and passive listening behaviors and interruptions during handoffs. Results In 48 handoffs (25 shift change, 23 service change), active listening behaviors (e.g. read-back (17%), note-taking (23%), and reading own copy of the written signout (27%)) occurred less frequently than passive listening behaviors (e.g. affirmatory statements (56%) nodding (50%) and eye contact (58%)) (p<0.01). Read-back occurred only 8 times (17%). In 11 handoffs (23%) receivers took notes. Almost all (98%) handoffs were interrupted at least once, most often by side conversations, pagers going off, or clinicians arriving. Handoffs with more patients, such as service change, were associated with more interruptions (r= 0.46, p<0.01). Conclusions Using the “HEAR Checklist”, we can characterize hospitalist handoff listening behaviors. While passive listening behaviors are common, active listening behaviors that promote memory retention are rare. Handoffs are often interrupted, most commonly by side conversations. Future handoff improvement efforts should focus on augmenting listening and minimizing interruptions. PMID:23258389

Variation in printed handoff documents: Results and recommendations from a multicenter needs assessment.

PubMed

Rosenbluth, Glenn; Bale, James F; Starmer, Amy J; Spector, Nancy D; Srivastava, Rajendu; West, Daniel C; Sectish, Theodore C; Landrigan, Christopher P

2015-08-01

Handoffs of patient care are a leading root cause of medical errors. Standardized techniques exist to minimize miscommunications during verbal handoffs, but studies to guide standardization of printed handoff documents are lacking. To determine whether variability exists in the content of printed handoff documents and to identify key data elements that should be uniformly included in these documents. Pediatric hospitalist services at 9 institutions in the United States and Canada. Sample handoff documents from each institution were reviewed, and structured group interviews were conducted to understand each institution's priorities for written handoffs. An expert panel reviewed all handoff documents and structured group-interview findings, and subsequently made consensus-based recommendations for data elements that were either essential or recommended, including best overall printed handoff practices. Nine sites completed structured group interviews and submitted data. We identified substantial variation in both the structure and content of printed handoff documents. Only 4 of 23 possible data elements (17%) were uniformly present in all sites' handoff documents. The expert panel recommended the following as essential for all printed handoffs: assessment of illness severity, patient summary, action items, situation awareness and contingency plans, allergies, medications, age, weight, date of admission, and patient and hospital service identifiers. Code status and several other elements were also recommended. Wide variation exists in the content of printed handoff documents. Standardizing printed handoff documents has the potential to decrease omissions of key data during patient care transitions, which may decrease the risk of downstream medical errors. © 2015 Society of Hospital Medicine.

Establishing a conceptual framework for handoffs using communication theory.

PubMed

Mohorek, Matthew; Webb, Travis P

2015-01-01

A significant consequence of the 2003 Accreditation Council for Graduate Medical Education duty hour restrictions has been the dramatic increase in patient care handoffs. Ineffective handoffs have been identified as the third most common cause of medical error. However, research into health care handoffs lacks a unifying foundational structure. We sought to identify a conceptual framework that could be used to critically analyze handoffs. A scholarly review focusing on communication theory as a possible conceptual framework for handoffs was conducted. A PubMed search of published handoff research was also performed, and the literature was analyzed and matched to the most relevant theory for health care handoff models. The Shannon-Weaver Linear Model of Communication was identified as the most appropriate conceptual framework for health care handoffs. The Linear Model describes communication as a linear process. A source encodes a message into a signal, the signal is sent through a channel, and the signal is decoded back into a message at the destination, all in the presence of internal and external noise. The Linear Model identifies 3 separate instances in handoff communication where error occurs: the transmitter (message encoding), channel, and receiver (signal decoding). The Linear Model of Communication is a suitable conceptual framework for handoff research and provides a structured approach for describing handoff variables. We propose the Linear Model should be used as a foundation for further research into interventions to improve health care handoffs. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Changes in medical errors after implementation of a handoff program.

PubMed

Starmer, Amy J; Spector, Nancy D; Srivastava, Rajendu; West, Daniel C; Rosenbluth, Glenn; Allen, April D; Noble, Elizabeth L; Tse, Lisa L; Dalal, Anuj K; Keohane, Carol A; Lipsitz, Stuart R; Rothschild, Jeffrey M; Wien, Matthew F; Yoon, Catherine S; Zigmont, Katherine R; Wilson, Karen M; O'Toole, Jennifer K; Solan, Lauren G; Aylor, Megan; Bismilla, Zia; Coffey, Maitreya; Mahant, Sanjay; Blankenburg, Rebecca L; Destino, Lauren A; Everhart, Jennifer L; Patel, Shilpa J; Bale, James F; Spackman, Jaime B; Stevenson, Adam T; Calaman, Sharon; Cole, F Sessions; Balmer, Dorene F; Hepps, Jennifer H; Lopreiato, Joseph O; Yu, Clifton E; Sectish, Theodore C; Landrigan, Christopher P

2014-11-06

Miscommunications are a leading cause of serious medical errors. Data from multicenter studies assessing programs designed to improve handoff of information about patient care are lacking. We conducted a prospective intervention study of a resident handoff-improvement program in nine hospitals, measuring rates of medical errors, preventable adverse events, and miscommunications, as well as resident workflow. The intervention included a mnemonic to standardize oral and written handoffs, handoff and communication training, a faculty development and observation program, and a sustainability campaign. Error rates were measured through active surveillance. Handoffs were assessed by means of evaluation of printed handoff documents and audio recordings. Workflow was assessed through time-motion observations. The primary outcome had two components: medical errors and preventable adverse events. In 10,740 patient admissions, the medical-error rate decreased by 23% from the preintervention period to the postintervention period (24.5 vs. 18.8 per 100 admissions, P<0.001), and the rate of preventable adverse events decreased by 30% (4.7 vs. 3.3 events per 100 admissions, P<0.001). The rate of nonpreventable adverse events did not change significantly (3.0 and 2.8 events per 100 admissions, P=0.79). Site-level analyses showed significant error reductions at six of nine sites. Across sites, significant increases were observed in the inclusion of all prespecified key elements in written documents and oral communication during handoff (nine written and five oral elements; P<0.001 for all 14 comparisons). There were no significant changes from the preintervention period to the postintervention period in the duration of oral handoffs (2.4 and 2.5 minutes per patient, respectively; P=0.55) or in resident workflow, including patient-family contact and computer time. Implementation of the handoff program was associated with reductions in medical errors and in preventable adverse events and with improvements in communication, without a negative effect on workflow. (Funded by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, and others.).

Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle.

PubMed

Starmer, Amy J; Sectish, Theodore C; Simon, Dennis W; Keohane, Carol; McSweeney, Maireade E; Chung, Erica Y; Yoon, Catherine S; Lipsitz, Stuart R; Wassner, Ari J; Harper, Marvin B; Landrigan, Christopher P

2013-12-04

Handoff miscommunications are a leading cause of medical errors. Studies comprehensively assessing handoff improvement programs are lacking. To determine whether introduction of a multifaceted handoff program was associated with reduced rates of medical errors and preventable adverse events, fewer omissions of key data in written handoffs, improved verbal handoffs, and changes in resident-physician workflow. Prospective intervention study of 1255 patient admissions (642 before and 613 after the intervention) involving 84 resident physicians (42 before and 42 after the intervention) from July-September 2009 and November 2009-January 2010 on 2 inpatient units at Boston Children's Hospital. Resident handoff bundle, consisting of standardized communication and handoff training, a verbal mnemonic, and a new team handoff structure. On one unit, a computerized handoff tool linked to the electronic medical record was introduced. The primary outcomes were the rates of medical errors and preventable adverse events measured by daily systematic surveillance. The secondary outcomes were omissions in the printed handoff document and resident time-motion activity. Medical errors decreased from 33.8 per 100 admissions (95% CI, 27.3-40.3) to 18.3 per 100 admissions (95% CI, 14.7-21.9; P < .001), and preventable adverse events decreased from 3.3 per 100 admissions (95% CI, 1.7-4.8) to 1.5 (95% CI, 0.51-2.4) per 100 admissions (P = .04) following the intervention. There were fewer omissions of key handoff elements on printed handoff documents, especially on the unit that received the computerized handoff tool (significant reductions of omissions in 11 of 14 categories with computerized tool; significant reductions in 2 of 14 categories without computerized tool). Physicians spent a greater percentage of time in a 24-hour period at the patient bedside after the intervention (8.3%; 95% CI 7.1%-9.8%) vs 10.6% (95% CI, 9.2%-12.2%; P = .03). The average duration of verbal handoffs per patient did not change. Verbal handoffs were more likely to occur in a quiet location (33.3%; 95% CI, 14.5%-52.2% vs 67.9%; 95% CI, 50.6%-85.2%; P = .03) and private location (50.0%; 95% CI, 30%-70% vs 85.7%; 95% CI, 72.8%-98.7%; P = .007) after the intervention. Implementation of a handoff bundle was associated with a significant reduction in medical errors and preventable adverse events among hospitalized children. Improvements in verbal and written handoff processes occurred, and resident workflow did not change adversely.

Enhanced Handoff Scheme for Downlink-Uplink Asymmetric Channels in Cellular Systems

PubMed Central

2013-01-01

In the latest cellular networks, data services like SNS and UCC can create asymmetric packet generation rates over the downlink and uplink channels. This asymmetry can lead to a downlink-uplink asymmetric channel condition being experienced by cell edge users. This paper proposes a handoff scheme to cope effectively with downlink-uplink asymmetric channels. The proposed handoff scheme exploits the uplink channel quality as well as the downlink channel quality to determine the appropriate timing and direction of handoff. We first introduce downlink and uplink channel models that consider the intercell interference, to verify the downlink-uplink channel asymmetry. Based on these results, we propose an enhanced handoff scheme that exploits both the uplink and downlink channel qualities to reduce the handoff-call dropping probability and the service interruption time. The simulation results show that the proposed handoff scheme reduces the handoff-call dropping probability about 30% and increases the satisfaction of the service interruption time requirement about 7% under high-offered load, compared to conventional mobile-assisted handoff. Especially, the proposed handoff scheme is more efficient when the uplink QoS requirement is much stricter than the downlink QoS requirement or uplink channel quality is worse than downlink channel quality. PMID:24501576

Measuring content overlap during handoff communication using distributional semantics: An exploratory study.

PubMed

Abraham, Joanna; Kannampallil, Thomas G; Srinivasan, Vignesh; Galanter, William L; Tagney, Gail; Cohen, Trevor

2017-01-01

We develop and evaluate a methodological approach to measure the degree and nature of overlap in handoff communication content within and across clinical professions. This extensible, exploratory approach relies on combining techniques from conversational analysis and distributional semantics. We audio-recorded handoff communication of residents and nurses on the General Medicine floor of a large academic hospital (n=120 resident and n=120 nurse handoffs). We measured semantic similarity, a proxy for content overlap, between resident-resident and nurse-nurse communication using multiple steps: a qualitative conversational content analysis; an automated semantic similarity analysis using Reflective Random Indexing (RRI); and comparing semantic similarity generated by RRI analysis with human ratings of semantic similarity. There was significant association between the semantic similarity as computed by the RRI method and human rating (ρ=0.88). Based on the semantic similarity scores, content overlap was relatively higher for content related to patient active problems, assessment of active problems, patient-identifying information, past medical history, and medications/treatments. In contrast, content overlap was limited on content related to allergies, family-related information, code status, and anticipatory guidance. Our approach using RRI analysis provides new opportunities for characterizing the nature and degree of overlap in handoff communication. Although exploratory, this method provides a basis for identifying content that can be used for determining shared understanding across clinical professions. Additionally, this approach can inform the development of flexibly standardized handoff tools that reflect clinical content that are most appropriate for fostering shared understanding during transitions of care. Copyright © 2016 Elsevier Inc. All rights reserved.

Investigating the scope of resident patient care handoffs within neurosurgery.

PubMed

Babu, Maya A; Nahed, Brian V; Heary, Robert F

2012-01-01

Handoffs are defined as verbal and written communications during patient care transitions. With the passage of recent ACMGE work hour rules further limiting the hours interns can spend in the hospital, many fear that more handoffs will occur, putting patient safety at risk. The issue of handoffs has not been studied in the neurosurgical literature. A validated, 20-question online-survey was sent to neurosurgical residents in all 98 accredited U.S. neurosurgery programs. Survey results were analyzed using tabulations. 449 surveys were completed yielding a 56% response rate. 63% of neurosurgical residents surveyed had not received formal instruction in what constitutes an effective handoff; 24% believe there is high to moderate variability among their co-residents in terms of the quality of the handoff provided; 55% experience three or more interruptions during handoffs on average. 90% of neurosurgical residents surveyed say that handoff most often occurs in a quiet, private area and 56% report a high level of comfort for knowing the potential acute, critical issues affecting a patient when receiving a handoff. There needs to be more focused education devoted to learning effective patient-care handoffs in neurosurgical training programs. Increasingly, handing off a patient adequately and safely is becoming a required skill of residency.

Sensemaking Handoffs: Why? How? and When?

ERIC Educational Resources Information Center

Sharma, Nikhil

2010-01-01

Sensemaking tasks are challenging and typically involve collecting, organizing and understanding information. Sensemaking often involves a handoff where a subsequent recipient picks up work done by a provider. Sensemaking handoffs are very challenging because handoffs introduce discontinuity in sensemaking. This dissertation attempts to explore…

The influence of organizational factors on patient safety: Examining successful handoffs in health care.

PubMed

Richter, Jason P; McAlearney, Ann Scheck; Pennell, Michael L

2016-01-01

Although patient handoffs have been extensively studied, they continue to be problematic. Studies have shown poor handoffs are associated with increased costs, morbidity, and mortality. No prior research compared perceptions of management and clinical staff regarding handoffs. Our aims were (a) to determine whether perceptions of organizational factors that can influence patient safety are positively associated with perceptions of successful patient handoffs, (b) to identify organizational factors that have the greatest influence on perceptions of successful handoffs, and (c) to determine whether associations between perceptions of these factors and successful handoffs differ for management and clinical staff. A total of 515,637 respondents from 1,052 hospitals completed the Hospital Survey on Patient Safety Culture that assessed perceptions about organizational factors that influence patient safety. Using weighted least squares multiple regression, we tested seven organizational factors as predictors of successful handoffs. We fit three separate models using data collected from (a) all staff, (b) management only, and (c) clinical staff only. We found that perceived teamwork across units was the most significant predictor of perceived successful handoffs. Perceptions of staffing and management support for safety were also significantly associated with perceived successful handoffs for both management and clinical staff. For management respondents, perceptions of organizational learning or continuous improvement had a significant positive association with perceived successful handoffs, whereas the association was negative for clinical staff. Perceived communication openness had a significant association only among clinical staff. Hospitals should prioritize teamwork across units and strive to improve communication across the organization in efforts to improve handoffs. In addition, hospitals should ensure sufficient staffing and management support for patient safety. Different perceptions between management and clinical staff with respect to the importance of organizational learning are noteworthy and merit additional study.

Running Memory for Clinical Handoffs: A Look at Active and Passive Processing.

PubMed

Anderson-Montoya, Brittany L; Scerbo, Mark W; Ramirez, Dana E; Hubbard, Thomas W

2017-05-01

The goal of the present study was to examine the effects of domain-relevant expertise on running memory and the ability to process handoffs of information. In addition, the role of active or passive processing was examined. Currently, there is little research that addresses how individuals with different levels of expertise process information in running memory when the information is needed to perform a real-world task. Three groups of participants differing in their level of clinical expertise (novice, intermediate, and expert) performed an abstract running memory span task and two tasks resembling real-world activities, a clinical handoff task and an air traffic control (ATC) handoff task. For all tasks, list length and the amount of information to be recalled were manipulated. Regarding processing strategy, all participants used passive processing for the running memory span and ATC tasks. The novices also used passive processing for the clinical task. The experts, however, appeared to use more active processing, and the intermediates fell in between. Overall, the results indicated that individuals with clinical expertise and a developed mental model rely more on active processing of incoming information for the clinical task while individuals with little or no knowledge rely on passive processing. The results have implications about how training should be developed to aid less experienced personnel identify what information should be included in a handoff and what should not.

Interns overestimate the effectiveness of their hand-off communication.

PubMed

Chang, Vivian Y; Arora, Vineet M; Lev-Ari, Shiri; D'Arcy, Michael; Keysar, Boaz

2010-03-01

Theories from the psychology of communication may be applicable in understanding why hand-off communication is inherently problematic. The purpose of this study was to assess whether postcall pediatric interns can correctly estimate the patient care information and rationale received by on-call interns during hand-off communication. Pediatric interns at the University of Chicago were interviewed about the hand-off. Postcall interns were asked to predict what on-call interns would report as the important pieces of information communicated during the hand-off about each patient, with accompanying rationale. Postcall interns also guessed on-call interns' rating of how well the hand-offs went. Then, on-call interns were asked to list the most important pieces of information for each patient that postcall interns communicated during the hand-off, with accompanying rationale. On-call interns also rated how well the hand-offs went. Interns had access to written hand-offs during the interviews. We conducted 52 interviews, which constituted 59% of eligible interviews. Seventy-two patients were discussed. The most important piece of information about a patient was not successfully communicated 60% of the time, despite the postcall intern's believing that it was communicated. Postcall and on-call interns did not agree on the rationales provided for 60% of items. In addition, an item was more likely to be effectively communicated when it was a to-do item (65%) or an item related to anticipatory guidance (69%) compared with a knowledge item (38%). Despite the lack of agreement on content and rationale of information communicated during hand-offs, peer ratings of hand-off quality were high. Pediatric interns overestimated the effectiveness of their hand-off communication. Theories from communication psychology suggest that miscommunication is caused by egocentric thought processes and a tendency for the speaker to overestimate the receiver's understanding. This study demonstrates that systematic causes of miscommunication may play a role in hand-off quality.

Utilizing information technology to mitigate the handoff risks caused by resident work hour restrictions.

PubMed

Bernstein, Joseph; MacCourt, Duncan C; Jacob, Dan M; Mehta, Samir

2010-10-01

Resident duty hours have been restricted to 80 per week, a limitation thought to increase patient safety by allowing adequate sleep. Yet decreasing work hours increases the number of patient exchanges (so-called "handoff") at the end of shifts. WHERE ARE WE NOW?: A greater frequency of handoff leads to an increased risk of physician error. Information technology can be used to minimize that risk. WHERE DO WE NEED TO GO?: A computer-based expert system can alleviate the problems of data omissions and data overload and minimize asynchrony and asymmetry. A smart system can further prompt departing physicians for information that improves their understanding of the patient's condition. Likewise, such a system can take full advantage of multimedia; generate a study record for self-improvement; and strengthen the interaction between specialists jointly managing patients. HOW DO WE GET THERE?: There are impediments to implementation, notably requirements of the Health Insurance Portability and Accountability Act; medical-legal ramifications, and computer programming costs. Nonetheless, the use of smart systems, not to supplant physicians' rational facilities but to supplement them, promises to mitigate the risks of frequent patient handoff and advance patient care. Thus, a concerted effort to promote such smart systems on the part of the Accreditation Council for Graduate Medical Education (the source of the duty hour restrictions) and the Association of American Medical Colleges (representing medical schools and teaching hospitals) may be effective. We propose that these organizations host a contest for the best smart handoff systems and vigorously promote the winners.

Exploring Physician Perspectives of Residency Holdover Handoffs: A Qualitative Study to Understand an Increasingly Important Type of Handoff.

PubMed

Duong, Jonathan A; Jensen, Trevor P; Morduchowicz, Sasha; Mourad, Michelle; Harrison, James D; Ranji, Sumant R

2017-06-01

The term "holdover admissions" refers to patients admitted by an overnight physician and whose care is then transferred to a new primary team the next morning. Descriptions of the holdover process in internal medicine are sparse. To identify important factors affecting the quality of holdover handoffs at an internal medicine (IM) residency program and to compare them to previously identified factors for other handoffs. We undertook a qualitative study using structured focus groups and interviews. We analyzed data using qualitative content analysis. IM residents, IM program directors, and hospitalists at a large academic medical center. A nine-question open-ended interview guide. We identified 13 factors describing holdover handoffs. Five factors-physical space, standardization, task accountability, closed-loop verification, and resilience-were similar to those described in prior handoff literature in other specialties. Eight factors were new concepts that may uniquely affect the quality of the holdover handoff in IM. These included electronic health record access, redundancy, unwritten thoughts, different clinician needs, diagnostic uncertainty, anchoring, teaching, and feedback. These factors were organized into five overarching themes: physical environment, information transfer, responsibility, clinical reasoning, and education. The holdover handoff in IM is complex and has unique considerations for achieving high quality. Further exploration of safe, efficient, and educational holdover handoff practices is necessary.

"Anybody on this list that you're more worried about?" Qualitative analysis exploring the functions of questions during end of shift handoffs.

PubMed

O'Brien, Colleen M; Flanagan, Mindy E; Bergman, Alicia A; Ebright, Patricia R; Frankel, Richard M

2016-02-01

Shift change handoffs are known to be a point of vulnerability in the quality, safety and outcomes of healthcare. Despite numerous efforts to improve handoff reliability, few interventions have produced lasting change. Although the opportunity to ask questions during patient handoff has been required by some regulatory bodies, the function of questions during handoff has been less well explored and understood. To investigate questions and the functions they serve in nursing and medicine handoffs. Qualitative thematic analysis based on audio recordings of nurse-to-nurse, medical resident-to-resident and surgical intern-to-intern handoffs. Twenty-seven nurse handoff dyads and 18 medical resident and surgical intern handoff dyads at one VA Medical Center. Our analysis revealed that the vast majority of questions were asked by the Incoming Providers. Although topics varied widely, the bulk of Incoming Provider questions requested information that would best help them understand individual patient conditions and plan accordingly. Other question types sought consensus on clinical reasoning or framing and alignment between the two professionals. Handoffs are a type of socially constructed work. Questions emerge with some frequency in virtually all handoffs but not in a linear or predictable way. Instead, they arise in the moment, as necessary, and without preplanning. A checklist cannot model this process element because it is a static memory aid and questions occur in a relational context that is emergent. Studying the different functions of questions during end of shift handoffs provides insights into the interface between the technical context in which information is transferred and the social context in which meaning is created. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance.

PubMed

Gaffney, Sean; Farnan, Jeanne M; Hirsch, Kristen; McGinty, Michael; Arora, Vineet M

2016-04-01

Despite the identification of transfer of patient responsibility as a Core Entrustable Professional Activity for Entering Residency, rigorous methods to evaluate incoming residents' ability to give a verbal handoff of multiple patients are lacking. Our purpose was to implement a multi-patient, simulation-based curriculum to assess verbal handoff performance. Graduate Medical Education (GME) orientation at an urban, academic medical center. Eighty-four incoming residents from four residency programs participated in the study. The curriculum featured an online training module and a multi-patient observed simulated handoff experience (M-OSHE). Participants verbally "handed off" three mock patients of varying acuity and were evaluated by a trained "receiver" using an expert-informed, five-item checklist. Prior handoff experience in medical school was associated with higher checklist scores (23% none vs. 33% either third OR fourth year vs. 58% third AND fourth year, p = 0.021). Prior training was associated with prioritization of patients based on acuity (12% no training vs. 38% prior training, p = 0.014). All participants agreed that the M-OSHE realistically portrayed a clinical setting. The M-OSHE is a promising strategy for teaching and evaluating entering residents' ability to give verbal handoffs of multiple patients. Prior training and more handoff experience was associated with higher performance, which suggests that additional handoff training in medical school may be of benefit.

Modeling and Analysis of Hybrid Cellular/WLAN Systems with Integrated Service-Based Vertical Handoff Schemes

NASA Astrophysics Data System (ADS)

Xia, Weiwei; Shen, Lianfeng

We propose two vertical handoff schemes for cellular network and wireless local area network (WLAN) integration: integrated service-based handoff (ISH) and integrated service-based handoff with queue capabilities (ISHQ). Compared with existing handoff schemes in integrated cellular/WLAN networks, the proposed schemes consider a more comprehensive set of system characteristics such as different features of voice and data services, dynamic information about the admitted calls, user mobility and vertical handoffs in two directions. The code division multiple access (CDMA) cellular network and IEEE 802.11e WLAN are taken into account in the proposed schemes. We model the integrated networks by using multi-dimensional Markov chains and the major performance measures are derived for voice and data services. The important system parameters such as thresholds to prioritize handoff voice calls and queue sizes are optimized. Numerical results demonstrate that the proposed ISHQ scheme can maximize the utilization of overall bandwidth resources with the best quality of service (QoS) provisioning for voice and data services.

Structured patient handoff on an internal medicine ward: A cluster randomized control trial.

PubMed

Tam, Penny; Nijjar, Aman P; Fok, Mark; Little, Chris; Shingina, Alexandra; Bittman, Jesse; Raghavan, Rashmi; Khan, Nadia A

2018-01-01

The effect of a multi-faceted handoff strategy in a high volume internal medicine inpatient setting on process and patient outcomes has not been clearly established. We set out to determine if a multi-faceted handoff intervention consisting of education, standardized handoff procedures, including fixed time and location for face-to-face handoff would result in improved rates of handoff compared with usual practice. We also evaluated resident satisfaction, health resource utilization and clinical outcomes. This was a cluster randomized controlled trial in a large academic tertiary care center with 18 inpatient internal medicine ward teams from January-April 2013. We randomized nine inpatient teams to an intervention where they received an education session standardizing who and how to handoff patients, with practice and feedback from facilitators. The control group of 9 teams continued usual non-standardized handoffs. The primary process outcome was the rate of patients handed over per 1000 patient nights. Other process outcomes included perceptions of inadequate handoff by overnight physicians, resource utilization overnight and hospital length of stay. Clinical outcomes included medical errors, frequency of patients requiring higher level of care overnight, and in-hospital mortality. The intervention group demonstrated a significant increase in the rate of patients handed over to the overnight physician (62.90/1000 person-nights vs. 46.86/1000 person-nights, p = 0.002). There was no significant difference in other process outcomes except resource utilization was increased in the intervention group (26.35/1000 person-days vs. 17.57/1000 person-days, p-value = 0.01). There was no significant difference between groups in medical errors (4.8% vs. 4.1%), need for higher level of care or in hospital mortality. Limitations include a dependence of accurate record keeping by the overnight physician, the possibility of cross-contamination in the handoff process, analysis at the cluster level and an overall low number of clinical events. Implementation of a multi-faceted resident handoff intervention did not result in a significant improvement in patient safety although did improve number of patients handed off. Novel methods to improve handoff need to be explored. Registered at ClinicalTrials.gov: NCT01796756.

Assessing the implementation of a bedside service handoff on an academic hospitalist service.

PubMed

Wray, Charlie M; Arora, Vineet M; Hedeker, Donald; Meltzer, David O

2018-06-01

Inpatient service handoffs are a vulnerable transition during a patients' hospitalization. We hypothesized that performing the service handoff at the patients' bedside may be one mechanism to more efficiently transfer patient information between physicians, while further integrating the patient into their hospital care. We performed a 6-month prospective study of performing a bedside handoff (BHO) at the service transition on a non-teaching hospitalist service. On a weekly basis, transitioning hospitalists co-rounded at patient's bedsides. Post-handoff surveys assessed for completeness of handoff, communication, missed information, and adverse events. A control group who performed the handoff via email, phone or face-to-face was also surveyed. Chi-square and item-response theory (IRT) analysis assessed for differences between BHO and control groups. Narrative responses were elicited to qualitatively describe the BHO. In total, 21/31 (67%) scheduled BHOs were performed. On average, 4 out of 6 eligible patients experienced a BHO, with a total of 90 patients experiencing a BHO. Of those asked to perform the BHO, 52% stated the service transition took 31-60 min compared to 24% in the control group. Controlling for the nesting of observations within physicians, IRT analysis found that BHO respondents had statistically significant greater odds of: reporting increased patient awareness of the service handoff, more certainty in the plan for each patient, less discovery of missed information, and less time needed to learn about the patient on the first day compared to control methods. Narrative responses described a more patient-centered handoff with improved communication that was time-consuming and often logistically difficult to implement. Despite its time-intensive nature, performing the service handoff at the patient's bedside may lead to a more complete and efficient service transition. Published by Elsevier Inc.

Effect of handoff skills training for students during the medicine clerkship: a quasi-randomized study.

PubMed

Reyes, Juan A; Greenberg, Larrie; Amdur, Richard; Gehring, James; Lesky, Linda G

2016-03-01

Continuity is critical for safe patient care and its absence is associated with adverse outcomes. Continuity requires handoffs between physicians, but most published studies of educational interventions to improve handoffs have focused primarily on residents, despite interns expected to being proficient. The AAMC core entrustable activities for graduating medical students includes handoffs as a milestone, but no controlled studies with students have assessed the impact of training in handoff skills. The purpose of this study was to assess the impact of an educational intervention to improve third-year medical student handoff skills, the durability of learned skills into the fourth year, and the transfer of skills from the simulated setting to the clinical environment. Trained evaluators used standardized patient cases and an observation tool to assess verbal handoff skills immediately post intervention and during the student's fourth-year acting internship. Students were also observed doing real time sign-outs during their acting internship. Evaluators assessed untrained control students using a standardized case and performing a real-time sign-out. Intervention students mean score demonstrated improvement in handoff skills immediately after the workshop (2.6-3.8; p < 0.0001) that persisted into their fourth year acting internship when compared to baseline performance (3.9-3.5; p = 0.06) and to untrained control students (3.5 vs. 2.5; p < 0.001, d = 1.2). Intervention students evaluated in the clinical setting also scored higher than control students when assessed doing real-time handoffs (3.8 vs. 3.3; p = 0.032, d = 0.71). These findings should be useful to others considering introducing handoff teaching in the undergraduate medical curriculum in preparation for post-graduate medical training. Trial Registration Number NCT02217241.

A Real-time Spectrum Handoff Algorithm for VoIP based Cognitive Radio Networks: Design and Performance Analysis

NASA Astrophysics Data System (ADS)

Chakraborty, Tamal; Saha Misra, Iti

2016-03-01

Secondary Users (SUs) in a Cognitive Radio Network (CRN) face unpredictable interruptions in transmission due to the random arrival of Primary Users (PUs), leading to spectrum handoff or dropping instances. An efficient spectrum handoff algorithm, thus, becomes one of the indispensable components in CRN, especially for real-time communication like Voice over IP (VoIP). In this regard, this paper investigates the effects of spectrum handoff on the Quality of Service (QoS) for VoIP traffic in CRN, and proposes a real-time spectrum handoff algorithm in two phases. The first phase (VAST-VoIP based Adaptive Sensing and Transmission) adaptively varies the channel sensing and transmission durations to perform intelligent dropping decisions. The second phase (ProReact-Proactive and Reactive Handoff) deploys efficient channel selection mechanisms during spectrum handoff for resuming communication. Extensive performance analysis in analytical and simulation models confirms a decrease in spectrum handoff delay for VoIP SUs by more than 40% and 60%, compared to existing proactive and reactive algorithms, respectively and ensures a minimum 10% reduction in call-dropping probability with respect to the previous works in this domain. The effective SU transmission duration is also maximized under the proposed algorithm, thereby making it suitable for successful VoIP communication.

Warm Handoffs: a Novel Strategy to Improve End-of-Rotation Care Transitions.

PubMed

Saag, Harry S; Chen, Jingjing; Denson, Joshua L; Jones, Simon; Horwitz, Leora; Cocks, Patrick M

2018-01-01

Hospitalized medical patients undergoing transition of care by house staff teams at the end of a ward rotation are associated with an increased risk of mortality, yet best practices surrounding this transition are lacking. To assess the impact of a warm handoff protocol for end-of-rotation care transitions. A large, university-based internal medicine residency using three different training sites. PGY-2 and PGY-3 internal medicine residents. Implementation of a warm handoff protocol whereby the incoming and outgoing residents meet at the hospital to sign out in-person and jointly round at the bedside on sicker patients using a checklist. An eight-question survey completed by 60 of 99 eligible residents demonstrated that 85% of residents perceived warm handoffs to be safer for patients (p < 0.001), while 98% felt warm handoffs improved their knowledge and comfort level of patients on day 1 of an inpatient rotation (p < 0.001) as compared to prior handoff techniques. Finally, 88% felt warm handoffs were worthwhile despite requiring additional time (p < 0.001). A warm handoff protocol represents a novel strategy to potentially mitigate the known risks associated with end-of-rotation care transitions. Additional studies analyzing patient outcomes will be needed to assess the impact of this strategy.

Implementation of a standardized handoff protocol for post-operative admissions to the surgical intensive care unit.

PubMed

Mukhopadhyay, Dhriti; Wiggins-Dohlvik, Katie C; MrDutt, Mary M; Hamaker, Jeffrey S; Machen, Graham L; Davis, Matthew L; Regner, Justin L; Smith, Randall W; Ciceri, David P; Shake, Jay G

2018-01-01

The transfer of critically ill patients from the operating room (OR) to the surgical intensive care unit (SICU) involves handoffs between multiple providers. Incomplete handoffs lead to poor communication, a major contributor to sentinel events. Our aim was to determine whether handoff standardization led to improvements in caregiver involvement and communication. A prospective intervention study was designed to observe thirty one patient handoffs from OR to SICU for 49 critical parameters including caregiver presence, peri-operative details, and time required to complete key steps. Following a six month implementation period, thirty one handoffs were observed to determine improvement. A significant improvement in presence of physician providers including intensivists and surgeons was observed (p = 0.0004 and p < 0.0001, respectively). Critical details were communicated more consistently, including procedure performed (p = 0.0048), complications (p < 0.0001), difficult airways (p < 0.0001), ventilator settings (p < 0.0001) and pressor requirements (p = 0.0134). Conversely, handoff duration did not increase significantly (p = 0.22). Implementation of a standardized protocol for handoffs between OR and SICU significantly improved caregiver involvement and reduced information omission without affecting provider time commitment. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of Patient Handoff Methods on an Inpatient Teaching Service

PubMed Central

Craig, Steven R.; Smith, Hayden L.; Downen, A. Matthew; Yost, W. John

2012-01-01

Background The patient handoff process can be a highly variable and unstructured period at risk for communication errors. The morning sign-in process used by resident physicians at teaching hospitals typically involves less rigorous handoff protocols than the resident evening sign-out process. Little research has been conducted on best practices for handoffs during morning sign-in exchanges between resident physicians. Research must evaluate optimal protocols for the resident morning sign-in process. Methods Three morning handoff protocols consisting of written, electronic, and face-to-face methods were implemented over 3 study phases during an academic year. Study participants included all interns covering the internal medicine inpatient teaching service at a tertiary hospital. Study measures entailed intern survey-based interviews analyzed for failures in handoff protocols with or without missed pertinent information. Descriptive and comparative analyses examined study phase differences. Results A scheduled face-to-face handoff process had the fewest protocol deviations and demonstrated best communication of essential patient care information between cross-covering teams compared to written and electronic sign-in protocols. Conclusion Intern patient handoffs were more reliable when the sign-in protocol included scheduled face-to-face meetings. This method provided the best communication of patient care information and allowed for open exchanges of information. PMID:23267259

Developing a medical emergency team running sheet to improve clinical handoff and documentation.

PubMed

Mardegan, Karen; Heland, Melodie; Whitelock, Tifany; Millar, Robert; Jones, Daryl

2013-12-01

During medical emergency team (MET) and cardiac arrest calls, a scribe usually records events on a running sheet. There is more agreement on what data should be recorded in cardiac arrest calls than for MET calls. In addition, handoff (handover) from ward staff to the arriving MET may be variable. In a quality improvement project, a novel MET running sheet was developed to document events and therapies administered during MET calls. Key characteristics of the form were improved form layout, increased space for event documentation, and prompts to assist handoff to the arriving MET using the Identity Situation, Background, Assessment, Request (ISBAR) format. Ward nurses commonly involved in MET activation were surveyed to assess their perceptions of the new MET running sheet. Files of 100 consecutive MET calls were reviewed to assess compliance. Of 109 nurses invited to complete the survey, 103 did so (94.5% response rate). Overall, 87 (84.5%) of the 103 respondents agreed or strongly agreed that the new MET running sheet was better than the previous form for documenting MET management, and 58 (57.4%) of 101 respondents agreed or strongly agreed that it assisted handoff. The form was completed in 91 of a sample of 100 consecutive MET calls. Areas of less complete documentation included aspects of the ISBAR handover to the arriving MET and notification of the next of kin and usual clinicians at the completion of the call. The MET running sheet, tailored to the clinical events that occur during episodes of MET review, may assist handoff from ward nurses to the arriving MET and event documentation.

Message passing with queues and channels

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

Dozsa, Gabor J; Heidelberger, Philip; Kumar, Sameer

In an embodiment, a send thread receives an identifier that identifies a destination node and a pointer to data. The send thread creates a first send request in response to the receipt of the identifier and the data pointer. The send thread selects a selected channel from among a plurality of channels. The selected channel comprises a selected hand-off queue and an identification of a selected message unit. Each of the channels identifies a different message unit. The selected hand-off queue is randomly accessible. If the selected hand-off queue contains an available entry, the send thread adds the first sendmore » request to the selected hand-off queue. If the selected hand-off queue does not contain an available entry, the send thread removes a second send request from the selected hand-off queue and sends the second send request to the selected message unit.« less

The Hidden Lives of Nurses' Cognitive Artifacts.

PubMed

Blaz, Jacquelyn W; Doig, Alexa K; Cloyes, Kristin G; Staggers, Nancy

2016-09-07

Standardizing nursing handoffs at shift change is recommended to improve communication, with electronic tools as the primary approach. However, nurses continue to rely on personally created paper-based cognitive artifacts - their "paper brains" - to support handoffs, indicating a deficiency in available electronic versions. The purpose of this qualitative study was to develop a deep understanding of nurses' paper-based cognitive artifacts in the context of a cancer specialty hospital. After completing 73 hours of hospital unit field observations, 13 medical oncology nurses were purposively sampled, shadowed for a single shift and interviewed using a semi-structured technique. An interpretive descriptive study design guided analysis of the data corpus of field notes, transcribed interviews, images of nurses' paper-based cognitive artifacts, and analytic memos. Findings suggest nurses' paper brains are personal, dynamic, living objects that undergo a life cycle during each shift and evolve over the course of a nurse's career. The life cycle has four phases: Creation, Application, Reproduction, and Destruction. Evolution in a nurse's individually styled, paper brain is triggered by a change in the nurse's environment that reshapes cognitive needs. If a paper brain no longer provides cognitive support in the new environment, it is modified into (adapted) or abandoned (made extinct) for a different format that will provide the necessary support. The "hidden lives" - the life cycle and evolution - of paper brains have implications for the design of successful electronic tools to support nursing practice, including handoff. Nurses' paper brains provide cognitive support beyond the context of handoff. Information retrieval during handoff is undoubtedly an important function of nurses' paper brains, but tools designed to standardize handoff communication without accounting for cognitive needs during all phases of the paper brain life cycle or the ability to evolve with changes to those cognitive needs will be underutilized.

A systematic review of nurses' inter-shift handoff reports in acute care hospitals.

PubMed

Poletick, Eilleen B; Holly, Cheryl

An inter-shift nursing handoff report is the exchange of patient care information for evidence-based nursing and midwifery from one nurse to another, and is a universal procedure used in hospitals to promote continuity of care. The objective of this review was to appraise and synthesize the best available qualitative evidence pertaining to the nursing handoff report at the time of shift change and make recommendations that can enhance the transfer of information between and among nurses, and by extension, improve patient care. The review considered qualitative studies that drew on the experiences of nurses at the time of inter-shift nursing handoff in acute care hospitals, and included designs such as phenomenology, grounded theory, narrative analysis, action research, ethnographic or cultural studies. The search strategy sought to find both published and unpublished research papers. An initial search of the Joanna Briggs Institute for Evidence-Based Nursing and Midwifery, the Cochrane Library, and PubMed's Clinical Inquiry/Find Systematic Review database was conducted. Following this, an extensive three stage search was conducted using PubMed, CINAHL, HealthStar, ScienceDirect, Dissertation Abstracts International, DARE, PsycINFO, BioMedCentral, TRIP, Pre-CINAHL, PsycARTICLES, Psychology and Behavioural Sciences Collection, ISI Current Contents, Science.gov, Web of Science/Web of Knowledge, Scirus.com website. Included was a hand search of reference lists of identified papers to capture all pertinent material as well as a search of relevant world wide websites and search engines, such as Google Scholar and the Virginia Henderson Library of Sigma Theta Tau International. Each paper was assessed independently, by two reviewers for methodological quality prior to inclusion in the review using the critical appraisal instrument QARI (Qualitative Assessment and Review Instrument) developed by the Joanna Briggs Institute for Evidence Based Nursing and Midwifery. A total of 21 qualitative papers were included in the review of the 42 papers retrieved. Twenty-one were excluded as they did not meet the inclusion criteria. Findings were extracted and a meta-synthesis conducted using JBI-QARI. Three syntheses about the process of handoffs at the time of inter-shift nurses' reports in acute care hospitals were derived: 1) An embedded hierarchy exists that influences the conduct of inter-shift nursing handoffs; 2) Participating in inter-shift nursing handoffs are a way of becoming acculturated into the nursing unit's norms, expectations and rituals; 3) The nurse is the gatekeeper of information handed off that is used for subsequent care decisions. There is evidence to support that the current process of inter-shift nurses' reports serves several purposes in addition to transfer of information, including the development of group solidarity. It is apparent from this review that the nurse is the gatekeeper for the flow of information regarding patient care and chooses what information to impart and act upon. Multiple ways of transferring information are recommended for the inter-shift nursing handoff as a way to manage information decay or funneling and to address potential communication gaps due to in congruencies between the medical record, verbal handoff report and actual clinical condition. A consistent guideline is a prerequisite to formulating an optimal shift report given the findings of this review that the quality of information transferred is unpredictable. The guideline needs to take into consideration, not only the exchange of information, but that nurses handle patient information in personal ways. To that end, a one-page report pre-populated with patient demographics, recent vital signs, laboratory results, and other information which can be accessed and printed at point-of-care at the time of change of shift is recommended. As external agencies continue to call for hand-off standardization that may not, in and of itself, reduce risk, further research is needed to determine the associations between inter-shift nursing reports and patient outcomes. Practice model initiatives, such as SBAR (situation-background-assessment-results) need to be investigated to determine if these methods can prevent information loss, particularly in those areas where information decays quickly, such as the Intensive Care Unit. As well, the current shortage of nurses make the composition of the nursing team less stable with more temporary and part-time workers resulting in a decrease in the cohesiveness and social interaction necessary to becoming acculturated in a nursing unit This could present a barrier to communication of important information and contribute to information loss that needs to be investigated.

Enhancing patient safety: improving the patient handoff process through appreciative inquiry.

PubMed

Shendell-Falik, Nancy; Feinson, Michael; Mohr, Bernard J

2007-02-01

Patient transfers from one care giver to another are an area of high safety consequence, as is evident by many studies and the Joint Commission on Accreditation of Healthcare Organization's Patient Safety Goals. The authors describe how one hospital made measurable improvements in a patient handoff process by using an unconventional approach to change called appreciative inquiry. Rather than identifying the root causes of ineffective handoffs, appreciative inquiry was used to engage staff in identifying and building on their most effective handoff experiences.

Rover mast calibration, exact camera pointing, and camara handoff for visual target tracking

NASA Technical Reports Server (NTRS)

Kim, Won S.; Ansar, Adnan I.; Steele, Robert D.

2005-01-01

This paper presents three technical elements that we have developed to improve the accuracy of the visual target tracking for single-sol approach-and-instrument placement in future Mars rover missions. An accurate, straightforward method of rover mast calibration is achieved by using a total station, a camera calibration target, and four prism targets mounted on the rover. The method was applied to Rocky8 rover mast calibration and yielded a 1.1-pixel rms residual error. Camera pointing requires inverse kinematic solutions for mast pan and tilt angles such that the target image appears right at the center of the camera image. Two issues were raised. Mast camera frames are in general not parallel to the masthead base frame. Further, the optical axis of the camera model in general does not pass through the center of the image. Despite these issues, we managed to derive non-iterative closed-form exact solutions, which were verified with Matlab routines. Actual camera pointing experiments aver 50 random target image paints yielded less than 1.3-pixel rms pointing error. Finally, a purely geometric method for camera handoff using stereo views of the target has been developed. Experimental test runs show less than 2.5 pixels error on high-resolution Navcam for Pancam-to-Navcam handoff, and less than 4 pixels error on lower-resolution Hazcam for Navcam-to-Hazcam handoff.

Changes in Efficiency and Safety Culture After Integration of an I-PASS-Supported Handoff Process.

PubMed

Sheth, Shreya; McCarthy, Elisa; Kipps, Alaina K; Wood, Matthew; Roth, Stephen J; Sharek, Paul J; Shin, Andrew Y

2016-02-01

Recent publications have shown improved outcomes associated with resident-to-resident handoff processes. However, the implementation of similar handoff processes for patients moving between units and teams with expansive responsibilities presents unique challenges. We sought to determine the impact of a multidisciplinary standardized handoff process on efficiency, safety culture, and satisfaction. A prospective improvement initiative to standardize handoffs during patient transitions from the cardiovascular ICU to the acute care unit was implemented in a university-affiliated children's hospital. Time between verbal handoff and patient transfer decreased from baseline (397 ± 167 minutes) to the postintervention period (24 ± 21 minutes) (P < .01). Percentage positive scores for the handoff/transitions domain of a national culture of safety survey improved (39.8% vs 15.2% and 38.8% vs 19.6%; P = .005 and 0.03, respectively). Provider satisfaction improved related to the information conveyed (34% to 41%; P = .03), time to transfer (5% to 34%; P < .01), and overall experience (3% to 24%; P < .01). Family satisfaction improved for several questions, including: "satisfaction with the information conveyed" (42% to 70%; P = .02), "opportunities to ask questions" (46% to 74%; P < .01), and "Acute Care team's knowledgeabout my child's issues" (50% to 73%; P = .04). No differences in rates of readmission, rapid response team calls, or mortality were observed. Implementation of a multidisciplinary I-PASS-supported handoff process for patients transferring from the cardiovascular ICU to the acute care unit resulted in improved transfer efficiency, safety culture scores, and satisfaction of providers and families. Copyright © 2016 by the American Academy of Pediatrics.

Information structure and organisation in change of shift reports: An observational study of nursing hand-offs in a Paediatric Intensive Care Unit.

PubMed

Foster-Hunt, Tara; Parush, Avi; Ellis, Jacqueline; Thomas, Margot; Rashotte, Judy

2015-06-01

Patient hand-offs involve the exchange of critical information. Ineffective hand-offs can result in reduced patient safety by leading to wrong treatment, delayed diagnoses or other outcomes that can negatively affect the healthcare system. The objectives of this study were to uncover the structure of the information conveyed during patient hand-offs and look for principles characterising the organisation of the information. With an observational study approach, data was gathered during the morning and evening nursing change of shift hand-offs in a Paediatric Intensive Care Unit. Content analysis identified a common meta-structure used for information transfer that contained categories with varying degrees of information integration and the repetition of high consequence information. Differences were found in the organisation of the hand-off structures, and these varied as a function of nursing experience. The findings are discussed in terms of the potential benefits of computerised tools which utilise standardised structure for information transfer and the implications for future education and critical care skill acquisition. Copyright © 2014 Elsevier Ltd. All rights reserved.

Cost-effective handoff scheme based on mobility-aware dual pointer forwarding in proxy mobile IPv6 networks.

PubMed

Son, Seungsik; Jeong, Jongpil

2014-01-01

In this paper, a mobility-aware Dual Pointer Forwarding scheme (mDPF) is applied in Proxy Mobile IPv6 (PMIPv6) networks. The movement of a Mobile Node (MN) is classified as intra-domain and inter-domain handoff. When the MN moves, this scheme can reduce the high signaling overhead for intra-handoff/inter-handoff, because the Local Mobility Anchor (LMA) and Mobile Access Gateway (MAG) are connected by pointer chains. In other words, a handoff is aware of low mobility between the previously attached MAG (pMAG) and newly attached MAG (nMAG), and another handoff between the previously attached LMA (pLMA) and newly attached LMA (nLMA) is aware of high mobility. Based on these mobility-aware binding updates, the overhead of the packet delivery can be reduced. Also, we analyse the binding update cost and packet delivery cost for route optimization, based on the mathematical analytic model. Analytical results show that our mDPF outperforms the PMIPv6 and the other pointer forwarding schemes, in terms of reducing the total cost of signaling.

"Ms. B changes doctors": using a comic and patient transition packet to engineer patient-oriented clinic handoffs (EPOCH).

PubMed

Pincavage, Amber T; Lee, Wei Wei; Venable, Laura Ruth; Prochaska, Megan; Staisiunas, Daina D; Beiting, Kimberly J; Czerweic, M K; Oyler, Julie; Vinci, Lisa M; Arora, Vineet M

2015-02-01

Few patient-centered interventions exist to improve year-end residency clinic handoffs. Our purpose was to assess the impact of a patient-centered transition packet and comic on clinic handoff outcomes. The study was conducted at an academic medicine residency clinic. Participants were patients undergoing resident clinic handoff 2011-2013 PROGRAM DESCRIPTION: Two months before the 2012 handoff, patients received a "transition packet" incorporating patient-identified solutions (i.e., a new primary care provider (PCP) welcome letter with photo, certificate of recognition, and visit preparation tool). In 2013, a comic was incorporated to stress the importance of follow-up. Patients were interviewed by phone with response rates of 32 % in 2011, 43 % in 2012 and 36 % in 2013. Most patients who were interviewed were aware of the handoff post-packet (95 %). With the comic, more patients recalled receiving the packet (44 % 2012 vs. 64 % 2013, p< 0.001) and correctly identified their new PCP (77 % 2012 vs. 98 % 2013, p< 0.001). Among patients recalling the packet, most (70 % 2012; 65 % 2013) agreed it helped them establish rapport. Both years, fewer patients missed their first new PCP visit (43 % in 2011, 31 % in 2012 and 26 % in 2013, p< 0.001). A patient-centered transition packet helped prepare patients for clinic handoffs. The comic was associated with increased packet recall and improved follow-up rates.

The Hidden Lives of Nurses’ Cognitive Artifacts

PubMed Central

Doig, Alexa K.; Cloyes, Kristin G.; Staggers, Nancy

2016-01-01

Summary Background Standardizing nursing handoffs at shift change is recommended to improve communication, with electronic tools as the primary approach. However, nurses continue to rely on personally created paper-based cognitive artifacts – their “paper brains” – to support handoffs, indicating a deficiency in available electronic versions. Objective The purpose of this qualitative study was to develop a deep understanding of nurses’ paper-based cognitive artifacts in the context of a cancer specialty hospital. Methods After completing 73 hours of hospital unit field observations, 13 medical oncology nurses were purposively sampled, shadowed for a single shift and interviewed using a semi-structured technique. An interpretive descriptive study design guided analysis of the data corpus of field notes, transcribed interviews, images of nurses’ paper-based cognitive artifacts, and analytic memos. Results Findings suggest nurses’ paper brains are personal, dynamic, living objects that undergo a life cycle during each shift and evolve over the course of a nurse’s career. The life cycle has four phases: Creation, Application, Reproduction, and Destruction. Evolution in a nurse’s individually styled, paper brain is triggered by a change in the nurse’s environment that reshapes cognitive needs. If a paper brain no longer provides cognitive support in the new environment, it is modified into (adapted) or abandoned (made extinct) for a different format that will provide the necessary support. Conclusions The “hidden lives“ – the life cycle and evolution – of paper brains have implications for the design of successful electronic tools to support nursing practice, including handoff. Nurses’ paper brains provide cognitive support beyond the context of handoff. Information retrieval during handoff is undoubtedly an important function of nurses’ paper brains, but tools designed to standardize handoff communication without accounting for cognitive needs during all phases of the paper brain life cycle or the ability to evolve with changes to those cognitive needs will be underutilized. PMID:27602412

Handover aspects for a Low Earth Orbit (LEO) CDMA Land Mobile Satellite (LMS) system

NASA Technical Reports Server (NTRS)

Carter, P.; Beach, M. A.

1993-01-01

This paper addresses the problem of handoff in a land mobile satellite (LMS) system between adjacent satellites in a low earth orbit (LEO) constellation. In particular, emphasis is placed on the application of soft handoff in a direct sequence code division multiple access (DS-CDMA) LMS system. Soft handoff is explained in terms of terrestrial macroscopic diversity, in which signals transmitted via several independent fading paths are combined to enhance the link quality. This concept is then reconsidered in the context of a LEO LMS system. A two-state Markov channel model is used to simulate the effects of shadowing on the communications path from the mobile to each satellite during handoff. The results of the channel simulation form a platform for discussion regarding soft handoff, highlighting the potential merits of the scheme when applied in a LEO LMS environment.

Integrating Research, Quality Improvement, and Medical Education for Better Handoffs and Safer Care: Disseminating, Adapting, and Implementing the I-PASS Program.

PubMed

Starmer, Amy J; Spector, Nancy D; West, Daniel C; Srivastava, Rajendu; Sectish, Theodore C; Landrigan, Christopher P

2017-07-01

In 2009 the I-PASS Study Group was formed by patient safety, medical education, health services research, and clinical experts from multiple institutions in the United States and Canada. When the I-PASS Handoff Program, which was developed by the I-PASS Study Group, was implemented in nine hospitals, it was associated with a 30% reduction in injuries due to medical errors and significant improvements in handoff processes, without any adverse effects on provider work flow. To effectively disseminate and adapt I-PASS for use across specialties and disciplines, a series of federally and privately funded dissemination and implementation projects were carried out following the publication of the initial study. The results of these efforts have informed ongoing initiatives intended to continue adapting and scaling the program. As of this writing, I-PASS Study Group members have directly worked with more than 50 hospitals to facilitate implementation of I-PASS. To further disseminate I-PASS, Study Group members delivered hundreds of academic presentations, including plenaries at scientific meetings, workshops, and institutional Grand Rounds. Some 3,563 individuals, representing more than 500 institutions in the 50 states in the United States, the District of Columbia, Puerto Rico, and 57 other countries, have requested access to I-PASS materials. Most recently, the I-PASS SM Patient Safety Institute has developed a virtual immersion training platform, mobile handoff observational tools, and processes to facilitate further spread of I-PASS. Implementation of I-PASS has been associated with substantial improvements in patient safety and can be applied to a variety of disciplines and types of patient handoffs. Widespread implementation of I-PASS has the potential to substantially improve patient safety in the United States and beyond. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Using continuous process improvement methodology to standardize nursing handoff communication.

PubMed

Klee, Kristi; Latta, Linda; Davis-Kirsch, Sallie; Pecchia, Maria

2012-04-01

The purpose of this article was to describe the use of continuous performance improvement (CPI) methodology to standardize nurse shift-to-shift handoff communication. The goals of the process were to standardize the content and process of shift handoff, improve patient safety, increase patient and family involvement in the handoff process, and decrease end-of-shift overtime. This article will describe process changes made over a 4-year period as result of application of the plan-do-check-act procedure, which is an integral part of the CPI methodology, and discuss further work needed to continue to refine this critical nursing care process. Copyright © 2012 Elsevier Inc. All rights reserved.

An Integrated Multi-layer Approach for Seamless Soft Handoff in Mobile Ad Hoc Networks

DTIC Science & Technology

2011-01-01

network to showcase how to leverage the IEEE 802.21 Media Independent Handover ( MIH ) framework [3] in our handoff solution. Moreover, to further...to the seamless handoff problem. The architecture leverages the IEEE 802.21 MIH standard to facilitate handover related decisions on multiple...provided by the MIH function (MIHF), the topology control manager dynamically activates/deactivates the wireless interfaces to ensure the network is

The DEVELOP National Program's Strategy for Communicating Applied Science Outcomes

NASA Astrophysics Data System (ADS)

Childs-Gleason, L. M.; Ross, K. W.; Crepps, G.; Favors, J.; Kelley, C.; Miller, T. N.; Allsbrook, K. N.; Rogers, L.; Ruiz, M. L.

2016-12-01

NASA's DEVELOP National Program conducts rapid feasibility projects that enable the future workforce and current decision makers to collaborate and build capacity to use Earth science data to enhance environmental management and policy. The program communicates its results and applications to a broad spectrum of audiences through a variety of methods: "virtual poster sessions" that engage the general public through short project videos and interactive dialogue periods, a "Campus Ambassador Corps" that communicates about the program and its projects to academia, scientific and policy conference presentations, community engagement activities and end-of-project presentations, project "hand-offs" providing results and tools to project partners, traditional publications (both gray literature and peer-reviewed), an interactive website project gallery, targeted brochures, and through multiple social media venues and campaigns. This presentation will describe the various methods employed by DEVELOP to communicate the program's scientific outputs, target audiences, general statistics, community response and best practices.

Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial.

PubMed

Richter, Kimber P; Faseru, Babalola; Mussulman, Laura M; Ellerbeck, Edward F; Shireman, Theresa I; Hunt, Jamie J; Carlini, Beatriz H; Preacher, Kristopher J; Ayars, Candace L; Cook, David J

2012-08-01

Post-discharge support is a key component of effective treatment for hospitalized smokers, but few hospitals provide it. Many hospitals and care settings fax-refer smokers to quitlines for follow-up; however, less than half of fax-referred smokers are successfully contacted and enrolled in quitline services. "Warm handoff" is a novel approach to care transitions in which health care providers directly link patients with substance abuse problems with specialists, using face-to-face or phone transfer. Warm handoff achieves very high rates of treatment enrollment for these vulnerable groups. The aim of this study-"EQUIP" (Enhancing Quitline Utilization among In-Patients)-is to determine the effectiveness, and cost-effectiveness, of warm handoff versus fax referral for linking hospitalized smokers with tobacco quitlines. This study employs a two-arm, individually randomized design. It is set in two large Kansas hospitals that have dedicated tobacco treatment interventionists on staff. At each site, smokers who wish to remain abstinent after discharge will be randomly assigned to groups. For patients in the fax group, staff will provide standard in-hospital intervention and will fax-refer patients to the state tobacco quitline for counseling post-discharge. For patients in the warm handoff group, staff will provide brief in-hospital intervention and immediate warm handoff: staff will call the state quitline, notify them that a warm handoff inpatient from Kansas is on the line, then transfer the call to the patients' mobile or bedside hospital phone for quitline enrollment and an initial counseling session. Following the quitline session, hospital staff provides a brief check-back visit. Outcome measures will be assessed at 1, 6, and 12 months post enrollment. Costs are measured to support cost-effectiveness analyses. We hypothesize that warm handoff, compared to fax referral, will improve care transitions for tobacco treatment, enroll more participants in quitline services, and lead to higher quit rates. We also hypothesize that warm handoff will be more cost-effective from a societal perspective. If successful, this project offers a low-cost solution for more efficiently linking millions of hospitalized smokers with effective outpatient treatment-smokers that might otherwise be lost in the transition to outpatient care. Clinical Trials Registration NCT01305928.

An entrustable professional activity (EPA) for handoffs as a model for EPA assessment development.

PubMed

Aylward, Michael; Nixon, James; Gladding, Sophia

2014-10-01

Medical education is moving toward assessment of educational outcomes rather than educational processes. The American Board of Internal Medicine and American Board of Pediatrics milestones and the concept of entrustable professional activities (EPA)--skills essential to the practice of medicine that educators progressively entrust learners to perform--provide new approaches to assessing outcomes. Although some defined EPAs exist for internal medicine and pediatrics, the continued development and implementation of EPAs remains challenging. As residency programs are expected to begin reporting milestone-based performance, however, they will need examples of how to overcome these challenges. The authors describe a model for the development and implementation of an EPA using the resident handoff as an example. The model includes nine steps: selecting the EPA, determining where skills are practiced and assessed, addressing barriers to assessment, determining components of the EPA, determining needed assessment tools, developing new assessments if needed, determining criteria for advancement through entrustment levels, mapping milestones to the EPA, and faculty development. Following implementation, 78% of interns at the University of Minnesota Medical School were observed giving handoffs and provided feedback. The authors suggest that this model of EPA development--which includes engaging stakeholders, an iterative process to describing the behavioral characteristics of each domain at each level of entrustment, and the development of specific assessment tools that support both formative feedback and summative decisions about entrustment--can serve as a model for EPA development for other clinical skills and specialty areas.

A Multimetric Approach for Handoff Decision in Heterogeneous Wireless Networks

NASA Astrophysics Data System (ADS)

Kustiawan, I.; Purnama, W.

2018-02-01

Seamless mobility and service continuity anywhere at any time are an important issue in the wireless Internet. This research proposes a scheme to make handoff decisions effectively in heterogeneous wireless networks using a fuzzy system. Our design lies in an inference engine which takes RSS (received signal strength), data rate, network latency, and user preference as strategic determinants. The logic of our engine is realized on a UE (user equipment) side in faster reaction to network dynamics while roaming across different radio access technologies. The fuzzy system handles four metrics jointly to deduce a moderate decision about when to initiate handoff. The performance of our design is evaluated by simulating move-out mobility scenarios. Simulation results show that our scheme outperforms other approaches in terms of reducing unnecessary handoff.

Refinement for fault-tolerance: An aircraft hand-off protocol

NASA Technical Reports Server (NTRS)

Marzullo, Keith; Schneider, Fred B.; Dehn, Jon

1994-01-01

Part of the Advanced Automation System (AAS) for air-traffic control is a protocol to permit flight hand-off from one air-traffic controller to another. The protocol must be fault-tolerant and, therefore, is subtle -- an ideal candidate for the application of formal methods. This paper describes a formal method for deriving fault-tolerant protocols that is based on refinement and proof outlines. The AAS hand-off protocol was actually derived using this method; that derivation is given.

Warm Handoff Versus Fax Referral for Linking Hospitalized Smokers to Quitlines.

PubMed

Richter, Kimber P; Faseru, Babalola; Shireman, Theresa I; Mussulman, Laura M; Nazir, Niaman; Bush, Terry; Scheuermann, Taneisha S; Preacher, Kristopher J; Carlini, Beatriz H; Magnusson, Brooke; Ellerbeck, Edward F; Cramer, Carol; Cook, David J; Martell, Mary J

2016-10-01

Few hospitals treat patients' tobacco dependence. To be effective, hospital-initiated cessation interventions must provide at least 1 month of supportive contact post-discharge. Individually randomized clinical trial. Recruitment commenced July 2011; analyses were conducted October 2014-June 2015. The study was conducted in two large Midwestern hospitals. Participants included smokers who were aged ≥18 years, planned to stay quit after discharge, and spoke English or Spanish. Hospital-based cessation counselors delivered the intervention. For patients randomized to warm handoff, staff immediately called the quitline from the bedside and handed the phone to participants for enrollment and counseling. Participants randomized to fax were referred on the day of hospital discharge. Outcomes at 6 months included quitline enrollment/adherence, medication use, biochemically verified cessation, and cost effectiveness. Significantly more warm handoff than fax participants enrolled in quitline (99.6% vs 59.6%; relative risk, 1.67; 95% CI=1.65, 1.68). One in four (25.4% warm handoff, 25.3% fax) were verified to be abstinent at 6-month follow-up; this did not differ significantly between groups (relative risk, 1.02; 95% CI=0.82, 1.24). Cessation medication use in the hospital and receipt of a prescription for medication at discharge did not differ between groups; however, significantly more fax participants reported using cessation medication post-discharge (32% vs 25%, p=0.01). The average incremental cost-effectiveness ratio of enrolling participants into warm handoff was $0.14. Hospital-borne costs were significantly lower in warm handoff than in fax ($5.77 vs $9.41, p<0.001). One in four inpatient smokers referred to quitline by either method were abstinent at 6 months post-discharge. Among motivated smokers, fax referral and warm handoff are efficient and comparatively effective ways to link smokers with evidence-based care. For hospitals, warm handoff is a less expensive and more effective method for enrolling smokers in quitline services. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

A Reinforcement Sensor Embedded Vertical Handoff Controller for Vehicular Heterogeneous Wireless Networks

PubMed Central

Li, Limin; Xu, Yubin; Soong, Boon-Hee; Ma, Lin

2013-01-01

Vehicular communication platforms that provide real-time access to wireless networks have drawn more and more attention in recent years. IEEE 802.11p is the main radio access technology that supports communication for high mobility terminals, however, due to its limited coverage, IEEE 802.11p is usually deployed by coupling with cellular networks to achieve seamless mobility. In a heterogeneous cellular/802.11p network, vehicular communication is characterized by its short time span in association with a wireless local area network (WLAN). Moreover, for the media access control (MAC) scheme used for WLAN, the network throughput dramatically decreases with increasing user quantity. In response to these compelling problems, we propose a reinforcement sensor (RFS) embedded vertical handoff control strategy to support mobility management. The RFS has online learning capability and can provide optimal handoff decisions in an adaptive fashion without prior knowledge. The algorithm integrates considerations including vehicular mobility, traffic load, handoff latency, and network status. Simulation results verify that the proposed algorithm can adaptively adjust the handoff strategy, allowing users to stay connected to the best network. Furthermore, the algorithm can ensure that RSUs are adequate, thereby guaranteeing a high quality user experience. PMID:24193101

Laboratory medicine handoff gaps experienced by primary care practices: A report from the shared networks of collaborative ambulatory practices and partners (SNOCAP).

PubMed

West, David R; James, Katherine A; Fernald, Douglas H; Zelie, Claire; Smith, Maxwell L; Raab, Stephen S

2014-01-01

The majority of errors in laboratory medicine testing are thought to occur in the pre- and postanalytic testing phases, and a large proportion of these errors are secondary to failed handoffs. Because most laboratory tests originate in ambulatory primary care, understanding the gaps in handoff processes within and between laboratories and practices is imperative for patient safety. Therefore, the purpose of this study was to understand, based on information from primary care practice personnel, the perceived gaps in laboratory processes as a precursor to initiating process improvement activities. A survey was used to assess perceptions of clinicians, staff, and management personnel of gaps in handoffs between primary care practices and laboratories working in 21 Colorado primary care practices. Data were analyzed to determine statistically significant associations between categorical variables. In addition, qualitative analysis of responses to open-ended survey questions was conducted. Primary care practices consistently reported challenges and a desire/need to improve their efforts to systematically track laboratory test status, confirm receipt of laboratory results, and report results to patients. Automated tracking systems existed in roughly 61% of practices, and all but one of those had electronic health record-based tracking systems in place. One fourth of these electronic health record-enabled practices expressed sufficient mistrust in these systems to warrant the concurrent operation of an article-based tracking system as backup. Practices also reported 12 different procedures used to notify patients of test results, varying by test result type. The results highlight the lack of standardization and definition of roles in handoffs in primary care laboratory practices for test ordering, monitoring, and receiving and reporting test results. Results also identify high-priority gaps in processes and the perceptions by practice personnel that practice improvement in these areas is needed. Commonalities in these areas warrant the development and support of tools for use in primary care settings. © Copyright 2014 by the American Board of Family Medicine.

Increased Mortality Rates During Resident Handoff Periods and the Effect of ACGME Duty Hour Regulations.

PubMed

Denson, Joshua L; McCarty, Matthew; Fang, Yixin; Uppal, Amit; Evans, Laura

2015-09-01

Medical errors occur following handoff-related miscommunication. Data regarding the effect on patient-centered outcomes, specifically mortality, are lacking. Our objective was to investigate handoff-related mortality and the effect of duty-hour regulations. Retrospective cohort study of adult medical patients at a public, university-affiliated hospital from 2010 to 2012. Patients were divided into 2 cohorts: handoff group (discharged within 7 days following a change in resident physician team) vs control group (discharged the 3 weeks of each 4-week rotation before resident service change). The primary outcome was unadjusted and adjusted hospital mortality rate. As a secondary prespecified analysis, we examined the effect of 2011 Accreditation Council for Graduate Medical Education (ACGME) duty-hour changes. Among 23,736 patients, unadjusted hospital mortality during the handoff group was higher than the control group (2.68% vs 2.08%, respectively; P = .007; odds ratio [OR] 1.30; 95% confidence interval [CI], 1.08-1.57). Following adjustment, this association remained statistically significant (adjusted OR 1.34; P = .003; 95% CI, 1.10-1.62). Similarly, pre-duty-hour unadjusted hospital mortality was higher in the handoff group vs control group (2.87% vs 2.01%, respectively; P = .006; OR 1.44; 95% CI, 1.11-1.86), which remained statistically significant following adjustment (adjusted OR 1.50; P = .002; 95% CI, 1.16-1.95). However, this association lost statistical significance following duty-hour revision with respect to both unadjusted (2.48% vs 2.15%, respectively; P = .30; OR 1.16; 95% CI, 0.88-1.53) and adjusted mortality (OR 1.18; P = .26; 95% CI, 0.89-1.56). Resident transition in care was significantly associated with an increase in unadjusted and adjusted hospital mortality. Although improved by 2011 ACGME duty-hour amendments, a trend toward higher mortality remained following resident handoff. Copyright © 2015 Elsevier Inc. All rights reserved.

Description of web-enhanced virtual character simulation system to standardize patient hand-offs.

PubMed

Filichia, Lori; Halan, Shivashankar; Blackwelder, Ethan; Rossen, Brent; Lok, Benjamin; Korndorffer, James; Cendan, Juan

2011-04-01

The 80-h work week has increased discontinuity of patient care resulting in reports of increased medication errors and preventable adverse events. Graduate medical programs are addressing these shortcomings in a number of ways. We have developed a computer simulation platform called the Virtual People Factory (VPF), which allows us to capture and simulate the dialogue between a real user and a virtual character. We have converted the system to reflect a physician in the process of "checking-out" a patient to a covering physician. The responses are tracked and matched to educator-defined information termed "discoveries." Our proof of concept represented a typical post-operative patient with tachycardia. The system is web enabled. So far, 26 resident users at two institutions have completed the module. The critical discovery of tachycardia was identified by 62% of users. Residents spend 85% of the time asking intraoperative, postoperative, and past medical history questions. The system improves over time such that there is a near-doubling of questions that yield appropriate answers between users 13 and 22. Users who identified the virtual patient's underlying tachycardia expressed more concern and were more likely to order further testing for the patient in a post-module questionnaire (P = 0.13 and 0.08, respectively, NS). The VPF system can capture unique details about the hand-off interchange. The system improves with sequential users such that better matching of questions and answers occurs within the initial 25 users allowing rapid development of new modules. A catalog of hand-off modules could be easily developed. Wide-scale web-based deployment was uncomplicated. Identification of the critical findings appropriately translated to user concern for the patient though our series was too small to reach significance. Performance metrics based on the identification of critical discoveries could be used to assess readiness of the user to carry off a successful hand-off. Copyright © 2011 Elsevier Inc. All rights reserved.

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

PubMed Central

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

2012-01-01

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

Analysis of Handoff Mechanisms in Mobile IP

NASA Astrophysics Data System (ADS)

Jayaraj, Maria Nadine Simonel; Issac, Biju; Haldar, Manas Kumar

2011-06-01

One of the most important challenges in mobile Internet Protocol (IP) is to provide service for a mobile node to maintain its connectivity to network when it moves from one domain to another. IP is responsible for routing packets across network. The first major version of IP is the Internet Protocol version 4 (IPv4). It is one of the dominant protocols relevant to wireless network. Later a newer version of IP called the IPv6 was proposed. Mobile IPv6 is mainly introduced for the purpose of mobility. Mobility management enables network to locate roaming nodes in order to deliver packets and maintain connections with them when moving into new domains. Handoff occurs when a mobile node moves from one network to another. It is a key factor of mobility because a mobile node can trigger several handoffs during a session. This paper briefly explains on mobile IP and its handoff issues, along with the drawbacks of mobile IP.

Solar and Heliospheric Observatory (SOHO) Flight Dynamics Simulations Using MATLAB (R)

NASA Technical Reports Server (NTRS)

Headrick, R. D.; Rowe, J. N.

1996-01-01

This paper describes a study to verify onboard attitude control laws in the coarse Sun-pointing (CSP) mode by simulation and to develop procedures for operational support for the Solar and Heliospheric Observatory (SOHO) mission. SOHO was launched on December 2, 1995, and the predictions of the simulation were verified with the flight data. This study used a commercial off the shelf product MATLAB(tm) to do the following: Develop procedures for computing the parasitic torques for orbital maneuvers; Simulate onboard attitude control of roll, pitch, and yaw during orbital maneuvers; Develop procedures for predicting firing time for both on- and off-modulated thrusters during orbital maneuvers; Investigate the use of feed forward or pre-bias torques to reduce the attitude handoff during orbit maneuvers - in particular, determine how to use the flight data to improve the feed forward torque estimates for use on future maneuvers. The study verified the stability of the attitude control during orbital maneuvers and the proposed use of feed forward torques to compensate for the attitude handoff. Comparison of the simulations with flight data showed: Parasitic torques provided a good estimate of the on- and off-modulation for attitude control; The feed forward torque compensation scheme worked well to reduce attitude handoff during the orbital maneuvers. The work has been extended to prototype calibration of thrusters from observed firing time and observed reaction wheel speed changes.

Standardized Reporting System Use During Handoffs Reduces Patient Length of Stay in the Emergency Department.

PubMed

Dahlquist, Robert T; Reyner, Karina; Robinson, Richard D; Farzad, Ali; Laureano-Phillips, Jessica; Garrett, John S; Young, Joseph M; Zenarosa, Nestor R; Wang, Hao

2018-05-01

Emergency department (ED) shift handoffs are potential sources of delay in care. We aimed to determine the impact that using standardized reporting tool and process may have on throughput metrics for patients undergoing a transition of care at shift change. We performed a prospective, pre- and post-intervention quality improvement study from September 1 to November 30, 2015. A handoff procedure intervention, including a mandatory workshop and personnel training on a standard reporting system template, was implemented. The primary endpoint was patient length of stay (LOS). A comparative analysis of differences between patient LOS and various handoff communication methods were assessed pre- and post-intervention. Communication methods were entered a multivariable logistic regression model independently as risk factors for patient LOS. The final analysis included 1,006 patients, with 327 comprising the pre-intervention and 679 comprising the post-intervention populations. Bedside rounding occurred 45% of the time without a standard reporting during pre-intervention and increased to 85% of the time with the use of a standard reporting system in the post-intervention period (P < 0.001). Provider time (provider-initiated care to patient care completed) in the pre-intervention period averaged 297 min, but decreased to 265 min in the post-intervention period (P < 0.001). After adjusting for other communication methods, the use of a standard reporting system during handoff was associated with shortened ED LOS (OR = 0.60, 95% CI 0.40 - 0.90, P < 0.05). Standard reporting system use during emergency physician handoffs at shift change improves ED throughput efficiency and is associated with shorter ED LOS.

Impact of electronic medical record integration of a handoff tool on sign-out in a newborn intensive care unit

PubMed Central

Palma, JP; Sharek, PJ; Longhurst, CA

2016-01-01

Objective To evaluate the impact of integrating a handoff tool into the electronic medical record (EMR) on sign-out accuracy, satisfaction and workflow in a neonatal intensive care unit (NICU). Study Design Prospective surveys of neonatal care providers in an academic children’s hospital 1 month before and 6 months following EMR integration of a standalone Microsoft Access neonatal handoff tool. Result Providers perceived sign-out information to be somewhat or very accurate at a rate of 78% with the standalone handoff tool and 91% with the EMR-integrated tool (P < 0.01). Before integration of neonatal sign-out into the EMR, 35% of providers were satisfied with the process of updating sign-out information and 71% were satisfied with the printed sign-out document; following EMR integration, 92% of providers were satisfied with the process of updating sign-out information (P < 0.01) and 98% were satisfied with the printed sign-out document (P < 0.01). Neonatal care providers reported spending a median of 11 to 15 min/day updating the standalone sign-out and 16 to 20 min/day updating the EMR-integrated sign-out (P = 0.026). The median percentage of total sign-out preparation time dedicated to transcribing information from the EMR was 25 to 49% before and <25% after EMR integration of the handoff tool (P < 0.01). Conclusion Integration of a NICU-specific handoff tool into an EMR resulted in improvements in perceived sign-out accuracy, provider satisfaction and at least one aspect of workflow. PMID:21273990

Improvement in Patient Transfer Process From the Operating Room to the PICU Using a Lean and Six Sigma-Based Quality Improvement Project.

PubMed

Gleich, Stephen J; Nemergut, Michael E; Stans, Anthony A; Haile, Dawit T; Feigal, Scott A; Heinrich, Angela L; Bosley, Christopher L; Tripathi, Sandeep

2016-08-01

Ineffective and inefficient patient transfer processes can increase the chance of medical errors. Improvements in such processes are high-priority local institutional and national patient safety goals. At our institution, nonintubated postoperative pediatric patients are first admitted to the postanesthesia care unit before transfer to the PICU. This quality improvement project was designed to improve the patient transfer process from the operating room (OR) to the PICU. After direct observation of the baseline process, we introduced a structured, direct OR-PICU transfer process for orthopedic spinal fusion patients. We performed value stream mapping of the process to determine error-prone and inefficient areas. We evaluated primary outcome measures of handoff error reduction and the overall efficiency of patient transfer process time. Staff satisfaction was evaluated as a counterbalance measure. With the introduction of the new direct OR-PICU patient transfer process, the handoff communication error rate improved from 1.9 to 0.3 errors per patient handoff (P = .002). Inefficiency (patient wait time and non-value-creating activity) was reduced from 90 to 32 minutes. Handoff content was improved with fewer information omissions (P < .001). Staff satisfaction significantly improved among nearly all PICU providers. By using quality improvement methodology to design and implement a new direct OR-PICU transfer process with a structured multidisciplinary verbal handoff, we achieved sustained improvements in patient safety and efficiency. Handoff communication was enhanced, with fewer errors and content omissions. The new process improved efficiency, with high staff satisfaction. Copyright © 2016 by the American Academy of Pediatrics.

Handoffs in care--can we make them safer?

PubMed

Streitenberger, Kim; Breen-Reid, Karen; Harris, Cheryl

2006-12-01

In today's complex and rapidly changing health care environments, patient harm may result if important patient information is not communicated from one health care provider to another during handoffs in care. Issues involving communication, continuity of care, and care planning are cited as a root cause in more than 80% of reported sentinel events. In light of the inherent risks associated with handoffs in care, the use of strategies that reduce the impact of human factors on effective communication and standardize the communication process is essential to ensure appropriate communication patient information and that a plan of care is continued through the process.

Increasing patient safety with neonates via handoff communication during delivery: a call for interprofessional health care team training across GME and CME.

PubMed

Vanderbilt, Allison A; Pappada, Scott M; Stein, Howard; Harper, David; Papadimos, Thomas J

2017-01-01

Hospitals have struggled for years regarding the handoff process of communicating patient information from one health care professional to another. Ineffective handoff communication is recognized as a serious patient safety risk within the health care community. It is essential to take communication into consideration when examining the safety of neonates who require immediate medical attention after birth; effective communication is vital for positive patient outcomes, especially with neonates in a delivery room setting. Teamwork and effective communication across the health care continuum are essential for providing efficient, quality care that leads to favorable patient outcomes. Interprofessional simulation and team training can benefit health care professionals by improving interprofessional competence, defined as one's knowledge of other professionals including an understanding of their training and skillsets, and role clarity. Interprofessional teams that include members with specialization in obstetrics, gynecology, and neonatology have the potential to considerably benefit from training effective handoff and communication practices that would ensure the safety of the neonate upon birth. We must strive to provide the most comprehensive systematic, standardized, interprofessional handoff communication training sessions for such teams, through Graduate Medical Education and Continuing Medical Education that will meet the needs across the educational continuum.

A Seamless Handoff Scheme with Access Point Load Balance for Real-Time Services Support in 802.11 Wireless LANs

NASA Astrophysics Data System (ADS)

Manodham, Thavisak; Loyola, Luis; Miki, Tetsuya

IEEE 802.11 wirelesses LANs (WLANs) have been rapidly deployed in enterprises, public areas, and households. Voice-over-IP (VoIP) and similar applications are now commonly used in mobile devices over wireless networks. Recent works have improved the quality of service (QoS) offering higher data rates to support various kinds of real-time applications. However, besides the need for higher data rates, seamless handoff and load balancing among APs are key issues that must be addressed in order to continue supporting real-time services across wireless LANs and providing fair services to all users. In this paper, we introduce a novel access point (AP) with two transceivers that improves network efficiency by supporting seamless handoff and traffic load balancing in a wireless network. In our proposed scheme, the novel AP uses the second transceiver to scan and find neighboring STAs in the transmission range and then sends the results to neighboring APs, which compare and analyze whether or not the STA should perform a handoff. The initial results from our simulations show that the novel AP module is more effective than the conventional scheme and a related work in terms of providing a handoff process with low latency and sharing traffic load with neighbor APs.

Fuzzy Logic based Handoff Latency Reduction Mechanism in Layer 2 of Heterogeneous Mobile IPv6 Networks

NASA Astrophysics Data System (ADS)

Anwar, Farhat; Masud, Mosharrof H.; Latif, Suhaimi A.

2013-12-01

Mobile IPv6 (MIPv6) is one of the pioneer standards that support mobility in IPv6 environment. It has been designed to support different types of technologies for providing seamless communications in next generation network. However, MIPv6 and subsequent standards have some limitations due to its handoff latency. In this paper, a fuzzy logic based mechanism is proposed to reduce the handoff latency of MIPv6 for Layer 2 (L2) by scanning the Access Points (APs) while the Mobile Node (MN) is moving among different APs. Handoff latency occurs when the MN switches from one AP to another in L2. Heterogeneous network is considered in this research in order to reduce the delays in L2. Received Signal Strength Indicator (RSSI) and velocity of the MN are considered as the input of fuzzy logic technique. This technique helps the MN to measure optimum signal quality from APs for the speedy mobile node based on fuzzy logic input rules and makes a list of interfaces. A suitable interface from the list of available interfaces can be selected like WiFi, WiMAX or GSM. Simulation results show 55% handoff latency reduction and 50% packet loss improvement in L2 compared to standard to MIPv6.

Standardized Reporting System Use During Handoffs Reduces Patient Length of Stay in the Emergency Department

PubMed Central

Dahlquist, Robert T.; Reyner, Karina; Robinson, Richard D.; Farzad, Ali; Laureano-Phillips, Jessica; Garrett, John S.; Young, Joseph M.; Zenarosa, Nestor R.; Wang, Hao

2018-01-01

Background Emergency department (ED) shift handoffs are potential sources of delay in care. We aimed to determine the impact that using standardized reporting tool and process may have on throughput metrics for patients undergoing a transition of care at shift change. Methods We performed a prospective, pre- and post-intervention quality improvement study from September 1 to November 30, 2015. A handoff procedure intervention, including a mandatory workshop and personnel training on a standard reporting system template, was implemented. The primary endpoint was patient length of stay (LOS). A comparative analysis of differences between patient LOS and various handoff communication methods were assessed pre- and post-intervention. Communication methods were entered a multivariable logistic regression model independently as risk factors for patient LOS. Results The final analysis included 1,006 patients, with 327 comprising the pre-intervention and 679 comprising the post-intervention populations. Bedside rounding occurred 45% of the time without a standard reporting during pre-intervention and increased to 85% of the time with the use of a standard reporting system in the post-intervention period (P < 0.001). Provider time (provider-initiated care to patient care completed) in the pre-intervention period averaged 297 min, but decreased to 265 min in the post-intervention period (P < 0.001). After adjusting for other communication methods, the use of a standard reporting system during handoff was associated with shortened ED LOS (OR = 0.60, 95% CI 0.40 - 0.90, P < 0.05). Conclusions Standard reporting system use during emergency physician handoffs at shift change improves ED throughput efficiency and is associated with shorter ED LOS. PMID:29581808

A novel briefing checklist at shift handoff in an emergency department improves situational awareness and safety event identification.

PubMed

Mullan, Paul C; Macias, Charles G; Hsu, Deborah; Alam, Sartaj; Patel, Binita

2015-04-01

Emergency department (ED) shift handoffs are sources of potential medical error, delays in care, and medicolegal liabilities. Few handoff studies exist in the ED literature. We aimed to describe the implementation of a standardized checklist for improving situational awareness during physician handoffs in a pediatric ED. This is a descriptive observational study in a large academic pediatric ED. Checklists were evaluated for rates of use, completion, and identification of potential safety events. We defined a complete checklist as 80% or more of items checked.  A user perception survey was used. After 1 year, all checklist users (residents, fellows, faculty, and charge nurses with ED experience before and after checklist implementation) were anonymously surveyed to assess the checklist's usability, perceived contributions to Institute of Medicine quality domains, and situational awareness. The electronically administered survey used Likert frequency scales. Of 732 handoffs, 98% used the checklist, and 89% were complete. A mean of 1.7 potential safety events were identified per handoff. The most frequent potential safety events were identification of intensive care unit-level patients in the ED (48%), equipment problems (46%), staffing issues (21%), and intensive care unit-level patients in transport (16%). Eighty-one subjects (88%) responded to the survey. The users agreed that the checklist promoted better communication, safety, efficiency, effective care, and situational awareness. The Physician Active Shift Signout in the Emergency Department briefing checklist was used often and at a high completion rate, frequently identifying potential safety events. The users found that it improved the quality of care and team communication. Future studies on outcomes and processes are needed.

Interhospital transfer handoff practices among US tertiary care centers: A descriptive survey.

PubMed

Herrigel, Dana J; Carroll, Madeline; Fanning, Christine; Steinberg, Michael B; Parikh, Amay; Usher, Michael

2016-06-01

Interhospital transfer is an understudied area within transitions of care. The process by which hospitals accept and transfer patients is not well described. National trends and best practices are unclear. To describe the demographics of large transfer centers, to identify common handoff practices, and to describe challenges and notable innovations involving the interhospital transfer handoff process. A convenience sample of 32 tertiary care centers in the United States was studied. Respondents were typically transfer center directors surveyed by phone. Data regarding transfer center demographics, handoff communication practices, electronic infrastructure, and data sharing were obtained. The median number of patients transferred each month per receiving institution was 700 (range, 250-2500); on average, 28% of these patients were transferred to an intensive care unit. Transfer protocols and practices varied by institution. Transfer center coordinators typically had a medical background (78%), and critical care-trained registered nurse was the most prevalent (38%). Common practices included: mandatory recorded 3-way physician-to-physician conversation (84%) and mandatory clinical status updates prior to patient arrival (81%). However, the timeline of clinical status updates was variable. Less frequent transfer practices included: electronic medical record (EMR) cross-talk availability and utilization (23%), real-time transfer center documentation accessibility in the EMR (32%), and referring center clinical documentation available prior to transport (29%). A number of innovative strategies to address challenges involving interhospital handoffs are reported. Interhospital transfer practices vary widely amongst tertiary care centers. Practices that lead to improved patient handoffs and reduced medical errors need additional prospective evaluation. Journal of Hospital Medicine 2016;11:413-417. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

A Wireless Text Messaging System Improves Communication for Neonatal Resuscitation.

PubMed

Hughes Driscoll, Colleen A; Schub, Jamie A; Pollard, Kristi; El-Metwally, Dina

Handoffs for neonatal resuscitation involve communicating critical delivery information (CDI). The authors sought to achieve ≥95% communication of CDI during resuscitation team requests. CDI included name of caller, urgency of request, location of delivery, gestation of fetus, status of amniotic fluid, and indication for presence of the resuscitation team. Three interventions were implemented: verbal scripted handoff, Spök text messaging, and Engage text messaging. Percentages of CDI communications were analyzed using statistical process control. Following implementation of Engage, the communication of all CDI, except for indication, was ≥95%; communication of indication occurred 93% of the time. Control limits for most CDI were narrower with Engage, indicating greater reliability of communication compared to the verbal handoff and Spök. Delayed resuscitation team arrival, a countermeasure, was not higher with text messaging compared to verbal handoff ( P = 1.00). Text messaging improved communication during high-risk deliveries, and it may represent an effective tool for other delivery centers.

In Search of Social Translucence: An Audit Log Analysis of Handoff Documentation Views and Updates.

PubMed

Jiang, Silis Y; Hum, R Stanley; Vawdrey, David; Mamykina, Lena

2015-01-01

Communication and information sharing are critical parts of teamwork in the hospital; however, achieving open and fluid communication can be challenging. Finding specific patient information within documentation can be difficult. Recent studies on handoff documentation tools show that resident handoff notes are increasingly used as an alternative information source by non-physician clinicians. Previous findings also show that residents have become aware of this unintended use. This study investigated the alignment of resident note updating patterns and team note viewing patterns based on usage log data of handoff notes. Qualitative interviews with clinicians were used to triangulate findings based on the log analysis. The study found that notes that were frequently updated were viewed significantly more frequently than notes updated less often (p < 2.2 × 10(-16)). Almost 44% of all notes had aligned frequency of views and updates. The considerable percentage (56%) of mismatched note utilization suggests an opportunity for improvement.

Nano-optical conveyor belt, part II: Demonstration of handoff between near-field optical traps.

PubMed

Zheng, Yuxin; Ryan, Jason; Hansen, Paul; Cheng, Yao-Te; Lu, Tsung-Ju; Hesselink, Lambertus

2014-06-11

Optical tweezers have been widely used to manipulate biological and colloidal material, but the diffraction limit of far-field optics makes focused beams unsuitable for manipulating nanoscale objects with dimensions much smaller than the wavelength of light. While plasmonic structures have recently been successful in trapping nanoscale objects with high positioning accuracy, using such structures for manipulation over longer range has remained a significant challenge. In this work, we introduce a conveyor belt design based on a novel plasmonic structure, the resonant C-shaped engraving (CSE). We show how long-range manipulation is made possible by means of handoff between neighboring CSEs, and we present a simple technique for controlling handoff by rotating the polarization of laser illumination. We experimentally demonstrate handoff between a pair of CSEs for polystyrene spheres 200, 390, and 500 nm in diameter. We then extend this technique and demonstrate controlled particle transport down a 4.5 μm long "nano-optical conveyor belt."

Using mobile devices for inpatient rounding and handoffs: an innovative application developed and rapidly adopted by clinicians in a pediatric hospital.

PubMed

Motulsky, Aude; Wong, Jenna; Cordeau, Jean-Pierre; Pomalaza, Jorge; Barkun, Jeffrey; Tamblyn, Robyn

2017-04-01

To describe the usage of a novel application (The FLOW) that allows mobile devices to be used for rounding and handoffs. The FLOW provides a view of patient data and the capacity to enter short notes via personal mobile devices. It was deployed using a "bring-your-own-device" model in 4 pilot units. Social network analysis (SNA) was applied to audit trails in order to visualize usage patterns. A questionnaire was used to describe user experience. Overall, 253 health professionals used The FLOW with their personal mobile devices from October 2013 to March 2015. In pediatric and neonatal intensive care units (ICUs), a median of 26-26.5 notes were entered per user per day. Visual network representation of app entries showed that usage patterns were different between the ICUs. In 127 questionnaires (50%), respondents reported using The FLOW most often to enter notes and for handoffs. The FLOW was perceived as having improved patient care by 57% of respondents, compared to usual care. Most respondents (86%) wished to continue using The FLOW. This study shows how a handoff and rounding tool was quickly adopted in pediatric and neonatal ICUs in a hospital setting where patient charts were still paper-based. Originally developed as a tool to support informal documentation using smartphones, it was adapted to local practices and expanded to print sign-out documents and import notes within the medicolegal record with desktop computers. Interestingly, even if not supported by the nursing administrative authorities, the level of use for data entry among nurses and doctors was similar in all units, indicating close collaboration in documentation practices in these ICUs. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Improving Nursing Satisfaction with Bedside-Information, Technology-Enhanced Handoffs

ERIC Educational Resources Information Center

Chapman, Yvonne L.

2014-01-01

Due to renewed national focus on patient safety and patient outcomes, the advent of the electronic health record (EHR) and standardization of data management has prompted the utilization of information technology (IT) tools to enhance nursing bedside handoff. However, there is limited literature regarding the nurses' satisfaction with the…

Energy-Efficient Channel Handoff for Sensor Network-Assisted Cognitive Radio Network

PubMed Central

Usman, Muhammad; Sajjad Khan, Muhammad; Vu-Van, Hiep; Insoo, Koo

2015-01-01

The visiting and less-privileged status of the secondary users (SUs) in a cognitive radio network obligates them to release the occupied channel instantly when it is reclaimed by the primary user. The SU has a choice to make: either wait for the channel to become free, thus conserving energy at the expense of delayed transmission and delivery, or find and switch to a vacant channel, thereby avoiding delay in transmission at the expense of increased energy consumption. An energy-efficient decision that considers the tradeoff between energy consumption and continuous transmission needs to be taken as to whether to switch the channels. In this work, we consider a sensor network-assisted cognitive radio network and propose a backup channel, which is sensed by the SU in parallel with the operating channel that is being sensed by the sensor nodes. Imperfect channel sensing and residual energy of the SU are considered in order to develop an energy-efficient handoff strategy using the partially observable Markov decision process (POMDP), which considers beliefs about the operating and backup channels and the remaining energy of the SU in order to take an optimal channel handoff decision on the question “Should we switch the channel?” The objective is to dynamically decide in each time slot whether the SU should switch the channel or not in order to maximize throughput by utilizing energy efficiently. Extensive simulations were performed to show the effectiveness of the proposed channel handoff strategy, which was demonstrated in the form of throughput with respect to various parameters, i.e., detection probability, the channel idle probabilities of the operating and backup channels, and the maximum energy of the SU. PMID:26213936

Practicing Handoffs Early: Applying a Clinical Framework in the Anatomy Laboratory

ERIC Educational Resources Information Center

Lazarus, Michelle D.; Dos Santos, Jason A.; Haidet, Paul M.; Whitcomb, Tiffany L.

2016-01-01

The anatomy laboratory provides an ideal environment for the integration of clinical contexts as the willed-donor is often regarded as a student's "first patient." This study evaluated an innovative approach to peer teaching in the anatomy laboratory using a clinical handoff context. The authors introduced the "Situation,…

Patient Handoffs between Emergency Department and Inpatient Physicians: A Qualitative Study to Inform Standardization of Practice and Organization Theory

ERIC Educational Resources Information Center

Hilligoss, Phillip Brian

2011-01-01

This dissertation is motivated by two problems. First, existing literature characterizes patient handoff as an information transfer activity in which safety and quality are compromised by practice variation. This has prompted a movement to standardize practice. However, existing research has not closely examined how practice variations may be…

Navigating Turn-Taking and Conversational Repair in an Online Synchronous Course

ERIC Educational Resources Information Center

Earnshaw, Yvonne

2017-01-01

In face-to-face conversations, speaker transitions (or hand-offs) are typically seamless. In computer-mediated communication settings, speaker hand-offs can be a bit more challenging. This paper presents the results of a study of audio communication problems that occur in an online synchronous course, and how, and by whom, those problems are…

Fast decision algorithms in low-power embedded processors for quality-of-service based connectivity of mobile sensors in heterogeneous wireless sensor networks.

PubMed

Jaraíz-Simón, María D; Gómez-Pulido, Juan A; Vega-Rodríguez, Miguel A; Sánchez-Pérez, Juan M

2012-01-01

When a mobile wireless sensor is moving along heterogeneous wireless sensor networks, it can be under the coverage of more than one network many times. In these situations, the Vertical Handoff process can happen, where the mobile sensor decides to change its connection from a network to the best network among the available ones according to their quality of service characteristics. A fitness function is used for the handoff decision, being desirable to minimize it. This is an optimization problem which consists of the adjustment of a set of weights for the quality of service. Solving this problem efficiently is relevant to heterogeneous wireless sensor networks in many advanced applications. Numerous works can be found in the literature dealing with the vertical handoff decision, although they all suffer from the same shortfall: a non-comparable efficiency. Therefore, the aim of this work is twofold: first, to develop a fast decision algorithm that explores the entire space of possible combinations of weights, searching that one that minimizes the fitness function; and second, to design and implement a system on chip architecture based on reconfigurable hardware and embedded processors to achieve several goals necessary for competitive mobile terminals: good performance, low power consumption, low economic cost, and small area integration.

The third-year medical student "grapevine": managing transitions between third-year clerkships using peer-to-peer handoffs.

PubMed

Masters, Dylan E; O'Brien, Bridget C; Chou, Calvin L

2013-10-01

As third-year medical students rotate between clerkships, they experience multiple transitions across workplace cultures and shifting learning expectations. The authors explored clerkship transitions from the students' perspective by examining the advice they passed on to their peers in preparation for new clerkships. Seventy-one students from three Veterans Affairs-based clerkship rotations at the University of California, San Francisco, School of Medicine participated in a peer-to-peer handoff session from 2008 to 2011. In the handoff session, they gave tips for optimizing performance to students starting the clerkship they had just completed. The authors transcribed student comments from four handoff sessions and used qualitative content analysis to identify and compare advice across clerkships. Students shared advice about workplace culture, content learning, logistics, and work-life balance. Common themes included expectations of the rotation, workplace norms, specific tasks, learning opportunities, and learning strategies. Comments about patient care and work-life balance were rare. Students emphasized different themes for each clerkship; for example, for some clerkships, students commented heavily on tasks and content learning, while in another students focused on workplace culture and exam preparation. These findings characterize the transitions that third-year students undergo as they rotate into new clinical training environments. Students emphasized different aspects of each clerkship in the advice they passed to their peers, and their comments often describe informal norms or opportunities that official clerkship orientations may not address. Peer-to-peer handoffs may help ease transitions between clerkships with dissimilar cultures and expectations.

The Role of Electronic Health Records in Structuring Nursing Handoff Communication and Maintaining Situation Awareness

ERIC Educational Resources Information Center

Alghenaimi, Said

2012-01-01

In healthcare institutions, work must continue 24 hours a day, 7 days a week. A team of nurses is needed to provide around-the-clock patient care, and this process requires transfer of patient care responsibilities, a process known as a "handoff." The present study explored the role of electronic health records in structuring handoff…

A Reliable Handoff Mechanism for Mobile Industrial Wireless Sensor Networks.

PubMed

Ma, Jian; Yang, Dong; Zhang, Hongke; Gidlund, Mikael

2017-08-04

With the prevalence of low-power wireless devices in industrial applications, concerns about timeliness and reliability are bound to continue despite the best efforts of researchers to design Industrial Wireless Sensor Networks (IWSNs) to improve the performance of monitoring and control systems. As mobile devices have a major role to play in industrial production, IWSNs should support mobility. However, research on mobile IWSNs and practical tests have been limited due to the complicated resource scheduling and rescheduling compared with traditional wireless sensor networks. This paper proposes an effective mechanism to guarantee the performance of handoff, including a mobility-aware scheme, temporary connection and quick registration. The main contribution of this paper is that the proposed mechanism is implemented not only in our testbed but in a real industrial environment. The results indicate that our mechanism not only improves the accuracy of handoff triggering, but also solves the problem of ping-pong effect during handoff. Compared with the WirelessHART standard and the RSSI-based approach, our mechanism facilitates real-time communication while being more reliable, which can help end-to-end packet delivery remain an average of 98.5% in the scenario of mobile IWSNs.

A Comparison of Techniques for Camera Selection and Hand-Off in a Video Network

NASA Astrophysics Data System (ADS)

Li, Yiming; Bhanu, Bir

Video networks are becoming increasingly important for solving many real-world problems. Multiple video sensors require collaboration when performing various tasks. One of the most basic tasks is the tracking of objects, which requires mechanisms to select a camera for a certain object and hand-off this object from one camera to another so as to accomplish seamless tracking. In this chapter, we provide a comprehensive comparison of current and emerging camera selection and hand-off techniques. We consider geometry-, statistics-, and game theory-based approaches and provide both theoretical and experimental comparison using centralized and distributed computational models. We provide simulation and experimental results using real data for various scenarios of a large number of cameras and objects for in-depth understanding of strengths and weaknesses of these techniques.

Mobile physician reporting of clinically significant events-a novel way to improve handoff communication and supervision of resident on call activities.

PubMed

Nabors, Christopher; Peterson, Stephen J; Aronow, Wilbert S; Sule, Sachin; Mumtaz, Arif; Shah, Tushar; Eskridge, Etta; Wold, Eric; Stallings, Gary W; Burak, Kathleen Kelly; Goldberg, Randy; Guo, Gary; Sekhri, Arunabh; Mathew, George; Khera, Sahil; Montoya, Jessica; Sharma, Mala; Paudel, Rajiv; Frishman, William H

2014-12-01

Reporting of clinically significant events represents an important mechanism by which patient safety problems may be identified and corrected. However, time pressure and cumbersome report entry procedures have discouraged the full participation of physicians. To improve the process, our internal medicine training program developed an easy-to-use mobile platform that combines the reporting process with patient sign-out. Between August 25, 2011, and January 25, 2012, our trainees entered clinically significant events into i-touch/i-phone/i-pad based devices functioning in wireless-synchrony with our desktop application. Events were collected into daily reports that were sent from the handoff system to program leaders and attending physicians to plan for rounds and to correct safety problems. Using the mobile module, residents entered 31 reportable events per month versus the 12 events per month that were reported via desktop during a previous 6-month study period. Advances in information technology now permit clinically significant events that take place during "off hours" to be identified and reported (via handoff) to next providers and to supervisors via collated reports. This information permits hospital leaders to correct safety issues quickly and effectively, while attending physicians are able to use information gleaned from the reports to optimize rounding plans and to provide additional oversight of trainee on call patient management decisions.

Comparisons of angularly and spectrally resolved Bremsstrahlung measurements to two-dimensional multi-stage simulations of short-pulse laser-plasma interactions

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

Chen, C. D.; Kemp, A. J.; Pérez, F.

2013-05-15

A 2-D multi-stage simulation model incorporating realistic laser conditions and a fully resolved electron distribution handoff has been developed and compared to angularly and spectrally resolved Bremsstrahlung measurements from high-Z planar targets. For near-normal incidence and 0.5-1 × 10{sup 20} W/cm{sup 2} intensity, particle-in-cell (PIC) simulations predict the existence of a high energy electron component consistently directed away from the laser axis, in contrast with previous expectations for oblique irradiation. Measurements of the angular distribution are consistent with a high energy component when directed along the PIC predicted direction, as opposed to between the target normal and laser axis asmore » previously measured.« less

What constitutes a good hand offs in the emergency department: a patient's perspective.

PubMed

Downey, La Vonne; Zun, Leslie; Burke, Trena

2013-01-01

The aim is to determine, from the patient's perspective, what constitutes a good hand-off procedure in the emergency department (ED). The secondary purpose is to evaluate what impact a formalized hand-off had on patient knowledge, throughput and customer service This study used a randomized controlled clinical trial involving two unique hand-off approaches and a convenience sample. The study alternated between the current hand-off process that documented the process but not specific elements (referred to as the informal process) to one using the IPASS the BATON process (considered the formal process). Consenting patients completed a 12-question validated questionnaire on how the process was perceived by patients and about their understanding why they waited in the ED. Statistical analysis using SPSS calculated descriptive frequencies and t-tests. In total 107 patients were enrolled: 50 in the informal and 57 in the formal group. Most patients had positive answers to the customer survey. There were significant differences between formal and informal groups: recalling the oncoming and outgoing physician coming to the patient's bed (p = 0.000), with more formal group recalling that than informal group patients; the oncoming physician introducing him/herself (p = 0.01), with more from the formal group answering yes and the physician discussing tests and implications with formal group patients (p = 0.02). This study was done at an urban inner city ED, a fact that may have skewed its results. A comparison of suburban and rural EDs would make the results stronger. It also reflected a very high level of customer satisfaction within the ED. This lack of variance may have meant that the correlation between customer service and handoffs was missed or underrepresented. There was no codified observation of either those using the IPASS the BATON script or those using informal procedures, so no comparison of level and types of information given between the two groups was done. There could have been a bias of those attending who had internalized the IPASS the BATON procedures and used them even when they were assigned to the informal group. A hand off from one physician to the next in the emergency department is best done using a formalized process. IPASS the BATON is a useful tool for hand off in the ED in part because it involved the patient in the process. The formal hand off increased communication between patient and doctor as its use increased the patient's opportunity to ask and respond to questions. The researchers evaluated an ED physician specific hand-off process and illustrate the value and impact of involving patients in the hand-off process.

Improving handoff communication from hospital to home: the development, implementation and evaluation of a personalized patient discharge letter.

PubMed

Buurman, Bianca M; Verhaegh, Kim J; Smeulers, Marian; Vermeulen, Hester; Geerlings, Suzanne E; Smorenburg, Susanne; de Rooij, Sophia E

2016-06-01

To develop, implement and evaluate a personalized patient discharge letter (PPDL) to improve the quality of handoff communication from hospital to home. From the end of 2006-09 we conducted a quality improvement project; consisting of a before-after evaluation design, and a process evaluation. Four general internal medicine wards, in a 1024-bed teaching hospital in Amsterdam, the Netherlands. All consecutive patients of 18 years and older, admitted for at least 48 h. A PPDL, a plain language handoff communication tool provided to the patient at hospital discharge. Verbal and written information provision at discharge, feasibility of integrating the PPDL into daily practice, pass rates of PPDLs provided at discharge. A total of 141 patients participated in the before-after evaluation study. The results from the first phase of quality improvement showed that providing patient with a PPDL increased the number of patients receiving verbal and written information at discharge. Patient satisfaction with the PPDL was 7.3. The level of implementation was low (30%). In the second phase, the level of implementation improved because of incorporating the PPDL into the electronic patient record (EPR) and professional education. An average of 57% of the discharged patients received the PPDL upon discharge. The number of discharge conversations also increased. Patients and professionals rated the PPDL positively. Key success factors for implementation were: education of interns, residents and staff, standardization of the content of the PPDL, integrating the PPDL into the electronic medical record and hospital-wide policy. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Development of the Connecticut Airway Risk Evaluation (CARE) system to improve handoff communication in pediatric patients with tracheotomy.

PubMed

Lawrason Hughes, Amy; Murray, Nicole; Valdez, Tulio A; Kelly, Raeanne; Kavanagh, Katherine

2014-01-01

National attention has focused on the importance of handoffs in medicine. Our practice during airway patient handoffs is to communicate a patient-specific emergency plan for airway reestablishment; patients who are not intubatable by standard means are at higher risk for failure. There is currently no standard classification system describing airway risk in tracheotomized patients. To introduce and assess the interrater reliability of a simple airway risk classification system, the Connecticut Airway Risk Evaluation (CARE) system. We created a novel classification system, the CARE system, based on ease of intubation and the need for ventilation: group 1, easily intubatable; group 2, intubatable with special equipment and/or maneuvers; group 3, not intubatable. A "v" was appended to any group number to indicate the need for mechanical ventilation. We performed a retrospective medical chart review of patients aged 0 to 18 years who were undergoing tracheotomy at our tertiary care pediatric hospital between January 2000 and April 2011. INTERVENTIONS Each patient's medical history, including airway disease and means of intubation, was reviewed by 4 raters. Patient airways were separately rated as CARE groups 1, 2, or 3, each group with or without a v appended, as appropriate, based on the available information. After the patients were assigned to an airway group by each of the 4 raters, the interrater reliability was calculated to determine the ease of use of the rating system. We identified complete data for 155 of 169 patients (92%), resulting in a total of 620 ratings. Based on the patient's ease of intubation, raters categorized tracheotomized patients into group 1 (70%, 432 of 620); group 2 (25%, 157 of 620); or group 3 (5%, 29 of 620), each with a v appended if appropriate. The interrater reliability was κ = 0.95. We propose an airway risk classification system for tracheotomized patients, CARE, that has high interrater reliability and is easy to use and interpret. As medical providers and national organizations place more focus on improvements in interprovider communication, the creation of an airway handoff tool is integral to improving patient safety and airway management strategies following tracheotomy complications.

NINDS translational programs: priming the pump of neurotherapeutics discovery and development.

PubMed

Ranganathan, Rajesh

2014-11-05

The National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH) recently issued a new suite of funding opportunities for neurotherapeutics development. The goals are to build a contiguous bridge from basic science, accelerate the advancement of promising projects to clinical testing with the contributions of multidisciplinary teams, and enhance hand-off to subsequent funders. Copyright © 2014 Elsevier Inc. All rights reserved.

Lessons learned from the implementation of a bedside handoff model.

PubMed

Hagman, Jan; Oman, Kathleen; Kleiner, Catherine; Johnson, Elizabeth; Nordhagen, Jamie

2013-06-01

At the University of Colorado Hospital, nurse-to-nurse shift reports traditionally occurred in a conference room setting and consisted of nurse-to-nurse verbal communication. Evidence supports moving this information exchange to the patient bedside. This model of report improves clinical effectiveness, patient safety, nurse efficiency, and staff satisfaction. Bedside reporting empowers patients and families to ask questions and contribute to their plan of care and increases patient satisfaction. This article describes the process of implementing and evaluating a model of nurse-to-nurse bedside handoff report.

Handoffs: Transitions of Care for Children in the Emergency Department.

PubMed

2016-11-01

Transitions of care (ToCs), also referred to as handoffs or sign-outs, occur when the responsibility for a patient's care transfers from 1 health care provider to another. Transitions are common in the acute care setting and have been noted to be vulnerable events with opportunities for error. Health care is taking ideas from other high-risk industries, such as aerospace and nuclear power, to create models of structured transition processes. Although little literature currently exists to establish 1 model as superior, multiorganizational consensus groups agree that standardization is warranted and that additional work is needed to establish characteristics of ToCs that are associated with clinical or practice outcomes. The rationale for structuring ToCs, specifically those related to the care of children in the emergency setting, and a description of identified strategies are presented, along with resources for educating health care providers on ToCs. Recommendations for development, education, and implementation of transition models are included. Copyright © 2016 by the American Academy of Pediatrics.

Facilitated release of substrate protein from prefoldin by chaperonin.

PubMed

Zako, Tamotsu; Iizuka, Ryo; Okochi, Mina; Nomura, Tomoko; Ueno, Taro; Tadakuma, Hisashi; Yohda, Masafumi; Funatsu, Takashi

2005-07-04

Prefoldin is a chaperone that captures a protein-folding intermediate and transfers it to the group II chaperonin for correct folding. However, kinetics of interactions between prefoldin and substrate proteins have not been investigated. In this study, dissociation constants and dissociation rate constants of unfolded proteins with prefoldin were firstly measured using fluorescence microscopy. Our results suggest that binding and release of prefoldin from hyperthermophilic archaea with substrate proteins were in a dynamic equilibrium. Interestingly, the release of substrate proteins from prefoldin was facilitated when chaperonin was present, supporting a handoff mechanism of substrate proteins from prefoldin to the chaperonin.

Mitigating Handoff Call Dropping in Wireless Cellular Networks: A Call Admission Control Technique

NASA Astrophysics Data System (ADS)

Ekpenyong, Moses Effiong; Udoh, Victoria Idia; Bassey, Udoma James

2016-06-01

Handoff management has been an important but challenging issue in the field of wireless communication. It seeks to maintain seamless connectivity of mobile users changing their points of attachment from one base station to another. This paper derives a call admission control model and establishes an optimal step-size coefficient (k) that regulates the admission probability of handoff calls. An operational CDMA network carrier was investigated through the analysis of empirical data collected over a period of 1 month, to verify the performance of the network. Our findings revealed that approximately 23 % of calls in the existing system were lost, while 40 % of the calls (on the average) were successfully admitted. A simulation of the proposed model was then carried out under ideal network conditions to study the relationship between the various network parameters and validate our claim. Simulation results showed that increasing the step-size coefficient degrades the network performance. Even at optimum step-size (k), the network could still be compromised in the presence of severe network crises, but our model was able to recover from these problems and still functions normally.

A Model of Process-Based Automation: Cost and Quality Implications in the Medication Management Process

ERIC Educational Resources Information Center

Spaulding, Trent Joseph

2011-01-01

The objective of this research is to understand how a set of systems, as defined by the business process, creates value. The three studies contained in this work develop the model of process-based automation. The model states that complementarities among systems are specified by handoffs in the business process. The model also provides theory to…

Improving interunit transitions of care between emergency physicians and hospital medicine physicians: a conceptual approach.

PubMed

Beach, Christopher; Cheung, Dickson S; Apker, Julie; Horwitz, Leora I; Howell, Eric E; O'Leary, Kevin J; Patterson, Emily S; Schuur, Jeremiah D; Wears, Robert; Williams, Mark

2012-10-01

Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focusing on the hand-off process between emergency and hospital medicine physicians. Sensitivity to cultural and operational differences and a common set of expectations pertaining to hand-off content will more effectively prepare the next provider to act safely and efficiently when caring for the patient. Through a consensus decision-making process of experienced and published authorities in health care transitions, including physicians in both specialties as well as in communication studies, the authors propose content and style principles clinicians may use to improve transition communication. With representation from both community and academic settings, similarities and differences between emergency medicine and internal medicine are highlighted to heighten appreciation of the values, attitudes, and goals of each specialty, particularly pertaining to communication. The authors also examine different communication media, social and cultural behaviors, and tools that practitioners use to share patient care information. Quality measures are proposed within the structure, process, and outcome framework for institutions seeking to evaluate and monitor improvement strategies in hand-off performance. Validation studies to determine if these suggested improvements in transition communication will result in improved patient outcomes will be necessary. By exploring the dynamics of transition communication between specialties and suggesting best practices, the authors hope to strengthen hand-off skills and contribute to improved continuity of care. © 2012 by the Society for Academic Emergency Medicine.

A comparative signaling cost analysis of Macro Mobility scheme in NEMO (MM-NEMO) with mobility management protocol

NASA Astrophysics Data System (ADS)

Islam, Shayla; Abdalla, Aisha H.; Habaebi, Mohamed H.; Latif, Suhaimi A.; Hassan, Wan H.; Hasan, Mohammad K.; Ramli, H. A. M.; Khalifa, Othman O.

2013-12-01

NEMO BSP is an upgraded addition to Mobile IPv6 (MIPv6). As MIPv6 and its enhancements (i.e. HMIPv6) possess some limitations like higher handoff latency, packet loss, NEMO BSP also faces all these shortcomings by inheritance. Network Mobility (NEMO) is involved to handle the movement of Mobile Router (MR) and it's Mobile Network Nodes (MNNs) during handoff. Hence it is essential to upgrade the performance of mobility management protocol to obtain continuous session connectivity with lower delay and packet loss in NEMO environment. The completion of handoff process in NEMO BSP usually takes longer period since MR needs to register its single primary care of address (CoA) with home network that may cause performance degradation of the applications running on Mobile Network Nodes. Moreover, when a change in point of attachment of the mobile network is accompanied by a sudden burst of signaling messages, "Signaling Storm" occurs which eventually results in temporary congestion, packet delays or even packet loss. This effect is particularly significant for wireless environment where a wireless link is not as steady as a wired link since bandwidth is relatively limited in wireless link. Hence, providing continuous Internet connection without any interruption through applying multihoming technique and route optimization mechanism in NEMO are becoming the center of attention to the current researchers. In this paper, we propose a handoff cost model to compare the signaling cost of MM-NEMO with NEMO Basic Support Protocol (NEMO BSP) and HMIPv6.The numerical results shows that the signaling cost for the MM-NEMO scheme is about 69.6 % less than the NEMO-BSP and HMIPv6.

Information Needs Assessment for a Medicine Ward-Focused Rounding Dashboard.

PubMed

Aakre, Christopher A; Chaudhry, Rajeev; Pickering, Brian W; Herasevich, Vitaly

2016-08-01

To identify the routine information needs of inpatient clinicians on the general wards for the development of an electronic dashboard. Survey of internal medicine and subspecialty clinicians from March 2014-July 2014 at Saint Marys Hospital in Rochester, Minnesota. An information needs assessment was generated from all unique data elements extracted from all handoff and rounding tools used by clinicians in our ICUs and general wards. An electronic survey was distributed to 104 inpatient medical providers. 89 unique data elements were identified from currently utilized handoff and rounding instruments. All data elements were present in our multipurpose ICU-based dashboard. 42 of 104 (40 %) surveys were returned. Data elements important (50/89, 56 %) and unimportant (24/89, 27 %) for routine use were identified. No significant differences in data element ranking were observed between supervisory and nonsupervisory roles. The routine information needs of general ward clinicians are a subset of data elements used routinely by ICU clinicians. Our findings suggest an electronic dashboard could be adapted from the critical care setting to the general wards with minimal modification.

Opportunistic Mobility Support for Resource Constrained Sensor Devices in Smart Cities

PubMed Central

Granlund, Daniel; Holmlund, Patrik; Åhlund, Christer

2015-01-01

A multitude of wireless sensor devices and technologies are being developed and deployed in cities all over the world. Sensor applications in city environments may include highly mobile installations that span large areas which necessitates sensor mobility support. This paper presents and validates two mechanisms for supporting sensor mobility between different administrative domains. Firstly, EAP-Swift, an Extensible Authentication Protocol (EAP)-based sensor authentication protocol is proposed that enables light-weight sensor authentication and key generation. Secondly, a mechanism for handoffs between wireless sensor gateways is proposed. We validate both mechanisms in a real-life study that was conducted in a smart city environment with several fixed sensors and moving gateways. We conduct similar experiments in an industry-based anechoic Long Term Evolution (LTE) chamber with an ideal radio environment. Further, we validate our results collected from the smart city environment against the results produced under ideal conditions to establish best and real-life case scenarios. Our results clearly validate that our proposed mechanisms can facilitate efficient sensor authentication and handoffs while sensors are roaming in a smart city environment. PMID:25738767

Opportunistic mobility support for resource constrained sensor devices in smart cities.

PubMed

Granlund, Daniel; Holmlund, Patrik; Åhlund, Christer

2015-03-02

A multitude of wireless sensor devices and technologies are being developed and deployed in cities all over the world. Sensor applications in city environments may include highly mobile installations that span large areas which necessitates sensor mobility support. This paper presents and validates two mechanisms for supporting sensor mobility between different administrative domains. Firstly, EAP-Swift, an Extensible Authentication Protocol (EAP)-based sensor authentication protocol is proposed that enables light-weight sensor authentication and key generation. Secondly, a mechanism for handoffs between wireless sensor gateways is proposed. We validate both mechanisms in a real-life study that was conducted in a smart city environment with several fixed sensors and moving gateways. We conduct similar experiments in an industry-based anechoic Long Term Evolution (LTE) chamber with an ideal radio environment. Further, we validate our results collected from the smart city environment against the results produced under ideal conditions to establish best and real-life case scenarios. Our results clearly validate that our proposed mechanisms can facilitate efficient sensor authentication and handoffs while sensors are roaming in a smart city environment.

Designing of Roaming Protocol for Bluetooth Equipped Multi Agent Systems

NASA Astrophysics Data System (ADS)

Subhan, Fazli; Hasbullah, Halabi B.

Bluetooth is an established standard for low cost, low power, wireless personal area network. Currently, Bluetooth does not support any roaming protocol in which handoff occurs dynamically when a Bluetooth device is moving out of the piconet. If a device is losing its connection to the master device, no provision is made to transfer it to another master. Handoff is not possible in a piconet, as in order to stay within the network, a slave would have to keep the same master. So, by definition intra-handoff is not possible within a piconet. This research mainly focuses on Bluetooth technology and designing a roaming protocol for Bluetooth equipped multi agent systems. A mathematical model is derived for an agent. The idea behind the mathematical model is to know when to initiate the roaming process for an agent. A desired trajectory for the agent is calculated using its x and y coordinates system, and is simulated in SIMULINK. Various roaming techniques are also studied and discussed. The advantage of designing a roaming protocol is to ensure the Bluetooth enabled roaming devices can freely move inside the network coverage without losing its connection or break of service in case of changing the base stations.

Fast and secure handover of intra-ASN IEEE802.16 network by proposed certificate based pre-authentication

NASA Astrophysics Data System (ADS)

Sridevi, B.; Supriya, T. S.; Rajaram, S.

2013-01-01

The current generation of wireless networks has been designed predominantly to support voice and more recently data traffic. WiMAX is currently one of the hottest technologies in wireless. The main motive of the mobile technologies is to provide seamless cost effective mobility. But this is affected by Authentication cost and handover delay since on each handoff the Mobile Station (MS) has to undergo all steps of authentication. Pre-Authentication is used to reduce the handover delay and increase the speed of the Intra-ASN Handover. Proposed Pre-Authentication method is intended to reduce the authentication delay by getting pre authenticated by central authority called Pre Authentication Authority (PAA). MS requests PAA for Pre Authentication Certificate (PAC) before performing handoff. PAA verifies the identity of MS and provides PAC to MS and also to the neighboring target Base Stations (tBSs). MS having time bound PAC can skip the authentication process when recognized by target BS during handoff. It also prevents the DOS (Denial Of Service) attack and Replay attack. It has no wastage of unnecessary key exchange of the resources. The proposed work is simulated by NS2 model and by MATLAB.

Information handoff and outcomes of critically ill patients transferred between hospitals

PubMed Central

Usher, Michael G.; Fanning, Christine; Wu, Di; Muglia, Christine; Balonze, Karen; Kim, Deborah; Parikh, Amay; Herrigel, Dana

2016-01-01

Purpose Patients transferred between hospitals are at high risk of adverse events and mortality. This study aims to identify which components of the transfer handoff process are important predictors of adverse events and mortality. Materials and Methods We conducted a retrospective, observational study of 335 consecutive patient transfers to three ICUs at an academic tertiary referral center. We assessed the relationship between handoff documentation completeness and patient outcomes. The primary outcome was in-hospital mortality. Secondary outcomes included adverse events, duplication of labor, disposition error, and length of stay. Results Transfer documentation was frequently absent with overall completeness of 58.3%. Adverse events occurred in 42% of patients within 24 hours of arrival, with an overall in-hospital mortality of 17.3%. Higher documentation completeness was associated with reduced in-hospital mortality (OR 0.07, 95% CI 0.02 to 0.38, p=0.002), reduced adverse events (coef −2.08, 95% CI −2.76 to −1.390, p<0.001), and reduced duplication of labor (OR 0.19, 95% CI 0.04 to 0.88, p=0.033) when controlling for severity of illness. Conclusions Documentation completeness is associated with improved outcomes and resource utilization in patients transferred between hospitals. PMID:27591388

Multi-Target Camera Tracking, Hand-off and Display LDRD 158819 Final Report

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

Anderson, Robert J.

2014-10-01

Modern security control rooms gather video and sensor feeds from tens to hundreds of cameras. Advanced camera analytics can detect motion from individual video streams and convert unexpected motion into alarms, but the interpretation of these alarms depends heavily upon human operators. Unfortunately, these operators can be overwhelmed when a large number of events happen simultaneously, or lulled into complacency due to frequent false alarms. This LDRD project has focused on improving video surveillance-based security systems by changing the fundamental focus from the cameras to the targets being tracked. If properly integrated, more cameras shouldn’t lead to more alarms, moremore » monitors, more operators, and increased response latency but instead should lead to better information and more rapid response times. For the course of the LDRD we have been developing algorithms that take live video imagery from multiple video cameras, identify individual moving targets from the background imagery, and then display the results in a single 3D interactive video. In this document we summarize the work in developing this multi-camera, multi-target system, including lessons learned, tools developed, technologies explored, and a description of current capability.« less

Multi-target camera tracking, hand-off and display LDRD 158819 final report

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

Anderson, Robert J.

2014-10-01

Modern security control rooms gather video and sensor feeds from tens to hundreds of cameras. Advanced camera analytics can detect motion from individual video streams and convert unexpected motion into alarms, but the interpretation of these alarms depends heavily upon human operators. Unfortunately, these operators can be overwhelmed when a large number of events happen simultaneously, or lulled into complacency due to frequent false alarms. This LDRD project has focused on improving video surveillance-based security systems by changing the fundamental focus from the cameras to the targets being tracked. If properly integrated, more cameras shouldn't lead to more alarms, moremore » monitors, more operators, and increased response latency but instead should lead to better information and more rapid response times. For the course of the LDRD we have been developing algorithms that take live video imagery from multiple video cameras, identifies individual moving targets from the background imagery, and then displays the results in a single 3D interactive video. In this document we summarize the work in developing this multi-camera, multi-target system, including lessons learned, tools developed, technologies explored, and a description of current capability.« less

Structure of eukaryotic prefoldin and of its complexes with unfolded actin and the cytosolic chaperonin CCT

PubMed Central

Martín-Benito, Jaime; Boskovic, Jasminka; Gómez-Puertas, Paulino; Carrascosa, José L.; Simons, C.Torrey; Lewis, Sally A.; Bartolini, Francesca; Cowan, Nicholas J.; Valpuesta, José M.

2002-01-01

The biogenesis of the cytoskeletal proteins actin and tubulin involves interaction of nascent chains of each of the two proteins with the oligomeric protein prefoldin (PFD) and their subsequent transfer to the cytosolic chaperonin CCT (chaperonin containing TCP-1). Here we show by electron microscopy that eukaryotic PFD, which has a similar structure to its archaeal counterpart, interacts with unfolded actin along the tips of its projecting arms. In its PFD-bound state, actin seems to acquire a conformation similar to that adopted when it is bound to CCT. Three-dimensional reconstruction of the CCT:PFD complex based on cryoelectron microscopy reveals that PFD binds to each of the CCT rings in a unique conformation through two specific CCT subunits that are placed in a 1,4 arrangement. This defines the phasing of the CCT rings and suggests a handoff mechanism for PFD. PMID:12456645

Use of failure mode and effects analysis for proactive identification of communication and handoff failures from organ procurement to transplantation.

PubMed

Steinberger, Dina M; Douglas, Stephen V; Kirschbaum, Mark S

2009-09-01

A multidisciplinary team from the University of Wisconsin Hospital and Clinics transplant program used failure mode and effects analysis to proactively examine opportunities for communication and handoff failures across the continuum of care from organ procurement to transplantation. The team performed a modified failure mode and effects analysis that isolated the multiple linked, serial, and complex information exchanges occurring during the transplantation of one solid organ. Failure mode and effects analysis proved effective for engaging a diverse group of persons who had an investment in the outcome in analysis and discussion of opportunities to improve the system's resilience for avoiding errors during a time-pressured and complex process.

Achieving balance on the inpatient internal medicine wards: a performance improvement project to restructure resident work hours at a tertiary care center.

PubMed

Cohee, Brian M; Hartzell, Joshua D; Shimeall, William T

2014-05-01

In an era of increasing duty hours restrictions, a growing body of literature describes how fatigue and handoffs affect patient care and educational experience. Although many studies examine these elements independently, there remains little understanding of how they interact. Previously reported interventions have yielded unexpected results that are likely dependent on local factors. The authors collected data on admissions, emergency department disposition, and team continuity during an 8-day period before and a 12-day period after changing from a night float system to a resident long-call system with a graded transition to a night team. House staff and attendings were surveyed afterwards. The intervention increased the portion of patients admitted to their primary resident from 47% (43/91) to 82% (75/91) (P < .01) and improved the percentage of emergency room admissions performed in less than 90 minutes from 39% (7/18) to 70% (39/44) (P = .02). The percentage of self-reported duty hours violations decreased from 55% (16/29) to 6.8% (3/44) (P < .01). Survey respondents reported an improved sense of patient involvement, quality of care, and handoffs. Designing a call system around a brief assessment of admission intensity resulted in better alignment of resident resources with workload and improvements in multiple outcomes. Optimization of inpatient work structure appears to be significantly affected by local factors. Future trials assessing work hour balance will need to take work intensity into account and assess a wide variety of potential consequences.

I'm clear, you're clear, we're all clear: improving consultation communication skills in undergraduate medical education.

PubMed

Kessler, Chad S; Chan, Teresa; Loeb, Jennifer M; Malka, S Terez

2013-06-01

Requesting and providing consultations are daily occurrences in most teaching hospitals. With increased attention on transitions of care in light of the recent scrutiny of duty hours, consultations and other interphysician interactions, such as handoffs, are becoming increasingly important. As modern medicine increases in complexity, the skill of communicating with medical colleagues throughout the continuum of care becomes more challenging. Like many of the other skills acquired by medical students, consultation communication is often learned by casual observation and through trial and error. Without formal training, however, miscommunications will continue to occur, nearly ensuring that medical errors happen. Interphysician communication skills, therefore, need to be emphasized in undergraduate and graduate medical education instead of being left to happenstance or hit-or-miss practice. In this article, the authors review two models for understanding and teaching the consultation process--5Cs and PIQUED--both of which were developed for specific subsets of learners. They then combine the two to create a consultation model that may be more widely applied.

P5 Truss installation

NASA Image and Video Library

2006-12-12

S116-E-05764 (11 Dec. 2006) --- The International Space Station's Canadarm2 moves toward the station's new P5 truss section for a hand-off from Space Shuttle Discovery's Remote Manipulator System (RMS) robotic arm.

P5 Truss installation

NASA Image and Video Library

2006-12-12

S116-E-05765 (11 Dec. 2006) --- The International Space Station's Canadarm2 moves toward the station's new P5 truss section for a hand-off from Space Shuttle Discovery's Remote Manipulator System (RMS) robotic arm.

Performance Analysis of Inter-Domain Handoff Scheme Based on Virtual Layer in PMIPv6 Networks for IP-Based Internet of Things.

PubMed

Cho, Chulhee; Choi, Jae-Young; Jeong, Jongpil; Chung, Tai-Myoung

2017-01-01

Lately, we see that Internet of things (IoT) is introduced in medical services for global connection among patients, sensors, and all nearby things. The principal purpose of this global connection is to provide context awareness for the purpose of bringing convenience to a patient's life and more effectively implementing clinical processes. In health care, monitoring of biosignals of a patient has to be continuously performed while the patient moves inside and outside the hospital. Also, to monitor the accurate location and biosignals of the patient, appropriate mobility management is necessary to maintain connection between the patient and the hospital network. In this paper, a binding update scheme on PMIPv6, which reduces signal traffic during location updates by Virtual LMA (VLMA) on the top original Local Mobility Anchor (LMA) Domain, is proposed to reduce the total cost. If a Mobile Node (MN) moves to a Mobile Access Gateway (MAG)-located boundary of an adjacent LMA domain, the MN changes itself into a virtual mode, and this movement will be assumed to be a part of the VLMA domain. In the proposed scheme, MAGs eliminate global binding updates for MNs between LMA domains and significantly reduce the packet loss and latency by eliminating the handoff between LMAs. In conclusion, the performance analysis results show that the proposed scheme improves performance significantly versus PMIPv6 and HMIPv6 in terms of the binding update rate per user and average handoff latency.

Airport Airside System Model

DOT National Transportation Integrated Search

1971-06-01

The model of an airport airside system simulates aircraft operations and controller functions in the terminal area, both in the air and on the ground. The model encompasses all operations between the terminal gate and the point of handoff between the...

A Pre-Emptive Horizontal Channel Borrowing and Vertical Traffic Overflowing Channel Allocation Scheme for Overlay Networks

NASA Astrophysics Data System (ADS)

Zhao, Fang-Ming; Jiang, Ling-Ge; He, Chen

In this paper, a channel allocation scheme is studied for overlay wireless networks to optimize connection-level QoS. The contributions of our work are threefold. First, a channel allocation strategy using both horizontal channel borrowing and vertical traffic overflowing (HCBVTO) is presented and analyzed. When all the channels in a given macrocell are used, high-mobility real-time handoff requests can borrow channels from adjacent homogeneous cells. In case that the borrowing requests fail, handoff requests may also be overflowed to heterogeneous cells, if possible. Second, high-mobility real-time service is prioritized by allowing it to preempt channels currently used by other services. And third, to meet the high QoS requirements of some services and increase the utilization of radio resources, certain services can be transformed between real-time services and non-real-time services as necessary. Simulation results demonstrate that the proposed schemes can improve system performance.

Multidisciplinary teamwork and communication training.

PubMed

Deering, Shad; Johnston, Lindsay C; Colacchio, Kathryn

2011-04-01

Every delivery is a multidisciplinary event, involving nursing, obstetricians, anesthesiologists, and pediatricians. Patients are often in labor across multiple provider shifts, necessitating numerous handoffs between teams. Each handoff provides an opportunity for errors. Although a traditional approach to improving patient outcomes has been to address individual knowledge and skills, it is now recognized that a significant number of complications result from team, rather than individual, failures. In 2004, a Sentinel Alert issued by the Joint Commission revealed that most cases of perinatal death and injury are caused by problems with an organization's culture and communication failures. It was recommended that hospitals implement teamwork training programs in an effort to improve outcomes. Instituting a multidisciplinary teamwork training program that uses simulation offers a risk-free environment to practice skills, including communication, role clarification, and mutual support. This experience should improve patient safety and outcomes, as well as enhance employee morale. Published by Elsevier Inc.

Interfacility Transfers to General Pediatric Floors: A Qualitative Study Exploring the Role of Communication.

PubMed

Rosenthal, Jennifer L; Okumura, Megumi J; Hernandez, Lenore; Li, Su-Ting T; Rehm, Roberta S

2016-01-01

Children with special health care needs often require health services that are only provided at subspecialty centers. Such children who present to nonspecialty hospitals might require a hospital-to-hospital transfer. When transitioning between medical settings, communication is an integral aspect that can affect the quality of patient care. The objectives of the study were to identify barriers and facilitators to effective interfacility pediatric transfer communication to general pediatric floors from the perspectives of referring and accepting physicians, and then develop a conceptual model for effective interfacility transfer communication. This was a single-center qualitative study using grounded theory methodology. Referring and accepting physicians of children with special health care needs were interviewed. Four researchers coded the data using ATLAS.ti (version 7, Scientific Software Development GMBH, Berlin, Germany), using a 2-step process of open coding, followed by focused coding until no new codes emerged. The research team reached consensus on the final major categories and subsequently developed a conceptual model. Eight referring and 9 accepting physicians were interviewed. Theoretical coding resulted in 3 major categories: streamlined transfer process, quality handoff and 2-way communication, and positive relationships between physicians across facilities. The conceptual model unites these categories and shows how these categories contribute to effective interfacility transfer communication. Proposed interventions involved standardizing the communication process and incorporating technology such as telemedicine during transfers. Communication is perceived to be an integral component of interfacility transfers. We recommend that transfer systems be re-engineered to make the process more streamlined, to improve the quality of the handoff and 2-way communication, and to facilitate positive relationships between physicians across facilities. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Piloting a Structured Practice Audit to Assess ACGME Milestones in Written Handoff Communication in Internal Medicine

PubMed Central

Martin, Shannon K.; Farnan, Jeanne M.; McConville, John F.; Arora, Vineet M.

2015-01-01

Background Written communication skills are integral to patient care handoffs. Residency programs require feasible assessment tools that provide timely formative and summative feedback, ideally linked to the Accreditation Council for Graduate Medical Education Milestones. Objective We describe the use of 1 such tool—UPDATED—to assess written handoff communication skills in internal medicine interns. Methods During 2012–2013, the authors piloted a structured practice audit at 1 academic institution to audit written sign-outs completed by 45 interns, using the UPDATED tool, which scores 7 aspects of sign-out communication linked to milestones. Intern sign-outs were audited by trained faculty members throughout the year. Results were incorporated into intern performance reviews and Clinical Competency Committees. Results A total of 136 sign-outs were audited (averaging 3.1 audits per intern). In the first trimester, 14 interns (31%) had satisfactory audit results. Five interns (11%) had critical deficiencies and received immediate feedback, and the remaining 26 (58%) were assigned future audits due to missing audits or unsatisfactory scores. In the second trimester, 21 interns (68%) had satisfactory results, 1 had critical deficiencies, and 9 (29%) required future audits. Nine of the 10 remaining interns in the final trimester had satisfactory audits. Faculty time was estimated at 10 to 15 minutes per sign-out audited. Conclusions The UPDATED audit is a milestone-based tool that can be used to assess written sign-out communication skills in internal medicine residency programs. Future work is planned to adapt the tool for use by senior supervisory residents to appraise sign-outs in real time. PMID:26221442

Piloting a Structured Practice Audit to Assess ACGME Milestones in Written Handoff Communication in Internal Medicine.

PubMed

Martin, Shannon K; Farnan, Jeanne M; McConville, John F; Arora, Vineet M

2015-06-01

Written communication skills are integral to patient care handoffs. Residency programs require feasible assessment tools that provide timely formative and summative feedback, ideally linked to the Accreditation Council for Graduate Medical Education Milestones. We describe the use of 1 such tool-UPDATED-to assess written handoff communication skills in internal medicine interns. During 2012-2013, the authors piloted a structured practice audit at 1 academic institution to audit written sign-outs completed by 45 interns, using the UPDATED tool, which scores 7 aspects of sign-out communication linked to milestones. Intern sign-outs were audited by trained faculty members throughout the year. Results were incorporated into intern performance reviews and Clinical Competency Committees. A total of 136 sign-outs were audited (averaging 3.1 audits per intern). In the first trimester, 14 interns (31%) had satisfactory audit results. Five interns (11%) had critical deficiencies and received immediate feedback, and the remaining 26 (58%) were assigned future audits due to missing audits or unsatisfactory scores. In the second trimester, 21 interns (68%) had satisfactory results, 1 had critical deficiencies, and 9 (29%) required future audits. Nine of the 10 remaining interns in the final trimester had satisfactory audits. Faculty time was estimated at 10 to 15 minutes per sign-out audited. The UPDATED audit is a milestone-based tool that can be used to assess written sign-out communication skills in internal medicine residency programs. Future work is planned to adapt the tool for use by senior supervisory residents to appraise sign-outs in real time.

Performance Analysis of Inter-Domain Handoff Scheme Based on Virtual Layer in PMIPv6 Networks for IP-Based Internet of Things

PubMed Central

Choi, Jae-Young; Jeong, Jongpil; Chung, Tai-Myoung

2017-01-01

Lately, we see that Internet of things (IoT) is introduced in medical services for global connection among patients, sensors, and all nearby things. The principal purpose of this global connection is to provide context awareness for the purpose of bringing convenience to a patient’s life and more effectively implementing clinical processes. In health care, monitoring of biosignals of a patient has to be continuously performed while the patient moves inside and outside the hospital. Also, to monitor the accurate location and biosignals of the patient, appropriate mobility management is necessary to maintain connection between the patient and the hospital network. In this paper, a binding update scheme on PMIPv6, which reduces signal traffic during location updates by Virtual LMA (VLMA) on the top original Local Mobility Anchor (LMA) Domain, is proposed to reduce the total cost. If a Mobile Node (MN) moves to a Mobile Access Gateway (MAG)-located boundary of an adjacent LMA domain, the MN changes itself into a virtual mode, and this movement will be assumed to be a part of the VLMA domain. In the proposed scheme, MAGs eliminate global binding updates for MNs between LMA domains and significantly reduce the packet loss and latency by eliminating the handoff between LMAs. In conclusion, the performance analysis results show that the proposed scheme improves performance significantly versus PMIPv6 and HMIPv6 in terms of the binding update rate per user and average handoff latency. PMID:28129355

47 CFR 101.75 - Involuntary relocation procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... adjustments, determine comparability, and ensure a seamless handoff. (d) Twelve-month trial period. If, within... SERVICES FIXED MICROWAVE SERVICES Applications and Licenses License Transfers, Modifications, Conditions and Forfeitures § 101.75 Involuntary relocation procedures. (a) If no agreement is reached during the...

47 CFR 101.75 - Involuntary relocation procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... adjustments, determine comparability, and ensure a seamless handoff. (d) Twelve-month trial period. If, within... SERVICES FIXED MICROWAVE SERVICES Applications and Licenses License Transfers, Modifications, Conditions and Forfeitures § 101.75 Involuntary relocation procedures. (a) If no agreement is reached during the...

47 CFR 101.75 - Involuntary relocation procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... adjustments, determine comparability, and ensure a seamless handoff. (d) Twelve-month trial period. If, within... SERVICES FIXED MICROWAVE SERVICES Applications and Licenses License Transfers, Modifications, Conditions and Forfeitures § 101.75 Involuntary relocation procedures. (a) If no agreement is reached during the...

47 CFR 101.75 - Involuntary relocation procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... adjustments, determine comparability, and ensure a seamless handoff. (d) Twelve-month trial period. If, within... SERVICES FIXED MICROWAVE SERVICES Applications and Licenses License Transfers, Modifications, Conditions and Forfeitures § 101.75 Involuntary relocation procedures. (a) If no agreement is reached during the...

Space to Ground: Handoff: 06/01/2018

NASA Image and Video Library

2018-05-31

This week will officially bring one expedition to a close, and welcome the beginning of another. NASA's Space to Ground is your weekly update on what's happening aboard the International Space Station. Got a question or comment? Use #spacetoground to talk to us.

Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool.

PubMed

Gonzalo, Jed D; Yang, Julius J; Stuckey, Heather L; Fischer, Christopher M; Sanchez, Leon D; Herzig, Shoshana J

2014-08-01

To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period. Prospective mixed-methods analysis of data submitted by medicine residents following admitting shifts before and after eSignout implementation. University-based, tertiary-care hospital. Internal medicine resident physicians admitting patients from the emergency department. An electronic handoff tool (eSignout) utilizing automated paging communication and responsibility acceptance without mandatory verbal communication between emergency department and medicine ward providers. (i) Incidence of reported near misses/adverse events, (ii) communication of key clinical information and quality of verbal communication and (iii) characterization of near misses/adverse events. Seventy-eight of 80 surveys (98%) and 1058 of 1388 surveys (76%) were completed before and after eSignout implementation. Compared with pre-intervention, residents in the post-intervention period reported similar number of shifts with a near miss/adverse event (10.3 vs. 7.8%; P = 0.27), similar communication of key clinical information, and improved verbal signout quality, when it occurred. Compared with the former process requiring mandatory verbal communication, 93% believed the eSignout was more efficient and 61% preferred the eSignout. Patient safety issues related to perceived sufficiency/accuracy of diagnosis, treatment or disposition, and information quality. The eSignout was perceived as more efficient and preferred over the mandatory verbal signout process. Rates of reported adverse events were similar before and after the intervention. Our experience suggests electronic platforms with optional verbal communication can be used to standardize and improve the perceived efficiency of patient handoffs. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Should air medical patients be transferred on helipad or trauma bay?

PubMed

Lehrfeld, David; Gemignani, Robert; Shiroff, Adam; Kuhlmann, Sarah; Ohman-Strickland, Pamela; Merlin, Mark A

2013-01-01

Helicopter emergency medical services (HEMS) are widely used in regional trauma care and present unique challenges in the patient handoff process. In particular, the practice of patient handoff on the landing zone versus the trauma bay does not exist in ground emergency medical services. We hypothesized that patients handed off on the landing zone versus the trauma bay would have different patient characteristics and outcomes. A retrospective review identified 305 HEMS trauma patients received at our level 1 trauma center over a 3-year period. Patients were sorted on the basis of the handoff location, (landing zone vs. trauma bay) and assessed for predictors of injury severity including the Revised Trauma Score, the Injury Severity Score, the Trauma and Injury Severity Score, and other outcomes, primarily mortality. Of the 305 patients, 235 (77%) were handed off in the bay, and 70 (23%) were not. Regarding the characteristics of patients who were handed off in the bay, they were more likely to have hypotension (100% vs. 73%), have a lower O(2) saturation level (97.9 vs. 99.4), and a lower Glasgow Coma Scale at the scene (10.9 vs. 13.9.). When controlling for injury severity, the odds of survival for patients who were handed off in the bay were 11.06 times the odds for patients who were not handed off in the bay. In this limited study, we found that HEMS did identify the sickest patients and brought them to the trauma bay. Despite their greater injury severity, the patients handed off in the bay fared better than those handed off on the landing zone. Copyright © 2013 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Standardized sign-out reduces intern perception of medical errors on the general internal medicine ward.

PubMed

Salerno, Stephen M; Arnett, Michael V; Domanski, Jeremy P

2009-01-01

Prior research on reducing variation in housestaff handoff procedures have depended on proprietary checkout software. Use of low-technology standardization techniques has not been widely studied. We wished to determine if standardizing the process of intern sign-out using low-technology sign-out tools could reduce perception of errors and missing handoff data. We conducted a pre-post prospective study of a cohort of 34 interns on a general internal medicine ward. Night interns coming off duty and day interns reassuming care were surveyed on their perception of erroneous sign-out data, mistakes made by the night intern overnight, and occurrences unanticipated by sign-out. Trainee satisfaction with the sign-out process was assessed with a 5-point Likert survey. There were 399 intern surveys performed 8 weeks before and 6 weeks after the introduction of a standardized sign-out form. The response rate was 95% for the night interns and 70% for the interns reassuming care in the morning. After the standardized form was introduced, night interns were significantly (p < .003) less likely to detect missing sign-out data including missing important diseases, contingency plans, or medications. Standardized sign-out did not significantly alter the frequency of dropped tasks or missed lab and X-ray data as perceived by the night intern. However, the day teams thought there were significantly less perceived errors on the part of the night intern (p = .001) after introduction of the standardized sign-out sheet. There was no difference in mean Likert scores of resident satisfaction with sign-out before and after the intervention. Standardized written sign-out sheets significantly improve the completeness and effectiveness of handoffs between night and day interns. Further research is needed to determine if these process improvements are related to better patient outcomes.

Military Operating Room of the Future

DTIC Science & Technology

2012-10-01

AORN ) Annual Conference in San Diego, USA Mar 3-7, 2013. K.R. Catchpole. Task, Team and Technology Integration in Surgical Care. Invited oral... AORN ) Annual Conference in San Diego, USA Mar 3-7, 2013. Effective handoffs are critical for maintaining quality of care across different care

A group communication approach for mobile computing mobile channel: An ISIS tool for mobile services

NASA Astrophysics Data System (ADS)

Cho, Kenjiro; Birman, Kenneth P.

1994-05-01

This paper examines group communication as an infrastructure to support mobility of users, and presents a simple scheme to support user mobility by means of switching a control point between replicated servers. We describe the design and implementation of a set of tools, called Mobile Channel, for use with the ISIS system. Mobile Channel is based on a combination of the two replication schemes: the primary-backup approach and the state machine approach. Mobile Channel implements a reliable one-to-many FIFO channel, in which a mobile client sees a single reliable server; servers, acting as a state machine, see multicast messages from clients. Migrations of mobile clients are handled as an intentional primary switch, and hand-offs or server failures are completely masked to mobile clients. To achieve high performance, servers are replicated at a sliding-window level. Our scheme provides a simple abstraction of migration, eliminates complicated hand-off protocols, provides fault-tolerance and is implemented within the existing group communication mechanism.

Patient Safety Culture in Intensive Care Units from the Perspective of Nurses: A Cross-Sectional Study.

PubMed

Farzi, Sedigheh; Moladoost, Azam; Bahrami, Masoud; Farzi, Saba; Etminani, Reza

2017-01-01

One of the goals of nursing is providing safe care, prevention of injury, and health promotion of patients. Patient safety in intensive care units is threatened for various reasons. This study aimed to survey patient safety culture from the perspective of nurses in intensive care units. This cross-sectional study was conducted in 2016. Sampling was done using the convenience method. The sample consisted of 367 nurses working in intensive care units of teaching hospitals affiliated to Isfahan University of Medical Sciences. Data collection was performed using a two-part questionnaire that included demographic and hospital survey on Patient Safety Culture (HSOPSC) questionnaire. Data analysis was done using descriptive statistics (mean and standard deviation). Among the 12 dimensions of safety culture, the nurses assigned the highest score to "team work within units" (97.3%) and "Organizational learning-continuous improvement" (84%). They assigned the least score to "handoffs and transitions"(21.1%), "non-punitive response to errors" (24.7%), "Staffing" (35.6%), "Communication openness" (47.5%), and "Teamwork across units" (49.4%). The patient safety culture dimensions have low levels that require adequate attention and essential measures of health care centers including facilitating teamwork, providing adequate staff, and developing a checklist of handoffs and transitions. Furthermore, to increase reporting error and to promote a patient safety culture in intensive care units, some strategies should be adopted including a system-based approach to deal with the error.

47 CFR 25.284 - Emergency Call Center Service.

Code of Federal Regulations, 2012 CFR

2012-10-01

... service to the extent that they offer real-time, two way switched voice service that is interconnected... provider to reuse frequencies and/or accomplish seamless hand-offs of subscriber calls. Emergency Call Center personnel must determine the emergency caller's phone number and location and then transfer or...

47 CFR 25.284 - Emergency Call Center Service.

Code of Federal Regulations, 2011 CFR

2011-10-01

... service to the extent that they offer real-time, two way switched voice service that is interconnected... provider to reuse frequencies and/or accomplish seamless hand-offs of subscriber calls. Emergency Call Center personnel must determine the emergency caller's phone number and location and then transfer or...

47 CFR 25.284 - Emergency Call Center Service.

Code of Federal Regulations, 2014 CFR

2014-10-01

... service to the extent that they offer real-time, two way switched voice service that is interconnected... provider to reuse frequencies and/or accomplish seamless hand-offs of subscriber calls. Emergency Call Center personnel must determine the emergency caller's phone number and location and then transfer or...

47 CFR 25.284 - Emergency Call Center Service.

Code of Federal Regulations, 2013 CFR

2013-10-01

... service to the extent that they offer real-time, two way switched voice service that is interconnected... provider to reuse frequencies and/or accomplish seamless hand-offs of subscriber calls. Emergency Call Center personnel must determine the emergency caller's phone number and location and then transfer or...

Integration of mobile satellite and cellular systems

NASA Technical Reports Server (NTRS)

Drucker, Elliott H.; Estabrook, Polly; Pinck, Deborah; Ekroot, Laura

1993-01-01

By integrating the ground based infrastructure component of a mobile satellite system with the infrastructure systems of terrestrial 800 MHz cellular service providers, a seamless network of universal coverage can be established. Users equipped for both cellular and satellite service can take advantage of a number of features made possible by such integration, including seamless handoff and universal roaming. To provide maximum benefit at lowest posible cost, the means by which these systems are integrated must be carefully considered. Mobile satellite hub stations must be configured to efficiently interface with cellular Mobile Telephone Switching Offices (MTSO's), and cost effective mobile units that provide both cellular and satellite capability must be developed.

Integration of mobile satellite and cellular systems

NASA Astrophysics Data System (ADS)

Drucker, Elliott H.; Estabrook, Polly; Pinck, Deborah; Ekroot, Laura

By integrating the ground based infrastructure component of a mobile satellite system with the infrastructure systems of terrestrial 800 MHz cellular service providers, a seamless network of universal coverage can be established. Users equipped for both cellular and satellite service can take advantage of a number of features made possible by such integration, including seamless handoff and universal roaming. To provide maximum benefit at lowest posible cost, the means by which these systems are integrated must be carefully considered. Mobile satellite hub stations must be configured to efficiently interface with cellular Mobile Telephone Switching Offices (MTSO's), and cost effective mobile units that provide both cellular and satellite capability must be developed.

An order (n) algorithm for the dynamics simulation of robotic systems

NASA Technical Reports Server (NTRS)

Chun, H. M.; Turner, J. D.; Frisch, Harold P.

1989-01-01

The formulation of an Order (n) algorithm for DISCOS (Dynamics Interaction Simulation of Controls and Structures), which is an industry-standard software package for simulation and analysis of flexible multibody systems is presented. For systems involving many bodies, the new Order (n) version of DISCOS is much faster than the current version. Results of the experimental validation of the dynamics software are also presented. The experiment is carried out on a seven-joint robot arm at NASA's Goddard Space Flight Center. The algorithm used in the current version of DISCOS requires the inverse of a matrix whose dimension is equal to the number of constraints in the system. Generally, the number of constraints in a system is roughly proportional to the number of bodies in the system, and matrix inversion requires O(p exp 3) operations, where p is the dimension of the matrix. The current version of DISCOS is therefore considered an Order (n exp 3) algorithm. In contrast, the Order (n) algorithm requires inversion of matrices which are small, and the number of matrices to be inverted increases only linearly with the number of bodies. The newly-developed Order (n) DISCOS is currently capable of handling chain and tree topologies as well as multiple closed loops. Continuing development will extend the capability of the software to deal with typical robotics applications such as put-and-place, multi-arm hand-off and surface sliding.

A Mixed Integer Efficient Global Optimization Framework: Applied to the Simultaneous Aircraft Design, Airline Allocation and Revenue Management Problem

NASA Astrophysics Data System (ADS)

Roy, Satadru

Traditional approaches to design and optimize a new system, often, use a system-centric objective and do not take into consideration how the operator will use this new system alongside of other existing systems. This "hand-off" between the design of the new system and how the new system operates alongside other systems might lead to a sub-optimal performance with respect to the operator-level objective. In other words, the system that is optimal for its system-level objective might not be best for the system-of-systems level objective of the operator. Among the few available references that describe attempts to address this hand-off, most follow an MDO-motivated subspace decomposition approach of first designing a very good system and then provide this system to the operator who decides the best way to use this new system along with the existing systems. The motivating example in this dissertation presents one such similar problem that includes aircraft design, airline operations and revenue management "subspaces". The research here develops an approach that could simultaneously solve these subspaces posed as a monolithic optimization problem. The monolithic approach makes the problem a Mixed Integer/Discrete Non-Linear Programming (MINLP/MDNLP) problem, which are extremely difficult to solve. The presence of expensive, sophisticated engineering analyses further aggravate the problem. To tackle this challenge problem, the work here presents a new optimization framework that simultaneously solves the subspaces to capture the "synergism" in the problem that the previous decomposition approaches may not have exploited, addresses mixed-integer/discrete type design variables in an efficient manner, and accounts for computationally expensive analysis tools. The framework combines concepts from efficient global optimization, Kriging partial least squares, and gradient-based optimization. This approach then demonstrates its ability to solve an 11 route airline network problem consisting of 94 decision variables including 33 integer and 61 continuous type variables. This application problem is a representation of an interacting group of systems and provides key challenges to the optimization framework to solve the MINLP problem, as reflected by the presence of a moderate number of integer and continuous type design variables and expensive analysis tool. The result indicates simultaneously solving the subspaces could lead to significant improvement in the fleet-level objective of the airline when compared to the previously developed sequential subspace decomposition approach. In developing the approach to solve the MINLP/MDNLP challenge problem, several test problems provided the ability to explore performance of the framework. While solving these test problems, the framework showed that it could solve other MDNLP problems including categorically discrete variables, indicating that the framework could have broader application than the new aircraft design-fleet allocation-revenue management problem.

A Randomized Trial Comparing Classical Participatory Design to VandAID, an Interactive CrowdSourcing Platform to Facilitate User-centered Design.

PubMed

Dufendach, Kevin R; Koch, Sabine; Unertl, Kim M; Lehmann, Christoph U

2017-10-26

Early involvement of stakeholders in the design of medical software is particularly important due to the need to incorporate complex knowledge and actions associated with clinical work. Standard user-centered design methods include focus groups and participatory design sessions with individual stakeholders, which generally limit user involvement to a small number of individuals due to the significant time investments from designers and end users. The goal of this project was to reduce the effort for end users to participate in co-design of a software user interface by developing an interactive web-based crowdsourcing platform. In a randomized trial, we compared a new web-based crowdsourcing platform to standard participatory design sessions. We developed an interactive, modular platform that allows responsive remote customization and design feedback on a visual user interface based on user preferences. The responsive canvas is a dynamic HTML template that responds in real time to user preference selections. Upon completion, the design team can view the user's interface creations through an administrator portal and download the structured selections through a REDCap interface. We have created a software platform that allows users to customize a user interface and see the results of that customization in real time, receiving immediate feedback on the impact of their design choices. Neonatal clinicians used the new platform to successfully design and customize a neonatal handoff tool. They received no specific instruction and yet were able to use the software easily and reported high usability. VandAID, a new web-based crowdsourcing platform, can involve multiple users in user-centered design simultaneously and provides means of obtaining design feedback remotely. The software can provide design feedback at any stage in the design process, but it will be of greatest utility for specifying user requirements and evaluating iterative designs with multiple options.

A tool for assessing the quality of nursing handovers: a validation study.

PubMed

Ferrara, Paolo; Terzoni, Stefano; Davì, Salvatore; Bisesti, Alberto; Destrebecq, Anne

2017-08-10

Handover, in particular between two shifts, is a crucial aspect of nursing for patient safety, aimed at ensuring continuity of care. During this process, several factors can affect quality of care and cause errors. This study aimed to assess quality of handovers, by validating the Handoff CEX-Italian scale. The scale was translated from English into Italian and the content validity index was calculated and internal consistency assessed. The scale was used in several units of the San Paolo Teaching Hospital in Milan, Italy. A total of 48 reports were assessed (192 evaluations). The median score was 6, interquartile range (IQR) [5;7] and was not influenced by specific (p=0.21) or overall working experience (p=0.13). The domains showing the lowest median values (median=6, IQR [4;8]) were context, communication, and organisation. Night to morning handovers obtained the lowest scores. CVI-S was 0.96, Cronbach's alpha was 0.79. The Handoff CEX-Italian scale is valid and reliable and it can be used to assess the quality of nurse handovers.

The Arabidopsis R-SNARE VAMP721 Interacts with KAT1 and KC1 K+ Channels to Moderate K+ Current at the Plasma Membrane.

PubMed

Zhang, Ben; Karnik, Rucha; Wang, Yizhou; Wallmeroth, Niklas; Blatt, Michael R; Grefen, Christopher

2015-06-01

SNARE (soluble N-ethylmaleimide-sensitive factor protein attachment protein receptor) proteins drive vesicle traffic, delivering membrane and cargo to target sites within the cell and at its surface. They contribute to cell homeostasis, morphogenesis, and pathogen defense. A subset of SNAREs, including the Arabidopsis thaliana SNARE SYP121, are known also to coordinate solute uptake via physical interactions with K(+) channels and to moderate their gating at the plasma membrane. Here, we identify a second subset of SNAREs that interact to control these K(+) channels, but with opposing actions on gating. We show that VAMPs (vesicle-associated membrane proteins), which target vesicles to the plasma membrane, also interact with and suppress the activities of the inward-rectifying K(+) channels KAT1 and KC1. Interactions were evident in yeast split-ubiquitin assays, they were recovered in vivo by ratiometric bimolecular fluorescence complementation, and they were sensitive to mutation of a single residue, Tyr-57, within the longin domain of VAMP721. Interaction was also recovered on exchange of the residue at this site in the homolog VAMP723, which normally localizes to the endoplasmic reticulum and otherwise did not interact. Functional analysis showed reduced channel activity and alterations in voltage sensitivity that are best explained by a physical interaction with the channel gates. These actions complement those of SYP121, a cognate SNARE partner of VAMP721, and lead us to propose that the channel interactions reflect a "hand-off" in channel control between the two SNARE proteins that is woven together with vesicle fusion. © 2015 American Society of Plant Biologists. All rights reserved.

From Kickoff to Handoff: Coaching Teens to Tackle STEM Literacy

ERIC Educational Resources Information Center

Ripberger, Chad; Blalock, Lydia B.

2015-01-01

This article discusses how intensive, content-rich, multiple-day conferences for teams of youth and their adult coaches can be used to initiate the training and planning needed for teens to successfully serve as STEM teachers. The concepts are based on three 4-H "teens as teachers" projects that included 29-36.5 hour initial training…

Model Development for EHR Interdisciplinary Information Exchange of ICU Common Goals

PubMed Central

Collins, Sarah A.; Bakken, Suzanne; Vawdrey, David K.; Coiera, Enrico; Currie, Leanne

2010-01-01

Purpose Effective interdisciplinary exchange of patient information is an essential component of safe, efficient, and patient–centered care in the intensive care unit (ICU). Frequent handoffs of patient care, high acuity of patient illness, and the increasing amount of available data complicate information exchange. Verbal communication can be affected by interruptions and time limitations. To supplement verbal communication, many ICUs rely on documentation in electronic health records (EHRs) to reduce errors of omission and information loss. The purpose of this study was to develop a model of EHR interdisciplinary information exchange of ICU common goals. Methods The theoretical frameworks of distributed cognition and the clinical communication space were integrated and a previously published categorization of verbal information exchange was used. 59.5 hours of interdisciplinary rounds in a Neurovascular ICU were observed and five interviews and one focus group with ICU nurses and physicians were conducted. Results Current documentation tools in the ICU were not sufficient to capture the nurses' and physicians' collaborative decision-making and verbal communication of goal-directed actions and interactions. Clinicians perceived the EHR to be inefficient for information retrieval, leading to a further reliance on verbal information exchange. Conclusion The model suggests that EHRs should support: 1) Information tools for the explicit documentation of goals, interventions, and assessments with synthesized and summarized information outputs of events and updates; and 2) Messaging tools that support collaborative decision-making and patient safety double checks that currently occur between nurses and physicians in the absence of EHR support. PMID:20974549

Thousands of microbial genomes shed light on interconnected biogeochemical processes in an aquifer system

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

Anantharaman, Karthik; Brown, Christopher T.; Hug, Laura A.

The subterranean world hosts up to one-fifth of all biomass, including microbial communities that drive transformations central to Earth's biogeochemical cycles. However, little is known about how complex microbial communities in such environments are structured, and how inter-organism interactions shape ecosystem function. Here we apply terabase-scale cultivation-independent metagenomics to aquifer sediments and groundwater, and reconstruct 2,540 draft-quality, near-complete and complete strain-resolved genomes that represent the majority of known bacterial phyla as well as 47 newly discovered phylum-level lineages. Metabolic analyses spanning this vast phylogenetic diversity and representing up to 36% of organisms detected in the system are used to documentmore » the distribution of pathways in coexisting organisms. Consistent with prior findings indicating metabolic handoffs in simple consortia, we find that few organisms within the community can conduct multiple sequential redox transformations. As environmental conditions change, different assemblages of organisms are selected for, altering linkages among the major biogeochemical cycles.« less

Thousands of microbial genomes shed light on interconnected biogeochemical processes in an aquifer system

DOE PAGES

Anantharaman, Karthik; Brown, Christopher T.; Hug, Laura A.; ...

2016-10-24

The subterranean world hosts up to one-fifth of all biomass, including microbial communities that drive transformations central to Earth's biogeochemical cycles. However, little is known about how complex microbial communities in such environments are structured, and how inter-organism interactions shape ecosystem function. Here we apply terabase-scale cultivation-independent metagenomics to aquifer sediments and groundwater, and reconstruct 2,540 draft-quality, near-complete and complete strain-resolved genomes that represent the majority of known bacterial phyla as well as 47 newly discovered phylum-level lineages. Metabolic analyses spanning this vast phylogenetic diversity and representing up to 36% of organisms detected in the system are used to documentmore » the distribution of pathways in coexisting organisms. Consistent with prior findings indicating metabolic handoffs in simple consortia, we find that few organisms within the community can conduct multiple sequential redox transformations. As environmental conditions change, different assemblages of organisms are selected for, altering linkages among the major biogeochemical cycles.« less

Thousands of microbial genomes shed light on interconnected biogeochemical processes in an aquifer system

PubMed Central

Anantharaman, Karthik; Brown, Christopher T.; Hug, Laura A.; Sharon, Itai; Castelle, Cindy J.; Probst, Alexander J.; Thomas, Brian C.; Singh, Andrea; Wilkins, Michael J.; Karaoz, Ulas; Brodie, Eoin L.; Williams, Kenneth H.; Hubbard, Susan S.; Banfield, Jillian F.

2016-01-01

The subterranean world hosts up to one-fifth of all biomass, including microbial communities that drive transformations central to Earth's biogeochemical cycles. However, little is known about how complex microbial communities in such environments are structured, and how inter-organism interactions shape ecosystem function. Here we apply terabase-scale cultivation-independent metagenomics to aquifer sediments and groundwater, and reconstruct 2,540 draft-quality, near-complete and complete strain-resolved genomes that represent the majority of known bacterial phyla as well as 47 newly discovered phylum-level lineages. Metabolic analyses spanning this vast phylogenetic diversity and representing up to 36% of organisms detected in the system are used to document the distribution of pathways in coexisting organisms. Consistent with prior findings indicating metabolic handoffs in simple consortia, we find that few organisms within the community can conduct multiple sequential redox transformations. As environmental conditions change, different assemblages of organisms are selected for, altering linkages among the major biogeochemical cycles. PMID:27774985

Thousands of microbial genomes shed light on interconnected biogeochemical processes in an aquifer system

NASA Astrophysics Data System (ADS)

Anantharaman, Karthik; Brown, Christopher T.; Hug, Laura A.; Sharon, Itai; Castelle, Cindy J.; Probst, Alexander J.; Thomas, Brian C.; Singh, Andrea; Wilkins, Michael J.; Karaoz, Ulas; Brodie, Eoin L.; Williams, Kenneth H.; Hubbard, Susan S.; Banfield, Jillian F.

2016-10-01

The subterranean world hosts up to one-fifth of all biomass, including microbial communities that drive transformations central to Earth's biogeochemical cycles. However, little is known about how complex microbial communities in such environments are structured, and how inter-organism interactions shape ecosystem function. Here we apply terabase-scale cultivation-independent metagenomics to aquifer sediments and groundwater, and reconstruct 2,540 draft-quality, near-complete and complete strain-resolved genomes that represent the majority of known bacterial phyla as well as 47 newly discovered phylum-level lineages. Metabolic analyses spanning this vast phylogenetic diversity and representing up to 36% of organisms detected in the system are used to document the distribution of pathways in coexisting organisms. Consistent with prior findings indicating metabolic handoffs in simple consortia, we find that few organisms within the community can conduct multiple sequential redox transformations. As environmental conditions change, different assemblages of organisms are selected for, altering linkages among the major biogeochemical cycles.

Modeling target normal sheath acceleration using handoffs between multiple simulations

NASA Astrophysics Data System (ADS)

McMahon, Matthew; Willis, Christopher; Mitchell, Robert; King, Frank; Schumacher, Douglass; Akli, Kramer; Freeman, Richard

2013-10-01

We present a technique to model the target normal sheath acceleration (TNSA) process using full-scale LSP PIC simulations. The technique allows for a realistic laser, full size target and pre-plasma, and sufficient propagation length for the accelerated ions and electrons. A first simulation using a 2D Cartesian grid models the laser-plasma interaction (LPI) self-consistently and includes field ionization. Electrons accelerated by the laser are imported into a second simulation using a 2D cylindrical grid optimized for the initial TNSA process and incorporating an equation of state. Finally, all of the particles are imported to a third simulation optimized for the propagation of the accelerated ions and utilizing a static field solver for initialization. We also show use of 3D LPI simulations. Simulation results are compared to recent ion acceleration experiments using SCARLET laser at The Ohio State University. This work was performed with support from ASOFR under contract # FA9550-12-1-0341, DARPA, and allocations of computing time from the Ohio Supercomputing Center.

The application of Reiki in nurses diagnosed with Burnout Syndrome has beneficial effects on concentration of salivary IgA and blood pressure.

PubMed

Díaz-Rodríguez, Lourdes; Arroyo-Morales, Manuel; Cantarero-Villanueva, Irene; Férnandez-Lao, Carolina; Polley, Marie; Fernández-de-las-Peñas, César

2011-01-01

This study aimed to investigate the immediate effects of the secretory immunoglobulin A (sIgA), α-amylase activity and blood pressure levels after the application of a Reiki session in nurses with Burnout Syndrome. A randomized, double-blind, placebo-controlled, crossover design was conducted to compare the immediate effects of Reiki versus control intervention (Hand-off sham intervention) in nurses with Burnout Syndrome. Sample was composed of eighteen nurses (aged 34-56 years) with burnout syndrome. Participants were randomly assigned to receive either a Reiki treatment or a placebo (sham Reiki) treatment, according to the established order in two different days. The ANOVA showed a significant interaction time x intervention for diastolic blood pressure (F=4.92, P=0.04) and sIgA concentration (F=4.71, P=0.04). A Reiki session can produce an immediate and statistically significant improvement in sIgA concentration and diastolic blood pressure in nurses with Burnout Syndrome.

Promotion of BRCA2-Dependent Homologous Recombination by DSS1 via RPA Targeting and DNA Mimicry.

PubMed

Zhao, Weixing; Vaithiyalingam, Sivaraja; San Filippo, Joseph; Maranon, David G; Jimenez-Sainz, Judit; Fontenay, Gerald V; Kwon, Youngho; Leung, Stanley G; Lu, Lucy; Jensen, Ryan B; Chazin, Walter J; Wiese, Claudia; Sung, Patrick

2015-07-16

The tumor suppressor BRCA2 is thought to facilitate the handoff of ssDNA from replication protein A (RPA) to the RAD51 recombinase during DNA break and replication fork repair by homologous recombination. However, we find that RPA-RAD51 exchange requires the BRCA2 partner DSS1. Biochemical, structural, and in vivo analyses reveal that DSS1 allows the BRCA2-DSS1 complex to physically and functionally interact with RPA. Mechanistically, DSS1 acts as a DNA mimic to attenuate the affinity of RPA for ssDNA. A mutation in the solvent-exposed acidic domain of DSS1 compromises the efficacy of RPA-RAD51 exchange. Thus, by targeting RPA and mimicking DNA, DSS1 functions with BRCA2 in a two-component homologous recombination mediator complex in genome maintenance and tumor suppression. Our findings may provide a paradigm for understanding the roles of DSS1 in other biological processes. Copyright © 2015 Elsevier Inc. All rights reserved.

Research of the key technology in satellite communication networks

NASA Astrophysics Data System (ADS)

Zeng, Yuan

2018-02-01

According to the prediction, in the next 10 years the wireless data traffic will be increased by 500-1000 times. Not only the wireless data traffic will be increased exponentially, and the demand for diversified traffic will be increased. Higher requirements for future mobile wireless communication system had brought huge market space for satellite communication system. At the same time, the space information networks had been greatly developed with the depth of human exploration of space activities, the development of space application, the expansion of military and civilian application. The core of spatial information networks is the satellite communication. The dissertation presented the communication system architecture, the communication protocol, the routing strategy, switch scheduling algorithm and the handoff strategy based on the satellite communication system. We built the simulation platform of the LEO satellites networks and simulated the key technology using OPNET.

Crossing the quality chasm: creating the ideal patient care experience.

PubMed

Gold, Kathleen S

2007-01-01

To create a health system that better meets patients' needs requires a fundamental redesign of our care delivery system and a new framework. Without a payment mechanism to reflect the value of care provided other than the face-to-face visit, adoption of advanced medical home principles will be challenging. The hand-off of the patient between providers and settings of care is a critical time for the patient and its effectiveness impacts patient care outcomes. The appropriate utilization of hospital and other health system resources is crucial, especially as hospitals, emergency departments, and other health care venues increasingly face capacity constraints and throughput challenges. It becomes the responsibility of the multidisciplinary team of providers to ensure that patients being discharged have an identified personal physician or team who will provide a medical home, and that the handoff to this medical home is thorough and well coordinated. An ideal patient care experience is one in which all systems and processes are geared to meet the needs of the patient: a safety-oriented system that provides standardized, evidence-based care supported by technology, but that recognizes and responds to individual needs.

A Polymerase With Potential: The Fe-S Cluster in Human DNA Primase.

PubMed

Holt, Marilyn E; Salay, Lauren E; Chazin, Walter J

2017-01-01

Replication of DNA in eukaryotes is primarily executed by the combined action of processive DNA polymerases δ and ɛ. These enzymes cannot initiate synthesis of new DNA without the presence of a primer on the template ssDNA. The primers on both the leading and lagging strands are generated by DNA polymerase α-primase (pol-prim). DNA primase is a DNA-dependent RNA polymerase that synthesizes the first ~10 nucleotides and then transfers the substrate to polymerase α to complete primer synthesis. The mechanisms governing the coordination and handoff between primase and polymerase α are largely unknown. Isolated DNA primase contains a [4Fe-4S] 2+ cluster that has been shown to serve as a redox switch modulating DNA binding affinity. This discovery suggests a mechanism for modulating the priming activity of primase and handoff to polymerase α. In this chapter, we briefly discuss the current state of knowledge of primase structure and function, including the role of its iron-sulfur cluster. This is followed by providing the methods for expressing, purifying, and biophysically/structurally characterizing primase and its iron-sulfur cluster-containing domain, p58C. © 2017 Elsevier Inc. All rights reserved.

Patient safety culture among nurses.

PubMed

Ammouri, A A; Tailakh, A K; Muliira, J K; Geethakrishnan, R; Al Kindi, S N

2015-03-01

Patient safety is considered to be crucial to healthcare quality and is one of the major parameters monitored by all healthcare organizations around the world. Nurses play a vital role in maintaining and promoting patient safety due to the nature of their work. The purpose of this study was to investigate nurses' perceptions about patient safety culture and to identify the factors that need to be emphasized in order to develop and maintain the culture of safety among nurses in Oman. A descriptive and cross-sectional design was used. Patient safety culture was assessed by using the Hospital Survey on Patient Safety Culture among 414 registered nurses working in four major governmental hospitals in Oman. Descriptive statistics and general linear regression were employed to assess the association between patient safety culture and demographic variables. Nurses who perceived more supervisor or manager expectations, feedback and communications about errors, teamwork across hospital units, and hospital handoffs and transitions had more overall perception of patient safety. Nurses who perceived more teamwork within units and more feedback and communications about errors had more frequency of events reported. Furthermore, nurses who had more years of experience and were working in teaching hospitals had more perception of patient safety culture. Learning and continuous improvement, hospital management support, supervisor/manager expectations, feedback and communications about error, teamwork, hospital handoffs and transitions were found to be major patient safety culture predictors. Investing in practices and systems that focus on improving these aspects is likely to enhance the culture of patient safety in Omani hospitals and others like them. Strategies to nurture patient safety culture in Omani hospitals should focus upon building leadership capacity that support open communication, blame free, team work and continuous organizational learning. © 2014 International Council of Nurses.

MSAT and cellular hybrid networking

NASA Astrophysics Data System (ADS)

Baranowsky, Patrick W., II

Westinghouse Electric Corporation is developing both the Communications Ground Segment and the Series 1000 Mobile Phone for American Mobile Satellite Corporation's (AMSC's) Mobile Satellite (MSAT) system. The success of the voice services portion of this system depends, to some extent, upon the interoperability of the cellular network and the satellite communication circuit switched communication channels. This paper will describe the set of user-selectable cellular interoperable modes (cellular first/satellite second, etc.) provided by the Mobile Phone and described how they are implemented with the ground segment. Topics including roaming registration and cellular-to-satellite 'seamless' call handoff will be discussed, along with the relevant Interim Standard IS-41 Revision B Cellular Radiotelecommunications Intersystem Operations and IOS-553 Mobile Station - Land Station Compatibility Specification.

Department of Defense Recovering Warrior Task Force

DTIC Science & Technology

2014-09-02

used by RWs, which DoD must first identify, such as private sector job training, employment skills training, apprenticeships, and internships (JTEST- AI ...employment, other transition support, referrals and warm handoffs within and across sectors , and case management. Communities that are geographically remote...of Medicine76; recognition of the need for private sector participation is coalescing. We see evidence of the private sector’s readiness to embrace

Pediatrician-experienced barriers in the medical care for refugee children in the Netherlands.

PubMed

Baauw, A; Rosiek, S; Slattery, B; Chinapaw, M; van Hensbroek, M Boele; van Goudoever, J B; Kist-van Holthe, J

2018-04-20

Pediatricians in the Netherlands have been confronted with high numbers of refugee children in their daily practice. Refugee children have been recognized as an at-risk population because they may have an increased burden of physical and mental health conditions, and their caretakers may experience barriers in gaining access to the Dutch health care system. The aim of the study was to gain insight into the barriers in the health care for refugee children perceived by pediatricians by analyzing logistical problems reported through the Dutch Pediatric Surveillance Unit, an online system where pediatricians can report predefined conditions. Pediatricians reported 68 cases of barriers in health care ranging from mild to severe impact on the health outcome of refugee children, reported from November 2015 till January 2017. Frequent relocation of children between asylum seeker centers was mentioned in 28 of the reports on lack of continuity of care. Unknown medical history (21/68) and poor handoffs of medical records resulting in poor communication between health professionals (17/68) contributed to barriers to provide good medical care for refugee children, as did poor health literacy (17/68) and cultural differences (5/68). Frequent relocations and the unknown medical history were reported most frequently as barriers impacting the delivery of health care to refugee children. To overcome these barriers, the Committee of International Child Health of the Dutch Society of Pediatrics recommends stopping the frequent relocations, improving medical assessment upon entry in the Netherlands, improving handoff of medical records, and improving the health literacy of refugee children and their families. What is Known: • Pediatricians in the Netherlands are confronted with high numbers of refugee children • Refugee children represent a population that is especially at risk due to their increased burden of physical and mental health conditions What is New: • Refugee children experience barriers in accessing medical care • To start overcoming these barriers, we recommend that frequent relocations be stopped, health assessment upon entry in the Netherlands be improved, medical handoffs be improved, and that the refugees be empowered by increasing their health literacy.

Air Force Journal of Logistics, Volume 32, Number 2, Summer 2008

DTIC Science & Technology

2008-01-01

inventory, overproduction, waiting time, motion, transportation , and over processing waste. Waste is often placed into the following categories (D-O-W-N-T-I-M...simpler tools would be sufficient. * Transportation : moving product between processes is a cost that adds no value to the product. * Intellect: human... Transportation . This is the unnecessary movement probles.e of information or materials. Examples include physical hand-off of information and moving

Incorporating bedside report into nursing handoff: evaluation of change in practice.

PubMed

Sand-Jecklin, Kari; Sherman, Jay

2013-01-01

Nursing shift report on the medical-surgical units of a large teaching hospital was modified from a recorded report to a blend of both recorded and bedside components. Comparisons between baseline and postimplementation data indicated increased patient satisfaction and nurse perception of accountability and patient involvement but reduced nurse perceptions of efficiency and effectiveness of report. Patient falls at shift change and medication errors were reduced, whereas nurse overtime remained unchanged.

Identification of Soldier Behaviors Associated with Search and Target Acquisition (STA)

DTIC Science & Technology

2010-05-01

specifically concentrated on representing Soldier and small unit behavior engaging "non-acquired" targets and "non-standard" entities, such as: muzzle ...Forces Are Targeting (e.g., weapon orientation, bullet impacts) Area Where Fire Coming From (e.g., muzzle Flash) Target Handoff...Surveys Cue Average Sum* Participants Muzzle Flash 7.51 34 Hostile Behaviors 7.35 40 Outgoing Fire 7.22 18 Suspicious Behaviors/Activities 6.91

Reliable Design Versus Trust

NASA Technical Reports Server (NTRS)

Berg, Melanie; LaBel, Kenneth A.

2016-01-01

This presentation focuses on reliability and trust for the users portion of the FPGA design flow. It is assumed that the manufacturer prior to hand-off to the user tests FPGA internal components. The objective is to present the challenges of creating reliable and trusted designs. The following will be addressed: What makes a design vulnerable to functional flaws (reliability) or attackers (trust)? What are the challenges for verifying a reliable design versus a trusted design?

Force Health Protection and Readiness, Volume 5, Issue 2

DTIC Science & Technology

2010-01-01

the immune responses to a vaccine, both in the laboratory and animal models; and design vaccine candidates. The total cost of the trial was $105...guidances are saying if you create a program it has to be sustainable and the hand-off to the host nation or NGOs working with the host nation is...involved in creating this instruction,” said Donald Thurston, a Public Health policy analyst with CMM. “They have incorporated the input of

What whiteboards in a trauma center operating suite can teach us about emergency department communication.

PubMed

Xiao, Yan; Schenkel, Stephen; Faraj, Samer; Mackenzie, Colin F; Moss, Jacqueline

2007-10-01

Highly reliable, efficient collaborative work relies on excellent communication. We seek to understand how a traditional whiteboard is used as a versatile information artifact to support communication in rapid-paced, highly dynamic collaborative work. The similar communicative demands of the trauma operating suite and an emergency department (ED) make the findings applicable to both settings. We took photographs and observed staff's interaction with a whiteboard in a 6-bed surgical suite dedicated to trauma service. We analyzed the integral role of artifacts in cognitive activities as when workers configure and manage visual spaces to simplify their cognitive tasks. We further identified characteristics of the whiteboard as a communicative information artifact in supporting coordination in fast-paced environments. We identified 8 ways in which the whiteboard was used by physicians, nurses, and with other personnel to support collaborative work: task management, team attention management, task status tracking, task articulation, resource planning and tracking, synchronous and asynchronous communication, multidisciplinary problem solving and negotiation, and socialization and team building. The whiteboard was highly communicative because of its location and installation method, high interactivity and usability, high expressiveness, and ability to visualize transition points to support work handoffs. Traditional information artifacts such as whiteboards play significant roles in supporting collaborative work. How these artifacts are used provides insights into complicated information needs of teamwork in highly dynamic, high-risk settings such as an ED.

Resident education in 2011: three key challenges on the road ahead.

PubMed

Van Eaton, Erik G; Tarpley, John L; Solorzano, Carmen C; Cho, Clifford S; Weber, Sharon M; Termuhlen, Paula M

2011-04-01

Two important changes in the past decade have altered the landscape of graduate medical education (GME) in the U.S. The national restrictions on trainee duty hours mandated by the Accreditation Council for Graduate Medical Education (ACGME) were the most visible and generated much controversy. Equally important is the ACGME Outcome Project, which mandates competency-based training. Both of these changes have unique implications for surgery trainees, who traditionally spent long hours caring for patients in the hospital, and who must be assessed in 2 broad domains: their medical care of pre- and postoperative patients, and their technical skill with procedures in and out of the operating room. This article summarizes 3 key challenges that lie ahead for surgical educators. First, the changes in duty hours in the past 7 years are summarized, and the conversation about added restrictions planned for July 2011 is reviewed. Next, the current state of the assessment of competency among surgical trainees is reviewed, with an outline of the challenges that need to be overcome to achieve widespread, competency-based training in surgery. Finally, the article summarizes the problems caused by increased reliance on handoffs among trainees as they compensate for decreased time in the hospital, and suggests changes that need to be made to improve safety and efficiency, including how to use handoffs as part of our educational evaluation of residents. Copyright © 2011 Mosby, Inc. All rights reserved.

Best Practices in Shift Handover Communication: Mars Exploration Rover Surface Operations

NASA Astrophysics Data System (ADS)

Parke, Bonny; Mishkin, Andrew

2005-12-01

During its prime mission, Mars Exploration Rover (MER) had many shift handovers in its surface operations. Because of the increased rates of accidents and errors historically associated with shift handovers, MER Mission management paid close attention to shift handovers and, when possible, developed them in accordance with best handover practices.We review the most important of these best practices, and include a generic "Checklist for Effective Handovers" to aid in the development of handovers.We present charts that depict structured information transfer across shifts. These charts show personnel schedules, meetings attended, handovers, and hand-offs on both the MER and on the earlier Mars Pathfinder Mission (MPF). It is apparent from these charts that although the MER Mission had a much larger number of surface operations personnel than MPF (approximately 300 vs. 178), and had three shifts instead of two, that it used many of the successful MPF communication strategies. Charts such as these can be helpful to those designing complicated and unique mission surface operations.

Police on the Front Line of Community Geriatric Healthcare: Challenges and Opportunities

PubMed Central

Brown, Rebecca T.; Ahalt, Cyrus; Steinman, Michael A.; Kruger, Kelly; Williams, Brie A.

2015-01-01

As the population ages, police increasingly serve as first responders to incidents involving older adults in which aging-related health plays a critical role. The goals of this study were to assess police officers’ knowledge of aging-related health; to identify challenges police experience in their encounters with older adults; and to describe their recommendations for how to address those challenges. This was a mixed methods study of 141 San Francisco police officers recruited from mandatory police trainings between 2011 and 2013. Descriptive statistics were used to analyze 141 self-administered questionnaires and principles of grounded theory were used to analyze open-ended questionnaire responses and 11 additional qualitative interviews. Nearly all officers (89%) reported interacting with older adults at least monthly. Although 84% of police reported prior training in working with older adults, only 32% rated themselves knowledgeable about aging-related health. Participants described themselves as first-responders to medical and social emergencies involving older adults and identified several challenges including identifying and responding to aging-related conditions and ensuring appropriate medical and social service hand-offs. To address these challenges, officers recommended developing trainings focused on recognizing and responding to aging-related conditions and improving police knowledge of community resources for older adults. They also called for enhanced communication and collaboration between police and clinicians. These findings suggest that despite playing a front-line role in responding to older adults with complex medical and social needs, many police may benefit from additional knowledge about aging-related health and community resources. Collaboration between police and healthcare providers presents an important opportunity to develop geriatrics training and interprofessional systems of care to support police work with a rapidly aging population. PMID:25378267

Police on the front line of community geriatric health care: challenges and opportunities.

PubMed

Brown, Rebecca T; Ahalt, Cyrus; Steinman, Michael A; Kruger, Kelly; Williams, Brie A

2014-11-01

As the population ages, police increasingly serve as first responders to incidents involving older adults in which aging-related health plays a critical role. The goals of this study were to assess police officers' knowledge of aging-related health, to identify challenges police experience in their encounters with older adults, and to describe their recommendations for how to address those challenges. This was a mixed-methods study of 141 San Francisco police officers recruited from mandatory police trainings between 2011 and 2013. Descriptive statistics were used to analyze 141 self-administered questionnaires, and principles of grounded theory were used to analyze open-ended questionnaire responses and 11 additional qualitative interviews. Eighty-nine percent of officers reported interacting with older adults at least monthly. Although 84% of police reported prior training in working with older adults, only 32% rated themselves as knowledgeable about aging-related health. Participants described themselves as first responders to medical and social emergencies involving older adults and identified several challenges, including identifying and responding to aging-related conditions and ensuring appropriate medical and social service handoffs. To address these challenges, officers recommended developing trainings focused on recognizing and responding to aging-related conditions and improving police knowledge of community resources for older adults. They also called for enhanced communication and collaboration between police and clinicians. These findings suggest that, because they assume a front-line role in responding to older adults with complex medical and social needs, many police may benefit from additional knowledge about aging-related health and community resources. Collaboration between police and healthcare providers presents an important opportunity to develop geriatrics training and interprofessional systems of care to support police work with a rapidly aging population. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

A fuzzy call admission control scheme in wireless networks

NASA Astrophysics Data System (ADS)

Ma, Yufeng; Gong, Shenguang; Hu, Xiulin; Zhang, Yunyu

2007-11-01

Scarcity of the spectrum resource and mobility of users make quality of service (QoS) provision a critical issue in wireless networks. This paper presents a fuzzy call admission control scheme to meet the requirement of the QoS. A performance measure is formed as a weighted linear function of new call and handoff call blocking probabilities. Simulation compares the proposed fuzzy scheme with an adaptive channel reservation scheme. Simulation results show that fuzzy scheme has a better robust performance in terms of average blocking criterion.

Intelligent Spectrum Handoff via Docitive Learning in Cognitive Radio Networks (CRNs)

DTIC Science & Technology

2017-03-01

loss rate. TABLE 8. PER Comparisons for Different Traffic Loads . Figure 42 shows the effect of traffic load on video PSNR. As we can see, the PSNR...REPORT DOCUMENTATION PAGE Form Approved OMB No . 0704-0188 The public reporting burden for this collection of information is estimated to average 1...other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a

The value of bedside shift reporting enhancing nurse surveillance, accountability, and patient safety.

PubMed

Jeffs, Lianne; Acott, Ashley; Simpson, Elisa; Campbell, Heather; Irwin, Terri; Lo, Joyce; Beswick, Susan; Cardoso, Roberta

2013-01-01

A study was undertaken to explore nurses' experiences and perceptions associated with implementation of bedside nurse-to-nurse shift handoff reporting. Interviews were conducted with nurses and analyzed using directed content analysis. Two themes emerged that illustrated the value of bedside shift reporting. These themes included clarifying information and intercepting errors and visualizing patients and prioritizing care. Nurse leaders can leverage study findings in their efforts to embed nurse-to-nurse bedside shift reporting in their respective organizations.

Optical burst switching based satellite backbone network

NASA Astrophysics Data System (ADS)

Li, Tingting; Guo, Hongxiang; Wang, Cen; Wu, Jian

2018-02-01

We propose a novel time slot based optical burst switching (OBS) architecture for GEO/LEO based satellite backbone network. This architecture can provide high speed data transmission rate and high switching capacity . Furthermore, we design the control plane of this optical satellite backbone network. The software defined network (SDN) and network slice (NS) technologies are introduced. Under the properly designed control mechanism, this backbone network is flexible to support various services with diverse transmission requirements. Additionally, the LEO access and handoff management in this network is also discussed.

The effect of a Lean quality improvement implementation program on surgical pathology specimen accessioning and gross preparation error frequency.

PubMed

Smith, Maxwell L; Wilkerson, Trent; Grzybicki, Dana M; Raab, Stephen S

2012-09-01

Few reports have documented the effectiveness of Lean quality improvement in changing anatomic pathology patient safety. We used Lean methods of education; hoshin kanri goal setting and culture change; kaizen events; observation of work activities, hand-offs, and pathways; A3-problem solving, metric development, and measurement; and frontline work redesign in the accessioning and gross examination areas of an anatomic pathology laboratory. We compared the pre- and post-Lean implementation proportion of near-miss events and changes made in specific work processes. In the implementation phase, we documented 29 individual A3-root cause analyses. The pre- and postimplementation proportions of process- and operator-dependent near-miss events were 5.5 and 1.8 (P < .002) and 0.6 and 0.6, respectively. We conclude that through culture change and implementation of specific work process changes, Lean implementation may improve pathology patient safety.

Evaluating a Clinical Decision Support Interface for End-of-Life Nurse Care.

PubMed

Febretti, Alessandro; Stifter, Janet; Keenan, Gail M; Lopez, Karen D; Johnson, Andrew; Wilkie, Diana J

2014-01-01

Clinical Decision Support Systems (CDSS) are tools that assist healthcare personnel in the decision-making process for patient care. Although CDSSs have been successfully deployed in the clinical setting to assist physicians, few CDSS have been targeted at professional nurses, the largest group of health providers. We present our experience in designing and testing a CDSS interface embedded within a nurse care planning and documentation tool. We developed four prototypes based on different CDSS feature designs, and tested them in simulated end-of-life patient handoff sessions with a group of 40 nurse clinicians. We show how our prototypes directed nurses towards an optimal care decision that was rarely performed in unassisted practice. We also discuss the effect of CDSS layout and interface navigation in a nurse's acceptance of suggested actions. These findings provide insights into effective nursing CDSS design that are generalizable to care scenarios different than end-of-life.

Quantifying the Diversity and Similarity of Surgical Procedures Among Hospitals and Anesthesia Providers.

PubMed

Dexter, Franklin; Ledolter, Johannes; Hindman, Bradley J

2016-01-01

In this Statistical Grand Rounds, we review methods for the analysis of the diversity of procedures among hospitals, the activities among anesthesia providers, etc. We apply multiple methods and consider their relative reliability and usefulness for perioperative applications, including calculations of SEs. We also review methods for comparing the similarity of procedures among hospitals, activities among anesthesia providers, etc. We again apply multiple methods and consider their relative reliability and usefulness for perioperative applications. The applications include strategic analyses (e.g., hospital marketing) and human resource analytics (e.g., comparisons among providers). Measures of diversity of procedures and activities (e.g., Herfindahl and Gini-Simpson index) are used for quantification of each facility (hospital) or anesthesia provider, one at a time. Diversity can be thought of as a summary measure. Thus, if the diversity of procedures for 48 hospitals is studied, the diversity (and its SE) is being calculated for each hospital. Likewise, the effective numbers of common procedures at each hospital can be calculated (e.g., by using the exponential of the Shannon index). Measures of similarity are pairwise assessments. Thus, if quantifying the similarity of procedures among cases with a break or handoff versus cases without a break or handoff, a similarity index represents a correlation coefficient. There are several different measures of similarity, and we compare their features and applicability for perioperative data. We rely extensively on sensitivity analyses to interpret observed values of the similarity index.

Factors that contribute to physician variability in decisions to limit life support in the ICU: a qualitative study.

PubMed

Wilson, Michael E; Rhudy, Lori M; Ballinger, Beth A; Tescher, Ann N; Pickering, Brian W; Gajic, Ognjen

2013-06-01

Our aim was to explore reasons for physician variability in decisions to limit life support in the intensive care unit (ICU) utilizing qualitative methodology. Single center study consisting of semi-structured interviews with experienced physicians and nurses. Seventeen intensivists from medical (n = 7), surgical (n = 5), and anesthesia (n = 5) critical care backgrounds, and ten nurses from medical (n = 5) and surgical (n = 5) ICU backgrounds were interviewed. Principles of grounded theory were used to analyze the interview transcripts. Eleven factors within four categories were identified that influenced physician variability in decisions to limit life support: (1) physician work environment-workload and competing priorities, shift changes and handoffs, and incorporation of nursing input; (2) physician experiences-of unexpected patient survival, and of limiting life support in physician's family; (3) physician attitudes-investment in a good surgical outcome, specialty perspective, values and beliefs; and (4) physician relationship with patient and family-hearing the patient's wishes firsthand, engagement in family communication, and family negotiation. We identified several factors which physicians and nurses perceived were important sources of physician variability in decisions to limit life support. Ways to raise awareness and ameliorate the potentially adverse effects of factors such as workload, competing priorities, shift changes, and handoffs should be explored. Exposing intensivists to long term patient outcomes, formalizing nursing input, providing additional training, and emphasizing firsthand knowledge of patient wishes may improve decision making.

Measuring safety culture: Application of the Hospital Survey on Patient Safety Culture to radiation therapy departments worldwide.

PubMed

Leonard, Sarah; O'Donovan, Anita

Minimizing errors and improving patient safety has gained prominence worldwide in high-risk disciplines such as radiation therapy. Patient safety culture has been identified as an important factor in reducing the incidence of adverse events and improving patient safety in the health care setting. The aim of distributing the Hospital Survey on Patient Safety Culture (HSPSC) to radiation therapy departments worldwide was to assess the current status of safety culture, identify areas for improvement and areas that excel, examine factors that influence safety culture, and raise staff awareness. The safety culture in radiation therapy departments worldwide was evaluated by distributing the HSPSC. A total of 266 participants were recruited from radiation therapy departments and included radiation oncologists, radiation therapists, physicists, and dosimetrists. The positive percent scores for the 12 dimensions of the HSPSC varied from 50% to 79%. The highest composite score among the 12 dimensions was teamwork within units; the lowest composite score was handoffs and transitions. The results indicated that health care professionals in radiation therapy departments felt positively toward patient safety. The HSPSC was successfully applied to radiation therapy departments and provided valuable insight into areas of potential improvement such as teamwork across units, staffing, and handoffs and transitions. Managers and policy makers in radiation therapy may use this assessment tool for focused improvement efforts toward patient safety culture. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Sharing Responsibility for Data Stewardship Between Scientists and Curators

NASA Astrophysics Data System (ADS)

Hedstrom, M. L.

2012-12-01

Data stewardship is becoming increasingly important to support accurate conclusions from new forms of data, integration of and computation across heterogeneous data types, interactions between models and data, replication of results, data governance and long-term archiving. In addition to increasing recognition of the importance of data management, data science, and data curation by US and international scientific agencies, the National Academies of Science Board on Research Data and Information is sponsoring a study on Data Curation Education and Workforce Issues. Effective data stewardship requires a distributed effort among scientists who produce data, IT staff and/or vendors who provide data storage and computational facilities and services, and curators who enhance data quality, manage data governance, provide access to third parties, and assume responsibility for long-term archiving of data. The expertise necessary for scientific data management includes a mix of knowledge of the scientific domain; an understanding of domain data requirements, standards, ontologies and analytical methods; facility with leading edge information technology; and knowledge of data governance, standards, and best practices for long-term preservation and access that rarely are found in a single individual. Rather than developing data science and data curation as new and distinct occupations, this paper examines the set of tasks required for data stewardship. The paper proposes an alternative model that embeds data stewardship in scientific workflows and coordinates hand-offs between instruments, repositories, analytical processing, publishers, distributors, and archives. This model forms the basis for defining knowledge and skill requirements for specific actors in the processes required for data stewardship and the corresponding educational and training needs.

Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

PubMed

Fagnan, Lyle J; Walunas, Theresa L; Parchman, Michael L; Dickinson, Caitlin L; Murphy, Katrina M; Howell, Ross; Jackson, Kathryn L; Madden, Margaret B; Ciesla, James R; Mazurek, Kathryn D; Kho, Abel N; Solberg, Leif I

2018-04-01

The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of $2.675 million, or $5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more. © 2018 Annals of Family Medicine, Inc.

Structural dissection of an interaction between transcription initiation and termination factors implicated in promoter-terminator cross-talk.

PubMed

Bratkowski, Matthew; Unarta, Ilona Christy; Zhu, Lizhe; Shubbar, Murtada; Huang, Xuhui; Liu, Xin

2018-02-02

Functional cross-talk between the promoter and terminator of a gene has long been noted. Promoters and terminators are juxtaposed to form gene loops in several organisms, and gene looping is thought to be involved in transcriptional regulation. The general transcription factor IIB (TFIIB) and the C-terminal domain phosphatase Ssu72, essential factors of the transcription preinitiation complex and the mRNA processing and polyadenylation complex, respectively, are important for gene loop formation. TFIIB and Ssu72 interact both genetically and physically, but the molecular basis of this interaction is not known. Here we present a crystal structure of the core domain of TFIIB in two new conformations that differ in the relative distance and orientation of the two cyclin-like domains. The observed extraordinary conformational plasticity may underlie the binding of TFIIB to multiple transcription factors and promoter DNAs that occurs in distinct stages of transcription, including initiation, reinitiation, and gene looping. We mapped the binding interface of the TFIIB-Ssu72 complex using a series of systematic, structure-guided in vitro binding and site-specific photocross-linking assays. Our results indicate that Ssu72 competes with acidic activators for TFIIB binding and that Ssu72 disrupts an intramolecular TFIIB complex known to impede transcription initiation. We also show that the TFIIB-binding site on Ssu72 overlaps with the binding site of symplekin, a component of the mRNA processing and polyadenylation complex. We propose a hand-off model in which Ssu72 mediates a conformational transition in TFIIB, accounting for the role of Ssu72 in transcription reinitiation, gene looping, and promoter-terminator cross-talk. © 2018 by The American Society for Biochemistry and Molecular Biology, Inc.

Surgical Specimen Management: A Descriptive Study of 648 Adverse Events and Near Misses.

PubMed

Steelman, Victoria M; Williams, Tamara L; Szekendi, Marilyn K; Halverson, Amy L; Dintzis, Suzanne M; Pavkovic, Stephen

2016-12-01

- Surgical specimen adverse events can lead to delays in treatment or diagnosis, misdiagnosis, reoperation, inappropriate treatment, and anxiety or serious patient harm. - To describe the types and frequency of event reports associated with the management of surgical specimens, the contributing factors, and the level of harm associated with these events. - A retrospective review was undertaken of surgical specimen adverse events and near misses voluntarily reported in the University HealthSystem Consortium Safety Intelligence Patient Safety Organization database by more than 50 health care facilities during a 3-year period (2011-2013). Event reports that involved surgical specimen management were reviewed for patients undergoing surgery during which tissue or fluid was sent to the pathology department. - Six hundred forty-eight surgical specimen events were reported in all stages of the specimen management process, with the most common events reported during the prelaboratory phase and, specifically, with specimen labeling, collection/preservation, and transport. The most common contributing factors were failures in handoff communication, staff inattention, knowledge deficit, and environmental issues. Eight percent of the events (52 of 648) resulted in either the need for additional treatment or temporary or permanent harm to the patient. - All phases of specimen handling and processing are vulnerable to errors. These results provide a starting point for health care organizations to conduct proactive risk analyses of specimen handling procedures and to design safer processes. Particular attention should be paid to effective communication and handoffs, consistent processes across care areas, and staff training. In addition, organizations should consider the use of technology-based identification and tracking systems.

Remote software upload techniques in future vehicles and their performance analysis

NASA Astrophysics Data System (ADS)

Hossain, Irina

Updating software in vehicle Electronic Control Units (ECUs) will become a mandatory requirement for a variety of reasons, for examples, to update/fix functionality of an existing system, add new functionality, remove software bugs and to cope up with ITS infrastructure. Software modules of advanced vehicles can be updated using Remote Software Upload (RSU) technique. The RSU employs infrastructure-based wireless communication technique where the software supplier sends the software to the targeted vehicle via a roadside Base Station (BS). However, security is critically important in RSU to avoid any disasters due to malfunctions of the vehicle or to protect the proprietary algorithms from hackers, competitors or people with malicious intent. In this thesis, a mechanism of secure software upload in advanced vehicles is presented which employs mutual authentication of the software provider and the vehicle using a pre-shared authentication key before sending the software. The software packets are sent encrypted with a secret key along with the Message Digest (MD). In order to increase the security level, it is proposed the vehicle to receive more than one copy of the software along with the MD in each copy. The vehicle will install the new software only when it receives more than one identical copies of the software. In order to validate the proposition, analytical expressions of average number of packet transmissions for successful software update is determined. Different cases are investigated depending on the vehicle's buffer size and verification methods. The analytical and simulation results show that it is sufficient to send two copies of the software to the vehicle to thwart any security attack while uploading the software. The above mentioned unicast method for RSU is suitable when software needs to be uploaded to a single vehicle. Since multicasting is the most efficient method of group communication, updating software in an ECU of a large number of vehicles could benefit from it. However, like the unicast RSU, the security requirements of multicast communication, i.e., authenticity, confidentiality and integrity of the software transmitted and access control of the group members is challenging. In this thesis, an infrastructure-based mobile multicasting for RSU in vehicle ECUs is proposed where an ECU receives the software from a remote software distribution center using the road side BSs as gateways. The Vehicular Software Distribution Network (VSDN) is divided into small regions administered by a Regional Group Manager (RGM). Two multicast Group Key Management (GKM) techniques are proposed based on the degree of trust on the BSs named Fully-trusted (FT) and Semi-trusted (ST) systems. Analytical models are developed to find the multicast session establishment latency and handover latency for these two protocols. The average latency to perform mutual authentication of the software vendor and a vehicle, and to send the multicast session key by the software provider during multicast session initialization, and the handoff latency during multicast session is calculated. Analytical and simulation results show that the link establishment latency per vehicle of our proposed schemes is in the range of few seconds and the ST system requires few ms higher time than the FT system. The handoff latency is also in the range of few seconds and in some cases ST system requires less handoff time than the FT system. Thus, it is possible to build an efficient GKM protocol without putting too much trust on the BSs.

Intelligent call admission control for multi-class services in mobile cellular networks

NASA Astrophysics Data System (ADS)

Ma, Yufeng; Hu, Xiulin; Zhang, Yunyu

2005-11-01

Scarcity of the spectrum resource and mobility of users make quality of service (QoS) provision a critical issue in mobile cellular networks. This paper presents a fuzzy call admission control scheme to meet the requirement of the QoS. A performance measure is formed as a weighted linear function of new call and handoff call blocking probabilities of each service class. Simulation compares the proposed fuzzy scheme with complete sharing and guard channel policies. Simulation results show that fuzzy scheme has a better robust performance in terms of average blocking criterion.

Mobile-ip Aeronautical Network Simulation Study

NASA Technical Reports Server (NTRS)

Ivancic, William D.; Tran, Diepchi T.

2001-01-01

NASA is interested in applying mobile Internet protocol (mobile-ip) technologies to its space and aeronautics programs. In particular, mobile-ip will play a major role in the Advanced Aeronautic Transportation Technology (AATT), the Weather Information Communication (WINCOMM), and the Small Aircraft Transportation System (SATS) aeronautics programs. This report presents the results of a simulation study of mobile-ip for an aeronautical network. The study was performed to determine the performance of the transmission control protocol (TCP) in a mobile-ip environment and to gain an understanding of how long delays, handoffs, and noisy channels affect mobile-ip performance.

A missed Fe-S cluster handoff causes a metabolic shakeup.

PubMed

Berteau, Olivier

2018-05-25

The general framework of pathways by which iron-sulfur (Fe-S) clusters are assembled in cells is well-known, but the cellular consequences of disruptions to that framework are not fully understood. Crooks et al. report a novel cellular system that creates an acute Fe-S cluster deficiency, using mutants of ISCU, the main scaffold protein for Fe-S cluster assembly. Surprisingly, the resultant metabolic reprogramming leads to the accumulation of lipid droplets, a situation encountered in many poorly understood pathological conditions, highlighting unanticipated links between Fe-S assembly machinery and human disease. © 2018 Berteau.

Opportunities and Efficiencies in Building a New Service Desk Model.

PubMed

Mayo, Alexa; Brown, Everly; Harris, Ryan

2017-01-01

In July 2015, the Health Sciences and Human Services Library (HS/HSL) at the University of Maryland, Baltimore (UMB), merged its reference and circulation services, creating the Information Services Department and Information Services Desk. Designing the Information Services Desk with a team approach allowed for the re-examination of the HS/HSL's service model from the ground up. With the creation of a single service point, the HS/HSL was able to create efficiencies, improve the user experience by eliminating handoffs, create a collaborative team environment, and engage information services staff in a variety of new projects.

Conference Proceedings of the America Institute for Aeronautics and Astronautics Missile Sciences Held in Monterey, California on 29 November - 1 December 1988. Volume 6. Navy Ballistic Missile Technology

DTIC Science & Technology

1988-11-01

atmospheric point the sensor line of sight to a target. Both oxidizers.) The stability of the booster plume as optical systems look out through windows...vertical. The optical layout olume unless it is tracking the UV plume outside for the UV camera is as shown in Figure 1. A the atmosphere. Thus, other...and olune and handoff to the missile in the atmosphere camera was used on the rear platform for the with high resolution optics . visible observation

Human recognition in a video network

NASA Astrophysics Data System (ADS)

Bhanu, Bir

2009-10-01

Video networks is an emerging interdisciplinary field with significant and exciting scientific and technological challenges. It has great promise in solving many real-world problems and enabling a broad range of applications, including smart homes, video surveillance, environment and traffic monitoring, elderly care, intelligent environments, and entertainment in public and private spaces. This paper provides an overview of the design of a wireless video network as an experimental environment, camera selection, hand-off and control, anomaly detection. It addresses challenging questions for individual identification using gait and face at a distance and present new techniques and their comparison for robust identification.

Cascaded neural networks for sequenced propagation estimation, multiuser detection, and adaptive radio resource control of third-generation wireless networks for multimedia services

NASA Astrophysics Data System (ADS)

Hortos, William S.

1999-03-01

A hybrid neural network approach is presented to estimate radio propagation characteristics and multiuser interference and to evaluate their combined impact on throughput, latency and information loss in third-generation (3G) wireless networks. The latter three performance parameters influence the quality of service (QoS) for multimedia services under consideration for 3G networks. These networks, based on a hierarchical architecture of overlaying macrocells on top of micro- and picocells, are planned to operate in mobile urban and indoor environments with service demands emanating from circuit-switched, packet-switched and satellite-based traffic sources. Candidate radio interfaces for these networks employ a form of wideband CDMA in 5-MHz and wider-bandwidth channels, with possible asynchronous operation of the mobile subscribers. The proposed neural network (NN) architecture allocates network resources to optimize QoS metrics. Parameters of the radio propagation channel are estimated, followed by control of an adaptive antenna array at the base station to minimize interference, and then joint multiuser detection is performed at the base station receiver. These adaptive processing stages are implemented as a sequence of NN techniques that provide their estimates as inputs to a final- stage Kohonen self-organizing feature map (SOFM). The SOFM optimizes the allocation of available network resources to satisfy QoS requirements for variable-rate voice, data and video services. As the first stage of the sequence, a modified feed-forward multilayer perceptron NN is trained on the pilot signals of the mobile subscribers to estimate the parameters of shadowing, multipath fading and delays on the uplinks. A recurrent NN (RNN) forms the second stage to control base stations' adaptive antenna arrays to minimize intra-cell interference. The third stage is based on a Hopfield NN (HNN), modified to detect multiple users on the uplink radio channels to mitigate multiaccess interference, control carrier-sense multiple-access (CSMA) protocols, and refine call handoff procedures. In the final stage, the Kohonen SOFM, operating in a hybrid continuous and discrete space, adaptively allocates the resources of antenna-based cell sectorization, activity monitoring, variable-rate coding, power control, handoff and caller admission to meet user demands for various multimedia services at minimum QoS levels. The performance of the NN cascade is evaluated through simulation of a candidate 3G wireless network using W-CDMA parameters in a small-cell environment. The simulated network consists of a representative number of cells. Mobile users with typical movement patterns are assumed. QoS requirements for different classes of multimedia services are considered. The proposed method is shown to provide relatively low probability of new call blocking and handoff dropping, while maintaining efficient use of the network's radio resources.

A pragmatic randomized comparative effectiveness trial of transitional care for a socioeconomically diverse population: Design, rationale and baseline characteristics.

PubMed

Schaeffer, Christine; Teter, Caroline; Finch, Emily A; Hurt, Courtney; Keeter, Mary Kate; Liss, David T; Rogers, Angela; Sheth, Avani; Ackermann, Ronald

2018-02-01

Transitional care programs have been widely used to reduce readmissions and improve the quality and safety of the handoff process between hospital and outpatient providers. Very little is known about effective transitional care interventions among patients who are uninsured or with Medicaid. This paper describes the design and baseline characteristics of a pragmatic randomized comparative effectiveness trial of transitional care. Northwestern Medical Group- Transitional Care (NMG-TC) care model was developed to address the needs of patients with multiple medical problems that required lifestyle changes and were amenable to office-based management. We present the design, evaluation methods and baseline characteristics of NMG-TC trial patients. Baseline demographic characteristics indicate that our patient population is predominantly male, Medicaid insured and non-white. This study will evaluate two methods for implementing an effective transitional care model in a medically complex and socioeconomically diverse population. Copyright © 2017 Elsevier Inc. All rights reserved.

Challenges for Early Responders to a Nuclear / Radiological Terrorism Incident

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

Wells, M.A.; Stearns, L.J.; Davie, A.D.

2007-07-01

Even in the best of circumstances, most municipalities would face severe challenges in providing effective incident response to a large scale radiation release caused by nuclear terrorism or accident. Compounding obvious complexities, the effectiveness of first and early responders to a radiological emergency may also be hampered by an insufficient distribution of radiation detection and monitoring equipment, local policies concerning triage and field decontamination of critical victims, malfunctioning communications, inadequate inter-agency agility, and the psychological 'fear' impact on early responders. This paper examines several issues impeding the early response to nuclear terrorism incidents with specific consideration given to the on-goingmore » and forward-thinking preparedness efforts currently being developed in the Sacramento, California region. Specific recommendations are provided addressing hot zone protocols, radiation detection and monitoring equipment, hasty patient packaging techniques, vertically and horizontally integrated pre-event training, mitigating psychological fear, and protocols for the effective 'hand-off' from first responders to subsequent early response-recovery teams. (authors)« less

Will Allis Prize Talk: Allis in Wonderland--Physics for Profit as well as Fun

NASA Astrophysics Data System (ADS)

Waymouth, John F.

2000-06-01

Unlike previous recipients of the William P. Allis Prize, I spent my entire working career as a physicist in industry, spanning the entire range from research to development to engineering, from science to technology. Further unlike them, I have been retired for twelve years. My knowledge of current leading-edge research in discharge light sources is consequently entirely second-hand. Rather than speak about it, therefore, I will relate instead the history of a successful physics-to-factory handoff I participated in, to give you some idea of the flavor of physics for profit as well as for fun, in an environment where any piece of work that results only in publications in refereed journals and meeting presentations must be considered a failure. I will conclude with some critical observations about the lack of scientific and technical expertise among the top managements of most of the Fortune-500 list of US firms, even those whose businesses are deeply rooted in science and technology.

Use of Virtual Mission Operations Center Technology to Achieve JPDO's Virtual Tower Vision

NASA Technical Reports Server (NTRS)

Ivancic, William D.; Paulsen, Phillip E.

2006-01-01

The Joint Program Development Office has proposed that the Next Generation Air Transportation System (NGATS) consolidate control centers. NGATS would be managed from a few strategically located facilities with virtual towers and TRACONS. This consolidation is about combining the delivery locations for these services not about decreasing service. By consolidating these locations, cost savings in the order of $500 million have been projected. Evolving to spaced-based communication, navigation, and surveillance offers the opportunity to reduce or eliminate much of the ground-based infrastructure cost. Dynamically adjusted airspace offers the opportunity to reduce the number of sectors and boundary inconsistencies; eliminate or reduce "handoffs;" and eliminate the distinction between Towers, TRACONS, and Enroute Centers. To realize a consolidation vision for air traffic management there must be investment in networking. One technology that holds great potential is the use of Virtual Mission Operations Centers to provide secure, automated, intelligent management of the NGATS. This paper provides a conceptual framework for incorporating VMOC into the NGATS.

Packaging Patients and Handing Them Over: Communication Context and Persuasion in the Emergency Department.

PubMed

Nugus, Peter; McCarthy, Sally; Holdgate, Anna; Braithwaite, Jeffrey; Schoenmakers, Anne; Wagner, Cordula

2017-02-01

Communication is commonly understood by health professional researchers to consist of relatively isolated exchanges of information. The social and organizational context is given limited credit. This article examines the significance of the environmental complexity of the emergency department (ED) in influencing communication strategies and makes the case for adopting a richer understanding of organizational communication. This study draws on approximately 12 months (1,600 hours) of ethnographic observations, yielding approximately 4,500 interactions across 260 clinicians and staff in the EDs of 2 metropolitan public teaching hospitals in Sydney, Australia. The study identifies 5 communication competencies of increasing complexity that emergency clinicians need to accomplish. Furthermore, it identifies several factors-hierarchy, formally imposed organizational boundaries and roles, power, and education-that contribute to the collective function of ensuring smooth patient transfer through and out of the ED. These factors are expressed by and shape external communication with clinicians from other hospital departments. This study shows that handoff of patients from the ED to other hospital departments is a complex communication process that involves more than a series of "checklistable" information exchanges. Clinicians must learn to use both negotiation and persuasion to achieve objectives. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Usb1 controls U6 snRNP assembly through evolutionarily divergent cyclic phosphodiesterase activities.

PubMed

Didychuk, Allison L; Montemayor, Eric J; Carrocci, Tucker J; DeLaitsch, Andrew T; Lucarelli, Stefani E; Westler, William M; Brow, David A; Hoskins, Aaron A; Butcher, Samuel E

2017-09-08

U6 small nuclear ribonucleoprotein (snRNP) biogenesis is essential for spliceosome assembly, but not well understood. Here, we report structures of the U6 RNA processing enzyme Usb1 from yeast and a substrate analog bound complex from humans. Unlike the human ortholog, we show that yeast Usb1 has cyclic phosphodiesterase activity that leaves a terminal 3' phosphate which prevents overprocessing. Usb1 processing of U6 RNA dramatically alters its affinity for cognate RNA-binding proteins. We reconstitute the post-transcriptional assembly of yeast U6 snRNP in vitro, which occurs through a complex series of handoffs involving 10 proteins (Lhp1, Prp24, Usb1 and Lsm2-8) and anti-cooperative interactions between Prp24 and Lhp1. We propose a model for U6 snRNP assembly that explains how evolutionarily divergent and seemingly antagonistic proteins cooperate to protect and chaperone the nascent snRNA during its journey to the spliceosome.The mechanism of U6 small nuclear ribonucleoprotein (snRNP) biogenesis is not well understood. Here the authors characterize the enzymatic activities and structures of yeast and human U6 RNA processing enzyme Usb1, reconstitute post-transcriptional assembly of yeast U6 snRNP in vitro, and propose a model for U6 snRNP assembly.

The impact of duty cycle workflow on sign-out practices: a qualitative study of an internal medicine residency program in Maryland, USA

PubMed Central

Lee, Soo-Hoon; Desai, Sanjay V

2017-01-01

Objectives Although JCAHO requires a standardised approach to handoffs, and while many standardised protocols have been tested, sign-out practices continue to vary. We believe this is due to the variability in workflow during inpatient duty cycle. We investigate the impact of such workflows on intern sign-out practices. Design We employed a prospective, grounded theory mixed-method design. Setting The study was conducted at a residency programme in the mid-Atlantic USA. Two observers randomly evaluated three types of daily sign-outs for 1 week every 3 months from September 2013 to March 2014. The compliance of each observed behaviour to JCAHO’s Handoff Communication Checklist was recorded. Participants Thirty one interns conducting 134 patient sign-outs were observed randomly among the 52 in the programme. Results In the 06:00 to 07:00 sign-back, the night-cover focused on providing information on overnight events to the day interns. In the 11:00 to 12:00 sign-out, the night-cover focused on transferring task accountability to a day-cover intern before departure. In the 20:00 to 21:00 sign-out, the day interns focused on transferring responsibility of their patients to a night-cover. Conclusion Different sign-out periods had different emphases regarding information exchange, personal responsibility and task accountability. Sign-outs are context-specific, implying that across-the-board standardised sign-out protocols are likely to have limited efficacy and compliance. Standardisation may need to be relative to the specific type and purpose of each sign-out to be supported by interns. PMID:28487461

An observational pre-post study of re-structuring Medicine inpatient teaching service: Improved continuity of care within constraint of 2011 duty hours.

PubMed

Cheung, Joseph Y; Mueller, Daniel; Blum, Marissa; Ravreby, Hannah; Williams, Paul; Moyer, Darilyn; Caroline, Malka; Zack, Chad; Fisher, Susan G; Feldman, Arthur M

2015-09-01

Implementation of more stringent regulations on duty hours and supervision by the Accreditation Council for Graduate Medical Education in July 2011 makes it challenging to design inpatient Medicine teaching service that complies with the duty hour restrictions while optimizing continuity of patient care. To prospectively compare two inpatient Medicine teaching service structures with respect to residents' impression of continuity of patient care (primary outcome), time available for teaching, resident satisfaction and length-of-stay (secondary endpoints). Observational pre-post study. Surveys were conducted both before and after Conventional Medicine teaching service was changed to a novel model (MegaTeam). Academic General Medicine inpatient teaching service. Surveys before and after MegaTeam implementation were completed by 68.5% and 72.2% of internal medicine residents, respectively. Comparing conventional with MegaTeam, the % of residents who agreed or strongly agreed that the (i) ability to care for majority of patients from admission to discharge increased from 29.7% to 86.6% (p<0.01); (ii) the concern that number of handoffs was too many decreased from 91.9% to 18.2% (p<0.01); (iii) ability to provide appropriate supervision to interns increased from 38.1% to 70.7% (p<0.01); (iv) overall resident satisfaction with inpatient Medicine teaching service increased from 24.7% to 56.4% (p<0.01); and (v) length-of-stay on inpatient Medicine service decreased from 5.3±6.2 to 4.9±6.8 days (p<0.03). According to our residents, the MegaTeam structure promotes continuity of patient care, decreases number of handoffs, provides adequate supervision and teaching of interns and medical students, increases resident overall satisfaction and decreases length-of-stay. Copyright © 2015 Elsevier Inc. All rights reserved.

Bedside Reporting: Protocols for Improving Patient Care.

PubMed

Ferguson, Teresa D; Howell, Teresa L

2015-12-01

Bedside reporting continues to gain much attention and is being investigated to support the premise that "hand-off" communications enhance efficacy in delivery of patient care. Patient inclusion in shift reports enhances good patient outcomes, increased satisfaction with care delivery, enhanced accountability for nursing professionals, and improved communications between patients and their direct care providers. This article discusses the multiple benefits of dynamic dialogue between patients and the health care team, challenges often associated with bedside reporting, and protocols for managing bedside reporting with the major aim of improving patient care. Nursing research supporting the concept of bedside reporting is examined. Copyright © 2015 Elsevier Inc. All rights reserved.

Challenges and opportunities for recruiting a new generation of neurosurgeons.

PubMed

Brown, Ann J; Friedman, Allan H

2007-12-01

Several factors have converged to raise concern among program directors about attracting and training the next generation of neurosurgeons. These include the relatively new duty-hour regulations, the projected physician shortage, and the preference of many current medical students for controllable lifestyles. Attracting top talent into training programs may require innovations geared to Generation X such as policies supporting work-life balance, flexible work options, lots of feedback, mentoring programs, talented leadership, and standardized communication strategies during patient handoffs. Larger programmatic changes may also be needed such as "competency-based" training and additional years of training for mastery of highly specialized procedures.

Detection of unknown targets from aerial camera and extraction of simple object fingerprints for the purpose of target reacquisition

NASA Astrophysics Data System (ADS)

Mundhenk, T. Nathan; Ni, Kang-Yu; Chen, Yang; Kim, Kyungnam; Owechko, Yuri

2012-01-01

An aerial multiple camera tracking paradigm needs to not only spot unknown targets and track them, but also needs to know how to handle target reacquisition as well as target handoff to other cameras in the operating theater. Here we discuss such a system which is designed to spot unknown targets, track them, segment the useful features and then create a signature fingerprint for the object so that it can be reacquired or handed off to another camera. The tracking system spots unknown objects by subtracting background motion from observed motion allowing it to find targets in motion, even if the camera platform itself is moving. The area of motion is then matched to segmented regions returned by the EDISON mean shift segmentation tool. Whole segments which have common motion and which are contiguous to each other are grouped into a master object. Once master objects are formed, we have a tight bound on which to extract features for the purpose of forming a fingerprint. This is done using color and simple entropy features. These can be placed into a myriad of different fingerprints. To keep data transmission and storage size low for camera handoff of targets, we try several different simple techniques. These include Histogram, Spatiogram and Single Gaussian Model. These are tested by simulating a very large number of target losses in six videos over an interval of 1000 frames each from the DARPA VIVID video set. Since the fingerprints are very simple, they are not expected to be valid for long periods of time. As such, we test the shelf life of fingerprints. This is how long a fingerprint is good for when stored away between target appearances. Shelf life gives us a second metric of goodness and tells us if a fingerprint method has better accuracy over longer periods. In videos which contain multiple vehicle occlusions and vehicles of highly similar appearance we obtain a reacquisition rate for automobiles of over 80% using the simple single Gaussian model compared with the null hypothesis of <20%. Additionally, the performance for fingerprints stays well above the null hypothesis for as much as 800 frames. Thus, a simple and highly compact single Gaussian model is useful for target reacquisition. Since the model is agnostic to view point and object size, it is expected to perform as well on a test of target handoff. Since some of the performance degradation is due to problems with the initial target acquisition and tracking, the simple Gaussian model may perform even better with an improved initial acquisition technique. Also, since the model makes no assumption about the object to be tracked, it should be possible to use it to fingerprint a multitude of objects, not just cars. Further accuracy may be obtained by creating manifolds of objects from multiple samples.

The changing nature of ICU charge nurses' decision making: from supervision of care delivery to unit resource management.

PubMed

Miller, Anne; Buerhaus, Peter I

2013-01-01

Recent findings that variations in nursing workload may affect inpatient outcomes now highlight nurse workload management and the need for an updated analysis of the role of the charge nurse (CN). Observational data for eight CNs, each at one of eight ICUs in a not-for-profit Level 1 Trauma Center, coded to capture interprofessional interactions, decision making, team coordination phases, and support tools. A researcher shadowed each participant for 12 hours. Each shift began and ended with a face-to-face handoff that included summaries of each patient's condition; the current bed census; anticipated admissions, discharges, and transfers; and the number of nurses available to work the current and coming two shifts. The researcher, using a notebook, recorded the substantive content of all work conversations initiated by or directed to the CN from physicians, staff nurses, allied health workers, other employees, and patients/families. The tools used to support conversations were collected as blank forms or computer screen prints and annotated to describe how they were used, when, and for what purpose. Statistically significant three-way interactions suggest that CNs' conversations with colleagues depend on the team coordination phase and the decision-making level, and that the support tools that CNs use when talking to colleagues depend on the decision-making level and the team coordination phase. The role of ICU CNs appears to be continuing to evolve, now encompassing unit resource management in addition to supervising care delivery. Effective support tools, together with education that would enhance communication and resource management skills, will be essential to CNs' ability to support unit resilience and adaptability in an increasingly complex environment.

Lean thinking transformation of the unsedated upper gastrointestinal endoscopy pathway improves efficiency and is associated with high levels of patient satisfaction.

PubMed

Hydes, Theresa; Hansi, Navjyot; Trebble, Timothy M

2012-01-01

Upper gastrointestinal (UGI) endoscopy is a routine healthcare procedure with a defined patient pathway. The objective of this study was to redesign this pathway for unsedated patients using lean thinking transformation to focus on patient-derived value-adding steps, remove waste and create a more efficient process. This was to form the basis of a pathway template that was transferrable to other endoscopy units. A literature search of patient expectations for UGI endoscopy identified patient-derived value. A value stream map was created of the current pathway. The minimum and maximum time per step, bottlenecks and staff-staff interactions were recorded. This information was used for service transformation using lean thinking. A patient pathway template was created and implemented into a secondary unit. Questionnaire studies were performed to assess patient satisfaction. In the primary unit the patient pathway reduced from 19 to 11 steps with a reduction in the maximum lead time from 375 to 80 min following lean thinking transformation. The minimum value/lead time ratio increased from 24% to 49%. The patient pathway was redesigned as a 'cellular' system with minimised patient and staff travelling distances, waiting times, paperwork and handoffs. Nursing staff requirements reduced by 25%. Patient-prioritised aspects of care were emphasised with increased patient-endoscopist interaction time. The template was successfully introduced into a second unit with an overall positive patient satisfaction rating of 95%. Lean thinking transformation of the unsedated UGI endoscopy pathway results in reduced waiting times, reduced staffing requirements and improved patient flow and can form the basis of a pathway template which may be successfully transferred into alternative endoscopy environments with high levels of patient satisfaction.

Transition Hand-Off from Inpatient to Outpatient Treatment of Acute Pyelonephritis in an Elderly Male.

PubMed

Orlando, Patricia L; Shane-McWhorter, Laura

2017-04-01

Pyelonephritis is the progression of a urinary tract infection (UTI) to the kidney. In younger patients the infection may not be as severe and may even be treated with oral antibiotics. However, in elderly males pyelonephritis can be more complex and may require hospitalization and treatment with intravenous antibiotics. In the United States UTIs are responsible for frequent visits to emergency departments by elderly individuals. Current literature suggests that pyelonephritis in elderly males is a serious infection that may result in significant morbidity and mortality. Pharmacists are in a unique position to oversee the transition of antibiotic treatment from the inpatient to outpatienT SETTING.

FAA Air Traffic Control Operations Concepts. Volume 6. ARTCC (Air Route Traffic Control Center)/Host En Route Controllers. Change 1

DTIC Science & Technology

1988-07-29

NOTICE OF RADAR S EIlS OR STATU5 vIA COIdWNICATIONS STATUS CHAINC-ES AI.I.2.5 I ICT AS S y F - RECEIVE NOTICE CC• COM ’-NICAT ION STATUS NECESSARY TO...R Ii i I 1 ,I.2.2.2 REVIEW POTENTIAl. CONFLICT SITUATION FOR RES0,UTION X X X , i 2.1.8 DETERMINE APPROPRIATE ACTION ID RESOLVE CUNFLICf I IX XNXx X...SELECTION OF THE SELLCT AUTOMA1IC HANDOFF FUNrIION. A1.4.13 ESTABLISHING, N/A MAINTAINING. AND TERMINATING RADIO COM •LNICATIONS 41.4.13.1 RECEIVE REQUES1 TO

Control and Non-Payload Communications (CNPC) Prototype Radio - Generation 2 Flight Test Report

NASA Technical Reports Server (NTRS)

Ishac, Joseph A.; Iannicca, Dennis C.; Shalkhauser, Kurt A.; Kachmar, Brian A.

2014-01-01

NASA Glenn Research Center conducted a series of flight tests for the purpose of evaluating air-to-ground communications links for future unmanned aircraft systems (UAS). The primary objective of the test effort was to evaluate the transition of the aircraft communications from one ground station to the next, and to monitor data flow during the "hand-off" event. To facilitate the testing, ground stations were installed at locations in Cleveland, Ohio and Albany, Ohio that each provides line-of-sight radio communications with an overflying aircraft. This report describes results from the flight tests including flight parameters, received signal strength measurements, data latency times, and performance observations for the air-to-ground channel.

LMJ Points Plus v2.6

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

Kertesz, Vilmos

Short summary of the software's functionality: • built-in scan feature to acquire optical image of the surface to be analyzed • click-and-point selection of points of interest on the surface • supporting standalone autosampler/HPLC/MS operation: creating independent batch files after points of interests are selected for LEAPShell (autosampler control software from Leap Technologies) and Analyst® (mass spectrometry (MS) software from AB Sciex) • supporting integrated autosampler/HPLC/MS operation: creating one batch file for all instruments controlled by Analyst® (mass spectrometry software from AB Sciex) after points of interests are selected •creating heatmaps of analytes of interests from collected MS files inmore » a hand-off fashion« less

Meeting the challenge of corporate entrepreneurship.

PubMed

Garvin, David A; Levesque, Lynne C

2006-10-01

To be competitive, companies must grow innovative new businesses. Corporate entrepreneurship, however, isn't easy. New ventures face innumerable barriers and seldom mesh smoothly with well-established systems, processes, and cultures. Nonetheless, success requires a balance of old and new organizational traits-and unless companies keep those opposing forces in equilibrium, their new businesses will flounder. The authors describe the challenges companies face when they pursue new businesses, as well as the usual problematic responses to those challenges. Such companies, they say, must perform three balancing acts: Develop strategy by trial and error, which includes narrowing potential choices, learning from small samples, using prototypes to test business models, tracking progress through nonfinancial measures, and knowing how and when to pull the plug on a new venture. Find the best combination of old and new operational processes by staffing new ventures with "mature turks", changing veterans' thinking, knowing which capabilities to develop and which to acquire, and having old and new businesses share responsibility for operating decisions. Strike the right balance of integration and autonomy by assigning both corporate and operating sponsors to new ventures, establishing criteria for handoffs to existing divisions, and using creative organizational structures. The authors provide a detailed look at IBM's Emerging Business Opportunity system, which manages all these balancing acts simultaneously.

Defining pediatric inpatient cardiology care delivery models: A survey of pediatric cardiology programs in the USA and Canada.

PubMed

Mott, Antonio R; Neish, Steven R; Challman, Melissa; Feltes, Timothy F

2017-05-01

The treatment of children with cardiac disease is one of the most prevalent and costly pediatric inpatient conditions. The design of inpatient medical services for children admitted to and discharged from noncritical cardiology care units, however, is undefined. North American Pediatric Cardiology Programs were surveyed to define noncritical cardiac care unit models in current practice. An online survey that explored institutional and functional domains for noncritical cardiac care unit was crafted. All questions were multi-choice with comment boxes for further explanation. The survey was distributed by email four times over a 5-month period. Most programs (n = 45, 60%) exist in free-standing children's hospitals. Most programs cohort cardiac patients on noncritical cardiac care units that are restricted to cardiac patients in 39 (54%) programs or restricted to cardiac and other subspecialty patients in 23 (32%) programs. The most common frontline providers are categorical pediatric residents (n = 58, 81%) and nurse practitioners (n = 48, 67%). However, nurse practitioners are autonomous providers in only 21 (29%) programs. Only 33% of programs use a postoperative fast-track protocol. When transitioning care to referring physicians, most programs (n = 53, 72%) use facsimile to deliver pertinent patient information. Twenty-two programs (31%) use email to transition care, and eighteen (25%) programs use verbal communication. Most programs exist in free-standing children's hospitals in which the noncritical cardiac care units are in some form restricted to cardiac patients. While nurse practitioners are used on most noncritical cardiac care units, they rarely function as autonomous providers. The majority of programs in this survey do not incorporate any postoperative fast-track protocols in their practice. Given the current era of focused handoffs within hospital systems, relatively few programs utilize verbal handoffs to the referring pediatric cardiologist/pediatrician. © 2016 Wiley Periodicals, Inc.

2500 high-quality genomes reveal that the biogeochemical cycles of C, N, S and H are cross-linked by metabolic handoffs in the terrestrial subsurface

NASA Astrophysics Data System (ADS)

Anantharaman, K.; Brown, C. T.; Hug, L. A.; Sharon, I.; Castelle, C. J.; Shelton, A.; Bonet, B.; Probst, A. J.; Thomas, B. C.; Singh, A.; Wilkins, M.; Williams, K. H.; Tringe, S. G.; Beller, H. R.; Brodie, E.; Hubbard, S. S.; Banfield, J. F.

2015-12-01

Microorganisms drive the transformations of carbon compounds in the terrestrial subsurface, a key reservoir of carbon on earth, and impact other linked biogeochemical cycles. Our current knowledge of the microbial ecology in this environment is primarily based on 16S rRNA gene sequences that paint a biased picture of microbial community composition and provide no reliable information on microbial metabolism. Consequently, little is known about the identity and metabolic roles of the uncultivated microbial majority in the subsurface. In turn, this lack of understanding of the microbial processes that impact the turnover of carbon in the subsurface has restricted the scope and ability of biogeochemical models to capture key aspects of the carbon cycle. In this study, we used a culture-independent, genome-resolved metagenomic approach to decipher the metabolic capabilities of microorganisms in an aquifer adjacent to the Colorado River, near Rifle, CO, USA. We sequenced groundwater and sediment samples collected across fifteen different geochemical regimes. Sequence assembly, binning and manual curation resulted in the recovery of 2,542 high-quality genomes, 27 of which are complete. These genomes represent 1,300 non-redundant organisms comprising both abundant and rare community members. Phylogenetic analyses involving ribosomal proteins and 16S rRNA genes revealed the presence of up to 34 new phyla that were hitherto unknown. Less than 11% of all genomes belonged to the 4 most commonly represented phyla that constitute 93% of all currently available genomes. Genome-specific analyses of metabolic potential revealed the co-occurrence of important functional traits such as carbon fixation, nitrogen fixation and use of electron donors and electron acceptors. Finally, we predict that multiple organisms are often required to complete redox pathways through a complex network of metabolic handoffs that extensively cross-link subsurface biogeochemical cycles.

Children With Medical Complexity: A Web-Based Multimedia Curriculum Assessing Pediatric Residents Across North America.

PubMed

Shah, Neha H; Bhansali, Priti; Barber, Aisha; Toner, Keri; Kahn, Michael; MacLean, Meaghan; Kadden, Micah; Sestokas, Jeffrey; Agrawal, Dewesh

No standardized curricula exist for training residents in the special needs of children with medical complexity. We assessed resident satisfaction, knowledge, and behavior after implementing a novel online curriculum composed of multimedia modules on care of children with medical complexity utilizing virtual simulation. We conducted a randomized controlled trial of residents across North America. A Web-based curriculum of 6 self-paced, interactive, multimedia modules was developed. Readings for each topic served as the control curriculum. Residents were randomized to 1 of 2 groups, each completing 3 modules and 3 sets of readings that were mutually exclusive. Outcomes included resident scores on satisfaction, knowledge-based assessments, and virtual simulation activities. Four hundred forty-two residents from 56 training programs enrolled in the curriculum, 229 of whom completed it and were included in the analysis. Subjects were more likely to report comfort with all topics if they reviewed modules compared to readings (P ≤ .01 for all 6 topics). Posttest knowledge scores were significantly higher than pretest scores overall (mean increase in score 17.7%; 95% confidence interval 16.0, 19.4), and the mean pre-post score increase for modules was significantly higher than readings (20.9% vs 15.4%, P < .001). Mean scores on the verbal handoff virtual simulation increased by 1.1 points (95% confidence interval 0.2, 2.0, P = .02). There were no significant differences found in pre-post performance for the device-related emergency virtual simulation. There was high satisfaction, significant knowledge acquisition, and specific behavior change after participating in this innovative online curriculum. This is the first multisite, randomized trial assessing satisfaction, knowledge impact, and behavior change in a virtually simulated environment with pediatric trainees. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

MRM1 in Atlantis Payload Bay

NASA Image and Video Library

2010-05-18

ISS023-E-047431 (18 May 2010) --- Intersecting the thin line of Earth's atmosphere, the docked space shuttle Atlantis is featured in this image photographed by an Expedition 23 crew member on the International Space Station. The Russian-built Mini-Research Module 1 (MRM-1) is visible in the payload bay as the shuttle robotic arm prepares to unberth the module from Atlantis and position it for handoff to the station robotic arm. Named Rassvet, Russian for "dawn," the module is the second in a series of new pressurized components for Russia and will be permanently attached to the Earth-facing port of the Zarya Functional Cargo Block (FGB). Rassvet will be used for cargo storage and will provide an additional docking port to the station.

Proceedings of the Ninth Annual Special Operations/Low Intensity Conflict (SO/LIC) Symposium and Exhibition, "National Security Strategy in Transition" The Critical Role of Special Operations Forces (SOF) in Preparing Now for an Uncertain Future.

DTIC Science & Technology

1998-02-19

Satan , and persons of color are non- human "mud people." Even with this in common; though, conflict continued over doctrinal minutiae among the var...200,000 copies of "The Turner Diaries" have been sold at gun shows and movement meetings over the years. They know that it is a bible to many in the...L /4kn BIA S AB U. 20 X = REPORTED SENSOR OUTPUT M C HANDOFF = FTS FOV __X-"BIAS )2 pdf (X) = 1 e 20A 2 J2% A Figure 4: FTS FOV defined in terms of

The experiences of family members in the nursing home to hospital transfer decision.

PubMed

Abrahamson, Kathleen; Bernard, Brittany; Magnabosco, Lara; Nazir, Arif; Unroe, Kathleen T

2016-11-15

The objective of this study was to better understand the experiences of family members in the nursing home to hospital transfer decision making process. Semi-structured interviews were conducted with 20 family members who had recently been involved in a nursing home to hospital transfer decision. Family members perceived themselves to play an advocacy role in their resident's care and interview themes clustered within three over-arching categories: Family perception of the nursing home's capacity to provide medical care: Resident and family choices; and issues at 'hand-off' and the hospital. Multiple sub-themes were also identified. Findings from this study contribute to knowledge surrounding the nursing home transfer decision by illuminating the experiences of family members in the transfer decision process.

Nurses' Perceptions of Patient Safety Culture in Three Hospitals in Saudi Arabia.

PubMed

Alquwez, Nahed; Cruz, Jonas Preposi; Almoghairi, Ahmed Mohammed; Al-Otaibi, Raid Salman; Almutairi, Khalid Obaid; Alicante, Jerico G; Colet, Paolo C

2018-05-14

To assess the present patient safety culture of three general hospitals in Saudi Arabia, as perceived by nurses. This study utilized a descriptive, cross-sectional design. A convenience sample of 351 nurses working in three general hospitals in the central region of Saudi Arabia was surveyed in this study using the Hospital Survey of Patients' Safety Culture (HSOPSC) from October 2016 to April 2017. From the 12 composites of the HSOPSC, the nurses perceived only the following two patient safety areas as strengths: teamwork within units and organizational learning-continuous improvement. Six areas of patient safety were identified as weaknesses, namely overall perception of patient safety, handoffs and transitions, communication openness, staffing, frequency of events reported, and nonpunitive response to errors. Nationality, educational attainment, hospital, length of service in the hospital, work area or unit, length of service in the current work area or unit, current position, and direct patient contact or interaction were significant predictors of the nurses' perceived patient safety culture. The findings in this study clarify the current status of patient safety culture in three hospitals in the Kingdom of Saudi Arabia. The present findings should be considered by policymakers, hospital leaders, and nurse executives in creating interventions aimed at improving the patient safety culture in hospitals. A multidimensional network intervention targeting the different dimensions of patient safety culture and involving different organizational levels should be implemented to improve patient safety. © 2018 Sigma Theta Tau International.

Non-Solenoidal Startup Research Directions on the Pegasus Toroidal Experiment

NASA Astrophysics Data System (ADS)

Fonck, R. J.; Bongard, M. W.; Lewicki, B. T.; Reusch, J. A.; Winz, G. R.

2017-10-01

The Pegasus research program has been focused on developing a physical understanding and predictive models for non-solenoidal tokamak plasma startup using Local Helicity Injection (LHI). LHI employs strong localized electron currents injected along magnetic field lines in the plasma edge that relax through magnetic turbulence to form a tokamak-like plasma. Pending approval, the Pegasus program will address a broader, more comprehensive examination of non-solenoidal tokamak startup techniques. New capabilities may include: increasing the toroidal field to 0.6 T to support critical scaling tests to near-NSTX-U field levels; deploying internal plasma diagnostics; installing a coaxial helicity injection (CHI) capability in the upper divertor region; and deploying a modest (200-400 kW) electron cyclotron RF capability. These efforts will address scaling of relevant physics to higher BT, separate and comparative studies of helicity injection techniques, efficiency of handoff to consequent current sustainment techniques, and the use of ECH to synergistically improve the target plasma for consequent bootstrap and neutral beam current drive sustainment. This has an ultimate goal of validating techniques to produce a 1 MA target plasma in NSTX-U and beyond. Work supported by US DOE Grant DE-FG02-96ER54375.

A simulated "Night-onCall" to assess and address the readiness-for-internship of transitioning medical students.

PubMed

Kalet, Adina; Zabar, Sondra; Szyld, Demian; Yavner, Steven D; Song, Hyuksoon; Nick, Michael W; Ng, Grace; Pusic, Martin V; Denicola, Christine; Blum, Cary; Eliasz, Kinga L; Nicholson, Joey; Riles, Thomas S

2017-01-01

Transitioning medical students are anxious about their readiness-for-internship, as are their residency program directors and teaching hospital leadership responsible for care quality and patient safety. A readiness-for-internship assessment program could contribute to ensuring optimal quality and safety and be a key element in implementing competency-based, time-variable medical education. In this paper, we describe the development of the Night-onCall program (NOC), a 4-h readiness-for-internship multi-instructional method simulation event. NOC was designed and implemented over the course of 3 years to provide an authentic "night on call" experience for near graduating students and build measurements of students' readiness for this transition framed by the Association of American Medical College's Core Entrustable Professional Activities for Entering Residency. The NOC is a product of a program of research focused on questions related to enabling individualized pathways through medical training. The lessons learned and modifications made to create a feasible, acceptable, flexible, and educationally rich NOC are shared to inform the discussion about transition to residency curriculum and best practices regarding educational handoffs from undergraduate to graduate education.

Perspective: creating an ethical workplace: reverberations of resident work hours reform.

PubMed

Lopez, Lenny; Katz, Joel T

2009-03-01

Medical professionals are a community of highly educated individuals with a commitment to a core set of ideals and principles. This community provides both technical and ethical socialization. The development of ethical physicians is highly linked to experiences in the training period. Moral traits are situation-sensitive psychological and behavioral dispositions. The consequence of long duty hours on the moral development of physicians is less understood. The clinical environment of medical training programs can be so intense as to lead to conditions that may actually deprofessionalize trainees. The dynamic relationship between individual character traits and the situational dependence of their expression suggests that a systems approach will help promote and nurture moral development. Ethical behavior can be supported by systems that make it more difficult to veer from the ideal. Work hours limits are a structural change that will help preserve public safety by preventing physicians from taking the moral shortcuts that can occur with increasing work and time pressures. Work hours rules are beneficial but insufficient to optimize an ethical work and training environment. Additional measures need to be put in place to ensure that ethical tensions are not created between the patient's well-being and the resident's adherence to work hours rules. The ethical ideals of physician autonomy, selflessness, and accountability to the patient must be protected through the judicious and flexible use of work hours limits, physician extenders, census caps, nonteaching services, and high-quality handoffs.

MRM1 in Atlantis Payload Bay

NASA Image and Video Library

2010-05-18

ISS023-E-046806 (18 May 2010) --- Backdropped by Earth?s horizon and the blackness of space, the docked space shuttle Atlantis is featured in this image photographed by an Expedition 23 crew member on the International Space Station. The Russian-built Mini-Research Module 1 (MRM-1) is visible in the payload bay as the shuttle robotic arm prepares to unberth the module from Atlantis and position it for handoff to the station robotic arm (visible at right). Named Rassvet, Russian for "dawn," the module is the second in a series of new pressurized components for Russia and will be permanently attached to the Earth-facing port of the Zarya Functional Cargo Block (FGB). Rassvet will be used for cargo storage and will provide an additional docking port to the station.

Collegial Activity Learning between Heterogeneous Sensors.

PubMed

Feuz, Kyle D; Cook, Diane J

2017-11-01

Activity recognition algorithms have matured and become more ubiquitous in recent years. However, these algorithms are typically customized for a particular sensor platform. In this paper we introduce PECO, a Personalized activity ECOsystem, that transfers learned activity information seamlessly between sensor platforms in real time so that any available sensor can continue to track activities without requiring its own extensive labeled training data. We introduce a multi-view transfer learning algorithm that facilitates this information handoff between sensor platforms and provide theoretical performance bounds for the algorithm. In addition, we empirically evaluate PECO using datasets that utilize heterogeneous sensor platforms to perform activity recognition. These results indicate that not only can activity recognition algorithms transfer important information to new sensor platforms, but any number of platforms can work together as colleagues to boost performance.

Global Interconnectivity Between Mobile Satellite and Terrestrial Users: Call Signalling Issues and Challenges

NASA Technical Reports Server (NTRS)

Estabrook, Polly; Moon, Todd; Spade, Rob

1996-01-01

This paper will discuss some of the challenges in connecting mobile satellite users and mobile terrestrial users in a cost efficient manner and with a grade of service comparable to that of satellite to fixed user calls. Issues arising from the translation between the mobility management protocols resident at the satellite Earth station and those resident at cellular switches - either GSM (Group Special Mobile) or IS-41 (used by U.S. digital cellular systems) type - will be discussed. The impact of GSM call routing procedures on the call setup of a satellite to roaming GSM user will be described. Challenges facing provision of seamless call handoff between satellite and cellular systems will be given. A summary of the issues explored in the paper are listed and future work outlined.

Automated secured cost effective key refreshing technique to enhance WiMAX privacy key management

NASA Astrophysics Data System (ADS)

Sridevi, B.; Sivaranjani, S.; Rajaram, S.

2013-01-01

In all walks of life the way of communication is transformed by the rapid growth of wireless communication and its pervasive use. A wireless network which is fixed and richer in bandwidth is specified as IEEE 802.16, promoted and launched by an industrial forum is termed as Worldwide Interoperability for Microwave Access (WiMAX). This technology enables seamless delivery of wireless broadband service for fixed and/or mobile users. The obscurity is the long delay which occurs during the handoff management in every network. Mobile WiMAX employs an authenticated key management protocol as a part of handoff management in which the Base Station (BS) controls the distribution of keying material to the Mobile Station (MS). The protocol employed is Privacy Key Management Version 2- Extensible Authentication Protocol (PKMV2-EAP) which is responsible for the normal and periodical authorization of MSs, reauthorization as well as key refreshing. Authorization key (AK) and Traffic Encryption key (TEK) plays a vital role in key exchange. When the lifetime of key expires, MS has to request for a new key to BS which in turn leads to repetition of authorization, authentication as well as key exchange. To avoid service interruption during reauthorization , two active keys are transmitted at the same time by BS to MS. The consequences of existing work are hefty amount of bandwidth utilization, time consumption and large storage. It is also endured by Man in the Middle attack and Impersonation due to lack of security in key exchange. This paper designs an automatic mutual refreshing of keys to minimize bandwidth utilization, key storage and time consumption by proposing Previous key and Iteration based Key Refreshing Function (PKIBKRF). By integrating PKIBKRF in key generation, the simulation results indicate that 21.8% of the bandwidth and storage of keys are reduced and PKMV2 mutual authentication time is reduced by 66.67%. The proposed work is simulated with Qualnet model and backed by MATLAB for processing and MYSQL for storing keys.

Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial.

PubMed

Desai, Sanjay V; Feldman, Leonard; Brown, Lorrel; Dezube, Rebecca; Yeh, Hsin-Chieh; Punjabi, Naresh; Afshar, Kia; Grunwald, Michael R; Harrington, Colleen; Naik, Rakhi; Cofrancesco, Joseph

2013-04-22

On July 1, 2011, the Accreditation Council for Graduate Medical Education implemented further restrictions of its 2003 regulations on duty hours and supervision. It remains unclear if the 2003 regulations improved trainee well-being or patient safety. To determine the effects of the 2011 Accreditation Council for Graduate Medical Education duty hour regulations compared with the 2003 regulations concerning sleep duration, trainee education, continuity of patient care, and perceived quality of care among internal medicine trainees. Crossover study design in an academic research setting. Medical house staff. General medical teams were randomly assigned using a sealed-envelope draw to an experimental model or a control model. We randomly assigned 4 medical house staff teams (43 interns) using a 3-month crossover design to a 2003-compliant model of every fourth night overnight call (control) with 30-hour duty limits or to one of two 2011-compliant models of every fifth night overnight call (Q5) or a night float schedule (NF), both with 16-hour duty limits. We measured sleep duration using actigraphy and used admission volumes, educational opportunities, the number of handoffs, and satisfaction surveys to assess trainee education, continuity of patient care, and perceived quality of care. RESULTS The study included 560 control, 420 Q5, and 140 NF days that interns worked and 834 hospital admissions. Compared with controls, interns on NF slept longer during the on call period (mean, 5.1 vs 8.3 hours; P = .003), and interns on Q5 slept longer during the postcall period (mean, 7.5 vs 10.2 hours; P = .05). However, both the Q5 and NF models increased handoffs, decreased availability for teaching conferences, and reduced intern presence during daytime work hours. Residents and nurses in both experimental models perceived reduced quality of care, so much so with NF that it was terminated early. Compared with a 2003-compliant model, two 2011 duty hour regulation-compliant models were associated with increased sleep duration during the on-call period and with deteriorations in educational opportunities, continuity of patient care, and perceived quality of care.

Failure mode and effects analysis: a comparison of two common risk prioritisation methods.

PubMed

McElroy, Lisa M; Khorzad, Rebeca; Nannicelli, Anna P; Brown, Alexandra R; Ladner, Daniela P; Holl, Jane L

2016-05-01

Failure mode and effects analysis (FMEA) is a method of risk assessment increasingly used in healthcare over the past decade. The traditional method, however, can require substantial time and training resources. The goal of this study is to compare a simplified scoring method with the traditional scoring method to determine the degree of congruence in identifying high-risk failures. An FMEA of the operating room (OR) to intensive care unit (ICU) handoff was conducted. Failures were scored and ranked using both the traditional risk priority number (RPN) and criticality-based method, and a simplified method, which designates failures as 'high', 'medium' or 'low' risk. The degree of congruence was determined by first identifying those failures determined to be critical by the traditional method (RPN≥300), and then calculating the per cent congruence with those failures designated critical by the simplified methods (high risk). In total, 79 process failures among 37 individual steps in the OR to ICU handoff process were identified. The traditional method yielded Criticality Indices (CIs) ranging from 18 to 72 and RPNs ranging from 80 to 504. The simplified method ranked 11 failures as 'low risk', 30 as medium risk and 22 as high risk. The traditional method yielded 24 failures with an RPN ≥300, of which 22 were identified as high risk by the simplified method (92% agreement). The top 20% of CI (≥60) included 12 failures, of which six were designated as high risk by the simplified method (50% agreement). These results suggest that the simplified method of scoring and ranking failures identified by an FMEA can be a useful tool for healthcare organisations with limited access to FMEA expertise. However, the simplified method does not result in the same degree of discrimination in the ranking of failures offered by the traditional method. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Understanding Care Integration from the Ground Up: Five Organizing Constructs that Shape Integrated Practices.

PubMed

Cohen, Deborah J; Balasubramanian, Bijal A; Davis, Melinda; Hall, Jennifer; Gunn, Rose; Stange, Kurt C; Green, Larry A; Miller, William L; Crabtree, Benjamin F; England, Mary Jane; Clark, Khaya; Miller, Benjamin F

2015-01-01

To provide empirical evidence on key organizing constructs shaping practical, real-world integration of behavior health and primary care to comprehensively address patients' medical, emotional, and behavioral health needs. In a comparative case study using an immersion-crystallization approach, a multidisciplinary team analyzed data from observations of practice operations, interviews, and surveys of practice members, and implementation diaries. Practices were drawn from 2 studies of practices attempting to integrate behavioral health and primary care: Advancing Care Together, a demonstration project of 11 practices located in Colorado, and the Integration Workforce Study, a study of 8 practices across the United States. We identified 5 key organizing constructs influencing integration of primary care and behavioral health: 1) Integration REACH (the extent to which the integration program was delivered to the identified target population), 2) establishment of continuum of care pathways addressing the location of care across the range of patient's severity of illness, 3) approach to patient transitions: referrals or warm handoffs, 4) location of the integration workforce, and 5) participants' mental model for integration. These constructs intertwine within an organization's historic and social context to produce locally adapted approaches to integrating care. Contextual factors, particularly practice type, influenced whether specialty mental health and substance use services were colocated within an organization. Interaction among 5 organizing constructs and practice context produces diverse expressions of integrated care. These constructs provide a framework for understanding how primary care and behavioral health services can be integrated in routine practice. © Copyright 2015 by the American Board of Family Medicine.

Responding to intimate partner violence: Healthcare providers' current practices and views on integrating a safety decision aid into primary care settings.

PubMed

Alvarez, Carmen; Debnam, Katrina; Clough, Amber; Alexander, Kamila; Glass, Nancy E

2018-04-01

Supportive care for survivors of intimate partner violence (IPV) remains limited in primary care settings. Low-income and Spanish-speaking survivors of IPV are even more disadvantaged, given the dearth of linguistically and culturally appropriate interventions for IPV. We conducted semi-structured individual interviews with 17 healthcare workers, including physicians, nurses, and social workers, to describe how healthcare workers serving primarily low-income, Latina populations are currently screening and responding to IPV disclosure, and to explore the acceptability of integrating an interactive, personalized safety decision aid application-myPlan app-into the clinic setting. Despite recognition of IPV as a problem, none of the clinical sites had a protocol to guide screening and response to IPV disclosure. Screening practices varied across the sites, sometimes conducted by medical assistants prior to the provider visit and other times by the physician or nurse provider. When IPV was disclosed, it was often during assessment for a presenting problem such as poor sleep or anxiety. Most healthcare workers felt that clinical and community resources were limited for their patients experiencing IPV. The "warm hand-off" to a social worker was the most common response strategy when possible; otherwise, women were given information about available resources such as hotlines and safe houses. We discuss structural, family, and individual barriers to accessing safety resources for underserved women and review how an easily accessible safety decision app, such as myPlan, could be a resource for women to safely tailor an action plan for her situation. © 2018 Wiley Periodicals, Inc.

Collaborative real-time scheduling of multiple PTZ cameras for multiple object tracking in video surveillance

NASA Astrophysics Data System (ADS)

Liu, Yu-Che; Huang, Chung-Lin

2013-03-01

This paper proposes a multi-PTZ-camera control mechanism to acquire close-up imagery of human objects in a surveillance system. The control algorithm is based on the output of multi-camera, multi-target tracking. Three main concerns of the algorithm are (1) the imagery of human object's face for biometric purposes, (2) the optimal video quality of the human objects, and (3) minimum hand-off time. Here, we define an objective function based on the expected capture conditions such as the camera-subject distance, pan tile angles of capture, face visibility and others. Such objective function serves to effectively balance the number of captures per subject and quality of captures. In the experiments, we demonstrate the performance of the system which operates in real-time under real world conditions on three PTZ cameras.

Effective implementation of work-hour limits and systemic improvements.

PubMed

Landrigan, Christopher P; Czeisler, Charles A; Barger, Laura K; Ayas, Najib T; Rothschild, Jeffrey M; Lockley, Steven W

2007-11-01

Sleep deprivation, ubiquitous among nurses and physicians, recently has been shown to greatly increase rates of serious medical errors and occupational injuries among health care workers in the United States. The Accreditation Council for Graduate Medical Education's current work-hour limits for physicians-in-training allow work hours well in excess of those proven safe. No regulations limit the work hours of other groups of health care providers in the United States. Consequently, nursing work shifts exceeding 12 hours remain common. Physician-in-training shifts of 30 consecutive hours continue to be endorsed officially, and data demonstrate that even the 30-hour limit is exceeded routinely. By contrast, European health care workers are limited by law to 13 consecutive hours of work and to 48-56 hours of work per week. Except for a few institutions that have eliminated 24-hour shifts, as a whole, the United States lags far behind other industrialized nations in ensuring safe work hours. Preventing health care provider sleep deprivation could be an extremely powerful means of addressing the epidemic of medical errors in the United States. Implementation of evidence-based work-hour limits, scientifically designed work schedules, and infrastructural changes, such as the development of standardized handoff systems, are urgently needed.

Improving the value of costly genetic reference laboratory testing with active utilization management.

PubMed

Dickerson, Jane A; Cole, Bonnie; Conta, Jessie H; Wellner, Monica; Wallace, Stephanie E; Jack, Rhona M; Rutledge, Joe; Astion, Michael L

2014-01-01

Tests that are performed outside of the ordering institution, send-out tests, represent an area of risk to patients because of complexity associated with sending tests out. Risks related to send-out tests include increased number of handoffs, ordering the wrong or unnecessary test, specimen delays, data entry errors, preventable delays in reporting and acknowledging results, and excess financial liability. Many of the most expensive and most misunderstood tests are send-out genetic tests. To design and develop an active utilization management program to reduce the risk to patients and improve value of genetic send-out tests. Send-out test requests that met defined criteria were reviewed by a rotating team of doctoral-level consultants and a genetic counselor in a pediatric tertiary care center. Two hundred fifty-one cases were reviewed during an 8-month period. After review, nearly one-quarter of genetic test requests were modified in the downward direction, saving a total of 2% of the entire send-out bill and 19% of the test requests under management. Ultimately, these savings were passed on to patients. Implementing an active utilization strategy for expensive send-out tests can be achieved with minimal technical resources and results in improved value of testing to patients.

The patient safety culture: a systematic review by characteristics of Hospital Survey on Patient Safety Culture dimensions.

PubMed

Reis, Cláudia Tartaglia; Paiva, Sofia Guerra; Sousa, Paulo

2018-05-08

To learn the weaknesses and strengths of safety culture as expressed by the dimensions measured by the Hospital Survey on Patient Safety Culture (HSOPSC) at hospitals in the various cultural contexts. The aim of this study was to identify studies that have used the HSOPSC to collect data on safety culture at hospitals; to survey their findings in the safety culture dimensions and possible contributions to improving the quality and safety of hospital care. Medline (via PubMed), Web of Science and Scopus were searched from 2005 to July 2016 in English, Portuguese and Spanish. Studies were identified using specific search terms and inclusion criteria. A total of 33 articles, reporting on 21 countries, was included. Scores were extracted by patient safety culture dimensions assessed by the HSOPSC. The quality of the studies was evaluated by the STROBE Statement. The dimensions that proved strongest were 'Teamwork within units' and 'Organisational learning-continuous improvement'. Particularly weak dimensions were 'Non-punitive response to error', 'Staffing', 'Handoffs and transitions' and 'Teamwork across units'. The studies revealed a predominance of hospital organisational cultures that were underdeveloped or weak as regards patient safety. For them to be effective, safety culture evaluation should be tied to strategies designed to develop safety culture hospital-wide.

Development of a Comprehensive Communication Skills Curriculum for Pediatrics Residents.

PubMed

Peterson, Eleanor B; Boland, Kimberly A; Bryant, Kristina A; McKinley, Tara F; Porter, Melissa B; Potter, Katherine E; Calhoun, Aaron W

2016-12-01

Effective communication is an essential element of medical care and a priority of medical education. Specific interventions to teach communication skills are at the discretion of individual residency programs. We developed the Resident Communication Skills Curriculum (RCSC), a formal curriculum designed to teach trainees the communication skills essential for high-quality practice. A multidisciplinary working group contributed to the development of the RCSC, guided by an institutional needs assessment, literature review, and the Accreditation Council for Graduate Medical Education core competencies. The result was a cohesive curriculum that incorporates didactic, role play, and real-life experiences over the course of the entire training period. Methods to assess curricular outcomes included self-reporting, surveys, and periodic faculty evaluations of the residents. Curricular components have been highly rated by residents (3.95-3.97 based on a 4-point Likert scale), and residents' self-reported communication skills demonstrated an improvement over the course of residency in the domains of requesting a consultation, providing effective handoffs, handling conflict, and having difficult conversations (intern median 3.0, graduate median 4.0 based on a 5-point Likert scale, P  ≤ .002). Faculty evaluations of residents have also demonstrated improvement over time (intern median 3.0, graduate median 4.5 based on a 5-point Likert scale, P  < .001). A comprehensive, integrated communication skills curriculum for pediatrics residents was implemented, with a multistep evaluative process showing improvement in skills over the course of the residency program. Positive resident evaluations and informal comments from faculty support its general acceptance. The use of existing resources makes this curriculum feasible.

Patient safety in transitional care of the elderly: effects of a quasi-experimental interorganisational educational intervention

PubMed Central

Storm, Marianne; Schulz, Jörn; Aase, Karina

2018-01-01

Objective The study objective was to assess the effects of an interorganisational educational intervention called the ‘Meeting Point’ on patient safety culture among staff in hospital and nursing home wards. Design The study employs a quasi-experimental, non-randomised design with a hospital and nursing home intervention group and a hospital and nursing home control group. The study uses one preintervention and two postintervention survey measurements. The intervention group participated in an educational programme ‘The Meeting Point’ including interorganisational staff meetings combining educational sessions with a discussion platform focusing on quality and safety in transitional care of the elderly. Results The results show a stable development over time for the patient safety culture factor ‘Handoff and transitions’, and small improvements for ‘Overall perceptions of patient safety culture’ and ‘Organisational learning - continuous improvement’ for the hospital intervention group. No similar development was reported in the nursing home intervention group, which is most likely explained by ongoing organisational changes. Qualitative data show the existence of ongoing initiatives in the hospital to improve transitional care, but not all were connected to the ‘Meeting Point’. Conclusion The ‘Meeting Point’ has the potential to be a useful measure for healthcare professionals when aiming to improve patient safety culture in transitional care. Further refinement of the key components and testing with a more robust study design will be beneficial. PMID:29391363

Applying the WHO conceptual framework for the International Classification for Patient Safety to a surgical population

PubMed Central

McElroy, L. M.; Woods, D. M.; Yanes, A. F.; Skaro, A. I.; Daud, A.; Curtis, T.; Wymore, E.; Holl, J. L.; Abecassis, M. M.; Ladner, D. P.

2016-01-01

Objective Efforts to improve patient safety are challenged by the lack of universally agreed upon terms. The International Classification for Patient Safety (ICPS) was developed by the World Health Organization for this purpose. This study aimed to test the applicability of the ICPS to a surgical population. Design A web-based safety debriefing was sent to clinicians involved in surgical care of abdominal organ transplant patients. A multidisciplinary team of patient safety experts, surgeons and researchers used the data to develop a system of classification based on the ICPS. Disagreements were reconciled via consensus, and a codebook was developed for future use by researchers. Results A total of 320 debriefing responses were used for the initial review and codebook development. In total, the 320 debriefing responses contained 227 patient safety incidents (range: 0–7 per debriefing) and 156 contributing factors/hazards (0–5 per response). The most common severity classification was ‘reportable circumstance,’ followed by ‘near miss.’ The most common incident types were ‘resources/organizational management,’ followed by ‘medical device/equipment.’ Several aspects of surgical care were encompassed by more than one classification, including operating room scheduling, delays in care, trainee-related incidents, interruptions and handoffs. Conclusions This study demonstrates that a framework for patient safety can be applied to facilitate the organization and analysis of surgical safety data. Several unique aspects of surgical care require consideration, and by using a standardized framework for describing concepts, research findings can be compared and disseminated across surgical specialties. The codebook is intended for use as a framework for other specialties and institutions. PMID:26803539

Values in translation: how asking the right questions can move translational science toward greater health impact.

PubMed

Kelley, Maureen; Edwards, Kelly; Starks, Helene; Fullerton, Stephanie M; James, Rosalina; Goering, Sara; Holland, Suzanne; Disis, Mary L; Burke, Wylie

2012-12-01

The speed and effectiveness of current approaches to research translation are widely viewed as disappointing given small gains in real population health outcomes despite huge investments in basic and translational science. We identify critical value questions-ethical, social, economic, and cultural-that arise at moments throughout the research pathway. By making these questions visible, and promoting discussion of them with diverse stakeholders, we can facilitate handoffs along the translational pathway and increase uptake of effective interventions. Who is involved with those discussions will determine which research projects, populations, and methods get prioritized. We argue that some upfront investment in community and interdisciplinary engagement, shaped by familiar questions in ethics, social justice, and cultural knowledge, can save time and resources in the long run because interventions and strategies will be aimed in the right direction, that is, toward health improvements for all. © 2012 Wiley Periodicals, Inc.

IEEE 802.21 Assisted Seamless and Energy Efficient Handovers in Mixed Networks

NASA Astrophysics Data System (ADS)

Liu, Huaiyu; Maciocco, Christian; Kesavan, Vijay; Low, Andy L. Y.

Network selection is the decision process for a mobile terminal to handoff between homogeneous or heterogeneous networks. With multiple available networks, the selection process must evaluate factors like network services/conditions, monetary cost, system conditions, user preferences etc. In this paper, we investigate network selection using a cost function and information provided by IEEE 802.21. The cost function provides flexibility to balance different factors in decision making and our research is focused on improving both seamlessness and energy efficiency of handovers. Our solution is evaluated using real WiFi, WiMax, and 3G signal strength traces. The results show that appropriate networks were selected based on selection policies, handovers were triggered at optimal times to increase overall network connectivity as compared to traditional triggering schemes, while at the same time the energy consumption of multi-radio devices for both on-going operations as well as during handovers is optimized.

Possible Detection of Perchlorates by Evolved Gas Analysis of Rocknest Soils: Global Implication

NASA Technical Reports Server (NTRS)

Archer, P. D., Jr.; Sutter, B.; Ming, D. W.; McKay, C. P.; Navarro-Gonzalez, R.; Franz, H. B.; McAdam, A.; Mahaffy, P. R.

2013-01-01

The Sample Analysis at Mars (SAM) instrument suite on board the Mars Science Laboratory (MSL) recently ran four samples from an aeolian bedform named Rocknest. Rocknest was selected as the source of the first samples analyzed because it is representative of both windblown material in Gale crater as well as the globally-distributed dust. The four samples analyzed by SAM were portioned from the fifth scoop at this location. The material delivered to SAM passed through a 150 m sieve and should have been well mixed during the sample acquisition/ preparation/handoff process. Rocknest samples were heated to 835 C at a 35 C/minute ramp rate with a He carrier gas flow rate of 1.5 standard cubic centimeters per minute and at an oven pressure of 30 mbar. Evolved gases were detected by a quadrupole mass spectrometer (QMS).

Effect of Dynamic Sector Boundary Changes on Air Traffic Controllers

NASA Technical Reports Server (NTRS)

Jung, Jaewoo; Lee, Paul; Kessell, Angela; Homola, Jeff; Zelinski, Shannon

2010-01-01

The effect of dynamic sector boundary changes on air traffic controller workload was investigated with data from a human-in-the-loop simulation. Multiple boundary changes were made during simulated operations, and controller rating of workload was recorded. Analysis of these data showed an increase of 16.9% in controller workload due to boundary changes. This increased workload was correlated with the number of aircraft handoffs and change in sector volume. There was also a 12.7% increase in average workload due to the changed sector design after boundary changes. This increase was correlated to traffic flow crossing points getting closer to sector boundaries and an increase in the number of flights with short dwell time in a sector. This study has identified some of the factors that affect controller workload when sector boundaries are changed, but more research is needed to better understand their relationships.

Welcoming Home the Patient with a New Ostomy.

PubMed

Walker, Cynthia A; Rau, Lou Ann; Green, Mary Phyllis

2015-01-01

The 5-day average inpatient hospital length-of-stay postostomy limits opportunities for patients and family members to master self-care of the new ostomy prior to discharge. The literature suggests premature discharge, poor care coordination, lack of symptom reporting and follow-up as the primary factors supporting causes of readmissions. Home care nurses are faced with failed handoffs, limited resources, poor care coordination, payor restrictions, and knowledge and skill deficits that negatively impact safe and effective discharge practices of patients with a new ostomy. This article describes an evolving community standard related to nursing care of the patient with a new ostomy as identified by the Baltimore Wound, Ostomy, Continence (WOC) Nursing Affiliate. Case managers, discharge planners, intake team members, and home care nurses benefit from ongoing education from WOC nurse experts to master the skills needed to care for patients with ostomies.

Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings.

PubMed

Tanner, C; Gans, D; White, J; Nath, R; Pohl, J

2015-01-01

The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Data from 209 primary care practices responding between 2006-2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings.

Ethnographic analysis on the use of the electronic medical record for clinical handoff.

PubMed

Nelson, Philippa; Bell, Anthony J; Nathanson, Larry; Sanchez, Leon D; Fisher, Jonathan; Anderson, Philip D

2017-12-01

The objective of this study was to understand the social elements of clinical and organizational interactions of the key stakeholders in the specific context of an electronic dashboard used by the emergency department (ED) and inpatient medicine teams at the time of clinical referral and handover. An electronic handover function is utilised at the ED-inpatient interface at this institution and has given clinicians the ability to better communicate, monitor the department and strive to improve patient safety in streamline the delivery of care in the acute phase. This study uses an ethnographic qualitative research design incorporating semistructured interviews, participant observation on the ED floor and fieldwork notes. The setting for this research was in the ED at a tertiary University affiliated hospital. Triangulation was used to combine information obtained from multiple sources and information from fieldwork and interviews refined into useable chunks culminating in a thematic analysis. Thematic analysis yielded five central themes that reflected how the clinical staff utilised this IT system and why it had become embedded in the culture of clinical referral and handover. Efficient time management for improved patient flow was demonstrated, value added communication (at the interpersonal level), the building trust at the ED-inpatient interface, the maintenance of mutual respect across medical cultures and an overall enhancement of the quality of ED communication (in terms of the information available). A robust electronic handover process, resulted in an integrated approach to patient care by removing barriers to admission for medical inpatients, admitted via ED. The value proposition for patients was a more complete information transfer, both within the ED and between departments.

"I want to know everything": a qualitative study of perspectives from patients with chronic diseases on sharing health information during hospitalization.

PubMed

Benham-Hutchins, Marge; Staggers, Nancy; Mackert, Michael; Johnson, Alisha H; deBronkart, Dave

2017-08-04

Patient-centered care promotes the inclusion of the most prominent and important member of the health care team, the patient, as an active participant in information exchange and decision making. Patient self-management of a chronic disease requires the patient to bridge the gap between multiple care settings and providers. Hospitalizations often disrupt established self-management routines. Access to medical information during hospitalization reflects patients' rights to partner in their own care and has the potential to improve self-management as well as promote informed decision making during and after hospitalization. The objectives of this study were to elicit the perspectives of patients with chronic disease about desired medical information content and access during hospitalization. This exploratory study incorporated a qualitative approach. The online survey included the research team created open and limited response survey, demographic and hospital characteristic questions, and the Patient Activation Measurement instrument (PAM®). Convenience and social media snowball sampling were used to recruit participants through patient support groups, email invitations, listservs, and blogs. The research team employed descriptive statistics and qualitative content analysis techniques. The study sample (n = 34) ranged in age from 20 to 76 (μ = 48; SD = 16.87), Caucasian (91%, n = 31), female (88%, n = 30) and very highly educated (64%, n = 22 were college graduates). The PAM® survey revealed a highly activated sample. Qualitative analysis of the open-ended question responses resulted in six themes: Caring for myself; I want to know everything; Include me during handoff and rounds; What I expect; You're not listening; and Tracking my health information. This study revealed that hospitalized patients want to be included in provider discussions, such as nursing bedside handoff and medical rounds. Only a few participants had smooth transitions from hospital to home. Participants expressed frustration with failures in communication among their providers during and after hospitalization and provider behaviors that interfered with patient provider communication processes. Patients also identified interest in maintaining their own health histories and information but most had to "cobble together" a myriad of methods to keep track of their evolving condition during hospitalization.

Measuring cognitive load: mixed results from a handover simulation for medical students.

PubMed

Young, John Q; Irby, David M; Barilla-LaBarca, Maria-Louise; Ten Cate, Olle; O'Sullivan, Patricia S

2016-02-01

The application of cognitive load theory to workplace-based activities such as patient handovers is hindered by the absence of a measure of the different load types. This exploratory study tests a method for measuring cognitive load during handovers. The authors developed the Cognitive Load Inventory for Handoffs (CLI4H) with items for intrinsic, extraneous, and germane load. Medical students completed the measure after participating in a simulated handover. Exploratory factor and correlation analyses were performed to collect evidence for validity. Results yielded a two-factor solution for intrinsic and germane load that explained 50 % of the variance. The extraneous load items performed poorly and were removed from the model. The score for intrinsic load correlated with the Paas Cognitive Load scale (r = 0.31, p = 0.004) and was lower for students with more prior handover training (p = 0.036). Intrinsic load did not, however, correlate with performance. Germane load did not correlate with the Paas Cognitive Load scale but did correlate as expected with performance (r = 0.30, p = 0.005) and was lower for those students with more prior handover training (p = 0.03). The CLI4H yielded mixed results with some evidence for validity of the score from the intrinsic load items. The extraneous load items performed poorly and the use of only a single item for germane load limits conclusions. The instrument requires further development and testing. Study results and limitations provide guidance to future efforts to measure cognitive load during workplace-based activities, such as handovers.

General Motors and the University of Michigan smart materials and structures collaborative research laboratory

NASA Astrophysics Data System (ADS)

Brei, Diann; Luntz, Jonathan; Shaw, John; Johnson, Nancy L.; Browne, Alan L.; Alexander, Paul W.; Mankame, Nilesh D.

2007-04-01

The field of Smart Materials and Structures is evolving from high-end, one-of-a-kind products for medical, military and aerospace applications to the point of viability for mainstream affordable high volume products for automotive applications. For the automotive industry, there are significant potential benefits to be realized including reduction in vehicle mass, added functionality and design flexibility and decrease in component size and cost. To further accelerate the path from basic research and development to launched competitive products, General Motors (GM) has teamed with the College of Engineering at the University of Michigan (UM) to establish a $2.9 Million Collaborative Research Laboratory (CRL) in Smart Materials and Structures. Researchers at both GM and UM are working closely together to create leap-frog technologies which start at conceptualization and proceed all the way through demonstration and handoff to product teams, thereby bridging the traditional technology gap between industry and academia. In addition to Smart Device Technology Innovation, other thrust areas in the CRL include Smart Material Maturity with a basic research focus on overcoming material issues that form roadblocks to commercialism and Mechamatronic System Design Methodology with an applied focus on development tools (synthesis and analysis) to aid the engineer in application of smart materials to system engineering. This CRL is a global effort with partners across the nation and world from GM's Global Research Network such as HRL Laboratories in California and GM's India Science Lab in Bangalore, India. This paper provides an overview of this new CRL and gives examples of several of the projects underway.

Making the Handoff from Earthquake Hazard Assessments to Effective Mitigation Measures (Invited)

NASA Astrophysics Data System (ADS)

Applegate, D.

2010-12-01

This year has witnessed a barrage of large earthquakes worldwide with the resulting damages ranging from inconsequential to truly catastrophic. We cannot predict when earthquakes will strike, but we can build communities that are resilient to strong shaking as well as to secondary hazards such as landslides and liquefaction. The contrasting impacts of the magnitude-7 earthquake that struck Haiti in January and the magnitude-8.8 event that struck Chile in April underscore the difference that mitigation and preparedness can make. In both cases, millions of people were exposed to severe shaking, but deaths in Chile were measured in the hundreds rather than the hundreds of thousands that perished in Haiti. Numerous factors contributed to these disparate outcomes, but the most significant is the presence of strong building codes in Chile and their total absence in Haiti. The financial cost of the Chilean earthquake still represents an unacceptably high percentage of that nation’s gross domestic product, a reminder that life safety is the paramount, but not the only, goal of disaster risk reduction measures. For building codes to be effective, both in terms of lives saved and economic cost, they need to reflect the hazard as accurately as possible. As one of four federal agencies that make up the congressionally mandated National Earthquake Hazards Reduction Program (NEHRP), the U.S. Geological Survey (USGS) develops national seismic hazard maps that form the basis for seismic provisions in model building codes through the Federal Emergency Management Agency and private-sector practitioners. This cooperation is central to NEHRP, which both fosters earthquake research and establishes pathways to translate research results into implementation measures. That translation depends on the ability of hazard-focused scientists to interact and develop mutual trust with risk-focused engineers and planners. Strengthening that interaction is an opportunity for the next generation of earthquake scientists and engineers. In addition to the national maps, the USGS produces more detailed urban seismic hazard maps that communities have used to prioritize retrofits and design critical infrastructure that can withstand large earthquakes. At a regional scale, the USGS and its partners in California have developed a time-dependent earthquake rupture forecast that is being used by the insurance sector, which can serve to distribute risk and foster mitigation if the right incentives are in place. What the USGS and partners are doing at the urban, regional, and national scales, the Global Earthquake Model project is seeking to do for the world. A significant challenge for engaging the public to prepare for earthquakes is making low-probability, high-consequence events real enough to merit personal action. Scenarios help by starting with the hazard posed by a specific earthquake and then exploring the fragility of the built environment, cascading failures, and the real-life consequences for the public. To generate such a complete picture takes multiple disciplines working together. Earthquake scenarios are being used both for emergency management exercises and much broader public preparedness efforts like the Great California ShakeOut, which engaged nearly 7 million people.

Hybrid model for wireless mobility management using IPv6

NASA Astrophysics Data System (ADS)

Howie, Douglas P.; Sun, Junzhao; Koivisto, Antti T.

2001-07-01

Within the coming decade, there will be a dramatic increase in the availability of inexpensive, computationally powerful mobile devices running applications which use the Internet Protocol (IP) to access multimedia services over broad-band wireless connections. To this end, there has been extensive research and standardization in the areas of Mobile IP and IPv6. The purpose of this paper is to apply this work to the issues involved in designing a mobility model able to adapt to different wireless mobile IP scenarios. We describe the usefulness of this model in the 4th generation mobile multimedia systems to come. This new model has been synthesized through a comparative analysis of current mobile IP models where particular attention has been given to the problems of mobile IP handoff and mobility management and their impact on QoS. By applying a unique perspective to these problems, our model is used to set a roadmap for future mobile IPv6 testbed construction.

The Effect of an Electronic SBAR Communication Tool on Documentation of Acute Events in the Pediatric Intensive Care Unit.

PubMed

Panesar, Rahul S; Albert, Ben; Messina, Catherine; Parker, Margaret

2016-01-01

The Situation, Background, Assessment, Recommendation (SBAR) handoff tool is designed to improve communication. The effects of integrating an electronic medical record (EMR) with a SBAR template are unclear. The research team hypothesizes that an electronic SBAR template improves documentation and communication between nurses and physicians. In all, 84 patient events were recorded from 542 admissions to the pediatric intensive care unit. Three time periods were studied: (a) paper documentation only, (b) electronic documentation, and (c) electronic documentation with an SBAR template. Documentation quality was assessed using a 4-point scoring system. The frequency of event notes increased progressively during the 3 study periods. Mean quality scores improved significantly from paper documentation to EMR free-text notes and to electronic SBAR-template notes, as did nurse and attending physician notification. The implementation of an electronic SBAR note is associated with more complete documentation and increased frequency of documentation of communication among nurses and physicians. © The Author(s) 2014.

Packet loss mitigation for biomedical signals in healthcare telemetry.

PubMed

Garudadri, Harinath; Baheti, Pawan K

2009-01-01

In this work, we propose an effective application layer solution for packet loss mitigation in the context of Body Sensor Networks (BSN) and healthcare telemetry. Packet losses occur due to many reasons including excessive path loss, interference from other wireless systems, handoffs, congestion, system loading, etc. A call for action is in order, as packet losses can have extremely adverse impact on many healthcare applications relying on BAN and WAN technologies. Our approach for packet loss mitigation is based on Compressed Sensing (CS), an emerging signal processing concept, wherein significantly fewer sensor measurements than that suggested by Shannon/Nyquist sampling theorem can be used to recover signals with arbitrarily fine resolution. We present simulation results demonstrating graceful degradation of performance with increasing packet loss rate. We also compare the proposed approach with retransmissions. The CS based packet loss mitigation approach was found to maintain up to 99% beat-detection accuracy at packet loss rates of 20%, with a constant latency of less than 2.5 seconds.

Single molecule techniques in DNA repair: A primer

PubMed Central

Hughes, Craig D.; Simons, Michelle; Mackenzie, Cassidy E.; Van Houten, Bennett; Kad, Neil M.

2016-01-01

A powerful new approach has become much more widespread and offers insights into aspects of DNA repair unattainable with billions of molecules. Single molecule techniques can be used to image, manipulate or characterize the action of a single repair protein on a single strand of DNA. This allows search mechanisms to be probed, and the effects of force to be understood. These physical aspects can dominate a biochemical reaction, where at the ensemble level their nuances are obscured. In this paper we discuss some of the many technical advances that permit study at the single molecule level. We focus on DNA repair to which these techniques are actively being applied. DNA repair is also a process that encompasses so much of what single molecule studies benefit – searching for targets, complex formation, sequential biochemical reactions and substrate hand-off to name just a few. We discuss how single molecule biophysics is poised to transform our understanding of biological systems, in particular DNA repair. PMID:24819596

Traffic handling capability of a broadband indoor wireless network using CDMA multiple access

NASA Astrophysics Data System (ADS)

Zhang, Chang G.; Hafez, H. M.; Falconer, David D.

1994-05-01

CDMA (code division multiple access) may be an attractive technique for wireless access to broadband services because of its multiple access simplicity and other appealing features. In order to investigate traffic handling capabilities of a future network providing a variety of integrated services, this paper presents a study of a broadband indoor wireless network supporting high-speed traffic using CDMA multiple access. The results are obtained through the simulation of an indoor environment and the traffic capabilities of the wireless access to broadband 155.5 MHz ATM-SONET networks using the mm-wave band. A distributed system architecture is employed and the system performance is measured in terms of call blocking probability and dropping probability. The impacts of the base station density, traffic load, average holding time, and variable traffic sources on the system performance are examined. The improvement of system performance by implementing various techniques such as handoff, admission control, power control and sectorization are also investigated.

Pharmacist-driven initiative for management of Staphylococcus aureus bacteremia using a clinical decision support system.

PubMed

Wang, Fei; Prier, Beth; Bauer, Karri A; Mellett, John

2018-06-01

The development and implementation of a clinical decision support system (CDSS) for pharmacists to use for identification of and intervention on patients with Staphylococcus aureus bacteremia (SAB) are described. A project team consisting of 3 informatics pharmacists and 2 infectious diseases (ID) pharmacists was formed to develop the CDSS. The primary CDSS component was a scoring system that generates a score in real time for a patient with a positive blood culture for S. aureus. In addition, 4 tools were configured in the CDSS to facilitate pharmacists' workflow and documentation tasks: a patient list, a patient list report, a handoff note, and a standardized progress note. Pharmacists are required to evaluate the patient list at least once per shift to identify newly listed patients with a blood culture positive for S. aureus and provide recommendations if necessary. The CDSS was implemented over a period of 2.5 months, with a pharmacy informatics resident dedicating approximately 200 hours in total. An audit showed that the standardized progress note was completed for 100% of the patients, with a mean time to completion of 8.5 hours. Importantly, this initiative can be implemented in hospitals without specialty-trained ID pharmacists. This study provides a framework for future antimicrobial stewardship program initiatives to incorporate pharmacists into the process of providing real-time recommendations. A pharmacist-driven patient scoring system was successfully used to improve adherence to quality performance measures for management of SAB. A pharmacist-driven CDSS can be utilized to assist in the management of SAB. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

EarthScope National Office (ESNO) Education and Outreach Program and its Broader Impacts: 2015 Update and Handoff to the Next ESNO

NASA Astrophysics Data System (ADS)

Semken, S. C.; Robinson, S.; Bohon, W.; Arrowsmith, R.; Garnero, E.; Baumback, D.; Boot, K. E.; Dick, C.

2015-12-01

The EarthScope Program (www.earthscope.org), funded by the National Science Foundation, fosters interdisciplinary exploration of the geologic structure and evolution of the North American continent by means of geodesy, seismology, magnetotellurics, in-situ fault-zone sampling, geochronology, and high-resolution topographic measurements. Data and scientific findings from EarthScope are impacting and revolutionizing wide areas of geoscientific research, the understanding and mitigation of geologic hazards, and applications of geoscience to environmental sustainability. The EarthScope Program also produces and disseminates resources and programs for education and outreach (E&O) in the Earth system sciences. The EarthScope National Office (ESNO), operated by Arizona State University from 2011 to 2015, serves all EarthScope stakeholders, including researchers, educators, students, and the general public. ESNO supports and promotes E&O through social media and the web, inSights newsletters and published articles, E&O workshops for informal educators (interpreters), an annual Speaker Series, assistance to K-12 STEM teacher professional development projects led by EarthScope researchers, continuing education for researchers, collaborations with other Earth-science E&O providers, and a biennial National Meeting. Significant activities during the final year of ESNO at ASU included the EarthScope National Meeting in Vermont; Native Science professional-development workshops for Native American teachers in Arizona and Minnesota; a sustained E&O presence online; and preparation for the transition of ESNO from ASU to the next host institution. The EarthScope National Office is supported by the National Science Foundation under grants EAR-1101100 and EAR-1216301. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation.

Mobility management techniques for the next-generation wireless networks

NASA Astrophysics Data System (ADS)

Sun, Junzhao; Howie, Douglas P.; Sauvola, Jaakko J.

2001-10-01

The tremendous demands from social market are pushing the booming development of mobile communications faster than ever before, leading to plenty of new advanced techniques emerging. With the converging of mobile and wireless communications with Internet services, the boundary between mobile personal telecommunications and wireless computer networks is disappearing. Wireless networks of the next generation need the support of all the advances on new architectures, standards, and protocols. Mobility management is an important issue in the area of mobile communications, which can be best solved at the network layer. One of the key features of the next generation wireless networks is all-IP infrastructure. This paper discusses the mobility management schemes for the next generation mobile networks through extending IP's functions with mobility support. A global hierarchical framework model for the mobility management of wireless networks is presented, in which the mobility management is divided into two complementary tasks: macro mobility and micro mobility. As the macro mobility solution, a basic principle of Mobile IP is introduced, together with the optimal schemes and the advances in IPv6. The disadvantages of the Mobile IP on solving the micro mobility problem are analyzed, on the basis of which three main proposals are discussed as the micro mobility solutions for mobile communications, including Hierarchical Mobile IP (HMIP), Cellular IP, and Handoff-Aware Wireless Access Internet Infrastructure (HAWAII). A unified model is also described in which the different micro mobility solutions can coexist simultaneously in mobile networks.

New technology, new errors: how to prime an upgrade of an insulin infusion pump.

PubMed

Rule, Ann M; Drincic, Andjela; Galt, Kimberly A

2007-03-01

A series of use errors occurred when switching an ambulatory care clinic patient from an older model to a newer model of an ambulatory continuous subcutaneous insulin infusion pump. The nurse practitioner (N.P.) reviewed the new pump's mechanics with the patient, who had a 26-year history of Type 1 diabetes mellitus, and supervised the patient's programming of the pump. At bedtime, a blood sugar of > 250 mg/dL prompted the patient to give herself insulin via the pump. The next morning, she was treated at the emergency department for diabetic ketoacidosis. The pump had been improperly primed, resulting in no insulin delivery. The incident also reflected the absence of a fail-safe mechanism(s) on the pump to alert the user to the improper priming and inappropriate handoff of the patient's care. Unlike the old pump, the new pump did not require manual priming. The lack of delivery of insulin resulted in DKA, a potentially life-threatening complication of diabetes. A root cause analysis suggested several important safety issues, including skipping of steps on the patient training checklist and other shortcuts in patient training. The clinic developed policies and procedures, including mandatory formal training for each pump model by the certified pump trainer and for initiation of insulin pump therapy. This case illustrates the importance of a structured device selection process, provider education, patient education, and monitoring for safety and effectiveness of technological devices in care.

Improving health care, Part 4: Concepts for improving any clinical process.

PubMed

Batalden, P B; Mohr, J J; Nelson, E C; Plume, S K

1996-10-01

One promising method for streamlining the generation of "good ideas" is to formulate what are sometimes called change concepts-general notions or approaches to change found useful in developing specific ideas for changes that lead to improvement. For example, in current efforts to reduce health care costs by discounting provider charges, the underlying generic concept is "reducing health care costs," and the specific idea is "discounting provider charges." Short-term gains in health care cost reduction can occur by pursuing discounts. After some time, however, limits to such reduction in costs are experienced. Persevering and continuing to travel down the "discounting provider charges" path is less likely to produce further substantial improvement than returning to the basic concept of "reducing health care costs." An interdisciplinary team aiming to reduce costs while improving quality of care for patients in need of hip joint replacement generated ideas for changing "what's done (process) to get better results." After team members wrote down their improvement ideas, they deduced the underlying change concepts and used them to generate even more ideas for improvement. Such change concepts include reordering the sequence of steps (preadmission physical therapy "certification"), eliminating failures at hand-offs between steps (transfer of information from physician's office to hospital), and eliminating a step (epidural pain control). Learning about making change, encouraging change, managing the change within and across organizations, and learning from the changes tested will characterize the sustainable, thriving health systems of the future.

Taking a unified approach to teaching and implementing quality improvements across multiple residency programs: the Atlantic Health experience.

PubMed

Daniel, Donna M; Casey, Donald E; Levine, Jeffrey L; Kaye, Susan T; Dardik, Raquel B; Varkey, Prathibha; Pierce-Boggs, Kimberly

2009-12-01

The Accreditation Council for Graduate Medical Education recently emphasized the importance of systems-based practice and systems-based learning; however, successful models of collaborative quality improvement (QI) initiatives in residency training curricula are not widely available. Atlantic Health successfully conceptualized and implemented a QI collaborative focused on medication safety across eight residency training programs representing 219 residents. During a six-month period, key faculty and resident leaders from 8 (of 10) Atlantic Health residency training programs participated in three half-day collaborative learning sessions focused on improving medication reconciliation. Each session included didactic presentations from a multidisciplinary team of clinical experts as well as the application of principles that identified challenges, barriers, and solutions to QI initiatives. The learning sessions emphasized the fundamental principles of medication reconciliation, its critical importance as a vital part of patient handoff in all health care settings, and the challenges of achieving successful medication reconciliation improvement in light of work hours restrictions and patient loads. Each residency program developed a detailed implementation and measurement plan for individual "action learning" projects, using the Plan-Do-Study-Act method of improvement. Each program then implemented its QI project, and expert faculty (e.g., physicians, nurses, pharmacists, QI staff) provided mentoring between learning sessions. Several projects resulted in permanent changes in medication reconciliation processes, which were then adopted by other programs. The structure, process, and outcomes of this effort are described in detail.

Applying importance-performance analysis to patient safety culture.

PubMed

Lee, Yii-Ching; Wu, Hsin-Hung; Hsieh, Wan-Lin; Weng, Shao-Jen; Hsieh, Liang-Po; Huang, Chih-Hsuan

2015-01-01

The Sexton et al.'s (2006) safety attitudes questionnaire (SAQ) has been widely used to assess staff's attitudes towards patient safety in healthcare organizations. However, to date there have been few studies that discuss the perceptions of patient safety both from hospital staff and upper management. The purpose of this paper is to improve and to develop better strategies regarding patient safety in healthcare organizations. The Chinese version of SAQ based on the Taiwan Joint Commission on Hospital Accreditation is used to evaluate the perceptions of hospital staff. The current study then lies in applying importance-performance analysis technique to identify the major strengths and weaknesses of the safety culture. The results show that teamwork climate, safety climate, job satisfaction, stress recognition and working conditions are major strengths and should be maintained in order to provide a better patient safety culture. On the contrary, perceptions of management and hospital handoffs and transitions are important weaknesses and should be improved immediately. Research limitations/implications - The research is restricted in generalizability. The assessment of hospital staff in patient safety culture is physicians and registered nurses. It would be interesting to further evaluate other staff's (e.g. technicians, pharmacists and others) opinions regarding patient safety culture in the hospital. Few studies have clearly evaluated the perceptions of healthcare organization management regarding patient safety culture. Healthcare managers enable to take more effective actions to improve the level of patient safety by investigating key characteristics (either strengths or weaknesses) that healthcare organizations should focus on.

Certification of Completion of ASC FY08 Level-2 Milestone ID #2933

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

Lipari, D A

2008-06-12

This report documents the satisfaction of the completion criteria associated with ASC FY08 Milestone ID No.2933: 'Deploy Moab resource management services on BlueGene/L'. Specifically, this milestone represents LLNL efforts to enhance both SLURM and Moab to extend Moab's capabilities to schedule and manage BlueGene/L, and increases portability of user scripts between ASC systems. The completion criteria for the milestone are the following: (1) Batch jobs can be specified, submitted to Moab, scheduled and run on the BlueGene/L system; (2) Moab will be able to support the markedly increased scale in node count as well as the wiring geometry that ismore » unique to BlueGene/L; and (3) Moab will also prepare and report statistics of job CPU usage just as it does for the current systems it supports. This document presents the completion evidence for both of the stated milestone certification methods: Completion evidence for this milestone will be in the form of (1) documentation--a report that certifies that the completion criteria have been met; and (2) user hand-off. As the selected Tri-Lab workload manager, Moab was chosen to replace LCRM as the enterprise-wide scheduler across Livermore Computing (LC) systems. While LCRM/SLURM successfully scheduled jobs on BG/L, the effort to replace LCRM with Moab on BG/L represented a significant challenge. Moab is a commercial product developed and sold by Cluster Resources, Inc. (CRI). Moab receives the users batch job requests and dispatches these jobs to run on a specific cluster. SLURM is an open-source resource manager whose development is managed by members of the Integrated Computational Resource Management Group (ICRMG) within the Services and Development Division at LLNL. SLURM is responsible for launching and running jobs on an individual cluster. Replacing LCRM with Moab on BG/L required substantial changes to both Moab and SLURM. While the ICRMG could directly manage the SLURM development effort, the work to enhance Moab had to be done by Moab's vendor. Members of the ICRMG held many meetings with CRI developers to develop the design and specify the requirements for what Moab needed to do. Extensions to SLURM are used to run jobs on the BlueGene/L architecture. These extensions support the three dimensional network topology unique to BG/L. While BG/L geometry support was already in SLURM, enhancements were needed to provide backfill capability and answer 'will-run' queries from Moab. For its part, the Moab architecture needed to be modified to interact with SLURM in a more coordinated way. It needed enhancements to support SLURM's shorthand notation for representing thousands of compute nodes and report this information using Moab's existing status commands. The LCRM wrapper scripts that emulated LCRM commands also needed to be enhanced to support BG/L usage. The effort was successful as Moab 5.2.2 and SLURM 1.3 was installed on the 106496 node BG/L machine on May 21, 2008, and turned over to the users to run production.« less

Experimental demonstration of plasma startup by coaxial helicity injection

NASA Astrophysics Data System (ADS)

Raman, R.; Jarboe, T. R.; Nelson, B. A.; Hamp, W. T.; Izzo, V. A.; O'Neill, R. G.; Redd, A. J.; Sieck, P. E.; Smith, R. J.

2004-05-01

Experimental results on the transfer of a coaxial-helicity-injection (CHI) produced discharge to inductive operation are reported. CHI assisted plasma startup is more robust than inductive only operation and reduces volt-seconds consumption. After handoff to inductive operation, the initial 100 kA of CHI produced current drops to 50 kA, then ramps up to 180 kA, using only 30 mVs, about 40% higher than that produced by induction alone. Results show that initiation of CHI discharges at lower densities produce higher levels of coupling current. Coupling a CHI produced discharge to induction from a precharged central solenoid has produced record currents of 290 kA using only 52 mWb of central solenoid flux. CHI discharges can also be generated while the central transformer is in the process of being precharged, during which period it induces a negative loop voltage on the CHI discharge. These significant results were obtained on the Helicity Injected Torus-II (HIT-II) [T.R. Jarboe, Fusion Technol. 15, 7 (1989)] spherical torus experiment (major/minor radius of 0.3/0.2 m and elongation of 1.5).

Quality improvement in pediatrics: past, present, and future.

PubMed

Schwartz, Stephanie P; Rehder, Kyle J

2017-01-01

Almost two decades ago, the landmark report "To Err is Human" compelled healthcare to address the large numbers of hospitalized patients experiencing preventable harm. Concurrently, it became clear that the rapidly rising cost of healthcare would be unsustainable in the long-term. As a result, quality improvement methodologies initially rooted in other high-reliability industries have become a primary focus of healthcare. Multiple pediatric studies demonstrate remarkable quality and safety improvements in several domains including handoffs, catheter-associated blood stream infections, and other serious safety events. While both quality improvement and research are data-driven processes, significant differences exist between the two. Research utilizes a hypothesis driven approach to obtain new knowledge while quality improvement often incorporates a cyclic approach to translate existing knowledge into clinical practice. Recent publications have provided guidelines and methods for effectively reporting quality and safety work and improvement implementations. This review examines not only how quality improvement in pediatrics has led to improved outcomes, but also looks to the future of quality improvement in healthcare with focus on education and collaboration to ensure best practice approaches to caring for children.

Minding the gap: Interprofessional communication during inpatient and post discharge chasm care.

PubMed

Scotten, Mitzi; Manos, Eva LaVerne; Malicoat, Allison; Paolo, Anthony M

2015-07-01

Poor communication is cited as a main cause of poor patient outcomes and errors in healthcare, and clear communication can be especially critical during transitions such as discharge. In this project, communication was standardized for clarity, and techniques were implemented to continue care from inpatient, to discharge, across the post-discharge chasm, to hand-off with the primary care provider (PCP). The interprofessional (IP) quality improvement initiative included: (1) evidence-based teamwork system; (2) in situ simulation; (3) creation of an IP model of care; and (4) innovations in use of telehealth technology to continue care post-discharge. Measures inpatient/parent satisfaction and the attitudes of the care team have improved. Traditional methods of communication and transition do not meet patient or healthcare provider needs. Communication must be standardized to be understandable and be used by the IP team. Care must continue post-discharge by utilizing technology to increase quality and continuity of care. Improving and practicing communication skills may lead to reductions in healthcare errors and readmissions, and may decrease the length of stay and improve satisfaction of care teams. Published by Elsevier Ireland Ltd.

Disaster mobile health technology: lessons from Haiti.

PubMed

Callaway, David W; Peabody, Christopher R; Hoffman, Ari; Cote, Elizabeth; Moulton, Seth; Baez, Amado Alejandro; Nathanson, Larry

2012-04-01

Mobile health (mHealth) technology can play a critical role in improving disaster victim tracking, triage, patient care, facility management, and theater-wide decision-making. To date, no disaster mHealth application provides responders with adequate capabilities to function in an austere environment. The Operational Medicine Institute (OMI) conducted a qualitative trial of a modified version of the off-the-shelf application iChart at the Fond Parisien Disaster Rescue Camp during the large-scale response to the January 12, 2010 earthquake in Haiti. The iChart mHealth system created a patient log of 617 unique entries used by on-the-ground medical providers and field hospital administrators to facilitate provider triage, improve provider handoffs, and track vulnerable populations such as unaccompanied minors, pregnant women, traumatic orthopedic injuries and specified infectious diseases. The trial demonstrated that even a non-disaster specific application with significant programmatic limitations was an improvement over existing patient tracking and facility management systems. A unified electronic medical record and patient tracking system would add significant value to first responder capabilities in the disaster response setting.

Power attenuation characteristics as switch-over criterion in personal satellite mobile communications

NASA Technical Reports Server (NTRS)

Castro, Jonathan P.

1993-01-01

A third generation mobile system intends to support communications in all environments (i.e., outdoors, indoors at home or office and when moving). This system will integrate services that are now available in architectures such as cellular, cordless, mobile data networks, paging, including satellite services to rural areas. One way through which service integration will be made possible is by supporting a hierarchical cellular structure based on umbrella cells, macro cells, micro and pico cells. In this type of structure, satellites are part of the giant umbrella cells allowing continuous global coverage, the other cells belong to cities, neighborhoods, and buildings respectively. This does not necessarily imply that network operation of terrestrial and satellite segments interconnect to enable roaming and spectrum sharing. However, the cell concept does imply hand-off between different cell types, which may involve change of frequency. Within this propsective, the present work uses power attenuation characteristics to determine a dynamic criterion that allows smooth transition from space to terrestrial networks. The analysis includes a hybrid channel that combines Rician, Raleigh and Log Normal fading characteristics.

Blood-based biomarkers in Alzheimer disease: Current state of the science and a novel collaborative paradigm for advancing from discovery to clinic.

PubMed

O'Bryant, Sid E; Mielke, Michelle M; Rissman, Robert A; Lista, Simone; Vanderstichele, Hugo; Zetterberg, Henrik; Lewczuk, Piotr; Posner, Holly; Hall, James; Johnson, Leigh; Fong, Yiu-Lian; Luthman, Johan; Jeromin, Andreas; Batrla-Utermann, Richard; Villarreal, Alcibiades; Britton, Gabrielle; Snyder, Peter J; Henriksen, Kim; Grammas, Paula; Gupta, Veer; Martins, Ralph; Hampel, Harald

2017-01-01

The last decade has seen a substantial increase in research focused on the identification of blood-based biomarkers that have utility in Alzheimer's disease (AD). Blood-based biomarkers have significant advantages of being time- and cost-efficient as well as reduced invasiveness and increased patient acceptance. Despite these advantages and increased research efforts, the field has been hampered by lack of reproducibility and an unclear path for moving basic discovery toward clinical utilization. Here we reviewed the recent literature on blood-based biomarkers in AD to provide a current state of the art. In addition, a collaborative model is proposed that leverages academic and industry strengths to facilitate the field in moving past discovery only work and toward clinical use. Key resources are provided. This new public-private partnership model is intended to circumvent the traditional handoff model and provide a clear and useful paradigm for the advancement of biomarker science in AD and other neurodegenerative diseases. Copyright © 2016 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Blood Based Biomarkers in Alzheimer Disease: Current State of the Science and a Novel Collaborative Paradigm for Advancing from Discovery to Clinic

PubMed Central

O’Bryant, Sid E.; Mielke, Michelle M.; Rissman, Robert A.; Lista, Simone; Vanderstichele, Hugo; Zetterberg, Henrik; Lewczuk, Piotr; Posner, Holly; Hall, James; Johnson, Leigh; Fong, Yiu-Lian; Luthman, Johan; Jeromin, Andreas; Batrla-Utermann, Richard; Villarreal, Alcibiades; Britton, Gabrielle; Snyder, Peter J.; Henriksen, Kim; Grammas, Paula; Gupta, Veer; Martins, Ralph; Hampel, Harald

2016-01-01

The last decade has seen a substantial increase in research focused on the identification of blood-based biomarkers that have utility in Alzheimer’s disease (AD). Blood-based biomarkers have significant advantages of being time- and cost-efficient as well as reduced invasiveness and increased patient acceptance. Despite these advantages and increased research efforts, the field has been hampered by lack of reproducibility as well as an unclear path for moving basic discovery towards clinical utilization. Here we reviewed the recent literature on blood-based biomarkers in AD to provide a current state-of-the-art. Additionally, a collaborative model is proposed that leverages academic and industry strengths to facilitate the field in moving past discovery only work and towards clinical use. Key resources are provided. This new public-private partnership model is intended to circumvent the traditional hand-off model and provide a clear and useful paradigm for the advancement of biomarker science in AD and other neurodegenerative diseases. PMID:27870940

Navigating the legal and ethical foundations of informed consent and confidentiality in integrated primary care.

PubMed

Hudgins, Cathy; Rose, Sandra; Fifield, Peter Y; Arnault, Steve

2013-03-01

This article describes findings from ongoing research and analysis of current literature in addition to discussions with leaders in the field, communications with lawyers and administrators of advocacy and government agencies pertaining to integrated primary care (IPC). Standards of care are established based on a myriad of factors, including professional codes of ethics, case law, state and federal laws, professional standards, existing best practices, current professional guidelines, administrative rules and regulations, and licensing board regulations. Regulations may differ for behavioral health and medical providers, posing challenges in IPC settings. This article provides a review of these regulations, particularly 42CFR Part 2, a federal law governing confidentiality for substance abuse programs, Health Insurance Portability and Accountability Act (HIPAA), and state laws relevant to patient care in IPC settings. On the basis of findings from the study, the authors make recommendations related to patient care practices concerning informed consent and release of information procedures, treatment and warm hand-off protocols, documentation and electronic record keeping, agreements with other providers, and billing. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Project IMPACT Pilot Report: Feasibility of Implementing a Hospital-to-Home Transition Bundle.

PubMed

Mallory, Leah A; Osorio, Snezana Nena; Prato, B Stephen; DiPace, Jennifer; Schmutter, Lisa; Soung, Paula; Rogers, Amanda; Woodall, William J; Burley, Kayla; Gage, Sandra; Cooperberg, David

2017-03-01

To improve hospital to home transitions, a 4-element pediatric patient-centered transition bundle was developed, including: a transition readiness checklist; predischarge teach-back education; timely and complete written handoff to the primary care provider; and a postdischarge phone call. The objective of this study was to demonstrate the feasibility of bundle implementation and report initial outcomes at 4 pilot sites. Outcome measures included postdischarge caregiver ability to teach-back key home management information and 30-day reuse rates. A multisite, observational time series using multiple planned sequential interventions to implement bundle components with non-technology-supported and technology-supported patients. Data were collected via electronic health record reviews and during postdischarge phone calls. Statistical process control charts were used to assess outcomes. Four pilot sites implemented the bundle between January 2014 and May 2015 for 2601 patients, of whom 1394 had postdischarge telephone encounters. Improvement was noted in the implementation of all bundle elements with the transitions readiness checklist posing the greatest feasibility challenge. Phone contact connection rates were 69%. Caregiver ability to teach-back essential home management information postdischarge improved from 18% to 82%. No improvement was noted in reuse rates, which differed dramatically between technology-supported and non-technology-supported patients. A pediatric care transition bundle was successfully tested and implemented, as demonstrated by improvement in all process measures, as well as caregiver home management skills. Important considerations for successful implementation and evaluation of the discharge bundle include the role of local context, electronic health record integration, and subgroup analysis for technology-supported patients. Copyright © 2017 by the American Academy of Pediatrics.

A Multidisciplinary Approach to a Pediatric Difficult Airway Simulation Course.

PubMed

Lind, Meredith Merz; Corridore, Marco; Sheehan, Cameron; Moore-Clingenpeel, Melissa; Maa, Tensing

2018-02-01

Objective To design and assess an advanced pediatric airway management course, through simulation-based team training and with multiple disciplines, to emphasize communication and cooperation across subspecialties and to provide a common skill set and knowledge base. Methods Trainees from anesthesiology, emergency medicine, critical care, pediatric surgery, and otolaryngology at a tertiary children's hospital participated in a 1-day workshop emphasizing airway skills and complex airway simulations. Small groups were multidisciplinary to promote teamwork. Participants completed pre- and postworkshop questionnaires. Results Thirty-nine trainees participated over the 3-year study period. Compared with their precourse responses, participants' postcourse responses indicated either agreement or strong agreement that the multidisciplinary format (1) helped in the development of team communication skills and (2) was preferred over single-discipline training. Improvement in confidence in managing critical airway situations and in advanced airway management skills was significant ( P < .05). Eighty-one percent of participants had improved confidence in following the hospital's critical airway protocol, and 64% were better able to locate advanced airway management equipment. Discussion Multiple subspecialists manage pediatric respiratory failure, where successful care requires complex handoffs and teamwork. Multidisciplinary education to teach advanced airway management, teamwork, and communication skills is practical and preferred by learners and is possible to achieve despite differences in experience. Future study is required to better understand the impact of this course on patient care outcomes. Implications for Practice Implementation of a pediatric difficult airway course through simulation-based team training is feasible and preferred by learners among multiple disciplines. A multidisciplinary approach exposes previously unrecognized knowledge gaps and allows for better communication and collaboration among the fields.

Acculturation Needs of Pediatric International Medical Graduates: A Qualitative Study.

PubMed

Osta, Amanda D; Barnes, Michelle M; Pessagno, Regina; Schwartz, Alan; Hirshfield, Laura E

2017-01-01

Phenomenon: International medical graduates (IMGs) play a key role in host countries' health systems but face unique challenges, which makes effective, tailored support for IMGs essential. Prior literature describing the acculturation needs of IMGs focused primarily on communication content and style. We conducted a qualitative study to explore acculturation that might be specific to IMG residents who care for children. In a study conducted from November 2011 to April 2012, we performed four 90-minute semistructured focus groups with 26 pediatric IMG residents from 12 countries. The focus group transcripts were analyzed using open and focused coding methodology. The focus groups and subsequent analysis demonstrated that pediatric IMG residents' socialization to their home culture impacts their transition to practice in the United States; they must adjust not only to a U.S. culture, different from their own, but also to the culture of medicine in the United States. We identified the following new acculturation themes: understanding the education system and family structure, social determinants of health, communication with African American parents, contraception, physician handoffs, physicians' role in prevention, adolescent health, and physicians' role in child advocacy. We further highlight the acculturation challenges faced by pediatric IMG residents and offer brief recommendations for the creation of a deliberate acculturation curriculum for pediatric IMG residents. Insight: Residency training is a unique period in physicians' personal and professional development and can be particularly challenging for IMGs. There is a significant gap in the identified acculturation needs and the current curricula available to IMG residents who care for children.

Climate Change Information Dashboards for Water Resource Managers

NASA Astrophysics Data System (ADS)

Buja, Lawrence

2016-04-01

It is in the context of its application that one needs to determine if climate information is of high quality and ultimately useful. Therefore, it is important that the intersection between data providers and data consumers is structured in form of an iterative and collaborative exchange where science and application viewpoints can be brought together. A traditional "loading dock"-style hand-off of data fails to optimally inform decisions. It is now broadly recognized that a collaborative, open exchange is better suited to generate credible and salient products and knowledge that can be more confidently used in decisions. But in order for this exchange to be successful in practice, it needs to be sufficiently efficient to actually facilitate an exploratory process that is inherently iterative to determine the most informative products. It also requires a transparent approach that is easily understood and communicated. We will present prototypes of Climate Information Dashboards that collect on a single page to integrate a suite of key climate information for resource managers. The content of dashboards is based on standardized products that can be assembled to meet specific needs. They were co-designed with the water resource managers and are tailored to selected management and decision topics. The visualizations are tuned to quickly provide the basic information, yet below individual diagnostics are more detailed analyses that can be consulted. These dashboards offer a flexible way to connect decision-makers to climate model output. Conversely, such dashboards can also be applied to inform model development by providing insight into a suite of key characteristics of model performance that have been identified as critical by a sector.

The myeloid-binding peptide adenoviral vector enables multi-organ vascular endothelial gene targeting.

PubMed

Lu, Zhi Hong; Kaliberov, Sergey; Zhang, Jingzhu; Muz, Barbara; Azab, Abdel K; Sohn, Rebecca E; Kaliberova, Lyudmila; Du, Yingqiu; Curiel, David T; Arbeit, Jeffrey M

2014-08-01

Vascular endothelial cells (ECs) are ideal gene therapy targets as they provide widespread tissue access and are the first contact surfaces following intravenous vector administration. Human recombinant adenovirus serotype 5 (Ad5) is the most frequently used gene transfer system because of its appreciable transgene payload capacity and lack of somatic mutation risk. However, standard Ad5 vectors predominantly transduce liver but not the vasculature following intravenous administration. We recently developed an Ad5 vector with a myeloid cell-binding peptide (MBP) incorporated into the knob-deleted, T4 fibritin chimeric fiber (Ad.MBP). This vector was shown to transduce pulmonary ECs presumably via a vector handoff mechanism. Here we tested the body-wide tropism of the Ad.MBP vector, its myeloid cell necessity, and vector-EC expression dose response. Using comprehensive multi-organ co-immunofluorescence analysis, we discovered that Ad.MBP produced widespread EC transduction in the lung, heart, kidney, skeletal muscle, pancreas, small bowel, and brain. Surprisingly, Ad.MBP retained hepatocyte tropism albeit at a reduced frequency compared with the standard Ad5. While binding specifically to myeloid cells ex vivo, multi-organ Ad.MBP expression was not dependent on circulating monocytes or macrophages. Ad.MBP dose de-escalation maintained full lung-targeting capacity but drastically reduced transgene expression in other organs. Swapping the EC-specific ROBO4 for the CMV promoter/enhancer abrogated hepatocyte expression but also reduced gene expression in other organs. Collectively, our multilevel targeting strategy could enable therapeutic biological production in previously inaccessible organs that pertain to the most debilitating or lethal human diseases.

Iterative development of visual control systems in a research vivarium.

PubMed

Bassuk, James A; Washington, Ida M

2014-01-01

The goal of this study was to test the hypothesis that reintroduction of Continuous Performance Improvement (CPI) methodology, a lean approach to management at Seattle Children's (Hospital, Research Institute, Foundation), would facilitate engagement of vivarium employees in the development and sustainment of a daily management system and a work-in-process board. Such engagement was implemented through reintroduction of aspects of the Toyota Production System. Iterations of a Work-In-Process Board were generated using Shewhart's Plan-Do-Check-Act process improvement cycle. Specific attention was given to the importance of detecting and preventing errors through assessment of the following 5 levels of quality: Level 1, customer inspects; Level 2, company inspects; Level 3, work unit inspects; Level 4, self-inspection; Level 5, mistake proofing. A functioning iteration of a Mouse Cage Work-In-Process Board was eventually established using electronic data entry, an improvement that increased the quality level from 1 to 3 while reducing wasteful steps, handoffs and queues. A visual workplace was realized via a daily management system that included a Work-In-Process Board, a problem solving board and two Heijunka boards. One Heijunka board tracked cage changing as a function of a biological kanban, which was validated via ammonia levels. A 17% reduction in cage changing frequency provided vivarium staff with additional time to support Institute researchers in their mutual goal of advancing cures for pediatric diseases. Cage washing metrics demonstrated an improvement in the flow continuum in which a traditional batch and queue push system was replaced with a supermarket-type pull system. Staff engagement during the improvement process was challenging and is discussed. The collective data indicate that the hypothesis was found to be true. The reintroduction of CPI into daily work in the vivarium is consistent with the 4P Model of the Toyota Way and selected Principles that guide implementation of the Toyota Production System.

NH11B-1726: FrankenRaven: A New Platform for Remote Sensing

NASA Technical Reports Server (NTRS)

Dahlgren, Robert; Fladeland, Matthew M.; Pinsker, Ethan A.; Jasionowicz, John P.; Jones, Lowell L.; Pscheid, Matthew J.

2016-01-01

Small, modular aircraft are an emerging technology with a goal to maximize flexibility and enable multi-mission support. This reports the progress of an unmanned aerial system (UAS) project conducted at the NASA Ames Research Center (ARC) in 2016. This interdisciplinary effort builds upon the success of the 2014 FrankenEye project to apply rapid prototyping techniques to UAS, to develop a variety of platforms to host remote sensing instruments. In 2016, ARC received AeroVironment RQ-11A and RQ-11B Raven UAS from the US Department of the Interior, Office of Aviation Services. These aircraft have electric propulsion, a wingspan of roughly 1.3m, and have demonstrated reliability in challenging environments. The Raven airframe is an ideal foundation to construct more complex aircraft, and student interns using 3D printing were able to graft multiple Raven wings and fuselages into FrankenRaven aircraft. Aeronautical analysis shows that the new configuration has enhanced flight time, payload capacity, and distance compared to the original Raven. The FrankenRaven avionics architecture replaces the mil-spec avionics with COTS technology based upon the 3DR Pixhawk PX4 autopilot with a safety multiplexer for failsafe handoff to 2.4 GHz RC control and 915 MHz telemetry. This project demonstrates how design reuse, rapid prototyping, and modular subcomponents can be leveraged into flexible airborne platforms that can host a variety of remote sensing payloads and even multiple payloads. Modularity advances a new paradigm: mass-customization of aircraft around given payload(s). Multi-fuselage designs are currently under development to host a wide variety of payloads including a zenith-pointing spectrometer, a magnetometer, a multi-spectral camera, and a RGB camera. After airworthiness certification, flight readiness review, and test flights are performed at Crows Landing airfield in central California, field data will be taken at Kilauea volcano in Hawaii and other locations.

So, You Think You Have an Idea: A Practical Risk Reduction-Conceptual Model for Academic Translational Research

PubMed Central

Schwartz, John; Macomber, Christopher

2017-01-01

Translational research for new drugs, medical devices, and diagnostics encompasses aspects of both basic science and clinical research, requiring multidisciplinary skills and resources that are not all readily available in either a basic laboratory or clinical setting alone. We propose that, to be successful, “translational” research ought to be understood as a defined process from basic science through manufacturing, regulatory, clinical testing all the way to market. The authors outline a process which has worked well for them to identify and commercialize academic innovation. The academic environment places a high value on novelty and less value on whether, among other things, data are reproducible, scalable, reimbursable, or have commercial freedom to operate. In other words, when investors, strategic companies, or other later stage stakeholders evaluate academic efforts at translational research the relative lack of attention to clinical, regulatory, reimbursement, and manufacturing and intellectual property freedom to operate almost universally results in more questions and doubts about the potential of the proposed product, thereby inhibiting further interest. This contrasts with industry-based R&D, which often emphasizes manufacturing, regulatory and commercial factors. Academics do not so much choose to ignore those necessary and standard elements of translation development, but rather, they are not built into the culture or incentive structure of the university environment. Acknowledging and addressing this mismatch of approach and lack of common language in a systematic way facilitates a more effective “translation” handoffs of academic project concepts into meaningful clinical solutions help translational researchers more efficiently develop and progress new and better medical products which address validated needs. The authors provide an overview and framework for academic researchers to use which will help them define the elements of a market-driven translational program (1) problem identification and validation; (2) defining the conceptual model of disease; and (3) risk evaluation and mitigation strategies. PMID:28952508

FrankenRaven: A New Platform for Remote Sensing

NASA Astrophysics Data System (ADS)

Dahlgren, R. P.; Fladeland, M. M.; Pinsker, E. A.; Jasionowicz, J. P.; Jones, L. L.; Mosser, C. D.; Pscheid, M. J.; Weidow, N. L.; Kelly, P. J.; Kern, C.; Werner, C. A.; Johnson, M. S.

2016-12-01

Small, modular aircraft are an emerging technology with a goal to maximize flexibility and enable multi-mission support. This reports the progress of an unmanned aerial system (UAS) project conducted at the NASA Ames Research Center (ARC) in 2016. This interdisciplinary effort builds upon the success of the 2014 FrankenEye project to apply rapid prototyping techniques to UAS, to develop a variety of platforms to host remote sensing instruments. In 2016, ARC received AeroVironment RQ-11A and RQ-11B Raven UAS from the US Department of the Interior, Office of Aviation Services. These aircraft have electric propulsion, a wingspan of roughly 1.3m, and have demonstrated reliability in challenging environments. The Raven airframe is an ideal foundation to construct more complex aircraft, and student interns using 3D printing were able to graft multiple Raven wings and fuselages into "FrankenRaven" aircraft. Aeronautical analysis shows that the new configuration has enhanced flight time, payload capacity, and distance compared to the original Raven. The FrankenRaven avionics architecture replaces the mil-spec avionics with COTS technology based upon the 3DR Pixhawk PX4 autopilot with a safety multiplexer for failsafe handoff to 2.4 GHz RC control and 915 MHz telemetry. This project demonstrates how design reuse, rapid prototyping, and modular subcomponents can be leveraged into flexible airborne platforms that can host a variety of remote sensing payloads and even multiple payloads. Modularity advances a new paradigm: mass-customization of aircraft around given payload(s). Multi-fuselage designs are currently under development to host a wide variety of payloads including a zenith-pointing spectrometer, a magnetometer, a multi-spectral camera, and a RGB camera. After airworthiness certification, flight readiness review, and test flights are performed at Crows Landing airfield in central California, field data will be taken at Kilauea volcano in Hawaii and other locations.

Iterative Development of Visual Control Systems in a Research Vivarium

PubMed Central

Bassuk, James A.; Washington, Ida M.

2014-01-01

The goal of this study was to test the hypothesis that reintroduction of Continuous Performance Improvement (CPI) methodology, a lean approach to management at Seattle Children’s (Hospital, Research Institute, Foundation), would facilitate engagement of vivarium employees in the development and sustainment of a daily management system and a work-in-process board. Such engagement was implemented through reintroduction of aspects of the Toyota Production System. Iterations of a Work-In-Process Board were generated using Shewhart’s Plan-Do-Check-Act process improvement cycle. Specific attention was given to the importance of detecting and preventing errors through assessment of the following 5 levels of quality: Level 1, customer inspects; Level 2, company inspects; Level 3, work unit inspects; Level 4, self-inspection; Level 5, mistake proofing. A functioning iteration of a Mouse Cage Work-In-Process Board was eventually established using electronic data entry, an improvement that increased the quality level from 1 to 3 while reducing wasteful steps, handoffs and queues. A visual workplace was realized via a daily management system that included a Work-In-Process Board, a problem solving board and two Heijunka boards. One Heijunka board tracked cage changing as a function of a biological kanban, which was validated via ammonia levels. A 17% reduction in cage changing frequency provided vivarium staff with additional time to support Institute researchers in their mutual goal of advancing cures for pediatric diseases. Cage washing metrics demonstrated an improvement in the flow continuum in which a traditional batch and queue push system was replaced with a supermarket-type pull system. Staff engagement during the improvement process was challenging and is discussed. The collective data indicate that the hypothesis was found to be true. The reintroduction of CPI into daily work in the vivarium is consistent with the 4P Model of the Toyota Way and selected Principles that guide implementation of the Toyota Production System. PMID:24736460

Moving survivorship care plans forward: focus on care coordination.

PubMed

Salz, Talya; Baxi, Shrujal

2016-07-01

After completing treatment for cancer, the coordination of oncology and primary care presents a challenge for cancer survivors. Many survivors need continued oncology follow-up, and all survivors require primary care. Coordinating the shared care of a cancer survivor, or facilitating an informed handoff from oncology to primary care, is essential for cancer survivors. Survivorship care plans are personalized documents that summarize cancer treatment and outline a plan of recommended ongoing care, with the goal of facilitating the coordination of post-treatment care. Despite their face validity, five trials have failed to demonstrate the effectiveness of survivorship care plans. We posit that these existing trials have critical shortcomings and do not adequately address whether survivorship care plans improve care coordination. Moving forward, we propose four criteria for future trials of survivorship care plans: focusing on high-needs survivor populations, tailoring the survivorship care plan to the care setting, facilitating implementation of the survivorship care plan in clinical practice, and selecting appropriate trial outcomes to assess care coordination. When trials meet these criteria, we can finally assess whether survivorship care plans help cancer survivors receive optimal oncology and primary care. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Clinical handover of patients arriving by ambulance to the emergency department - a literature review.

PubMed

Bost, Nerolie; Crilly, Julia; Wallis, Marianne; Patterson, Elizabeth; Chaboyer, Wendy

2010-10-01

To provide a critical review of research on clinical handover between the ambulance service and emergency department (ED) in hospitals. Data base and hand searches were conducted using the keywords ambulance, handover, handoff, emergency department, emergency room, ER, communication, and clinical handover. Data were extracted, summarised and critically assessed to provide evidence of current clinical handover processes. From 252 documents, eight studies fitted the inclusion criteria of clinical handover and the ambulance to ED patient transfer. Three themes were identified in the review: (1) important information may be missed during clinical handover; (2) structured handovers that include both written and verbal components may improve information exchange; (3) multidisciplinary education about the clinical handover process may encourage teamwork, a shared common language and a framework for minimum patient information to be transferred from the ambulance service to the hospital ED. Knowledge gaps exist concerning handover information, consequences of poor handover, transfer of responsibility, staff perception of handovers, staff training and evaluation of recommended strategies to improve clinical handover. Evidence of strategies being implemented and further research is required to examine the ongoing effects of implementing the strategies. Copyright © 2009 Elsevier Ltd. All rights reserved.

Exploring Research Topics and Trends in Nursing-related Communication in Intensive Care Units Using Social Network Analysis.

PubMed

Son, Youn-Jung; Lee, Soo-Kyoung; Nam, SeJin; Shim, Jae Lan

2018-05-04

This study used social network analysis to identify the main research topics and trends in nursing-related communication in intensive care units. Keywords from January 1967 to June 2016 were extracted from PubMed using Medical Subject Headings terms. Social network analysis was performed using Gephi software. Research publications and newly emerging topics in nursing-related communication in intensive care units were classified into five chronological phases. After the weighting was adjusted, the top five keyword searches were "conflict," "length of stay," "nursing continuing education," "family," and "nurses." During the most recent phase, research topics included "critical care nursing," "patient handoff," and "quality improvement." The keywords of the top three groups among the 10 groups identified were related to "neonatal nursing and practice guideline," "infant or pediatric and terminal care," and "family, aged, and nurse-patient relations," respectively. This study can promote a systematic understanding of communication in intensive care units by identifying topic networks. Future studies are needed to conduct large prospective cohort studies and randomized controlled trials to verify the effects of patient-centered communication in intensive care units on patient outcomes, such as length of hospital stay and mortality.

Optimizing perioperative Crohn's disease management: role of coordinated medical and surgical care.

PubMed

Bennett, Jennifer L; Ha, Christina Y; Efron, Jonathan E; Gearhart, Susan L; Lazarev, Mark G; Wick, Elizabeth C

2015-01-28

To investigate rates of re-establishing gastroenterology care, colonoscopy, and/or initiating medical therapy after Crohn's disease (CD) surgery at a tertiary care referral center. CD patients having small bowel or ileocolonic resections with a primary anastomosis between 2009-2012 were identified from a tertiary academic referral center. CD-specific features, medications, and surgical outcomes were abstracted from the medical record. The primary outcome measure was compliance rates with medical follow-up within 4 wk of hospital discharge and surveillance colonoscopy within 12 mo of surgery. Eighty-eight patients met study inclusion criteria with 92% (n=81) of patients returning for surgical follow-up compared to only 41% (n=36) of patients with documented gastroenterology follow-up within four-weeks of hospital discharge, P<0.05. Factors associated with more timely postoperative medical follow-up included younger age, longer length of hospitalization, postoperative biologic use and academic center patients. In the study cohort, 75.0% of patients resumed medical therapy within 12 mo, whereas only 53.4% of patients underwent a colonoscopy within 12 mo of surgery. Our study highlights the need for coordinated CD multidisciplinary clinics and structured handoffs among providers to improve of quality of care in the postoperative setting.

Bronson Methodist Hospital: journey to excellence in quality and safety.

PubMed

Knapp, Cheryl

2006-10-01

Bronson Healthcare Group, a 343-bed not-for-profit health care system serving all of southwest Michigan and northern Indiana, has as its flagship Bronson Methodist Hospital, the recipient of the 2005 Malcolm Baldrige National Quality Award. The Baldrige criteria were used to formalize Bronson's approach to performance excellence. The strategic plan is condensed and communicated via a "Plan for Excellence" focused on three strategies: clinical excellence, customer and service excellence, and corporate effectiveness. Initiatives include clinical scene investigation (a system for reporting and investigating sentinel and atypical events), a strategy for educating staff in the Situation-Background-Assessment-Recommendations (SBAR) communication technique, and mandatory influenza immunization for health care staff (safety), patient health literacy needs and a health information center (patient centeredness); methods to reduce bloodstream and ventilator-acquired pneumonia infections (effectiveness); a physician portal for access to forms, test results, and patient information (efficiency); restaurant-style pagers for patients and families while waiting (timeliness); and community outreach (equity). Bronson's journey to excellence continues with more accountability for hand-off communication and teamwork, enhancing a non-punitive environment for patient safety reporting, and further incorporating patient and family involvement.

Improving the Transition of Care in Patients Transferred Through the Ochsner Medical Center Transfer Center

PubMed Central

Amedee, Ronald G.; Maronge, Genevieve F.; Pinsky, William W.

2012-01-01

Background Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. Methods We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. Results The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (P<0.0001). Conclusions By including residents in the transfer calls (a result of the kaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects. PMID:23267257

Improving the transition of care in patients transferred through the ochsner medical center transfer center.

PubMed

Amedee, Ronald G; Maronge, Genevieve F; Pinsky, William W

2012-01-01

Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (P<0.0001). By including residents in the transfer calls (a result of the kaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects.

Multiple access techniques and spectrum utilization of the GLOBALSTAR mobile satellite system

NASA Astrophysics Data System (ADS)

Louie, Ming; Cohen, Michel; Rouffet, Denis; Gilhousen, Klein S.

The GLOBALSTAR System is a Low Earth Orbit (LEO) satellite-based mobile communications system that is interoperable with the current and future Public Land Mobile Network (PLMN). The GLOBALSTAR System concept is based upon technological advancement in two key areas: (1) the advancement in LEO satellite technology; (2) the advancement in cellular telephone technology, including the commercial applications of Code Division Multiple Access (CDMA) technologies, and of the most recent progress in Time Division Multiple Access technologies. The GLOBALSTAR System uses elements of CDMA, Frequency Division Multiple Access (FDMA), and Time Division Multiple Access (TDMA) technology, combining with satellite Multiple Beam Antenna (MBA) technology, to arrive at one of the most efficient modulation and multiple access system ever proposed for a satellite communications system. The technology used in GLOBALSTAR exploits the following techniques in obtaining high spectral efficiency and affordable cost per channel, with minimum coordination among different systems: power control, in open and closed loops, voice activation, spot beam satellite antenna for frequency reuse, weighted satellite antenna gain, multiple satellite coverage, and handoff between satellites. The GLOBALSTAR system design will use the following frequency bands: 1610-1626.5 MHz for up-link and 2483.5-2500 MHz for down-link.

Perspectives and attitudes of pediatricians concerning post-discharge care practice of premature infants.

PubMed

Gad, A; Parkinson, E; Khawar, N; Elmeki, A; Narula, P; Hoang, D

2017-01-01

Survival rates of premature infants are at a historical high and increasingly more pediatricians are caring for former premature infants. The goal of this study was to describe the perspectives and attitudes of pediatricians, as well as, the challenges of rendering post-neonatal intensive care unit (NICU) discharge care for premature infants. An anonymous 22-question web-based survey was emailed to pediatricians who are current members of the American Academy of Pediatrics (AAP) and practicing in Kings County, New York. There were 148 completed surveys with 79% being general pediatricians. Of all respondents, 63% believed that premature infants should have a neonatal high risk follow-up visit within days after discharge and 64% were satisfied with the NICU discharge summary acquisition. While 74% of pediatricians felt comfortable following up with former extremely premature infants, 65% referred to specialists, most often to child development, neurology, and physical and/or occupational therapy. The majority (85%) were more likely to refer premature infants to early intervention. Participating pediatricians varied in their knowledge of immunization and breastfeeding guidelines. Finally, 88% of respondents acknowledged that caregivers of premature infants experience increased stress, with 53% stating that the stress should be addressed. Understanding the perceptions and challenges of pediatricians who care for premature infants may help improve post NICU quality of care. Transition to the outpatient setting is a crucial step in the management of premature infants and a focus on improved hand-off procedures between hospital and physicians may prove beneficial. Also, pediatricians must stay abreast of current recommendations for breastfeeding and vaccinations. Furthermore, emphasis should be given to stress reduction and management for caregivers of former premature infants.

Level-2 Milestone 3244: Deploy Dawn ID Machine for Initial Science Runs

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

Fox, D

2009-09-21

This report documents the delivery, installation, integration, testing, and acceptance of the Dawn system, ASC L2 milestone 3244: Deploy Dawn ID Machine for Initial Science Runs, due September 30, 2009. The full text of the milestone is included in Attachment 1. The description of the milestone is: This milestone will be a result of work started three years ago with the planning for a multi-petaFLOPS UQ-focused platform (Sequoia) and will be satisfied when a smaller ID version of the final system is delivered, installed, integrated, tested, accepted, and deployed at LLNL for initial science runs in support of SSP mission.more » The deliverable for this milestone will be a LA petascale computing system (named Dawn) usable for code development and scaling necessary to ensure effective use of a final Sequoia platform (expected in 2011-2012), and for urgent SSP program needs. Allocation and scheduling of Dawn as an LA system will likely be performed informally, similar to what has been used for BlueGene/L. However, provision will be made to allow for dedicated access times for application scaling studies across the entire Dawn resource. The milestone was completed on April 1, 2009, when science runs began running on the Dawn system. The following sections describe the Dawn system architecture, current status, installation and integration time line, and testing and acceptance process. A project plan is included as Attachment 2. Attachment 3 is a letter certifying the handoff of the system to a nuclear weapons stockpile customer. Attachment 4 presents the results of science runs completed on the system.« less

The Remote Brief Intervention and Referral to Treatment Model: Development, Functionality, Acceptability, and Feasibility

PubMed Central

Boudreaux, Edwin D.; Haskins, Brianna; Harralson, Tina; Bernstein, Edward

2015-01-01

Background Screening, brief intervention, and referral to treatment (SBIRT) is effective for reducing risky alcohol use across a variety of medical settings. However, most programs have been unsustainable because of cost and time demands. Telehealth may alleviate on-site clinician burden. This exploratory study examines the feasibility of a new Remote Brief Intervention and Referral to Treatment (R-BIRT) model. Methods Eligible emergency department (ED) patients were enrolled into one of five models. (1) Warm Handoff: clinician-facilitated phone call during ED visit. (2) Patient Direct: patient-initiated call during visit. (3) Electronic Referral: patient contacted by R-BIRT personnel post visit. (4) Patient Choice: choice of models 1–3. (5) Modified Patient Choice: choice of models 1–2, Electronic Referral offered if 1–2 were declined. Once connected, a health coach offered assessment, counseling, and referral to treatment. Follow up assessments were conducted at 1 and 3 months. Primary outcomes measured were acceptance, satisfaction, and completion rates. Results Of 125 eligible patients, 50 were enrolled, for an acceptance rate of 40%. Feedback and satisfaction ratings were generally positive. Completion rates were 58% overall, with patients enrolled into a model wherein the consultation occurred during the ED visit, as opposed to after the visit, much more likely to complete a consultation, 90% vs. 10%, χ2 (4, N=50) = 34.8, p<0.001. Conclusions The R-BIRT offers a feasible alternative to in-person alcohol SBIRT and should be studied further. The public health impact of having accessible, sustainable, evidence-based SBIRT for substance use across a range of medical settings could be considerable. PMID:26297297

The remote brief intervention and referral to treatment model: Development, functionality, acceptability, and feasibility.

PubMed

Boudreaux, Edwin D; Haskins, Brianna; Harralson, Tina; Bernstein, Edward

2015-10-01

Screening, brief intervention, and referral to treatment (SBIRT) is effective for reducing risky alcohol use across a variety of medical settings. However, most programs have been unsustainable because of cost and time demands. Telehealth may alleviate on-site clinician burden. This exploratory study examines the feasibility of a new Remote Brief Intervention and Referral to Treatment (R-BIRT) model. Eligible emergency department (ED) patients were enrolled into one of five models. (1) Warm Handoff: clinician-facilitated phone call during ED visit. (2) Patient Direct: patient-initiated call during visit. (3) Electronic Referral: patient contacted by R-BIRT personnel post visit. (4) Patient Choice: choice of models 1-3. (5) Modified Patient Choice: choice of models 1-2, Electronic Referral offered if 1-2 were declined. Once connected, a health coach offered assessment, counseling, and referral to treatment. Follow up assessments were conducted at 1 and 3 months. Primary outcomes measured were acceptance, satisfaction, and completion rates. Of 125 eligible patients, 50 were enrolled, for an acceptance rate of 40%. Feedback and satisfaction ratings were generally positive. Completion rates were 58% overall, with patients enrolled into a model wherein the consultation occurred during the ED visit, as opposed to after the visit, much more likely to complete a consultation, 90% vs. 10%, χ(2) (4, N=50)=34.8, p<0.001. The R-BIRT offers a feasible alternative to in-person alcohol SBIRT and should be studied further. The public health impact of having accessible, sustainable, evidence-based SBIRT for substance use across a range of medical settings could be considerable. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Implications of electronic health record downtime: an analysis of patient safety event reports.

PubMed

Larsen, Ethan; Fong, Allan; Wernz, Christian; Ratwani, Raj M

2018-02-01

We sought to understand the types of clinical processes, such as image and medication ordering, that are disrupted during electronic health record (EHR) downtime periods by analyzing the narratives of patient safety event report data. From a database of 80 381 event reports, 76 reports were identified as explicitly describing a safety event associated with an EHR downtime period. These reports were analyzed and categorized based on a developed code book to identify the clinical processes that were impacted by downtime. We also examined whether downtime procedures were in place and followed. The reports were coded into categories related to their reported clinical process: Laboratory, Medication, Imaging, Registration, Patient Handoff, Documentation, History Viewing, Delay of Procedure, and General. A majority of reports (48.7%, n = 37) were associated with lab orders and results, followed by medication ordering and administration (14.5%, n = 11). Incidents commonly involved patient identification and communication of clinical information. A majority of reports (46%, n = 35) indicated that downtime procedures either were not followed or were not in place. Only 27.6% of incidents (n = 21) indicated that downtime procedures were successfully executed. Patient safety report data offer a lens into EHR downtime-related safety hazards. Important areas of risk during EHR downtime periods were patient identification and communication of clinical information; these should be a focus of downtime procedure planning to reduce safety hazards. EHR downtime events pose patient safety hazards, and we highlight critical areas for downtime procedure improvement. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Reducing Operating Room Turnover Time for Robotic Surgery Using a Motor Racing Pit Stop Model.

PubMed

Souders, Colby P; Catchpole, Ken R; Wood, Lauren N; Solnik, Jonathon M; Avenido, Raymund M; Strauss, Paul L; Eilber, Karyn S; Anger, Jennifer T

2017-08-01

Operating room (OR) turnover time, time taken between one patient leaving the OR and the next entering, is an important determinant of OR utilization, a key value metric for hospital administrators. Surgical robots have increased the complexity and number of tasks required during an OR turnover, resulting in highly variable OR turnover times. We sought to streamline the turnover process and decrease robotic OR turnover times and increase efficiency. Direct observation of 45 pre-intervention robotic OR turnovers was performed. Following a previously successful model for handoffs, we employed concepts from motor racing pit stops, including briefings, leadership, role definition, task allocation and task sequencing. Turnover task cards for staff were developed, and card assignments were distributed for each turnover. Forty-one cases were observed post-intervention. Average total OR turnover time was 99.2 min (95% CI 88.0-110.3) pre-intervention and 53.2 min (95% CI 48.0-58.5) at 3 months post-intervention. Average room ready time from when the patient exited the OR until the surgical technician was ready to receive the next patient was 42.2 min (95% CI 36.7-47.7) before the intervention, which reduced to 27.2 min at 3 months (95% CI 24.7-29.7) post-intervention (p < 0.0001). Role definition, task allocation and sequencing, combined with a visual cue for ease-of-use, create efficient, and sustainable approaches to decreasing robotic OR turnover times. Broader system changes are needed to capitalize on that result. Pit stop and other high-risk industry models may inform approaches to the management of tasks and teams.

Patient safety attitudes of paediatric trainee physicians.

PubMed

Parry, G; Horowitz, L; Goldmann, D

2009-12-01

To measure the patient safety attitudes of trainee physicians at an academic paediatric hospital. Cross-sectional survey. An academic paediatric hospital. 209 trainee physicians based at the academic paediatric hospital in January 2004. Patient safety attitudes of trainee physicians measured using the Safety Attitudes Questionnaire (Inpatient Version) and a specific trainee survey. In the Safety Attitudes Questionnaire, responses were most positive in areas associated with independent care: job satisfaction (mean factor score = 77.5) safety climate (76.1), working conditions (75.6), perception of management (70.4) and less positively in areas associated with interdependent care: teamwork climate (64.6) and stress recognition (59.1). In the trainee survey, following a principal component analysis to identify summary factors, responses were most positive in the independent areas of clinical supervision and support (75.0), communication with their immediate senior physician (65.5) and orientation of new personnel (63.9), and less positive in the interdependent areas of handoffs and multiple services, (58.1), role identification during codes (51.0) and support following an adverse event (42.8). The combined independent factor scores were higher than the interdependent (difference = 17.9, 95% CI 16.1 to 19.7, p<0.001). Fellows reported higher independent factor scores than residents (5.5, 95% CI 2.2 to 8.9, p = 0.001), but not for the interdependent scores (-0.5, 95% CI -3.6 to 2.7, p = 0.767). Trainees appear comfortable with caring independently for patients but less so caring interdependently. With experience, trainee physicians may experience improvement in their ability to act independently but not interdependently. Recently developed patient safety culture instruments may enable additional understanding of what could be implemented to make improvements.

Health Care Transition in Patients With Type 1 Diabetes

PubMed Central

Garvey, Katharine C.; Wolpert, Howard A.; Rhodes, Erinn T.; Laffel, Lori M.; Kleinman, Ken; Beste, Margaret G.; Wolfsdorf, Joseph I.; Finkelstein, Jonathan A.

2012-01-01

OBJECTIVE To examine characteristics of the transition from pediatric to adult care in emerging adults with type 1 diabetes and evaluate associations between transition characteristics and glycemic control. RESEARCH DESIGN AND METHODS We developed and mailed a survey to evaluate the transition process in emerging adults with type 1 diabetes, aged 22 to 30 years, receiving adult diabetes care at a single center. Current A1C data were obtained from the medical record. RESULTS The response rate was 53% (258 of 484 eligible). The mean transition age was 19.5 ± 2.9 years, and 34% reported a gap >6 months in establishing adult care. Common reasons for transition included feeling too old (44%), pediatric provider suggestion (41%), and college (33%). Less than half received an adult provider recommendation and <15% reported having a transition preparation visit or receiving written transition materials. The most recent A1C was 8.1 ± 1.3%. Respondents who felt mostly/completely prepared for transition had lower likelihood of a gap >6 months between pediatric and adult care (adjusted odds ratio 0.47 [95% CI 0.25–0.88]). In multivariate analysis, pretransition A1C (β = 0.49, P < 0.0001), current age (β = −0.07, P = 0.03), and education (β = −0.55, P = 0.01) significantly influenced current posttransition A1C. There was no independent association of transition preparation with posttransition A1C (β = −0.17, P = 0.28). CONCLUSIONS Contemporary transition practices may help prevent gaps between pediatric and adult care but do not appear to promote improvements in A1C. More robust preparation strategies and handoffs between pediatric and adult care should be evaluated. PMID:22699289

Towards an autonomous sensor architecture for persistent area protection

NASA Astrophysics Data System (ADS)

Thomas, Paul A.; Marshall, Gillian F.; Stubbins, Daniel J.; Faulkner, David A.

2016-10-01

The majority of sensor installations for area protection (e.g. critical national infrastructure, military forward operating bases, etc.) make use of banks of screens each containing one or more sensor feeds, such that the burden of combining data from the various sources, understanding the situation, and controlling the sensors all lies with the human operator. Any automation in the system is generally heavily bespoke for the particular installation, leading to an inflexible system which is difficult to change or upgrade. We have developed a modular system architecture consisting of intelligent autonomous sensor modules, a high level decision making module, a middleware integration layer and an end-user GUI. The modules are all effectively "plug and play", and we have demonstrated that it is relatively simple to incorporate legacy sensors into the architecture. We have extended our previously-reported SAPIENT demonstration system to operate with a larger number and variety of sensor modules, over an extended area, detecting and classifying a wider variety of "threat activities", both vehicular and pedestrian. We report the results of a demonstration of the SAPIENT system containing multiple autonomous sensor modules with a range of modalities including laser scanners, radar, TI, EO, acoustic and seismic sensors. They operate from a combination of mains, generator and battery power, and communicate with the central "hub" over Ethernet, point-to-point wireless links and Wi-Fi. The system has been configured to protect an extended area in a complex semi-urban environment. We discuss the operation of the SAPIENT system in a realistic demonstration environment (which included significant activity not under trial control), showing sensor cueing, multi-modal sensor fusion, threat prioritisation and target hand-off.

The CEO's real legacy.

PubMed

Freeman, Kenneth W

2004-11-01

The literature on CEO succession planning is nearly unanimous in its advice: Begin early, look first inside your company for exceptional talent, see that candidates gain experience in all aspects of the business, and help them develop the skills they will need in the top job. It all makes sense and sounds pretty straightforward. Nevertheless, the list of CEOs who last no more than a few years on the job continues to grow. Implicit in many, if not all, of these unceremonious departures is the absence of an effective CEO succession plan. The problem is, most boards simply don't want to talk about CEO succession: Why rock the boat when things are going well? Why risk offending the current CEO? Meanwhile, most CEOs can't imagine that anyone could adequately replace them. In this article, Kenneth W. Freeman, the retired CEO of Quest Diagnostics, discusses his own recent handoff experience (Surya N. Mohapatra became chief executive in May 2004) and offers his approach to succession planning. He says it falls squarely on the incumbent CEO to put ego aside and initiate and actively manage the process of selecting and grooming a successor. Aggressive succession planning is one of the best ways for CEOs to ensure the long-term health of the company, he says. Plus, thinking early and often about a successor will likely improve the chief executive's performance during his tenure. Freeman advocates the textbook rules for succession planning but adds to that list a few more that apply specifically to the incumbent CEO: Insist that the board become engaged in succession planning, look for a successor who is different from you, and make the successor's success your own. After all, Freeman argues, the CEO's true legacy is determined by what happens after he leaves the corner office.

Implementation science for ambulatory care safety: a novel method to develop context-sensitive interventions to reduce quality gaps in monitoring high-risk patients.

PubMed

McDonald, Kathryn M; Su, George; Lisker, Sarah; Patterson, Emily S; Sarkar, Urmimala

2017-06-24

Missed evidence-based monitoring in high-risk conditions (e.g., cancer) leads to delayed diagnosis. Current technological solutions fail to close this safety gap. In response, we aim to demonstrate a novel method to identify common vulnerabilities across clinics and generate attributes for context-flexible population-level monitoring solutions for widespread implementation to improve quality. Based on interviews with staff in otolaryngology, pulmonary, urology, breast, and gastroenterology clinics at a large urban publicly funded health system, we applied journey mapping to co-develop a visual representation of how patients are monitored for high-risk conditions. Using a National Academies framework and context-sensitivity theory, we identified common systems vulnerabilities and developed preliminary concepts for improving the robustness for monitoring patients with high-risk conditions ("design seeds" for potential solutions). Finally, we conducted a face validity and prioritization assessment of the design seeds with the original interviewees. We identified five high-risk situations for potentially consequential diagnostic delays arising from suboptimal patient monitoring. All situations related to detection of cancer (head and neck, lung, prostate, breast, and colorectal). With clinic participants we created 5 journey maps, each representing specialty clinic workflow directed at evidence-based monitoring. System vulnerabilities common to the different clinics included challenges with: data systems, communications handoffs, population-level tracking, and patient activities. Clinic staff ranked 13 design seeds (e.g., keep patient list up to date, use triggered notifications) addressing these vulnerabilities. Each design seed has unique evaluation criteria for the usefulness of potential solutions developed from the seed. We identified and ranked 13 design seeds that characterize situations that clinicians described 'wake them up at night', and thus could reduce their anxiety, save time, and improve monitoring of high-risk patients. We anticipate that the design seed approach promotes robust and context-sensitive solutions to safety and quality problems because it provides a human-centered link between the experienced problem and various solutions that can be tested for viability. The study also demonstrates a novel integration of industrial and human factors methods (journey mapping, process tracing and design seeds) linked to implementation theory for use in designing interventions that anticipate and reduce implementation challenges.

Design process optimization, virtual prototyping of manufacturing, and foundry-portable DFM (Invited Paper)

NASA Astrophysics Data System (ADS)

Hogan, James; Progler, Christopher; Chatila, Ahmad; Bruggeman, Bert; Heins, Mitchell; Pack, Robert; Boksha, Victor

2005-05-01

We consider modern design for manufacturing (DFM) as a manifestation of IC industry re-integration and intensive cost management dynamics. In that regard DFM is somewhat different from so-called design for yield (DFY) which essentially focuses on productivity (yield) management (that is not to say that DFM and DFY do not have significant overlaps and interactions). We clearly see the shaping of a new "full-chip DFM" infrastructure on the background of the "back to basics" design-manufacturing re-integration dynamics. In the presented work we are focusing on required DFM-efficiencies in a "foundry-fabless" link. Concepts of "virtual prototyping of manufacturing", "design process optimization", and "foundry-portable DFM" models are explored. Both senior management of the industry and leading design groups finally realize the need for a radical change of design styles. Some of the DFM super-goals are to isolate designers from process details and to make designs foundry portable. It requires qualification of designs at different foundries. In their turn, foundries specified and are implementing a set of DFM rules: "action-required", "recommended", and "guidelines" while asking designers to provide netlist and testing information. Also, we observe strong signs of innovation coming back to the mask industry. Powerful solutions are emerging and shaping up toward mask-centered IP as a business. While it seems that pure-play foundries have found their place for now in the "IDM+" model (supporting manufacturing capacity of IDMs) it is not obvious how sustainable the model is. Wafer as a production unit is not sufficient anymore; foundries are being asked by large customers to price products in terms of good die. It brings back the notion of the old ASIC business model where the foundry is responsible for dealing with both random and systematic yield issues for a given design. One scenario of future development would be that some of the leading foundries might eventually transform themselves into IDMs. Another visible trend: some of the manufacturing capacities started to diversify business by providing services for new emerging markets (for example, new energy and medicine applications). Finally it is very unclear what"s going to happen to fabless players. We continue building on the "Think SPICE again!" methodology introduced last year and expanding on previous platforms' discussion. Model expression of DFM, most probably, will be supplied by the equipment suppliers and yield management community. Actual content for a design intent model will be provided by manufacturing. Much like SPICE it describes the behavior and not what the actual measurement in manufacturing is. When the model is available and populated, a design automation solution can be created that will allow a designer to extract, analyze, simulate, and optimize the circuit prior to handoff to manufacturing.

Dynamic Call Admission Control Scheme Based on Predictive User Mobility Behavior for Cellular Networks

NASA Astrophysics Data System (ADS)

Intarasothonchun, Silada; Thipchaksurat, Sakchai; Varakulsiripunth, Ruttikorn; Onozato, Yoshikuni

In this paper, we propose a modified scheme of MSODB and PMS, called Predictive User Mobility Behavior (PUMB) to improve performance of resource reservation and call admission control for cellular networks. This algorithm is proposed in which bandwidth is allocated more efficiently to neighboring cells by key mobility parameters in order to provide QoS guarantees for transferring traffic. The probability is used to form a cluster of cells and the shadow cluster, where a mobile unit is likely to visit. When a mobile unit may change the direction and migrate to the cell that does not belong to its shadow cluster, we can support it by making efficient use of predicted nonconforming call. Concomitantly, to ensure continuity of on-going calls with better utilization of resources, bandwidth is borrowed from predicted nonconforming calls and existing adaptive calls without affecting the minimum QoS guarantees. The performance of the PUMB is demonstrated by simulation results in terms of new call blocking probability, handoff call dropping probability, bandwidth utilization, call successful probability, and overhead message transmission when arrival rate and speed of mobile units are varied. Our results show that PUMB provides the better performances comparing with those of MSODB and PMS under different traffic conditions.

Quality and safety in pediatric anesthesia: how can guidelines, checklists, and initiatives improve the outcome?

PubMed

Hagerman, Nancy S; Varughese, Anna M; Kurth, C Dean

2014-06-01

Cognitive aids are tangible or intangible instruments that guide users in decision-making and in the completion of a complex series of tasks. Common examples include mnemonics, checklists, and algorithms. Cognitive aids constitute very effective approaches to achieve well tolerated, high quality healthcare because they promote highly reliable processes that reduce the likelihood of failure. This review describes recent advances in quality improvement for pediatric anesthesiology with emphasis on application of cognitive aids to impact patient safety and outcomes. Quality improvement encourages the examination of systems to create stable processes and ultimately high-value care. Quality improvement initiatives in pediatric anesthesiology have been shown to improve outcomes and the delivery of efficient and effective care at many institutions. The use of checklists, in particular, improves adherence to evidence-based care in crisis situations, decreases catheter-associated bloodstream infections, reduces blood product utilization, and improves communication during the patient handoff process. Use of this simple tool has been associated with decreased morbidity, fewer medical errors, improved provider satisfaction, and decreased mortality in nonanesthesia disciplines as well. Successful quality improvement initiatives utilize cognitive aids such as checklists and have been shown to optimize pediatric patient experience and anesthesia outcomes and reduce perioperative complications.

Concept and implementation of the Globalstar mobile satellite system

NASA Technical Reports Server (NTRS)

Schindall, Joel

1995-01-01

Globalstar is a satellite-based mobile communications system which provides quality wireless communications (voice and/or data) anywhere in the world except the polar regions. The Globalstar system concept is based upon technological advancements in Low Earth Orbit (LEO) satellite technology and in cellular telephone technology, including the commercial application of Code Division Multiple Access (CDMA) technologies. The Globalstar system uses elements of CDMA and Frequency Division Multiple Access (FDMA), combined with satellite Multiple Beam Antenna (MBA) technology and advanced variable-rate vocoder technology to arrive at one of the most efficient modulation and multiple access systems ever proposed for a satellite communications system. The technology used in Globalstar includes the following techniques in obtaining high spectral efficiency and affordable cost per channel: (1) CDMA modulation with efficient power control; (2) high efficiency vocoder with voice activity factor; (3) spot beam antenna for increased gain and frequency reuse; (4) weighted satellite antenna gain for broad geographic coverage; (5) multisatellite user links (diversity) to enhance communications reliability; and (6) soft hand-off between beams and satellites. Initial launch is scheduled in 1997 and the system is scheduled to be operational in 1998. The Globalstar system utilizes frequencies in L-, S- and C-bands which have the potential to offer worldwide availability with authorization by the appropriate regulatory agencies.

Tele-autonomous systems: New methods for projecting and coordinating intelligent action at a distance

NASA Technical Reports Server (NTRS)

Conway, Lynn; Volz, Richard; Walker, Michael W.

1989-01-01

There is a growing need for humans to perform complex remote operations and to extend the intelligence and experience of experts to distant applications. It is asserted that a blending of human intelligence, modern information technology, remote control, and intelligent autonomous systems is required, and have coined the term tele-autonomous technology, or tele-automation, for methods producing intelligent action at a distance. Tele-automation goes beyond autonomous control by blending in human intelligence. It goes beyond tele-operation by incorporating as much autonomy as possible and/or reasonable. A new approach is discussed for solving one of the fundamental problems facing tele-autonomous systems: The need to overcome time delays due to telemetry and signal propagation. New concepts are introduced called time and position clutches, that allow the time and position frames between the local user control and the remote device being controlled, to be desynchronized respectively. The design and implementation of these mechanisms are described in detail. It is demonstrated that these mechanisms lead to substantial telemanipulation performance improvements, including the result of improvements even in the absence of time delays. The new controls also yield a simple protocol for control handoffs of manipulation tasks between local operators and remote systems.

En route care patient safety: thoughts from the field.

PubMed

McNeill, Margaret M; Pierce, Penny; Dukes, Susan; Bridges, Elizabeth J

2014-08-01

The purpose of this study was to describe the patient safety culture of en route care in the United States Air Force aeromedical evacuation system. Almost 100,000 patients have been transported since 2001. Safety concerns in this unique environment are complex because of the extraordinary demands of multitasking, time urgency, long duty hours, complex handoffs, and multiple stressors of flight. An internet-based survey explored the perceptions and experiences of safety issues among nursing personnel involved throughout the continuum of aeromedical evacuation care. A convenience sample of 236 nurses and medical technicians from settings representing the continuum was studied. Descriptive and nonparametric statistics were used to analyze the quantitative data, and thematic analysis was applied to the qualitative data. Results indicate that over 90% of respondents agree or strongly agree safety is a priority in their unit and that their unit is responsive to patient safety initiatives. Many respondents described safety incidents or near misses, and these have been categorized as personnel physical capability limitations, environmental threats, medication and equipment issues, and care process problems. Results suggest the care of patients during transport is influenced by the safety culture, human factors, training, experience, and communication. Suggestions to address safety issues emerged from the survey data. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Abundances of Volatile - Bearing Species from Evolved Gas Analysis of Samples from the Rocknest Aeolian Bedform in Gale Crater

NASA Technical Reports Server (NTRS)

Archer, P. D., Jr.; Franc, H. B.; Sutter, B.; McAdam, A.; Ming, D. W.; Morris, R. V.; Mahaffy, P. R.

2013-01-01

The Sample Analysis at Mars (SAM) instrument suite on board the Mars Science Laboratory (MSL) recently ran four samples from an aeolian bedform named Rocknest. SAM detected the evolution of H2O, CO2, O2, and SO2, indicative of the presence of multiple volatile bearing species (Fig 1). The Rocknest bedform is a windblown deposit selected as representative of both the windblown material in Gale crater as well as the globally-distributed martian dust. Four samples of Rocknest material were analyzed by SAM, all from the fifth scoop taken at this location. The material delivered to SAM passed through a 150 m sieve and is assumed to have been well mixed during the sample acquisition/preparation/handoff process. SAM heated the Rocknest samples to approx.835 C at a ramp rate of 35 C/min with a He carrier gas flow rate of apprx.1.5 standard cubic centimeters per minute and at an oven pressure of 30 mbar [1]. Evolved gases were detected by a quadrupole mass spectrometer (QMS). This abstract presents the molar abundances of H2O, CO2, O2, and SO2 as well as their concentration in rocknest samples using an estimated sample mass.

The Accreditation Council for Graduate Medical Education resident duty hour new standards: history, changes, and impact on staffing of intensive care units.

PubMed

Pastores, Stephen M; O'Connor, Michael F; Kleinpell, Ruth M; Napolitano, Lena; Ward, Nicholas; Bailey, Heatherlee; Mollenkopf, Fred P; Coopersmith, Craig M

2011-11-01

The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units. A multidisciplinary group of professionals with expertise in critical care education and clinical practice. Relevant medical literature was accessed through a systematic MEDLINE search and by requesting references from all task force members. Material published by the Accreditation Council for Graduate Medical Education and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force corresponded by electronic mail and held several conference calls to finalize this report. The new rules mandate that all first-year residents work no more than 16 hrs continuously, preserving the 80-hr limit on the resident workweek and 10-hr period between duty periods. More senior trainees may work a maximum of 24 hrs continuously, with an additional 4 hrs permitted for handoffs. Strategic napping is strongly suggested for trainees working longer shifts. Compliance with the new Accreditation Council for Graduate Medical Education duty-hour standards will compel workflow restructuring in intensive care units, which depend on residents to provide a substantial portion of care. Potential solutions include expanded utilization of nurse practitioners and physician assistants, telemedicine, offering critical care training positions to emergency medicine residents, and partnerships with hospitalists. Additional research will be necessary to evaluate the impact of the new standards on patient safety, continuity of care, resident learning, and staffing in the intensive care unit.

Nurse training with simulation: an innovative approach to teach complex microsurgery patient care.

PubMed

Flurry, Mitchell; Brooke, Sebastian; Micholetti, Brett; Natoli, Noel; Moyer, Kurtis; Mnich, Stephanie; Potochny, John

2012-10-01

Simulation has become an integral part of education at all levels within the medical field. The ability to allow personnel to practice and learn in a safe and controlled environment makes it a valuable tool for initial training and continued competence verification. An area of specific interest to the reconstructive microsurgeon is assurance that the nursing staff has adequate training and experience to provide optimum care for microsurgery patients. Plastic surgeons in institutions where few microsurgeries are performed face challenges teaching nurses how to care for these complex patients. Because no standard exists to educate microsurgery nurses, learning often happens by chance on-the-job encounters. Outcomes, therefore, may be affected by poor handoffs between inexperienced personnel. Our objective is to create a course that augments such random clinical experience and teaches the knowledge and skills necessary for successful microsurgery through simulated patient scenarios. Quality care reviews at our institution served as the foundation to develop an accredited nursing course providing clinical training for the care of microsurgery patients. The course combined lectures on microsurgery, pharmacology, and flap monitoring as well as simulated operating room, surgical intensive care unit, postanesthesia care unit, Trauma Bay, and Floor scenarios. Evaluation of participants included precourse examination, postcourse examination, and a 6-month follow-up. Average test scores were 72% precourse and 92% postcourse. Educational value, effectiveness of lectures and simulation, and overall course quality was rated very high or high by 86% of respondents; 0% respondents rated it as low. Six-month follow-up test score average was 88%. Learning to care for microsurgery patients should not be left to chance patient encounters on the job. Simulation provides a safe, reproducible, and controlled clinical experience. Our results show that simulation is a highly rated and effective way to teach nurses microsurgery patient care. Simulated patient care training should be considered to augment the clinical experience in hospitals where microsurgery is performed.

Australian Space Situational Awareness Capability Demonstrations

NASA Astrophysics Data System (ADS)

Morreale, B.; Bessell, T.; Rutten, M.; Cheung, B.

Australia is increasing its contribution to the global space situational awareness (SSA) problem by committing to acquire and operate SSA sensors. Over the last year, a series of collaborative SSA experiments have been undertaken to demonstrate the capabilities of Australian sensors. These experiments aimed to demonstrate how existing Australian sensors could perform in a surveillance of space role, prove passive radar’s capability to observe low earth orbit (LEO) satellites and perform SSA handoffs to optical sensors. The trials established a data sharing and communications protocol that bridged defence, academia, and industry partners. Geographically dispersed optical assets, including the Falcon telescope in Canberra, Raven telescopes in Exmouth (Western Australia) and Defence Science and Technology (DST) Telescopes in Adelaide (South Australia) collected on LEO satellites and established cueing protocols. The Murchison Widefield Array (MWA) located in Western Australia, demonstrated the capability of passive radar as an SSA asset after successfully observing LEO satellites based on reflected terrestrial radio signals. The combination of radar and optical SSA assets allows for the exploitation of each sensors unique advantages and locations across the Australian continent. This paper outlines the capabilities and diversity of Australian optical and radar sensors as demonstrated by field trials in 2016 and 2017. It suggests future potential for harnessing novel radar and optical integration techniques to supplement high-value assets such as the Space Surveillance Telescope as part of the Space Surveillance Network.

Improved communication in post-ICU care by improving writing of ICU discharge letters: a longitudinal before-after study.

PubMed

Medlock, Stephanie; Eslami, Saeid; Askari, Marjan; van Lieshout, Erik Jan; Dongelmans, Dave A; Abu-Hanna, Ameen

2011-11-01

The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the timeliness of discharge letters. A management directive was operationalised by a working group of ICU staff in a longitudinal before-after study. The intervention consisted of (a) changing policy to require a letter for use as a transfer note at the time of ICU discharge, (b) changing the assignment of responsibility to an automatic process, (c) leveraging positive peer pressure by making the list of patients in need of letters visible to colleagues and (d) provision of decision support, through automatic copying of important content from the patient record to the letter and email reminders if letters were not written on time. Statistical process control charts were used to monitor the longitudinal effect of the intervention. The intervention resulted in a 77.9% absolute improvement in the proportion of patients with a complete transfer note at the time of discharge, and an 85.2% absolute improvement in the number of discharge letters written. Statistical process control shows that the effect was sustained over time. A multifaceted intervention can be highly effective for improving discharge communication from the ICU.

Organizational Factors Affect Safety-Net Hospitals' Breast Cancer Treatment Rates.

PubMed

Bickell, Nina A; Moss, Alexandra DeNardis; Castaldi, Maria; Shah, Ajay; Sickles, Alan; Pappas, Peter; Lewis, Theophilus; Kemeny, Margaret; Arora, Shalini; Schleicher, Lori; Fei, Kezhen; Franco, Rebeca; McAlearney, Ann Scheck

2017-12-01

To identify key organizational approaches associated with underuse of breast cancer care. Nine New York City area safety-net hospitals. Mixed qualitative-quantitative, cross-sectional cohort. We used qualitative comparative analysis (QCA) of key stakeholder interviews, defined organizational "conditions," calibrated conditions, and identified solution pathways. We defined underuse as no radiation after lumpectomy in women <75 years or mastectomy in women with ≥4 positive nodes, or no systemic therapy in women with tumors ≥1 cm. We used hierarchical models to assess organizational and patient factors' impact on underuse. Underuse varied by hospital (8-29 percent). QCA found lower underuse sites designated individuals to track and follow-up no-shows; shared clinical information during handoffs; had fully integrated electronic medical records enabling transfer of responsibility across specialties; had strong system support; allocated resources to cancer clinics; had a patient-centered culture paying close organizational attention to clinic patients. High underuse sites lacked these characteristics. Multivariate modeling found that hospitals with strong approaches to follow-up had low underuse rates (RR = 0.28; 0.08-0.95); individual patient characteristics were not significant. At safety-net hospitals, underuse of needed cancer therapies is associated with organizational approaches to track and follow-up treatment. Findings provide varying approaches to safety nets to improve cancer care delivery. © Health Research and Educational Trust.

Improving the reliability of verbal communication between primary care physicians and pediatric hospitalists at hospital discharge.

PubMed

Mussman, Grant M; Vossmeyer, Michael T; Brady, Patrick W; Warrick, Denise M; Simmons, Jeffrey M; White, Christine M

2015-09-01

Timely and reliable verbal communication between hospitalists and primary care physicians (PCPs) is critical for prevention of medical adverse events but difficult in practice. Our aim was to increase the proportion of completed verbal handoffs from on-call residents or attendings to PCPs within 24 hours of patient discharge from a hospital medicine service to ≥90% within 18 months. A multidisciplinary team collaborated to redesign the process by which PCPs were contacted following patient discharge. Interventions focused on the key drivers of obtaining stakeholder buy-in, standardization of the communication process, including assigning primary responsibility for discharge communication to a single resident on each team and batching calls during times of maximum resident availability, reliable automated process initiation through leveraging the electronic health record (EHR), and transparency of data. A run chart assessed the impact of interventions over time. The percentage of calls initiated within 24 hours of discharge improved from 52% to 97%, and the percentage of calls completed improved to 93%. Results were sustained for 18 months. Standardization of the communication process through hospital telephone operators, use of the discharge order to ensure initiation of discharge communication, and batching of phone calls were associated with improvements in our measures. Reliable verbal discharge communication can be achieved through the use of a standardized discharge communication process coupled with the EHR. © 2015 Society of Hospital Medicine.

Effective Implementation of Collaborative Care for Depression: What is Needed?

PubMed Central

Whitebird, Robin R.; Solberg, Leif I.; Jaeckels, Nancy A.; Pietruszewski, Pamela B.; Hadzic, Senka; Unützer, Jürgen; Ohnsorg, Kris A.; Rossom, Rebecca C.; Beck, Arne; Joslyn, Ken; Rubenstein, Lisa V.

2014-01-01

Objective To identify the care model factors that were key for successful implementation of collaborative depression care in a statewide Minnesota primary care initiative. Study Design We used a mixed-methods design incorporating both qualitative data from clinic site visits and quantitative measures of patient activation and 6-month remission rates. Methods Care model factors identified from the site visits were tested for association with rates of activation into the program and remission rates. Results Nine factors were identified as important for successful implementation of collaborative care by the consultants who had trained and interviewed participating clinic teams. Factors correlated with higher patient activation rates were: strong leadership support (0.63), well-defined and implemented care manager roles (0.62), a strong primary care physician champion (0.60), and an on-site and accessible care manager (0.59). However, remission rates at six months were correlated with: an engaged psychiatrist (0.62), not seeing operating costs as a barrier to participation (0.56), and face-to-face communication (warm handoffs) between the care-manager and primary care physician for new patients (0.54). Conclusions Care model factors most important for successful program implementation differ for patient activation into the program versus remission at six months. Knowing which implementation factors are most important for successful implementation will be useful for those interested in adopting this evidence-based approach to improve primary care for patients with depression. PMID:25365745

Using multisensory cues to facilitate air traffic management.

PubMed

Ngo, Mary K; Pierce, Russell S; Spence, Charles

2012-12-01

In the present study, we sought to investigate whether auditory and tactile cuing could be used to facilitate a complex, real-world air traffic management scenario. Auditory and tactile cuing provides an effective means of improving both the speed and accuracy of participants' performance in a variety of laboratory-based visual target detection and identification tasks. A low-fidelity air traffic simulation task was used in which participants monitored and controlled aircraft.The participants had to ensure that the aircraft landed or exited at the correct altitude, speed, and direction and that they maintained a safe separation from all other aircraft and boundaries. The performance measures recorded included en route time, handoff delay, and conflict resolution delay (the performance measure of interest). In a baseline condition, the aircraft in conflict was highlighted in red (visual cue), and in the experimental conditions, this standard visual cue was accompanied by a simultaneously presented auditory, vibrotactile, or audiotactile cue. Participants responded significantly more rapidly, but no less accurately, to conflicts when presented with an additional auditory or audiotactile cue than with either a vibrotactile or visual cue alone. Auditory and audiotactile cues have the potential for improving operator performance by reducing the time it takes to detect and respond to potential visual target events. These results have important implications for the design and use of multisensory cues in air traffic management.

Identifying Risk Factors Associated with Inappropriate Use of Acid Suppressive Therapy at a Community Hospital

PubMed Central

Bodukam, Vijay; Saigal, Kirit; Bahl, Jaya; Wang, Yvette; Hanlon, Alexandra; Lu, Yinghui; Davis, Michael

2016-01-01

Purpose. By examining the prescribing patterns and inappropriate use of acid suppressive therapy (AST) during hospitalization and at discharge we sought to identify the risk factors associated with such practices. Methods. In this retrospective observational study, inpatient records were reviewed from January 2011 to December 2013. Treatment with AST was considered appropriate if the patient had a known specific indication or met criteria for stress ulcer prophylaxis. Results. In 2011, out of 58 patients who were on AST on admission, 32 were newly started on it and 23 (72%) were inappropriate cases. In 2012, out of 97 patients on AST, 61 were newly started on it and 51 (84%) were inappropriate cases. In 2013, 99 patients were on AST, of which 48 were newly started on it and 36 (75%) were inappropriate cases. 19% of the patients inappropriately started on AST were discharged on it in three years. Younger age, female sex, and 1 or more handoffs between services were significantly associated with increased risk of inappropriate AST. Conclusion. Our findings reflect inappropriate prescription of AST which leads to increase in costs of care and unnecessarily puts the patient at risk for potential adverse events. The results of this study emphasize the importance of examining the patient's need for AST at each level of care especially when the identified risk factors are present. PMID:27818680

Small-Scale, Local Area, and Transitional Millimeter Wave Propagation for 5G Communications

NASA Astrophysics Data System (ADS)

Rappaport, Theodore S.; MacCartney, George R.; Sun, Shu; Yan, Hangsong; Deng, Sijia

2017-12-01

This paper studies radio propagation mechanisms that impact handoffs, air interface design, beam steering, and MIMO for 5G mobile communication systems. Knife edge diffraction (KED) and a creeping wave linear model are shown to predict diffraction loss around typical building objects from 10 to 26 GHz, and human blockage measurements at 73 GHz are shown to fit a double knife-edge diffraction (DKED) model which incorporates antenna gains. Small-scale spatial fading of millimeter wave received signal voltage amplitude is generally Ricean-distributed for both omnidirectional and directional receive antenna patterns under both line-of-sight (LOS) and non-line-of-sight (NLOS) conditions in most cases, although the log-normal distribution fits measured data better for the omnidirectional receive antenna pattern in the NLOS environment. Small-scale spatial autocorrelations of received voltage amplitudes are shown to fit sinusoidal exponential and exponential functions for LOS and NLOS environments, respectively, with small decorrelation distances of 0.27 cm to 13.6 cm (smaller than the size of a handset) that are favorable for spatial multiplexing. Local area measurements using cluster and route scenarios show how the received signal changes as the mobile moves and transitions from LOS to NLOS locations, with reasonably stationary signal levels within clusters. Wideband mmWave power levels are shown to fade from 0.4 dB/ms to 40 dB/s, depending on travel speed and surroundings.

Pilot trial of IOM duty hour recommendations in neurology residency programs: unintended consequences.

PubMed

Schuh, L A; Khan, M A; Harle, H; Southerland, A M; Hicks, W J; Falchook, A; Schultz, L; Finney, G R

2011-08-30

To study the potential effect of the 2008 Institute of Medicine (IOM) work duty hour (WDH) recommendations on neurology residency programs. This study evaluated resident sleepiness, personal study hours, quality of life, and satisfaction and faculty satisfaction during a control month using the Accreditation Council for Graduate Medical Education WDH requirements and during an intervention month using the IOM WDH recommendations. Resident participation in both schedules was mandatory, but both resident and faculty participation in the outcome measures was voluntary. Thirty-four residents (11 postgraduate year [PGY]-4, 9 PGY-3, and 14 PGY-2) participated. End-of-work shift sleepiness, mean weekly sleep hours, personal study hours, and hours spent in lectures did not differ between the control and intervention months. Resident quality of life measured by the Maslach Burnout Inventory declined for 1 subscore in the intervention month (p = 0.03). Resident education satisfaction declined during the intervention month for issues related to continuity of care, patient hand-offs, and knowledge of their patients. Faculty satisfaction declined during the intervention month, without a decline in quality of life. The results from 3 residency programs suggest that the IOM WDH recommendations may negatively affect neurology resident education. This study was limited by the short duration of implementation, negative bias against the IOM recommendations, and inability to blind faculty. Additional study of the IOM WDH recommendations is warranted before widespread implementation.

Effects of acuity-adaptable rooms on flow of patients and delivery of care.

PubMed

Hendrich, Ann L; Fay, Joy; Sorrells, Amy K

2004-01-01

Delayed transfers of patients between nursing units and lack of available beds are significant problems that increase costs and decrease quality of care and satisfaction among patients and staff. To test whether use of acuity-adaptable rooms helps solve problems with transfers of patients, satisfaction levels, and medical errors. A pre-post method was used to compare the effects of environmental design on various clinical and financial measures. Twelve outcome-based questions were formulated as the basis for inquiry. Two years of baseline data were collected before the unit moved and were compared with 3 years of data collected after the move. Significant improvements in quality and operational cost occurred after the move, including a large reduction in clinician handoffs and transfers; reductions in medication error and patient fall indexes; improvements in predictive indicators of patients' satisfaction; decrease in budgeted nursing hours per patient day and increased available nursing time for direct care without added cost; increase in patient days per bed, with a smaller bed base (number of beds per patient days). Some staff turnover occurred during the first year; turnover stabilized thereafter. Data in 5 key areas (flow of patients and hospital capacity, patients' dissatisfaction, sentinel events, mean length of stay, and allocation of nursing productivity) appear to be sufficient to test the business case for future investment in partial or complete replication of this model with appropriate populations of patients.

Enhanced Algorithms for EO/IR Electronic Stabilization, Clutter Suppression, and Track-Before-Detect for Multiple Low Observable Targets

NASA Astrophysics Data System (ADS)

Tartakovsky, A.; Brown, A.; Brown, J.

The paper describes the development and evaluation of a suite of advanced algorithms which provide significantly-improved capabilities for finding, fixing, and tracking multiple ballistic and flying low observable objects in highly stressing cluttered environments. The algorithms have been developed for use in satellite-based staring and scanning optical surveillance suites for applications including theatre and intercontinental ballistic missile early warning, trajectory prediction, and multi-sensor track handoff for midcourse discrimination and intercept. The functions performed by the algorithms include electronic sensor motion compensation providing sub-pixel stabilization (to 1/100 of a pixel), as well as advanced temporal-spatial clutter estimation and suppression to below sensor noise levels, followed by statistical background modeling and Bayesian multiple-target track-before-detect filtering. The multiple-target tracking is performed in physical world coordinates to allow for multi-sensor fusion, trajectory prediction, and intercept. Output of detected object cues and data visualization are also provided. The algorithms are designed to handle a wide variety of real-world challenges. Imaged scenes may be highly complex and infinitely varied -- the scene background may contain significant celestial, earth limb, or terrestrial clutter. For example, when viewing combined earth limb and terrestrial scenes, a combination of stationary and non-stationary clutter may be present, including cloud formations, varying atmospheric transmittance and reflectance of sunlight and other celestial light sources, aurora, glint off sea surfaces, and varied natural and man-made terrain features. The targets of interest may also appear to be dim, relative to the scene background, rendering much of the existing deployed software useless for optical target detection and tracking. Additionally, it may be necessary to detect and track a large number of objects in the threat cloud, and these objects may not always be resolvable in individual data frames. In the present paper, the performance of the developed algorithms is demonstrated using real-world data containing resident space objects observed from the MSX platform, with backgrounds varying from celestial to combined celestial and earth limb, with instances of extremely bright aurora clutter. Simulation results are also presented for parameterized variations in signal-to-clutter levels (down to 1/1000) and signal-to-noise levels (down to 1/6) for simulated targets against real-world terrestrial clutter backgrounds. We also discuss algorithm processing requirements and C++ software processing capabilities from our on-going MDA- and AFRL-sponsored development of an image processing toolkit (iPTK). In the current effort, the iPTK is being developed to a Technology Readiness Level (TRL) of 6 by mid-2010, in preparation for possible integration with STSS-like, SBIRS high-like and SBSS-like surveillance suites.

The High Altitude Balloon Experiment demonstration of acquisition, tracking, and pointing technologies (HABE-ATP)

NASA Astrophysics Data System (ADS)

Dimiduk, D.; Caylor, M.; Williamson, D.; Larson, L.

1995-01-01

The High Altitude Balloon Experiment demonstration of Acquisition, Tracking, and Pointing (HABE-ATP) is a system built around balloon-borne payload which is carried to a nominal 26-km altitude. The goal is laser tracking thrusting theater and strategic missiles, and then pointing a surrogate laser weapon beam, with performance levels end a timeline traceable to operational laser weapon system requirements. This goal leads to an experiment system design which combines hardware from many technology areas: an optical telescope and IR sensors; an advanced angular inertial reference; a flexible multi-level of actuation digital control system; digital tracking processors which incorporate real-time image analysis and a pulsed, diode-pumped solid state tracking laser. The system components have been selected to meet the overall experiment goals of tracking unmodified boosters at 50- 200 km range. The ATP system on HABE must stabilize and control a relative line of sight between the platform and the unmodified target booster to a 1 microrad accuracy. The angular pointing reference system supports both open loop and closed loop track modes; GPS provides absolute position reference. The control system which positions the line of sight for the ATP system must sequence through accepting a state vector handoff, closed-loop passive IR acquisition, passive IR intermediate fine track, active fine track, and then finally aimpoint determination and maintenance modes. Line of sight stabilization to fine accuracy levels is accomplished by actuating wide bandwidth fast steering mirrors (FSM's). These control loops off-load large-amplitude errors to the outer gimbal in order to remain within the limited angular throw of the FSM's. The SWIR acquisition and MWIR intermediate fine track sensors (both PtSi focal planes) image the signature of the rocket plume. After Hard Body Handover (HBHO), active fine tracking is conducted with a visible focal plane viewing the laser-illuminated target rocket body. The track and fire control performance must be developed to the point that an aimpoint can be selected, maintained, and then track performance scored with a low-power 'surrogate' weapon beam. Extensive instrumentation monitors not only the optical sensors and the video data, but all aspects of each of the experiment subsystems such as the control system, the experiment flight vehicle, and the tracker. Because the system is balloon-borne and recoverable, it is expected to fly many times during its development program.

Variability of patient safety culture in Belgian acute hospitals.

PubMed

Vlayen, Annemie; Schrooten, Ward; Wami, Welcome; Aerts, Marc; Barrado, Leandro Garcia; Claes, Neree; Hellings, Johan

2015-06-01

The aim of this study was to measure differences in safety culture perceptions within Belgian acute hospitals and to examine variability based on language, work area, staff position, and work experience. The Hospital Survey on Patient Safety Culture was distributed to hospitals participating in the national quality and safety program (2007-2009). Hospitals were invited to participate in a comparative study. Data of 47,136 respondents from 89 acute hospitals were used for quantitative analysis. Percentages of positive response were calculated on 12 dimensions. Generalized estimating equations models were fitted to explore differences in safety culture. Handoffs and transitions, staffing, and management support for patient safety were considered as major problem areas. Dutch-speaking hospitals had higher odds of positive perceptions for most dimensions in comparison with French-speaking hospitals. Safety culture scores were more positive for respondents working in pediatrics, psychiatry, and rehabilitation compared with the emergency department, operating theater, and multiple hospital units. We found an important gap in safety culture perceptions between leaders and assistants within disciplines. Administration and middle management had lower perceptions toward patient safety. Respondents working less than 1 year in the current hospital had more positive safety culture perceptions in comparison with all other respondents. Large comparative databases provide the opportunity to identify distinct high and low scoring groups. In our study, language, work area, and profession were identified as important safety culture predictors. Years of experience in the hospital had only a small effect on safety culture perceptions.

Toward sensor modular autonomy for persistent land intelligence surveillance and reconnaissance (ISR)

NASA Astrophysics Data System (ADS)

Thomas, Paul A.; Marshall, Gillian; Faulkner, David; Kent, Philip; Page, Scott; Islip, Simon; Oldfield, James; Breckon, Toby P.; Kundegorski, Mikolaj E.; Clark, David J.; Styles, Tim

2016-05-01

Currently, most land Intelligence, Surveillance and Reconnaissance (ISR) assets (e.g. EO/IR cameras) are simply data collectors. Understanding, decision making and sensor control are performed by the human operators, involving high cognitive load. Any automation in the system has traditionally involved bespoke design of centralised systems that are highly specific for the assets/targets/environment under consideration, resulting in complex, non-flexible systems that exhibit poor interoperability. We address a concept of Autonomous Sensor Modules (ASMs) for land ISR, where these modules have the ability to make low-level decisions on their own in order to fulfil a higher-level objective, and plug in, with the minimum of preconfiguration, to a High Level Decision Making Module (HLDMM) through a middleware integration layer. The dual requisites of autonomy and interoperability create challenges around information fusion and asset management in an autonomous hierarchical system, which are addressed in this work. This paper presents the results of a demonstration system, known as Sensing for Asset Protection with Integrated Electronic Networked Technology (SAPIENT), which was shown in realistic base protection scenarios with live sensors and targets. The SAPIENT system performed sensor cueing, intelligent fusion, sensor tasking, target hand-off and compensation for compromised sensors, without human control, and enabled rapid integration of ISR assets at the time of system deployment, rather than at design-time. Potential benefits include rapid interoperability for coalition operations, situation understanding with low operator cognitive burden and autonomous sensor management in heterogenous sensor systems.

Adolescent to Adult HIV Health Care Transition From the Perspective of Adult Providers in the United States.

PubMed

Tanner, Amanda E; Philbin, Morgan M; Ma, Alice; Chambers, Brittany D; Nichols, Sharon; Lee, Sonia; Fortenberry, J Dennis

2017-10-01

The HIV Care Continuum highlights the need for HIV-infected youth to be tested, linked, and maintained in lifelong care. Care engagement is important for HIV-infected youth in order for them to stay healthy, maintain a low viral load, and reduce further transmission. One point of potential interruption in the care continuum is during health care transition from adolescent- to adult-centered HIV care. HIV-related health care transition research focuses mainly on youth and on adolescent clinic providers; missing is adult clinic providers' perspectives. We examined health care transition processes through semi-structured interviews with 28 adult clinic staff across Adolescent Trials Network sites. We also collected quantitative data related to clinical characteristics and transition-specific strategies. Overall, participants described health care transition as a "warm handoff" and a collaborative effort across adolescent and adult clinics. Emergent transition themes included adult clinical care culture (e.g., patient responsibility), strategies for connecting youth to adult care (e.g., adolescent clinic staff attending youth's first appointment at adult clinic), and approaches to evaluating transition outcomes (e.g., data sharing). Participants provided transition improvement recommendations (e.g., formalized protocols). Using evidence-based research and a quality improvement framework to inform comprehensive and streamlined transition protocols can help enhance the capacity of adult clinics to collaborate with adolescent clinics to provide coordinated and uninterrupted HIV-related care and to improve continuum of care outcomes. Copyright © 2017 Society for Adolescent Health and Medicine. All rights reserved.

Limits on same-day billing in Medicaid hinders integration of behavioral health into the medical home model.

PubMed

Roby, Dylan H; Jones, Erynne E

2016-02-01

The potential expansion of insurance coverage through the Patient Protection and Affordable Care Act of 2010 can facilitate the reduction of access barriers and improved quality for behavioral health care. More than 5 million of the newly insured are expected to have mental health and substance use disorders. In addition, state and federal efforts to integrate behavioral and medical health needs through patient-centered medical home models and innovations in payment strategies provide an unprecedented opportunity to use federal financial support to improve not only access to care, but also improve quality through active care coordination, use of interdisciplinary teams, colocating services, and engaging in warm hand-offs between providers in the same setting. These potential advances are hindered in 24 different states because of Medicaid payment policy, with 7 explicitly limiting the ability to reimburse for physical health and behavioral health services on the same day for all providers. Without the ability for providers to be reimbursed for different services on the same day to improve behavioral and medical health care coordination, these states could be limited in their ability to improve care via patient-centered approaches and interdisciplinary team-based care that would involve physicians, clinical psychologists, psychiatrists, and other mental health professionals. Limits on same-day billing in Medicaid programs could impact up to 36.7 million people in 24 states, which is approximately 52.6% of all Medicaid enrollees. (c) 2016 APA, all rights reserved).

Use of a Shared Mental Model by a Team Composed of Oncology, Palliative Care, and Supportive Care Clinicians to Facilitate Shared Decision Making in a Patient With Advanced Cancer.

PubMed

D'Ambruoso, Sarah F; Coscarelli, Anne; Hurvitz, Sara; Wenger, Neil; Coniglio, David; Donaldson, Dusty; Pietras, Christopher; Walling, Anne M

2016-11-01

Our case describes the efforts of team members drawn from oncology, palliative care, supportive care, and primary care to assist a woman with advanced cancer in accepting care for her psychosocial distress, integrating prognostic information so that she could share in decisions about treatment planning, involving family in her care, and ultimately transitioning to hospice. Team members in our setting included a medical oncologist, oncology nurse practitioner, palliative care nurse practitioner, oncology social worker, and primary care physician. The core members were the patient and her sister. Our team grew organically as a result of patient need and, in doing so, operationalized an explicitly shared understanding of care priorities. We refer to this shared understanding as a shared mental model for care delivery, which enabled our team to jointly set priorities for care through a series of warm handoffs enabled by the team's close proximity within the same clinic. When care providers outside our integrated team became involved in the case, significant communication gaps exposed the difficulty in extending our shared mental model outside the integrated team framework, leading to inefficiencies in care. Integration of this shared understanding for care and close proximity of team members proved to be key components in facilitating treatment of our patient's burdensome cancer-related distress so that she could more effectively participate in treatment decision making that reflected her goals of care.

Program Director Perceptions of Proficiency in the Core Entrustable Professional Activities.

PubMed

Pearlman, R Ellen; Pawelczak, Melissa; Yacht, Andrew C; Akbar, Salaahuddin; Farina, Gino A

2017-10-01

The Association of American Medical Colleges describes 13 core entrustable professional activities (EPAs) that every graduating medical student should be expected to perform proficiently on day 1 of residency, regardless of chosen specialty. Studies have shown wide variability in program director (PD) confidence in interns' abilities to perform these core EPAs. Little is known regarding comparison of United States Medical Licensing Examination (USMLE) scores with proficiency in EPAs. We determined if PDs from a large health system felt confident in their postgraduate year 1 residents' abilities to perform the 13 core EPAs, and compared perceived EPA proficiency with USMLE Step 1 and Step 2 scores. The PDs were asked to rate their residents' proficiency in each EPA and to provide residents' USMLE scores. Timing coincided with the reporting period for resident milestones. Surveys were completed on 204 of 328 residents (62%). PDs reported that 69% of residents (140 of 204) were prepared for EPA 4 (orders/prescriptions), 61% (117 of 192) for EPA 7 (form clinical questions), 68% (135 of 198) for EPA 8 (handovers), 63% (116 of 185) for EPA 11 (consent), and 38% (49 of 129) for EPA 13 (patient safety). EPA ratings and USMLE 1 and 2 were negatively correlated ( r (101) = -0.23, P  = .031). PDs felt that a significant percentage of residents were not adequately prepared in order writing, forming clinical questions, handoffs, informed consent, and promoting a culture of patient safety. We found no positive association between USMLE scores and EPA ratings.

Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals

PubMed Central

Tucker, Anita L; Heisler, W Scott; Janisse, Laura D

2014-01-01

Frontline care clinicians and staff in hospitals spend at least 10% of their time working around operational failures: situations in which information, supplies, or equipment needed for patient care are insufficient. However, little is known about underlying causes of operational failures and what hospitals can do to reduce their occurrence. To address this gap, we examined the internal supply chains at 2 hospitals with the aim of discovering organizational factors that contribute to operational failures. We conducted in-depth qualitative research, including observations and interviews of more than 80 individuals from 4 nursing units and the ancillary support departments that provide equipment and supplies needed for patient care. We found that a lack of interconnectedness among interdependent departments’ routines was a major source of operational failures. The low levels of interconnectedness occurred because of how the internal supply chains were designed and managed rather than because of employee error or a shortfall in training. Thus, we propose that the time that hospital staff members spend on workarounds can be reduced through deliberate efforts to increase interconnectedness among hospitals’ internal supply departments. Four dimensions of interconnectedness include: 1) hospital-level—rather than department-level—performance measures; 2) internal supply department routines that respond to specific patients’ needs rather than to predetermined stocking routines; 3) knowledge that is necessary for efficient handoffs of materials that is translated across departmental boundaries; and 4) cross-departmental collaboration mechanisms that enable improvement in the flow of materials across departmental boundaries. PMID:25102517

Designed for workarounds: a qualitative study of the causes of operational failures in hospitals.

PubMed

Tucker, Anita L; Heisler, W Scott; Janisse, Laura D

2014-01-01

Frontline care clinicians and staff in hospitals spend at least 10% of their time working around operational failures: situations in which information, supplies, or equipment needed for patient care are insufficient. However, little is known about underlying causes of operational failures and what hospitals can do to reduce their occurrence. To address this gap, we examined the internal supply chains at 2 hospitals with the aim of discovering organizational factors that contribute to operational failures. We conducted in-depth qualitative research, including observations and interviews of more than 80 individuals from 4 nursing units and the ancillary support departments that provide equipment and supplies needed for patient care. We found that a lack of interconnectedness among interdependent departments' routines was a major source of operational failures. The low levels of interconnectedness occurred because of how the internal supply chains were designed and managed rather than because of employee error or a shortfall in training. Thus, we propose that the time that hospital staff members spend on workarounds can be reduced through deliberate efforts to increase interconnectedness among hospitals' internal supply departments. Four dimensions of interconnectedness include: 1) hospital-level-rather than department-level-performance measures; 2) internal supply department routines that respond to specific patients' needs rather than to predetermined stocking routines; 3) knowledge that is necessary for efficient handoffs of materials that is translated across departmental boundaries; and 4) cross-departmental collaboration mechanisms that enable improvement in the flow of materials across departmental boundaries.

Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients

PubMed Central

Johnston, Maximilian; Cookson, Natalie; King, Dominic; Arora, Sonal; Darzi, Ara

2016-01-01

Background Most hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication. Objective The objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers. Methods We recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users’ satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses. Results We recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100–121 versus pager median 77, range 39–104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included “enhances interprofessional efficiency,” “results in less disturbance,” “performed desired functions reliably,” and “allows me to clearly transfer information.” Conclusions Hark improved the quality of transfer of information about simulated patients and was rated by users as more effective and efficient, and less distracting than pagers. Using this device did not result in delay in patient care. PMID:27052694

Towards a Mobile Ecogenomic sensor: the Third Generation Environmental Sample Processor (3G-ESP).

NASA Astrophysics Data System (ADS)

Birch, J. M.; Pargett, D.; Jensen, S.; Roman, B.; Preston, C. M.; Ussler, W.; Yamahara, K.; Marin, R., III; Hobson, B.; Zhang, Y.; Ryan, J. P.; Scholin, C. A.

2016-02-01

Researchers are increasingly using one or more autonomous platforms to characterize ocean processes that change in both space and time. Conceptually, studying processes that change quickly both spatially and temporally seems relatively straightforward. One needs to sample in many locations synoptically over time, or follow a coherent water mass and sample it repeatedly. However, implementing either approach presents many challenges. For example, acquiring samples over days to weeks far from shore, without human intervention, requires multiple systems to work together seamlessly, and the level of autonomy, navigation and communications needed to conduct the work exposes the complexity of these requirements. We are addressing these challenges by developing a new generation of robotic systems that are primarily aimed at studies of microbial-mediated processes. As a step towards realizing this new capability, we have taken lessons learned from our second-generation Environmental Sample Processor (2G-ESP), a robotic microbiology "lab-in-a-can" and have re-engineered the system for use on a Tethys-class Long Range AUV (LRAUV). The new instrument is called the third-generation ESP (3G-ESP), and its integration with the LRAUV provides mobility and a persistent presence not seen before in microbial oceanography. The 3G-ESP autonomously filters a water sample and then either preserves that material for eventual return to a laboratory, or processes the sample in real-time for further downstream molecular analytical analyses. The 3G ESP modularizes hardware needed for the collection and preparation of a sample from subsequent molecular analyses by the use of self-contained "cartridges". Cartridges currently come in two forms: one for the preservation of a sample, and the other for onboard homogenization and handoff for downstream processing via one or more analytical devices. The 3G-ESP is designed as a stand-alone instrument, and thus could be deployed on a variety of platforms. This presentation will focus on results from early deployments of the prototype 3G-ESP/LRAUV, the challenges encountered in cartridge design, ESP/LRAUV integration, and operational capabilities that show the potential of mobile, ecogenomic sensors in the ocean sciences.

Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: A targeted needs assessment using the Intervention Mapping framework.

PubMed

Kerstenetzky, Luiza; Birschbach, Matthew J; Beach, Katherine F; Hager, David R; Kennelty, Korey A

2018-02-01

Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy. We report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to SNF and LTC pharmacy staff. Applying the Intervention Mapping (IM) framework, a targeted needs assessment was performed using quantitative and qualitative methods. Using the hospital discharge medication list as reference, medication discrepancies in the SNF and LTC pharmacy lists were identified. SNF and LTC pharmacy staffs were also interviewed regarding the continuity of medication information post-discharge from the hospital. At least one medication discrepancy was discovered in 77.6% (n = 45/58) of SNF and 76.0% (n = 19/25) of LTC pharmacy medication lists. A total of 191 medication discrepancies were identified across all SNF and LTC pharmacy records. Of the 69 SNF staff interviewed, 20.3% (n = 14) reported patient care delays due to omitted documents during the hospital-to-SNF transition. During interviews, communication between the SNF/LTC pharmacy and the discharging hospital was described by facility staff as unidirectional with little opportunity for feedback on patient care concerns. The targeted needs assessment guided by the IM framework has lent to several planned process improvements initiatives to help reduce medication discrepancies during the hospital-to-SNF transition as well as improve communication between healthcare entities. Opening lines of communication along with aligning healthcare entity goals may help prevent medication-related errors. Copyright © 2017 Elsevier Inc. All rights reserved.

Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients.

PubMed

Patel, Bhavesh; Johnston, Maximilian; Cookson, Natalie; King, Dominic; Arora, Sonal; Darzi, Ara

2016-04-06

Most hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication. The objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers. We recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users' satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses. We recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100-121 versus pager median 77, range 39-104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included "enhances interprofessional efficiency," "results in less disturbance," "performed desired functions reliably," and "allows me to clearly transfer information." Hark improved the quality of transfer of information about simulated patients and was rated by users as more effective and efficient, and less distracting than pagers. Using this device did not result in delay in patient care.

Interaction Mindsets, Interactional Behaviors, and L2 Development: An Affective-Social-Cognitive Model

ERIC Educational Resources Information Center

Sato, Masatoshi

2017-01-01

This classroom-based study explored links among second language (L2) learners' interaction mindsets, interactional behaviors, and L2 development in the context of peer interaction. While peer interaction research has revealed that certain interactional behaviors (e.g., receiving corrective feedback and engaging in collaborative interaction) assist…

Constructing an understanding of mind: the development of children's social understanding within social interaction.

PubMed

Carpendale, Jeremy I M; Lewis, Charlie

2004-02-01

Theories of children's developing understanding of mind tend to emphasize either individualistic processes of theory formation, maturation, or introspection, or the process of enculturation. However, such theories must be able to account for the accumulating evidence of the role of social interaction in the development of social understanding. We propose an alternative account, according to which the development of children's social understanding occurs within triadic interaction involving the child's experience of the world as well as communicative interaction with others about their experience and beliefs (Chapman 1991; 1999). It is through such triadic interaction that children gradually construct knowledge of the world as well as knowledge of other people. We contend that the extent and nature of the social interaction children experience will influence the development of children's social understanding. Increased opportunity to engage in cooperative social interaction and exposure to talk about mental states should facilitate the development of social understanding. We review evidence suggesting that children's understanding of mind develops gradually in the context of social interaction. Therefore, we need a theory of development in this area that accords a fundamental role to social interaction, yet does not assume that children simply adopt socially available knowledge but rather that children construct an understanding of mind within social interaction.

A Social-Interactive Neuroscience Approach to Understanding the Developing Brain.

PubMed

Redcay, Elizabeth; Warnell, Katherine Rice

2018-01-01

From birth onward, social interaction is central to our everyday lives. Our ability to seek out social partners, flexibly navigate and learn from social interactions, and develop social relationships is critically important for our social and cognitive development and for our mental and physical health. Despite the importance of our social interactions, the neurodevelopmental bases of such interactions are underexplored, as most research examines social processing in noninteractive contexts. We begin this chapter with evidence from behavioral work and adult neuroimaging studies demonstrating how social-interactive context fundamentally alters cognitive and neural processing. We then highlight four brain networks that play key roles in social interaction and, drawing on existing developmental neuroscience literature, posit the functional roles these networks may play in social-interactive development. We conclude by discussing how a social-interactive neuroscience approach holds great promise for advancing our understanding of both typical and atypical social development. © 2018 Elsevier Inc. All rights reserved.

Drug interactions evaluation: An integrated part of risk assessment of therapeutics

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

Zhang, Lei; Reynolds, Kellie S.; Zhao, Ping

2010-03-01

Pharmacokinetic drug interactions can lead to serious adverse events or decreased drug efficacy. The evaluation of a new molecular entity's (NME's) drug-drug interaction potential is an integral part of risk assessment during drug development and regulatory review. Alteration of activities of enzymes or transporters involved in the absorption, distribution, metabolism, or excretion of a new molecular entity by concomitant drugs may alter drug exposure, which can impact response (safety or efficacy). The recent Food and Drug Administration (FDA) draft drug interaction guidance ( (http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm072101.pdf)) highlights the methodologies and criteria that may be used to guide drug interaction evaluation by industrymore » and regulatory agencies and to construct informative labeling for health practitioner and patients. In addition, the Food and Drug Administration established a 'Drug Development and Drug Interactions' website to provide up-to-date information regarding evaluation of drug interactions ( (http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/DrugInteractionsLabeling/ucm080499.htm)). This review summarizes key elements in the FDA drug interaction guidance and new scientific developments that can guide the evaluation of drug-drug interactions during the drug development process.« less

Interactive Instructional Technology Systems Development at Kirtland Community College, Roscommon, Michigan.

ERIC Educational Resources Information Center

Perry, Steven B.

1988-01-01

Describes Kirtland Community College's plans to develop an interactive instructional studio on campus to transmit academic courses, develop six interactive satellite stations, provide in-service teacher training on the use of two-way telecommunications, modify existing courses, and incorporate interactive televideo into the college's instructional…

The Development of Interactive Video for Children's Education.

ERIC Educational Resources Information Center

Dockterman, Gabrielle Savage

1991-01-01

Development of two interactive videodisks in space science for middle-school-age children is described, and suggestions for development of affordable and successful interactive products are offered. The first interactive program is a touchscreen exhibit designed for museum use, and the second is a classroom tool for teaching a planetary sciences…

[Early interaction is a prerequisite for favorable psychic development].

PubMed

Pesonen, Anu-Katriina

2010-01-01

Empirical studies on the parent-baby interaction have greatly influenced our insight into the child's psychological development. Initial stages of the research attempted to reveal features in the mother's action that would predict the child's favorable development. Since then, also fathers and the child's development in a more broad sense have been studied. The most prominent progress has taken place in microanalytical methods for these interactions. The research has increased our knowledge of the baby's interactive capabilities and the significance of successful interactive events for the child's development, laying the basis for various interventions related to parenthood.

For the general internist: a review of relevant 2013 innovations in medical education.

PubMed

Roy, Brita; Willett, Lisa L; Bates, Carol; Duffy, Briar; Dunn, Kathel; Karani, Reena; Chheda, Shobhina G

2015-04-01

We conducted a review of articles published in 2013 to identify high-quality research in medical education that was relevant to general medicine education practice. Our review team consisted of six general internists with expertise in medical education of varying ranks, as well as a professional medical librarian. We manually searched 15 journals in pairs, and performed an online search using the PubMed search engine for all original research articles in medical education published in 2013. From the total 4,181 citations identified, we selected 65 articles considered most relevant to general medicine educational practice. Each team member then independently reviewed and rated the quality of each selected article using the modified Medical Education Research Study Quality Instrument. We then reviewed the quality and relevance of each selected study and grouped them into categories of propensity for inclusion. Nineteen studies were felt to be of adequate quality and were of moderate to high propensity for inclusion. Team members then independently voted for studies they felt to be of the highest relevance and quality within the 19 selected studies. The ten articles with the greatest number of votes were included in the review. We categorized the studies into five general themes: Improving Clinical Skills in UME, Inpatient Clinical Teaching Methods, Advancements in Continuity Clinic, Handoffs/Transitions in Care, and Trainee Assessment. Most studies in our review of the 2013 literature in general medical education were limited to single institutions and non-randomized study designs; we identified significant limitations of each study. Selected articles may inform future research and practice of medical educators.

Lithography-induced limits to scaling of design quality

NASA Astrophysics Data System (ADS)

Kahng, Andrew B.

2014-03-01

Quality and value of an IC product are functions of power, performance, area, cost and reliability. The forthcoming 2013 ITRS roadmap observes that while manufacturers continue to enable potential Moore's Law scaling of layout densities, the "realizable" scaling in competitive products has for some years been significantly less. In this paper, we consider aspects of the question, "To what extent should this scaling gap be blamed on lithography?" Non-ideal scaling of layout densities has been attributed to (i) layout restrictions associated with multi-patterning technologies (SADP, LELE, LELELE), as well as (ii) various ground rule and layout style choices that stem from misalignment, reliability, variability, device architecture, and electrical performance vs. power constraints. Certain impacts seem obvious, e.g., loss of 2D flexibility and new line-end placement constraints with SADP, or algorithmically intractable layout stitching and mask coloring formulations with LELELE. However, these impacts may well be outweighed by weaknesses in design methodology and tooling. Arguably, the industry has entered a new era in which many new factors - (i) standard-cell library architecture, and layout guardbanding for automated place-and-route: (ii) performance model guardbanding and signoff analyses: (iii) physical design and manufacturing handoff algorithms spanning detailed placement and routing, stitching and RET; and (iv) reliability guardbanding - all contribute, hand in hand with lithography, to a newly-identified "design capability gap". How specific aspects of process and design enablements limit the scaling of design quality is a fundamental question whose answer must guide future RandD investment at the design-manufacturing interface. terface.

Eddy heat flux across the Antarctic Circumpolar Current estimated from sea surface height standard deviation

NASA Astrophysics Data System (ADS)

Foppert, Annie; Donohue, Kathleen A.; Watts, D. Randolph; Tracey, Karen L.

2017-08-01

Eddy heat flux (EHF) is a predominant mechanism for heat transport across the zonally unbounded mean flow of the Antarctic Circumpolar Current (ACC). Observations of dynamically relevant, divergent, 4 year mean EHF in Drake Passage from the cDrake project, as well as previous studies of atmospheric and oceanic storm tracks, motivates the use of sea surface height (SSH) standard deviation, H*, as a proxy for depth-integrated, downgradient, time-mean EHF (>[EHF>¯>]) in the ACC. Statistics from the Southern Ocean State Estimate corroborate this choice and validate throughout the ACC the spatial agreement between H* and >[EHF>¯>] seen locally in Drake Passage. Eight regions of elevated >[EHF>¯>] are identified from nearly 23.5 years of satellite altimetry data. Elevated cross-front exchange usually does not span the full latitudinal width of the ACC in each region, implying a hand-off of heat between ACC fronts and frontal zones as they encounter the different >[EHF>¯>] hot spots along their circumpolar path. Integrated along circumpolar streamlines, defined by mean SSH contours, there is a convergence of ∮>[EHF>¯>] in the ACC: 1.06 PW enters from the north and 0.02 PW exits to the south. Temporal trends in low-frequency [EHF] are calculated in a running-mean sense using H* from overlapping 4 year subsets of SSH. Significant increases in downgradient [EHF] magnitude have occurred since 1993 at Kerguelen Plateau, Southeast Indian Ridge, and the Brazil-Malvinas Confluence, whereas the other five >[EHF>¯>] hot spots have insignificant trends of varying sign.

The dynamic disulphide relay of quiescin sulphydryl oxidase.

PubMed

Alon, Assaf; Grossman, Iris; Gat, Yair; Kodali, Vamsi K; DiMaio, Frank; Mehlman, Tevie; Haran, Gilad; Baker, David; Thorpe, Colin; Fass, Deborah

2012-08-16

Protein stability, assembly, localization and regulation often depend on the formation of disulphide crosslinks between cysteine side chains. Enzymes known as sulphydryl oxidases catalyse de novo disulphide formation and initiate intra- and intermolecular dithiol/disulphide relays to deliver the disulphides to substrate proteins. Quiescin sulphydryl oxidase (QSOX) is a unique, multi-domain disulphide catalyst that is localized primarily to the Golgi apparatus and secreted fluids and has attracted attention owing to its overproduction in tumours. In addition to its physiological importance, QSOX is a mechanistically intriguing enzyme, encompassing functions typically carried out by a series of proteins in other disulphide-formation pathways. How disulphides are relayed through the multiple redox-active sites of QSOX and whether there is a functional benefit to concatenating these sites on a single polypeptide are open questions. Here we present the first crystal structure of an intact QSOX enzyme, derived from a trypanosome parasite. Notably, sequential sites in the disulphide relay were found more than 40 Å apart in this structure, too far for direct disulphide transfer. To resolve this puzzle, we trapped and crystallized an intermediate in the disulphide hand-off, which showed a 165° domain rotation relative to the original structure, bringing the two active sites within disulphide-bonding distance. The comparable structure of a mammalian QSOX enzyme, also presented here, shows further biochemical features that facilitate disulphide transfer in metazoan orthologues. Finally, we quantified the contribution of concatenation to QSOX activity, providing general lessons for the understanding of multi-domain enzymes and the design of new catalytic relays.

Implementation and spread of interventions into the multilevel context of routine practice and policy: implications for the cancer care continuum.

PubMed

Yano, Elizabeth M; Green, Lawrence W; Glanz, Karen; Ayanian, John Z; Mittman, Brian S; Chollette, Veronica; Rubenstein, Lisa V

2012-05-01

The promise of widespread implementation of efficacious interventions across the cancer continuum into routine practice and policy has yet to be realized. Multilevel influences, such as communities and families surrounding patients or health-care policies and organizations surrounding provider teams, may determine whether effective interventions are successfully implemented. Greater recognition of the importance of these influences in advancing (or hindering) the impact of single-level interventions has motivated the design and testing of multilevel interventions designed to address them. However, implementing research evidence from single- or multilevel interventions into sustainable routine practice and policy presents substantive challenges. Furthermore, relatively few multilevel interventions have been conducted along the cancer care continuum, and fewer still have been implemented, disseminated, or sustained in practice. The purpose of this chapter is, therefore, to illustrate and examine the concepts underlying the implementation and spread of multilevel interventions into routine practice and policy. We accomplish this goal by using a series of cancer and noncancer examples that have been successfully implemented and, in some cases, spread widely. Key concepts across these examples include the importance of phased implementation, recognizing the need for pilot testing, explicit engagement of key stakeholders within and between each intervention level; visible and consistent leadership and organizational support, including financial and human resources; better understanding of the policy context, fiscal climate, and incentives underlying implementation; explication of handoffs from researchers to accountable individuals within and across levels; ample integration of multilevel theories guiding implementation and evaluation; and strategies for long-term monitoring and sustainability.

Prospective memory in an air traffic control simulation: External aids that signal when to act

PubMed Central

Loft, Shayne; Smith, Rebekah E.; Bhaskara, Adella

2011-01-01

At work and in our personal life we often need to remember to perform intended actions at some point in the future, referred to as Prospective Memory. Individuals sometimes forget to perform intentions in safety-critical work contexts. Holding intentions can also interfere with ongoing tasks. We applied theories and methods from the experimental literature to test the effectiveness of external aids in reducing prospective memory error and costs to ongoing tasks in an air traffic control simulation. Participants were trained to accept and hand-off aircraft, and to detect aircraft conflicts. For the prospective memory task participants were required to substitute alternative actions for routine actions when accepting target aircraft. Across two experiments, external display aids were provided that presented the details of target aircraft and associated intended actions. We predicted that aids would only be effective if they provided information that was diagnostic of target occurrence and in this study we examined the utility of aids that directly cued participants when to allocate attention to the prospective memory task. When aids were set to flash when the prospective memory target aircraft needed to be accepted, prospective memory error and costs to ongoing tasks of aircraft acceptance and conflict detection were reduced. In contrast, aids that did not alert participants specifically when the target aircraft were present provided no advantage compared to when no aids we used. These findings have practical implications for the potential relative utility of automated external aids for occupations where individuals monitor multi-item dynamic displays. PMID:21443381

Implementation and Spread of Interventions Into the Multilevel Context of Routine Practice and Policy: Implications for the Cancer Care Continuum

PubMed Central

Green, Lawrence W.; Glanz, Karen; Ayanian, John Z.; Mittman, Brian S.; Chollette, Veronica; Rubenstein, Lisa V.

2012-01-01

The promise of widespread implementation of efficacious interventions across the cancer continuum into routine practice and policy has yet to be realized. Multilevel influences, such as communities and families surrounding patients or health-care policies and organizations surrounding provider teams, may determine whether effective interventions are successfully implemented. Greater recognition of the importance of these influences in advancing (or hindering) the impact of single-level interventions has motivated the design and testing of multilevel interventions designed to address them. However, implementing research evidence from single- or multilevel interventions into sustainable routine practice and policy presents substantive challenges. Furthermore, relatively few multilevel interventions have been conducted along the cancer care continuum, and fewer still have been implemented, disseminated, or sustained in practice. The purpose of this chapter is, therefore, to illustrate and examine the concepts underlying the implementation and spread of multilevel interventions into routine practice and policy. We accomplish this goal by using a series of cancer and noncancer examples that have been successfully implemented and, in some cases, spread widely. Key concepts across these examples include the importance of phased implementation, recognizing the need for pilot testing, explicit engagement of key stakeholders within and between each intervention level; visible and consistent leadership and organizational support, including financial and human resources; better understanding of the policy context, fiscal climate, and incentives underlying implementation; explication of handoffs from researchers to accountable individuals within and across levels; ample integration of multilevel theories guiding implementation and evaluation; and strategies for long-term monitoring and sustainability. PMID:22623601

Seasonal variation in family member perceptions of physician competence in the intensive care unit: findings from one academic medical center.

PubMed

Stevens, Jennifer P; Kachniarz, Bart; O'Reilly, Kristin; Howell, Michael D

2015-04-01

Researchers have found mixed results about the risk to patient safety in July, when newly minted physicians enter U.S. hospitals to begin their clinical training, the so-called "July effect." However, patient and family satisfaction and perception of physician competence during summer months remain unknown. The authors conducted a retrospective observational cohort study of 815 family members of adult intensive care unit (ICU) patients who completed the Family Satisfaction with Care in the Intensive Care Unit instrument from eight ICUs at Beth Israel Deaconess Medical Center, Boston, Massachusetts, between April 2008 and June 2011. The association of ICU care in the summer months (July-September) versus other seasons and family perception of physician competence was examined in univariable and multivariable analyses. A greater proportion of family members described physicians as competent in summer months as compared with winter months (odds ratio [OR] 1.9; 95% confidence interval [CI] 1.2-3.0; P = .003). After adjustment for patient and proxy demographics, severity of illness, comorbidities, and features of the admission in a multivariable model, seasonal variation of family perception of physician competence persisted (summer versus winter, OR of judging physicians competent 2.4; 95% CI 1.3-4.4; P = .004). Seasonal variation exists in family perception of physician competence in the ICU, but opposite to the "July effect." The reasons for this variation are not well understood. Further research is necessary to explore the role of senior provider involvement, trainee factors, system factors such as handoffs, or other possible contributors.

Challenges to nurses' efforts of retrieving, documenting, and communicating patient care information.

PubMed

Keenan, Gail; Yakel, Elizabeth; Dunn Lopez, Karen; Tschannen, Dana; Ford, Yvonne B

2013-01-01

To examine information flow, a vital component of a patient's care and outcomes, in a sample of multiple hospital nursing units to uncover potential sources of error and opportunities for systematic improvement. This was a qualitative study of a sample of eight medical-surgical nursing units from four diverse hospitals in one US state. We conducted direct work observations of nursing staff's communication patterns for entire shifts (8 or 12 h) for a total of 200 h and gathered related documentation artifacts for analyses. Data were coded using qualitative content analysis procedures and then synthesized and organized thematically to characterize current practices. Three major themes emerged from the analyses, which represent serious vulnerabilities in the flow of patient care information during nurse hand-offs and to the entire interdisciplinary team across time and settings. The three themes are: (1) variation in nurse documentation and communication; (2) the absence of a centralized care overview in the patient's electronic health record, ie, easily accessible by the entire care team; and (3) rarity of interdisciplinary communication. The care information flow vulnerabilities are a catalyst for multiple types of serious and undetectable clinical errors. We have two major recommendations to address the gaps: (1) to standardize the format, content, and words used to document core information, such as the plan of care, and make this easily accessible to all team members; (2) to conduct extensive usability testing to ensure that tools in the electronic health record help the disconnected interdisciplinary team members to maintain a shared understanding of the patient's plan.

Challenges to nurses' efforts of retrieving, documenting, and communicating patient care information

PubMed Central

Yakel, Elizabeth; Dunn Lopez, Karen; Tschannen, Dana; Ford, Yvonne B

2013-01-01

Objective To examine information flow, a vital component of a patient's care and outcomes, in a sample of multiple hospital nursing units to uncover potential sources of error and opportunities for systematic improvement. Design This was a qualitative study of a sample of eight medical–surgical nursing units from four diverse hospitals in one US state. We conducted direct work observations of nursing staff's communication patterns for entire shifts (8 or 12 h) for a total of 200 h and gathered related documentation artifacts for analyses. Data were coded using qualitative content analysis procedures and then synthesized and organized thematically to characterize current practices. Results Three major themes emerged from the analyses, which represent serious vulnerabilities in the flow of patient care information during nurse hand-offs and to the entire interdisciplinary team across time and settings. The three themes are: (1) variation in nurse documentation and communication; (2) the absence of a centralized care overview in the patient's electronic health record, ie, easily accessible by the entire care team; and (3) rarity of interdisciplinary communication. Conclusion The care information flow vulnerabilities are a catalyst for multiple types of serious and undetectable clinical errors. We have two major recommendations to address the gaps: (1) to standardize the format, content, and words used to document core information, such as the plan of care, and make this easily accessible to all team members; (2) to conduct extensive usability testing to ensure that tools in the electronic health record help the disconnected interdisciplinary team members to maintain a shared understanding of the patient's plan. PMID:22822042

Prospective memory in an air traffic control simulation: external aids that signal when to act.

PubMed

Loft, Shayne; Smith, Rebekah E; Bhaskara, Adella

2011-03-01

At work and in our personal life we often need to remember to perform intended actions at some point in the future, referred to as Prospective Memory. Individuals sometimes forget to perform intentions in safety-critical work contexts. Holding intentions can also interfere with ongoing tasks. We applied theories and methods from the experimental literature to test the effectiveness of external aids in reducing prospective memory error and costs to ongoing tasks in an air traffic control simulation. Participants were trained to accept and hand-off aircraft and to detect aircraft conflicts. For the prospective memory task, participants were required to substitute alternative actions for routine actions when accepting target aircraft. Across two experiments, external display aids were provided that presented the details of target aircraft and associated intended actions. We predicted that aids would only be effective if they provided information that was diagnostic of target occurrence, and in this study, we examined the utility of aids that directly cued participants when to allocate attention to the prospective memory task. When aids were set to flash when the prospective memory target aircraft needed to be accepted, prospective memory error and costs to ongoing tasks of aircraft acceptance and conflict detection were reduced. In contrast, aids that did not alert participants specifically when the target aircraft were present provided no advantage compared to when no aids were used. These findings have practical implications for the potential relative utility of automated external aids for occupations where individuals monitor multi-item dynamic displays.

"Why Is This Patient Being Sent Here?": Communication from Urgent Care to the Emergency Department.

PubMed

Gardner, Rebekah; Choo, Esther K; Gravenstein, Stefan; Baier, Rosa R

2016-03-01

Despite patients' increasing use of urgent care centers (UCC), little is known about how urgent care clinicians communicate with the emergency department (ED). To assess ED clinicians' perceptions of the quality and consistency of communication when patients are referred from UCCs to EDs. Emergency medicine department chairs distributed a brief, electronic survey to a statewide sample of ED clinicians via e-mail. The survey included multiple-choice and free-text questions focused on types of communication desired and received from UCCs, types of test results available on transfer, and suggestions for improvement. Of 199 ED clinicians, 102 (51.3%) responded. More than four out of five respondents "somewhat" or "strongly agreed" that each of the following would be helpful: a telephone call, the reason for referral, specific concern, a copy of the chart, and UCC contact information. However, ED clinicians reported not consistently receiving these: only a fifth (21.6%) of clinicians reported receiving the specific concern for their last 5 patients transferred from a UCC, and 34.3% recalled receiving a copy of the chart. Overall, 54.9% reported receiving laboratory test results "often or almost always," 49.0% electrocardiograms, and 44.1% imaging reports. Qualitative analysis revealed several themes: incomplete data when patients are referred; barriers to discussion between ED and urgent care clinicians; and possible solutions to improve communication. Our findings highlight variation in communication from UCCs to EDs, indicating a need to improve communication standards and practices. We identify several potential ways to improve this clinical information hand-off. Copyright © 2016 Elsevier Inc. All rights reserved.

Overcoming Barriers to Sustained Engagement in Mental Health Care: Perspectives of Rural Veterans and Providers.

PubMed

Fischer, Ellen P; McSweeney, Jean C; Wright, Patricia; Cheney, Ann; Curran, Geoffrey M; Henderson, Kathy; Fortney, John C

2016-09-01

To better understand the attitudes, beliefs, and values that influence use of mental health care among rural veterans. In-depth, semistructured interviews were conducted with 25 rural veterans and 11 rural mental health care providers in 4 states. Experienced qualitative interviewers asked participants about the attitudinal factors they thought most influenced rural veterans' decisions to seek and sustain mental health care. Verbatim transcriptions were analyzed using content analysis and constant comparison. Rural veterans and their mental health care providers reported the same major attitudinal barriers to veterans' mental health treatment-seeking. Pre-eminent among those barriers was the importance rural veterans place on independence and self-reliance. The centrality of self-reliance was attributed variously to rural, military, religious, and/or gender-based belief systems. Stoicism, the stigma associated with mental illness and health care, and a lack of trust in the VA as a caring organization were also frequently mentioned. Perceived need for care and the support of other veterans were critical to overcoming attitudinal barriers to initial treatment-seeking, whereas critical facilitators of ongoing service use included "warm handoffs" from medical to mental health care providers, perceived respect and caring from providers, as well as provider accessibility and continuity. Attitudes and values, like self-reliance, commonly associated with rural culture may play an important role in underutilization of needed mental health services. System support for peer and provider behaviors that generate trust and demonstrate caring may help overcome attitudinal barriers to treatment-seeking and sustained engagement in mental health care among rural veterans. © 2016 National Rural Health Association.

Differential Contributions of Ventral and Dorsal Striatum to Early and Late Phases of Cognitive Set Reconfiguration

PubMed Central

Sleezer, Brianna J.; Hayden, Benjamin Y.

2017-01-01

Flexible decision-making, a defining feature of human cognition, is typically thought of as a canonical pFC function. Recent work suggests that the striatum may participate as well; however, its role in this process is not well understood. We recorded activity of neurons in both the ventral (VS) and dorsal (DS) striatum while rhesus macaques performed a version of the Wisconsin Card Sorting Test, a classic test of flexibility. Our version of the task involved a trial-and-error phase before monkeys could identify the correct rule on each block. We observed changes in firing rate in both regions when monkeys switched rules. Specifically, VS neurons demonstrated switch-related activity early in the trial-and-error period when the rule needed to be updated, and a portion of these neurons signaled information about the switch context (i.e., whether the switch was intradimensional or extradimensional). Neurons in both VS and DS demonstrated switch-related activity at the end of the trial-and-error period, immediately before the rule was fully established and maintained, but these signals did not carry any information about switch context. We also observed associative learning signals (i.e., specific responses to options associated with rewards in the presentation period before choice) that followed the same pattern as switch signals (early in VS, later in DS). Taken together, these results endorse the idea that the striatum participates directly in cognitive set reconfiguration and suggest that single neurons in the striatum may contribute to a functional handoff from the VS to the DS during reconfiguration processes. PMID:27417204

Communication in healthcare: a narrative review of the literature and practical recommendations.

PubMed

Vermeir, P; Vandijck, D; Degroote, S; Peleman, R; Verhaeghe, R; Mortier, E; Hallaert, G; Van Daele, S; Buylaert, W; Vogelaers, D

2015-11-01

Effective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare. Narrative literature review. A search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (MeSH)terms 'communication', 'primary health care', 'correspondence', 'patient safety', 'patient handoff' and 'continuity of patient care'. Reviewers screened 4609 records and 462 full texts were checked according following inclusion criteria: (1) publication between January 1985 and March 2014, (2) availability as full text in English, (3) categorisation as original research, reviews, meta-analyses or letters to the editor. A total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences. There is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow-up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver. © 2015 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

FIRESTORM: a collaborative network suite application for rapid sensor data processing and precise decisive responses

NASA Astrophysics Data System (ADS)

Kaniyantethu, Shaji

2011-06-01

This paper discusses the many features and composed technologies in Firestorm™ - a Distributed Collaborative Fires and Effects software. Modern response management systems capitalize on the capabilities of a plethora of sensors and its output for situational awareness. Firestorm utilizes a unique networked lethality approach by integrating unmanned air and ground vehicles to provide target handoff and sharing of data between humans and sensors. The system employs Bayesian networks for track management of sensor data, and distributed auction algorithms for allocating targets and delivering the right effect without information overload to the Warfighter. Firestorm Networked Effects Component provides joint weapon-target pairing, attack guidance, target selection standards, and other fires and effects components. Moreover, the open and modular architecture allows for easy integration with new data sources. Versatility and adaptability of the application enable it to devise and dispense a suitable response to a wide variety of scenarios. Recently, this application was used for detecting and countering a vehicle intruder with the help of radio frequency spotter sensor, command driven cameras, remote weapon system, portable vehicle arresting barrier, and an unmanned aerial vehicle - which confirmed the presence of the intruder, as well as provided lethal/non-lethal response and battle damage assessment. The completed demonstrations have proved Firestorm's™ validity and feasibility to predict, detect, neutralize, and protect key assets and/or area against a variety of possible threats. The sensors and responding assets can be deployed with numerous configurations to cover the various terrain and environmental conditions, and can be integrated to a number of platforms.

Internal Medicine Trainees’ Views of Training Adequacy and Duty Hours Restrictions in 2009

PubMed Central

Shea, Judy A.; Weissman, Arlene; McKinney, Sean; Silber, Jeffrey H.; Volpp, Kevin G.

2012-01-01

Purpose To gauge internal medicine (IM) trainees’ perceptions regarding aspects of their inpatient rotations, including supervision and educational opportunities, the perceived effect of duty hours regulations on quality of patient care, the causes of medical errors, and sleep. Method The authors analyzed the results of questionnaires administered to trainees following the October 2009 IM In-Training Examination (IM-ITE). Results Of the 21,768 IM trainees in post-graduate years 1 through 3 who took the IM-ITE, 18,272 (83.9%) responded. The majority of these trainees (87.7%) reported that supervision was adequate, and nearly half (46.3%) reported insufficient or minimal time to participate in learning activities. Two-thirds or more of medicine trainees thought specific work regulations such as limited shift length and more time off after nights and extended shifts would at least “occasionally,” if not “usually” or “always,” improve patient care. IM trainees at least “occasionally” attributed errors to workload (68.8% of respondents), fatigue (66.9%), inexperience or lack of knowledge (61.0%), incomplete handoffs (60.2%), and insufficient ancillary staff (53.5%). IM trainees’ sleep hours were limited during extended and overnight shifts. Conclusions IM trainees agree that limited educational opportunities are the weakest part of the average inpatient rotation. Few have complaints about the adequacy of supervision. These trainees’ optimism regarding the positive influence of potential work-hour restrictions on patient care and their views of likely causes of medical errors suggest the need for innovative patient care schedules and education curricula. PMID:22622211

Coupling giant impacts and longer-term evolution models

NASA Astrophysics Data System (ADS)

Golabek, Gregor; Jutzi, Martin; Emsenhuber, Alexandre; Gerya, Taras; Asphaug, Erik

2016-04-01

The crustal dichotomy is the dominant geological feature on planet Mars. The exogenic approach to the origin of the crustal dichotomy assumes that the northern lowlands correspond to a giant impact basin formed after primordial crust formation. However these simulations only consider the impact phase without studying the long-term repercussions of such a collision. The endogenic approach, suggesting a degree-1 mantle upwelling underneath the southern highlands, relies on a high Rayleigh number and a particular viscosity profile to form a low degree convective pattern within the geological constraints for the dichotomy formation. Such vigorous convection, however, results in continuous magmatic resurfacing, destroying the initially dichotomous crustal structure in the long-term. A further option is a hybrid exogenic-endogenic approach, which proposes an impact-induced magma ocean and subsequent superplume in the southern hemisphere. However these models rely on simple scaling laws to impose the thermal effects of the collision. Here we present the first results of impact simulations performed with a SPH code serially coupled with geodynamical computations performed using the code I3VIS to improve the latter approach and test it against observations. We are exploring collisions varying the impactor velocities, impact angles and target body properties, and are gauging the sensitivity to the handoff from SPH to I3VIS. As expected, our first results indicate the formation of a transient hemispherical magma ocean in the impacted hemisphere, and the merging of the cores. We also find that impact angle and velocity have a strong effect on the post-impact temperature field and on the timescale and nature of core merger.

Quitline Tobacco Interventions in Hospitalized Patients: A Randomized Trial.

PubMed

Warner, David O; Nolan, Margaret B; Kadimpati, Sandeep; Burke, Michael V; Hanson, Andrew C; Schroeder, Darrell R

2016-10-01

Hospitalization provides an opportunity for smokers to quit, but tobacco interventions can require specialized services that are not available to many hospitals. This study tests the hypothesis that a brief intervention to facilitate the use of telephone quitline services for both initial and follow-up counseling is effective in helping patients achieve sustained abstinence. This was a population-based RCT. Participants were Olmsted County, MN residents who reported current smoking and were admitted to Mayo Clinic hospitals in Rochester, MN between May 2012 and August 2014. A control group received brief (~5-minute) cessation advice; an intervention group received a brief (~5-minute) quitline facilitation intervention, with either warm handoff or faxed referral to a national quitline provider. All were offered a 2-week supply of nicotine patches at discharge. Outcomes included self-reported 7-day point prevalence abstinence at 6 months after hospitalization and quitline utilization. Data analysis was performed from September 2014 to March 2015. Of the 1,409 eligible patients who were approached, 600 (47%) were randomized. The quitline intake call was completed by 195 subjects (65% of the intervention group). Of these, 128 (66%) completed the first coaching call. Self-reported abstinence rates at 6 months after discharge were identical in both groups (24%). The quitline facilitation intervention did not improve self-reported abstinence rates compared with a standard brief stop-smoking intervention. These results do not support the effectiveness of quitlines in providing tobacco use interventions to a general population of hospitalized smokers. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Radial Internal Material Handling System (RIMS) for Circular Habitat Volumes

NASA Technical Reports Server (NTRS)

Howe, Alan S.; Haselschwardt, Sally; Bogatko, Alex; Humphrey, Brian; Patel, Amit

2013-01-01

On planetary surfaces, pressurized human habitable volumes will require a means to carry equipment around within the volume of the habitat, regardless of the partial gravity (Earth, Moon, Mars, etc.). On the NASA Habitat Demonstration Unit (HDU), a vertical cylindrical volume, it was determined that a variety of heavy items would need to be carried back and forth from deployed locations to the General Maintenance Work Station (GMWS) when in need of repair, and other equipment may need to be carried inside for repairs, such as rover parts and other external equipment. The vertical cylindrical volume of the HDU lent itself to a circular overhead track and hoist system that allows lifting of heavy objects from anywhere in the habitat to any other point in the habitat interior. In addition, the system is able to hand-off lifted items to other material handling systems through the side hatches, such as through an airlock. The overhead system consists of two concentric circle tracks that have a movable beam between them. The beam has a hoist carriage that can move back and forth on the beam. Therefore, the entire system acts like a bridge crane curved around to meet itself in a circle. The novelty of the system is in its configuration, and how it interfaces with the volume of the HDU habitat. Similar to how a bridge crane allows coverage for an entire rectangular volume, the RIMS system covers a circular volume. The RIMS system is the first generation of what may be applied to future planetary surface vertical cylinder habitats on the Moon or on Mars.

Interactional synchrony and the origins of infant-mother attachment: a replication study.

PubMed

Isabella, R A; Belsky, J

1991-04-01

This study sought to replicate previous work in testing the hypothesis that interactions of dyads developing secure attachment relationships would be characterized by disproportionately synchronous and those of dyads developing insecure relationships by disproportionately asynchronous exchanges. Additionally, a priori hypotheses were tested regarding expected differences in the interactional histories of dyads developing insecure-avoidant and insecure-resistant attachments. Results supported the study's predictions in all cases. Dyads developing secure attachments were observed at 3 and 9 months to interact in a disproportionately well-timed, reciprocal, and mutually rewarding manner; dyads developing insecure relationships were disproportionately characterized by interactions in which mothers were minimally involved, unresponsive to infant signals, or intrusive. Within the insecure group, as predicted, 3- and 9-month interactions of avoidant dyads were characterized by maternal intrusiveness and overstimulation; resistant dyads were characterized at both ages by poorly coordinated interactions in which mothers were underinvolved and inconsistent. These findings are discussed as they lend to a growing body of evidence concerning associations between differential interactional histories and attachment quality.

Developing and Evaluating a Technology Enhanced Interaction Framework and Method That Can Enhance the Accessibility of Mobile Learning

ERIC Educational Resources Information Center

Angkananon, Kewalin; Wald, Mike; Gilbert, Lester

2014-01-01

This paper focuses on the development and evaluation of a Technology Enhanced Interaction Framework and Method that can help with designing accessible mobile learning interactions involving disabled people. This new framework and method were developed to help design technological support for communication and interactions between people,…

Development of an Observational Procedure for Assessment of Parent-Child Interaction.

ERIC Educational Resources Information Center

Cunningham, Jo Lynn; Boger, Robert P.

The feasibility of using an observational rating schedule to elicit information about parent-child interaction was studied. The Parent-Child Interaction Rating Procedure (P-CIRP), focusing specifically on parent-child interaction with a structured teaching task, was developed for this purpose. The interaction setting is teaching the child simple…

Development and use of behavior and social interaction software installed on Palm handheld for observation of a child's social interactions with the environment.

PubMed

Sarkar, Archana; Dutta, Arup; Dhingra, Usha; Dhingra, Pratibha; Verma, Priti; Juyal, Rakesh; Black, Robert E; Menon, Venugopal P; Kumar, Jitendra; Sazawal, Sunil

2006-08-01

In settings in developing countries, children often socialize with multiple socializing agents (peers, siblings, neighbors) apart from their parents, and thus, a measurement of a child's social interactions should be expanded beyond parental interactions. Since the environment plays a role in shaping a child's development, the measurement of child-socializing agents' interactions is important. We developed and used a computerized observational software Behavior and Social Interaction Software (BASIS) with a preloaded coding scheme installed on a handheld Palm device to record complex observations of interactions between children and socializing agents. Using BASIS, social interaction assessments were conducted on 573 preschool children for 1 h in their natural settings. Multiple screens with a set of choices in each screen were designed that included the child's location, broad activity, state, and interactions with child-socializing agents. Data were downloaded onto a computer and systematically analyzed. BASIS, installed on Palm OS (M-125), enabled the recording of the complex interactions of child-socializing agents that could not be recorded with manual forms. Thus, this tool provides an innovative and relatively accurate method for the systematic recording of social interactions in an unrestricted environment.

Development of living cell force sensors for the interrogation of cell surface interactions

NASA Astrophysics Data System (ADS)

Brown, Scott Chang

The measurement of cell surface interactions, or cell interaction forces, are critical for the early diagnosis and prevention of disease, the design of targeted drug and gene delivery vehicles, the development of next-generation implant materials, and much more. However, the technologies and devices that are currently available are highly limited with respect to the dynamic force range over which they can measure cell-cell or cell-substratum interactions, and with their ability to adequately mimic biologically relevant systems. Consequently, research efforts that involve cell surface interactions have been limited. In this dissertation, existing tools for research at the nanoscale (i.e., atomic force microscopy microcantilevers) are modified to develop living cell force sensors that allow for the highly sensitive measurement of cell-mediated interactions over the entire range of forces expected in biotechnology (and nano-biotechnology) research (from a single to millions of receptor-ligand bonds). Several force sensor motifs have been developed that can be used to measure interactions using single adherent cells, single suspension culture cell, and cell monolayers (tissues) over a wide range of interaction conditions (e.g., approach velocity, shear rate, contact time) using a conventional atomic force microscope. This new tool has been applied to study the pathogenesis of spontaneous pneumothorax and the interaction of cells with 14 man-made interfaces. Consequently, a new hypothesis of the interactions that manifest spontaneous pneumothorax has been developed. Additionally, these findings have the potential to lead to the development of tools for data mining materials and surfaces for unique cell interactions that could have an immense societal impact.

Simple Web-based interactive key development software (WEBiKEY) and an example key for Kuruna (Poaceae: Bambusoideae).

PubMed

Attigala, Lakshmi; De Silva, Nuwan I; Clark, Lynn G

2016-04-01

Programs that are user-friendly and freely available for developing Web-based interactive keys are scarce and most of the well-structured applications are relatively expensive. WEBiKEY was developed to enable researchers to easily develop their own Web-based interactive keys with fewer resources. A Web-based multiaccess identification tool (WEBiKEY) was developed that uses freely available Microsoft ASP.NET technologies and an SQL Server database for Windows-based hosting environments. WEBiKEY was tested for its usability with a sample data set, the temperate woody bamboo genus Kuruna (Poaceae). WEBiKEY is freely available to the public and can be used to develop Web-based interactive keys for any group of species. The interactive key we developed for Kuruna using WEBiKEY enables users to visually inspect characteristics of Kuruna and identify an unknown specimen as one of seven possible species in the genus.

Limiting parental interaction during vocal development affects acoustic call structure in marmoset monkeys

PubMed Central

2018-01-01

Human vocal development is dependent on learning by imitation through social feedback between infants and caregivers. Recent studies have revealed that vocal development is also influenced by parental feedback in marmoset monkeys, suggesting vocal learning mechanisms in nonhuman primates. Marmoset infants that experience more contingent vocal feedback than their littermates develop vocalizations more rapidly, and infant marmosets with limited parental interaction exhibit immature vocal behavior beyond infancy. However, it is yet unclear whether direct parental interaction is an obligate requirement for proper vocal development because all monkeys in the aforementioned studies were able to produce the adult call repertoire after infancy. Using quantitative measures to compare distinct call parameters and vocal sequence structure, we show that social interaction has a direct impact not only on the maturation of the vocal behavior but also on acoustic call structures during vocal development. Monkeys with limited parental interaction during development show systematic differences in call entropy, a measure for maturity, compared with their normally raised siblings. In addition, different call types were occasionally uttered in motif-like sequences similar to those exhibited by vocal learners, such as birds and humans, in early vocal development. These results indicate that a lack of parental interaction leads to long-term disturbances in the acoustic structure of marmoset vocalizations, suggesting an imperative role for social interaction in proper primate vocal development. PMID:29651461

Limiting parental interaction during vocal development affects acoustic call structure in marmoset monkeys.

PubMed

Gultekin, Yasemin B; Hage, Steffen R

2018-04-01

Human vocal development is dependent on learning by imitation through social feedback between infants and caregivers. Recent studies have revealed that vocal development is also influenced by parental feedback in marmoset monkeys, suggesting vocal learning mechanisms in nonhuman primates. Marmoset infants that experience more contingent vocal feedback than their littermates develop vocalizations more rapidly, and infant marmosets with limited parental interaction exhibit immature vocal behavior beyond infancy. However, it is yet unclear whether direct parental interaction is an obligate requirement for proper vocal development because all monkeys in the aforementioned studies were able to produce the adult call repertoire after infancy. Using quantitative measures to compare distinct call parameters and vocal sequence structure, we show that social interaction has a direct impact not only on the maturation of the vocal behavior but also on acoustic call structures during vocal development. Monkeys with limited parental interaction during development show systematic differences in call entropy, a measure for maturity, compared with their normally raised siblings. In addition, different call types were occasionally uttered in motif-like sequences similar to those exhibited by vocal learners, such as birds and humans, in early vocal development. These results indicate that a lack of parental interaction leads to long-term disturbances in the acoustic structure of marmoset vocalizations, suggesting an imperative role for social interaction in proper primate vocal development.

The Role of Collegial Interaction in Continuing Professional Development

ERIC Educational Resources Information Center

Gagliardi, Anna R.; Wright, Frances C.; Anderson, Michael A. B.; Davis, Dave

2007-01-01

Introduction: Many physicians seek information from colleagues over other sources, highlighting the important role of interaction in continuing professional development (CPD). To guide the development of CPD opportunities, this study explored the nature of cancer-related questions faced by general surgeons, and how interaction with colleagues…

Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion.

PubMed

Heffernan, Kayla Joanne; Chang, Shanton; Maclean, Skye Tamara; Callegari, Emma Teresa; Garland, Suzanne Marie; Reavley, Nicola Jane; Varigos, George Andrew; Wark, John Dennis

2016-02-09

The now ubiquitous catchphrase, "There's an app for that," rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of "do no harm." There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). This research has provided principles for developing interactive eHealth apps for complex messaging as guidelines by aggregating existing design concepts and expanding these concepts and new learnings from our development process. A set of guidelines to develop interactive eHealth apps generally, and specifically those for complex messaging, was previously missing from the literature; this research has contributed these principles. Safe-D delivers complex messaging simply, to aid education, and explicitly, considering user safety.

Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion

PubMed Central

Heffernan, Kayla Joanne; Maclean, Skye Tamara; Callegari, Emma Teresa; Garland, Suzanne Marie; Reavley, Nicola Jane; Varigos, George Andrew; Wark, John Dennis

2016-01-01

Background The now ubiquitous catchphrase, “There’s an app for that,” rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of “do no harm.” There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. Objective This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. Methods For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. Results By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). Conclusions This research has provided principles for developing interactive eHealth apps for complex messaging as guidelines by aggregating existing design concepts and expanding these concepts and new learnings from our development process. A set of guidelines to develop interactive eHealth apps generally, and specifically those for complex messaging, was previously missing from the literature; this research has contributed these principles. Safe-D delivers complex messaging simply, to aid education, and explicitly, considering user safety. PMID:26860623

A Proposed Performance-Based System for Teacher Interactive Electronic Continuous Professional Development (TIE-CPD)

ERIC Educational Resources Information Center

Razak, Rafiza Abdul; Yusop, Farrah Dina; Idris, Aizal Yusrina; Al-Sinaiyah, Yanbu; Halili, Siti Hajar

2016-01-01

The paper introduces Teacher Interactive Electronic Continuous Professional Development (TIE-CPD), an online interactive training system. The framework and methodology of TIE-CPD are designed with functionalities comparable with existing e-training systems. The system design and development literature offers several methodology and framework…

Influences of brain development and ageing on cortical interactive networks.

PubMed

Zhu, Chengyu; Guo, Xiaoli; Jin, Zheng; Sun, Junfeng; Qiu, Yihong; Zhu, Yisheng; Tong, Shanbao

2011-02-01

To study the effect of brain development and ageing on the pattern of cortical interactive networks. By causality analysis of multichannel electroencephalograph (EEG) with partial directed coherence (PDC), we investigated the different neural networks involved in the whole cortex as well as the anterior and posterior areas in three age groups, i.e., children (0-10 years), mid-aged adults (26-38 years) and the elderly (56-80 years). By comparing the cortical interactive networks in different age groups, the following findings were concluded: (1) the cortical interactive network in the right hemisphere develops earlier than its left counterpart in the development stage; (2) the cortical interactive network of anterior cortex, especially at C3 and F3, is demonstrated to undergo far more extensive changes, compared with the posterior area during brain development and ageing; (3) the asymmetry of the cortical interactive networks declines during ageing with more loss of connectivity in the left frontal and central areas. The age-related variation of cortical interactive networks from resting EEG provides new insights into brain development and ageing. Our findings demonstrated that the PDC analysis of EEG is a powerful approach for characterizing the cortical functional connectivity during brain development and ageing. Copyright © 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Recent Developments in Interactive and Communicative CALL: Hypermedia and "Intelligent" Systems.

ERIC Educational Resources Information Center

Coughlin, Josette M.

Two recent developments in computer-assisted language learning (CALL), interactive video systems and "intelligent" games, are discussed. Under the first heading, systems combining the use of a computer and video disc player are described, and Compact Discs Interactive (CDI) and Digital Video Interactive (DVI) are reviewed. The…

Early relations between language development and the quality of mother-child interaction in very-low-birth-weight children.

PubMed

Stolt, S; Korja, R; Matomäki, J; Lapinleimu, H; Haataja, L; Lehtonen, L

2014-05-01

It is not clearly understood how the quality of early mother-child interaction influences language development in very-low-birth-weight children (VLBW). We aim to analyze associations between early language and the quality of mother-child interaction, and, the predictive value of the features of early mother-child interaction on language development at 24 months of corrected age in VLBW children. A longitudinal prospective follow-up study design was used. The participants were 28 VLBW children and 34 full-term controls. Language development was measured using different methods at 6, 12 and at 24 months of age. The quality of mother-child interaction was assessed using PC-ERA method at 6 and at 12 months of age. Associations between the features of early interaction and language development were different in the groups of VLBW and full-term children. There were no significant correlations between the features of mother-child interaction and language skills when measured at the same age in the VLBW group. Significant longitudinal correlations were detected in the VLBW group especially if the quality of early interactions was measured at six months and language skills at 2 years of age. However, when the predictive value of the features of early interactions for later poor language performance was analyzed separately, the features of early interaction predicted language skills in the VLBW group only weakly. The biological factors may influence on the language development more in the VLBW children than in the full-term children. The results also underline the role of maternal and dyadic factors in early interactions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Measuring the Interactive Skills of Caregivers in Child Care Centers: Development and Validation of the Caregiver Interaction Profile Scales

ERIC Educational Resources Information Center

Helmerhorst, Katrien O. W.; Riksen-Walraven, J. Marianne; Vermeer, Harriet J.; Fukkink, Ruben G.; Tavecchio, Louis W. C.

2014-01-01

Research Findings: High-quality caregiver-child interactions constitute the core of high-quality child care for young children. This article describes the background and development of the Caregiver Interaction Profile (CIP) scales to rate 6 key skills of caregivers for interacting with 0-to 4-year-old children in child care centers: sensitive…

"Aw, Man Where You Goin'?": Classroom Interaction and the Development of L2 Interactional Competence.

ERIC Educational Resources Information Center

Hall, Joan Kelly

1995-01-01

Examines the discursive structures and linguistic resources of the interactional environments influencing the development of individual communicative competence, with specific reference to providing speaking opportunities to students studying Spanish as a second language. Findings reveal that the ways in which topics are developed differ from how…

Including Students' Diverse Perspectives on Classroom Interactions into Video-Based Professional Development for Teachers

ERIC Educational Resources Information Center

Vogler, Anna-Marietha; Prediger, Susanne

2017-01-01

Video is often used in professional development courses to sensitize mathematics teachers to students' thinking and issues of classroom interaction. This article presents an approach that incorporates students' perspectives on mathematics classroom interactions into video-based professional development in order to enhance teachers' reflection on…

Developing L2 Interactional Competence: Increasing Participation through Self-Selection in Post-Expansion Sequences

ERIC Educational Resources Information Center

Watanabe, Aya

2017-01-01

Using longitudinal conversation analysis as a methodological framework, this study documents the development of second language (L2) interactional competence by focusing on a recurrent interactional practice observed in an English as a foreign language (EFL) classroom. Through observing a novice L2 learner's developing methods of participation in…

Development and Evaluation of an Interactive Electronic Laboratory Manual for Cooperative Learning of Medical Histology

ERIC Educational Resources Information Center

Khalil, Mohammed K.; Kirkley, Debbie L.; Kibble, Jonathan D.

2013-01-01

This article describes the development of an interactive computer-based laboratory manual, created to facilitate the teaching and learning of medical histology. The overarching goal of developing the manual is to facilitate self-directed group interactivities that actively engage students during laboratory sessions. The design of the manual…

Breaking the Cycle: Supporting Parent-Child Relationships through the "Parents Interacting With Infants" Intervention

ERIC Educational Resources Information Center

Nenide, Lana; Sontoski, Staci

2014-01-01

The Parents Interacting With Infants (PIWI) intervention is designed to support parents in developing their capacity to create positive, sensitive, and engaging interactions with their infants and toddlers. These interactions, as indicated by research, are essential for healthy brain development and overall well-being, yet they are particularly…

Simple Web-based interactive key development software (WEBiKEY) and an example key for Kuruna (Poaceae: Bambusoideae)1

PubMed Central

Attigala, Lakshmi; De Silva, Nuwan I.; Clark, Lynn G.

2016-01-01

Premise of the study: Programs that are user-friendly and freely available for developing Web-based interactive keys are scarce and most of the well-structured applications are relatively expensive. WEBiKEY was developed to enable researchers to easily develop their own Web-based interactive keys with fewer resources. Methods and Results: A Web-based multiaccess identification tool (WEBiKEY) was developed that uses freely available Microsoft ASP.NET technologies and an SQL Server database for Windows-based hosting environments. WEBiKEY was tested for its usability with a sample data set, the temperate woody bamboo genus Kuruna (Poaceae). Conclusions: WEBiKEY is freely available to the public and can be used to develop Web-based interactive keys for any group of species. The interactive key we developed for Kuruna using WEBiKEY enables users to visually inspect characteristics of Kuruna and identify an unknown specimen as one of seven possible species in the genus. PMID:27144109

Virtual Breakthrough Series, Part 2: Improving Fall Prevention Practices in the Veterans Health Administration.

PubMed

Zubkoff, Lisa; Neily, Julia; Quigley, Pat; Soncrant, Christina; Young-Xu, Yinong; Boar, Shoshana; Mills, Peter D

2016-11-01

The Veterans Health Administration (VHA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help prevent falls and fall-related injuries. This project enabled teams to expand program infrastructure, redesign improvement strategies, and enhance program evaluation. A VBTS collaborative involves prework, action, and continuous improvement. Actions included educational calls, monthly reports, coaching, and feedback. Evaluation included assessment of interventions, team capacity and infrastructure changes, and rates of falls and fall-related major injuries. Fifty-nine teams completed the project. The majority submitted monthly reports. The average number of interventions per team was 6.66 (range, 1-12; mode = 6). The most frequently implemented changes were staff education; post-fall huddles; data tracking; and classifying falls, handoff communication, and intentional rounding. On a program questionnaire aggregated average summary scores improved from 136.54 (baseline) to 58.26 (follow-up; range, 0-189; p < 0.0001). The mean aggregated fall-related major injury rate for participants decreased from 6.8 to 4.8 per 100,000 bed-days of care (p = 0.02), or 5 major injuries avoided per month. No statistically significant changes occurred for nonparticipants. The mean aggregated fall rate did not change significantly from baseline to follow-up for participants (p = 0.42) or nonparticipants (p = 0.21). Teams submitted reports and implemented changes resulting in decreased major injuries related to falls for participating units. Teams also made changes in their fall prevention programs such as classifying how they analyze falls and implementing injury reduction strategies. The approaches used show promise for reducing fall-related harm for inpatients, as well as assisting teams in implementing changes. Copyright 2016 The Joint Commission.

A Family-Centered Rounds Checklist, Family Engagement, and Patient Safety: A Randomized Trial

PubMed Central

Jacobsohn, Gwen C.; Rajamanickam, Victoria P.; Carayon, Pascale; Kelly, Michelle M.; Wetterneck, Tosha B.; Rathouz, Paul J.; Brown, Roger L.

2017-01-01

BACKGROUND AND OBJECTIVES: Family-centered rounds (FCRs) have become standard of care, despite the limited evaluation of FCRs’ benefits or interventions to support high-quality FCR delivery. This work examines the impact of the FCR checklist intervention, a checklist and associated provider training, on performance of FCR elements, family engagement, and patient safety. METHODS: This cluster randomized trial involved 298 families. Two hospital services were randomized to use the checklist; 2 others delivered usual care. We evaluated the performance of 8 FCR checklist elements and family engagement from 673 pre- and postintervention FCR videos and assessed the safety climate with the Children’s Hospital Safety Climate Questionnaire. Random effects regression models were used to assess intervention impact. RESULTS: The intervention significantly increased the number of FCR checklist elements performed (β = 1.2, P < .001). Intervention rounds were significantly more likely to include asking the family (odds ratio [OR] = 2.43, P < .05) or health care team (OR = 4.28, P = .002) for questions and reading back orders (OR = 12.43, P < .001). Intervention families’ engagement and reports of safety climate were no different from usual care. However, performance of specific checklist elements was associated with changes in these outcomes. For example, order read-back was associated with significantly more family engagement. Asking families for questions was associated with significantly better ratings of staff’s communication openness and safety of handoffs and transitions. CONCLUSIONS: The performance of FCR checklist elements was enhanced by checklist implementation and associated with changes in family engagement and more positive perceptions of safety climate. Implementing the checklist improves delivery of FCRs, impacting quality and safety of care. PMID:28557720

Implementation and Evaluation of the Safety Net Specialty Care Program in the Denver Metropolitan Area

PubMed Central

Fort, Meredith P; Namba, Lynnette M; Dutcher, Sarah; Copeland, Tracy; Bermingham, Neysa; Fellenz, Chris; Lantz, Deborah; Reusch, John J; Bayliss, Elizabeth A

2017-01-01

Objectives: In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned. Methods: We quantified electronic consultations (e-consults) between safety-net clinicians and specialists, and face-to-face specialist visits between May 2013 and December 2014. We reviewed and categorized all e-consults from November and December 2014. In 2015, we interviewed 21 safety-net clinicians and staff, 12 specialists, and 10 patients, and conducted a thematic analysis to determine factors facilitating and limiting optimal program use. Results: In the first 20 months of the program, safety-net clinicians at 23 clinics made 602 e-consults to specialists, and 81 patients received face-to-face specialist visits. Of 204 primary care clinicians, 103 made e-consults; 65 specialists participated in the program. Aspects facilitating program use were referral case managers’ involvement and the use of clear, concise questions in e-consults. Key recommendations for process improvement were to promote an understanding of the different health care contexts, support provider-to-provider communication, facilitate hand-offs between settings, and clarify program scope. Conclusion: Participants perceived the program as responsive to their needs, yet opportunities exist for continued uptake and expansion. Communitywide efforts to assess and address needs remain important. PMID:28241908

Creativity and the role of the leader.

PubMed

Amabile, Teresa M; Khaire, Mukti

2008-10-01

In today's innovation-driven economy, understanding how to generate great ideas has become an urgent managerial priority. Suddenly, the spotlight has turned on the academics who've studied creativity for decades. How relevant is their research to the practical challenges leaders face? To connect theory and practice, Harvard Business School professors Amabile and Khaire convened a two-day colloquium of leading creativity scholars and executives from companies such as Google, IDEO, Novartis, Intuit, and E Ink. In this article, the authors present highlights of the research presented and the discussion of its implications. At the event, a new leadership agenda began to take shape, one rooted in the awareness that you can't manage creativity--you can only manage for creativity. A number of themes emerged: The leader's job is not to be the source of ideas but to encourage and champion ideas. Leaders must tap the imagination of employees at all ranks and ask inspiring questions. They also need to help their organizations incorporate diverse perspectives, which spur creative insights, and facilitate creative collaboration by, for instance, harnessing new technologies. The participants shared tactics for enabling discoveries, as well as thoughts on how to bring process to bear on creativity without straitjacketing it. They pointed out that process management isn't appropriate in all stages of creative work; leaders should apply it thoughtfully and manage the handoff from idea generators to commercializers deftly. The discussion also examined the need to clear paths through bureaucracy, weed out weak ideas, and maximize the organization's learning from failure. Though points of view varied, the theories and frameworks explored advance the understanding of creativity in business and offer executives a playbook for increasing innovation.

Integrated Behavioral Health Care in Family Medicine Residencies A CERA Survey.

PubMed

Jacobs, Christine; Brieler, Jay A; Salas, Joanne; Betancourt, Renée M; Cronholm, Peter F

2018-05-01

Behavioral health integration (BHI) in primary care settings is critical to mental health care in the United States. Family medicine resident experience in BHI in family medicine residency (FMR) continuity clinics is essential preparation for practice. We surveyed FMR program directors to characterize the status of BHI in FMR training. Using the Council of Academic Family Medicine Educational Research Alliance (CERA) 2017 survey, FMR program directors (n=478, 261 respondents, 54.6% response rate) were queried regarding the stage of BHI within the residency family medicine center (FMC), integration activities at the FMC, and the professions of the BH faculty. BHI was characterized by Substance Abuse and Mental Health Services Agency (SAMHSA) designations within FMRs, and chi-square or ANOVA with Tukey honest significant difference (HSD) post hoc testing was used to assess differences in reported BHI attributes. Program directors reported a high level of BHI in their FMCs (44.1% full integration, 33.7% colocated). Higher levels of BHI were associated with increased use of warm handoffs, same day consultation, shared health records, and the use of behavioral health (BH) professionals for both mental health and medical issues. Family physicians, psychiatrists, and psychologists were most likely to be training residents in BHI. Almost half of FMR programs have colocated BH care or fully integrated BH as defined by SAMHSA. Highly integrated FMRs use a diversity of behavioral professionals and activities. Residencies currently at the collaboration stage could increase BH provider types and BHI practices to better prepare residents for practice. Residencies with full BHI may consider focusing on supporting BHI-trained residents transitioning into practice, or disseminating the model in the general primary care community.

Duty hours restriction for our surgical trainees: An ethical obligation or a bad idea?

PubMed

Adin, Christopher A; Fogle, Callie A; Marks, Steven L

2018-04-01

To ensure patient safety and protect the well-being of interns and residents, the Accreditation Council for Graduate Medical Education (ACGME) issued guidelines in 2003 limiting the working hours of physician trainees. Although many supported the goals of the ACGME, institutions struggled to restructure their programs and hire staff required by this unfunded mandate. Numerous studies have analyzed the effects of duty hours restrictions on patient outcomes and physician training over the past 15 years. Most agree that duty hours restrictions improved well-being of house officers, but these improvements came at the expense of continuity, and patient hand-offs led to medical errors. Effects on resident training are program specific, with duty hours restrictions having the most deleterious effects on surgical disciplines. Because veterinary specialists assume a similar role in providing 24-hour patient care, interns and residents face work-related stress as a result of extended working hours, on-call duty, and an increasingly complex caseload. The North Carolina State Veterinary Hospital is staffed by approximately 100 house officers representing almost every veterinary specialty group. We surveyed departing house officers regarding their quality of life and training experience. Sixty-six percent of interns and residents reported that they do not have time to take care of personal needs, and 57%-62% felt neutral or dissatisfied with their mental and physical well-being. Most trainees believed that decreased duty hours would improve learning, but 42% believed that decreased caseload would be detrimental to training. Veterinary educators must consider post-DVM veterinary training guidelines that maintain patient care with a good learning environment for interns and residents. © 2018 The American College of Veterinary Surgeons.

Psychiatric Emergency Services - Can Duty-Hour Changes Help Residents and Patients?

PubMed

Brainch, Navjot; Schule, Patrick; Laurel, Faith; Bodic, Maria; Jacob, Theresa

2018-04-14

Limitations on resident duty hours have been widely introduced with the intention of decreasing resident fatigue and improving patient outcomes. While there is evidence of improvement in resident well-being and education following such initiatives, they have inadvertently resulted in increased number of hand-offs between clinicians leading to potential errors in patient care. Current literature emphasizes need for more specialty/setting-specific scheduling, while considering residents' opinions when implementing duty-hour reforms. There are no reports examining the impact of duty-hour changes on residents or patients in psychiatric emergency service (PES) settings. Our purpose was to assess the impact of a recent scheduling change and decrease in overall duty hours, on resident well-being and sense of burnout, while also evaluating changes to patient wait-time and length of stay (LOS) in PES. Residents completed Maslach Burnout Inventory and anonymous surveys focusing on: fatigue, sleep, life outside work for shifts - regular (8 am-8 pm) and swing shifts (12 pm-10 pm). Data from the electronic medical records were collected for 6 months pre- and post-schedule change (January 2016-February 2017), for LOS and patient wait-time. Residents' preference for shifts was split. However, 86% reported getting enough sleep during swing shifts, while 83% reported lack of sleep during regular shifts. The average patient wait-time and LOS significantly decreased from 169 to 147 and 690 to 515 min, respectively. The change to swing shifts significantly impacts LOS and patient wait-time. The short shifts demonstrated an improvement in well-being for residents, but were not the singular factor for overall resident satisfaction.

Fabrication and Operation of a Nano-Optical Conveyor Belt

PubMed Central

Ryan, Jason; Zheng, Yuxin; Hansen, Paul; Hesselink, Lambertus

2015-01-01

The technique of using focused laser beams to trap and exert forces on small particles has enabled many pivotal discoveries in the nanoscale biological and physical sciences over the past few decades. The progress made in this field invites further study of even smaller systems and at a larger scale, with tools that could be distributed more easily and made more widely available. Unfortunately, the fundamental laws of diffraction limit the minimum size of the focal spot of a laser beam, which makes particles smaller than a half-wavelength in diameter hard to trap and generally prevents an operator from discriminating between particles which are closer together than one half-wavelength. This precludes the optical manipulation of many closely-spaced nanoparticles and limits the resolution of optical-mechanical systems. Furthermore, manipulation using focused beams requires beam-forming or steering optics, which can be very bulky and expensive. To address these limitations in the system scalability of conventional optical trapping our lab has devised an alternative technique which utilizes near-field optics to move particles across a chip. Instead of focusing laser beams in the far-field, the optical near field of plasmonic resonators produces the necessary local optical intensity enhancement to overcome the restrictions of diffraction and manipulate particles at higher resolution. Closely-spaced resonators produce strong optical traps which can be addressed to mediate the hand-off of particles from one to the next in a conveyor-belt-like fashion. Here, we describe how to design and produce a conveyor belt using a gold surface patterned with plasmonic C-shaped resonators and how to operate it with polarized laser light to achieve super-resolution nanoparticle manipulation and transport. The nano-optical conveyor belt chip can be produced using lithography techniques and easily packaged and distributed. PMID:26381708

Fabrication and Operation of a Nano-Optical Conveyor Belt.

PubMed

Ryan, Jason; Zheng, Yuxin; Hansen, Paul; Hesselink, Lambertus

2015-08-26

The technique of using focused laser beams to trap and exert forces on small particles has enabled many pivotal discoveries in the nanoscale biological and physical sciences over the past few decades. The progress made in this field invites further study of even smaller systems and at a larger scale, with tools that could be distributed more easily and made more widely available. Unfortunately, the fundamental laws of diffraction limit the minimum size of the focal spot of a laser beam, which makes particles smaller than a half-wavelength in diameter hard to trap and generally prevents an operator from discriminating between particles which are closer together than one half-wavelength. This precludes the optical manipulation of many closely-spaced nanoparticles and limits the resolution of optical-mechanical systems. Furthermore, manipulation using focused beams requires beam-forming or steering optics, which can be very bulky and expensive. To address these limitations in the system scalability of conventional optical trapping our lab has devised an alternative technique which utilizes near-field optics to move particles across a chip. Instead of focusing laser beams in the far-field, the optical near field of plasmonic resonators produces the necessary local optical intensity enhancement to overcome the restrictions of diffraction and manipulate particles at higher resolution. Closely-spaced resonators produce strong optical traps which can be addressed to mediate the hand-off of particles from one to the next in a conveyor-belt-like fashion. Here, we describe how to design and produce a conveyor belt using a gold surface patterned with plasmonic C-shaped resonators and how to operate it with polarized laser light to achieve super-resolution nanoparticle manipulation and transport. The nano-optical conveyor belt chip can be produced using lithography techniques and easily packaged and distributed.

Patient safety culture and job stress among nurses in Mazandaran, Iran.

PubMed

Asefzadeh, Saeed; Kalhor, Rohollah; Tir, Mohammad

2017-12-01

Paying attention to patient safety is a basic right and a necessary issue in providing medical care, and failure to observe it leads to irreparable damage. One of the factors affecting an individuals' performance in an organization is stress, which also endangers their health. To determine the relationship between patient safety culture and levels of job stress among the nurses working in the hospitals affiliated with Mazandaran University of Medical Sciences. The present study was carried out using a cross-sectional method in the hospitals affiliated with Mazandaran University of Medical Sciences in 2016. A multistage stratified sampling method using a Morgan Table was employed to select 380 nurses as the study sample from among 3,180 nurses. They were selected by a multistage stratified sampling method. The study instruments were Stinemetz Standard Job Stress Questionnaire and Hospital Survey on Patient Safety Culture (HSOPSC). After the required data were collected, they were analyzed using descriptive and inferential statistical methods (Pearson correlation, independent-samples t-test, and ANOVA) through SPSS version 23. The results of the present study showed that 75% of the nurses experienced average and high levels of stress. Among different dimensions of safety culture, organizational learning and handoffs and transitions obtained the highest and the lowest scores, respectively (72.5 and 24.5). The mean score of safety culture dimensions was 51.52. The results of the Pearson correlation test showed that there was a direct significant relationship between different dimensions of safety culture among nurses and the level of stress (p≤0.05). According to the findings, patient safety should be considered as a strategic priority for the senior managers of the health system. In order to enhance patient safety, managers should pay special attention to evaluating safety culture in organizations that deliver health service, especially hospitals.

A nationwide hospital survey on patient safety culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan.

PubMed

Vlayen, Annemie; Hellings, Johan; Claes, Neree; Peleman, Hilde; Schrooten, Ward

2012-09-01

To measure patient safety culture in Belgian hospitals and to examine the homogeneous grouping of underlying safety culture dimensions. The Hospital Survey on Patient Safety Culture was distributed organisation-wide in 180 Belgian hospitals participating in the federal program on quality and safety between 2007 and 2009. Participating hospitals were invited to submit their data to a comparative database. Homogeneous groups of underlying safety culture dimensions were sought by hierarchical cluster analysis. 90 acute, 42 psychiatric and 11 long-term care hospitals submitted their data for comparison to other hospitals. The benchmark database included 55 225 completed questionnaires (53.7% response rate). Overall dimensional scores were low, although scores were found to be higher for psychiatric and long-term care hospitals than for acute hospitals. The overall perception of patient safety was lower in French-speaking hospitals. Hierarchical clustering of dimensions resulted in two distinct clusters. Cluster I grouped supervisor/manager expectations and actions promoting safety, organisational learning-continuous improvement, teamwork within units and communication openness, while Cluster II included feedback and communication about error, overall perceptions of patient safety, non-punitive response to error, frequency of events reported, teamwork across units, handoffs and transitions, staffing and management support for patient safety. The nationwide safety culture assessment confirms the need for a long-term national initiative to improve patient safety culture and provides each hospital with a baseline patient safety culture profile to direct an intervention plan. The identification of clusters of safety culture dimensions indicates the need for a different approach and context towards the implementation of interventions aimed at improving the safety culture. Certain clusters require unit level improvements, whereas others demand a hospital-wide policy.

Restrictions on surgical resident shift length does not impact type of medical errors.

PubMed

Anderson, Jamie E; Goodman, Laura F; Jensen, Guy W; Salcedo, Edgardo S; Galante, Joseph M

2017-05-15

In 2011, resident duty hours were restricted in an attempt to improve patient safety and resident education. With the goal of reducing fatigue, shorter shift length leads to more patient handoffs, raising concerns about adverse effects on patient safety. This study seeks to determine whether differences in duty-hour restrictions influence types of errors made by residents. This is a nested retrospective cohort study at a surgery department in an academic medical center. During 2013-14, standard 2011 duty hours were in place for residents. In 2014-15, duty-hour restrictions at the study site were relaxed ("flexible") with no restrictions on shift length. We reviewed all morbidity and mortality submissions from July 1, 2013-June 30, 2015 and compared differences in types of errors between these periods. A total of 383 patients experienced adverse events, including 59 deaths (15.4%). Comparing standard versus flexible periods, there was no difference in mortality (15.7% versus 12.6%, P = 0.479) or complication rates (2.6% versus 2.5%, P = 0.696). There was no difference in types of errors between periods (P = 0.050-0.808). The most number of errors were due to cognitive failures (229, 59.6%), whereas the fewest number of errors were due to team failure (127, 33.2%). By subset, technical errors resulted in the highest number of errors (169, 44.1%). There were no differences between types of errors of cases that were nonelective, at night, or involving residents. Among adverse events reported in this departmental surgical morbidity and mortality, there were no differences in types of errors when resident duty hours were less restrictive. Copyright © 2017 Elsevier Inc. All rights reserved.

Development of a novel coding scheme (SABICS) to record nurse-child interactive behaviours in a community dental preventive intervention.

PubMed

Zhou, Yuefang; Cameron, Elaine; Forbes, Gillian; Humphris, Gerry

2012-08-01

To develop and validate the St Andrews Behavioural Interaction Coding Scheme (SABICS): a tool to record nurse-child interactive behaviours. The SABICS was developed primarily from observation of video recorded interactions; and refined through an iterative process of applying the scheme to new data sets. Its practical applicability was assessed via implementation of the scheme on specialised behavioural coding software. Reliability was calculated using Cohen's Kappa. Discriminant validity was assessed using logistic regression. The SABICS contains 48 codes. Fifty-five nurse-child interactions were successfully coded through administering the scheme on The Observer XT8.0 system. Two visualization results of interaction patterns demonstrated the scheme's capability of capturing complex interaction processes. Cohen's Kappa was 0.66 (inter-coder) and 0.88 and 0.78 (two intra-coders). The frequency of nurse behaviours, such as "instruction" (OR = 1.32, p = 0.027) and "praise" (OR = 2.04, p = 0.027), predicted a child receiving the intervention. The SABICS is a unique system to record interactions between dental nurses and 3-5 years old children. It records and displays complex nurse-child interactive behaviours. It is easily administered and demonstrates reasonable psychometric properties. The SABICS has potential for other paediatric settings. Its development procedure may be helpful for other similar coding scheme development. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Storyboard Development for Interactive Multimedia Training.

ERIC Educational Resources Information Center

Orr, Kay L.; And Others

1994-01-01

Discusses procedures for storyboard development and provides guidelines for designing interactive multimedia courseware, including interactivity, learner control, feedback, visual elements, motion video, graphics/animation, text, audio, and programming. A topical bibliography that lists 98 items is included. (LRW)

Methodical and technological aspects of creation of interactive computer learning systems

NASA Astrophysics Data System (ADS)

Vishtak, N. M.; Frolov, D. A.

2017-01-01

The article presents a methodology for the development of an interactive computer training system for training power plant. The methods used in the work are a generalization of the content of scientific and methodological sources on the use of computer-based training systems in vocational education, methods of system analysis, methods of structural and object-oriented modeling of information systems. The relevance of the development of the interactive computer training systems in the preparation of the personnel in the conditions of the educational and training centers is proved. Development stages of the computer training systems are allocated, factors of efficient use of the interactive computer training system are analysed. The algorithm of work performance at each development stage of the interactive computer training system that enables one to optimize time, financial and labor expenditure on the creation of the interactive computer training system is offered.

Discover the pythagorean theorem using interactive multimedia learning

NASA Astrophysics Data System (ADS)

Adhitama, I.; Sujadi, I.; Pramudya, I.

2018-04-01

In learning process students are required to play an active role in learning. They do not just accept the concept directly from teachers, but also build their own knowledge so that the learning process becomes more meaningful. Based on the observation, when learning Pythagorean theorem, students got difficulty on determining hypotenuse. One of the solution to solve this problem is using an interactive multimedia learning. This article aims to discuss the interactive multimedia as learning media for students. This was a Research and Development (R&D) by using ADDIE model of development. The results obtained was multimedia which was developed proper for students as learning media. Besides, on Phytagorian theorem learning activity we also compare Discovery Learning (DL) model with interactive multimedia and DL without interactive multimedia, and obtained that DL with interactive gave positive effect better than DL without interactive multimedia. It was also obtainde that interactive multimedia can attract and increase the interest ot the students on learning math. Therefore, the use of interactive multimedia on DL procees can improve student learning achievement.

A Research-Informed, School-Based Professional Development Workshop Programme to Promote Dialogic Teaching with Interactive Technologies

ERIC Educational Resources Information Center

Hennessy, Sara; Dragovic, Tatjana; Warwick, Paul

2018-01-01

The study reported in this article investigated the influence of a research-informed, school-based, professional development workshop programme on the quality of classroom dialogue using the interactive whiteboard (IWB). The programme aimed to develop a dialogic approach to teaching and learning mediated through more interactive uses of the IWB,…

Challenges of Malaysian Developers in Creating Good Interfaces for Interactive Courseware

ERIC Educational Resources Information Center

Kamaruddin, Norfadilah

2010-01-01

There are many reasons why interface design for interactive courseware fails to support quality of learning experiences. The causes such as the level of interactivity, the availability of the interfaces to interact with the end users and a lack of deep knowledge about the role of interface design by the designers in the development process are…

Experimental study of grain interactions on rolling texture development in face-centered cubic metals

NASA Astrophysics Data System (ADS)

Kumar Ray, Atish

There exists considerable debate in the texture community about whether grain interactions are a necessary factor to explain the development of deformation textures in polycrystalline metals. Computer simulations indicate that grain interactions play a significant role, while experimental evidence shows that the material type and starting orientation are more important in the development of texture and microstructure. A balanced review of the literature on face-centered cubic metals shows that the opposing viewpoints have developed due to the lack of any complete experimental study which considers both the intrinsic (material type and starting orientation) and extrinsic (grain interaction) factors. In this study, a novel method was developed to assemble ideally orientated crystalline aggregates in 99.99% aluminum (Al) or copper (Cu) to experimentally evaluate the effect of grain interactions on room temperature deformation texture. Ideal orientations relevant to face-centered cubic rolling textures, Cube {100} <001>, Goss {110} <001>, Brass {110} <11¯2> and Copper {112} <111¯> were paired in different combinations and deformed by plane strain compression to moderate strain levels of 1.0 to 1.5. Orientation dependent mechanical behavior was distinguishable from that of the neighbor-influenced behavior. In interacting crystals the constraint on the rolling direction shear strains (gammaXY , gammaXZ) was found to be most critical to show the effect of interactions via the evolution of local microstructure and microtexture. Interacting crystals with increasing deformations were observed to gradually rotate towards the S-component, {123} <634>. Apart from the average lattice reorientations, the interacting crystals also developed strong long-range orientation gradients inside the bulk of the crystal, which were identified as accumulating misorientations across the deformation boundaries. Based on a statistical procedure using quaternions, the orientation and interaction related heterogeneous deformations were characterized by three principal component vectors and their respective eigenvalues for both the orientation and misorientation distributions. For the case of a medium stacking fault energy metal like Cu, the texture and microstructure development depends wholly on the starting orientations. Microstructural instabilities in Cu are explained through a local slip clustering process, and the possible role of grain interactions on such instabilities is proposed. In contrast, the texture and microstructure development in a high stacking fault energy metal like Al is found to be dependent on the grain interactions. In general, orientation, grain interaction and material type were found to be key factors in the development of rolling textures in face-centered cubic metals and alloys. Moreso, in the texture development not any single parameter can be held responsible, rather, the interdependency of each of the three parameters must be considered. In this frame-work polycrystalline grains can be classified into four types according to their stability and susceptibility during deformation.

Effects of parenting role and parent-child interaction on infant motor development in Taiwan Birth Cohort Study.

PubMed

Chiang, Yi-Chen; Lin, Dai-Chan; Lee, Chun-Yang; Lee, Meng-Chih

2015-04-01

Previous studies have rarely focused on healthy infants' motor development, and nationwide birth cohort studies in Taiwan are limited. It has been shown that parent-child interactions significantly influence infant motor development and the effect of mother-infant attachment on infant development is stronger than father-infant attachment. However, it is not well understood that whether the mother-infant or father-infant interaction has the confounding effect on infant motor development. To understand healthy infant motor development in Taiwan; and to investigate the effects of parenting roles and parent-child interactions on infant motor development. Data were derived from the 1st through the 2nd waves of the Taiwan Birth Cohort Study-Pilot Database. Infants were classified into two categories (complete or incomplete development) according to their developmental milestones. Generalized estimating equations (GEE) and random effects models were used to clarify the possible long-term effects. The rate of infants who completed development in 6 months was 30.50%; however the rate was increased in 18 month-old children (80.01%). A mother's perceived infant care competence was the most important factor for infant motor development. "Whether or not the infant was the only baby in the family" and "parent-child interaction" had slightly significant effect on infant motor development. In conclusion, the mother's perceived competence must be strengthened and parent-infant interactions should be emphasized on a daily basis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Evidence-based adaptation and scale-up of a mobile phone health information service.

PubMed

L'Engle, Kelly; Plourde, Kate F; Zan, Trinity

2017-01-01

The research base recommending the use of mobile phone interventions for health improvement is growing at a rapid pace. The use of mobile phones to deliver health behavior change and maintenance interventions in particular is gaining a robust evidence base across geographies, populations, and health topics. However, research on best practices for successfully scaling mHealth interventions is not keeping pace, despite the availability of frameworks for adapting and scaling health programs. m4RH-Mobile for Reproductive Health-is an SMS, or text message-based, health information service that began in two countries and over a period of 7 years has been adapted and scaled to new population groups and new countries. Success can be attributed to following key principles for scaling up health programs, including continuous stakeholder engagement; ongoing monitoring, evaluation, and research including extensive content and usability testing with the target audience; strategic dissemination of results; and use of marketing and sustainability principles for social initiatives. This article investigates how these factors contributed to vertical, horizontal, and global scale-up of the m4RH program. Vertical scale of m4RH is demonstrated in Tanzania, where the early engagement of stakeholders including the Ministry of Health catalyzed expansion of m4RH content and national-level program reach. Ongoing data collection has provided real-time data for decision-making, information about the user base, and peer-reviewed publications, yielding government endorsement and partner hand-off for sustainability of the m4RH platform. Horizontal scale-up and adaptation of m4RH has occurred through expansion to new populations in Rwanda, Uganda, and Tanzania, where best practices for design and implementation of mHealth programs were followed to ensure the platform meets the needs of target populations. m4RH also has been modified and packaged for global scale-up through licensing and toolkit development, research into new business/distribution models, and serving as the foundation for derivative NGO and quasi-governmental mHealth platforms. The m4RH platform provides an excellent case study of how to apply best practices to successfully scale up mobile phone interventions for health improvement. Applying principles of scale can inform the successful scale-up, sustainability, and potential impact of mHealth programs across health topics and settings.

Targeting Virus-host Interactions of HIV Replication.

PubMed

Weydert, Caroline; De Rijck, Jan; Christ, Frauke; Debyser, Zeger

2016-01-01

Cellular proteins that are hijacked by HIV in order to complete its replication cycle, form attractive new targets for antiretroviral therapy. In particular, the protein-protein interactions between these cellular proteins (cofactors) and viral proteins are of great interest to develop new therapies. Research efforts have led to the validation of different cofactors and some successes in therapeutic applications. Maraviroc, the first cofactor inhibitor approved for human medicinal use, provided a proof of concept. Furthermore, compounds developed as Integrase-LEDGF/p75 interaction inhibitors (LEDGINs) have advanced to early clinical trials. Other compounds targeting cofactors and cofactor-viral protein interactions are currently under development. Likewise, interactions between cellular restriction factors and their counteracting HIV protein might serve as interesting targets in order to impair HIV replication. In this respect, compounds targeting the Vif-APOBEC3G interaction have been described. In this review, we focus on compounds targeting the Integrase- LEDGF/p75 interaction, the Tat-P-TEFb interaction and the Vif-APOBEC3G interaction. Additionally we give an overview of currently discovered compounds presumably targeting cellular cofactor-HIV protein interactions.

EINVis: a visualization tool for analyzing and exploring genetic interactions in large-scale association studies.

PubMed

Wu, Yubao; Zhu, Xiaofeng; Chen, Jian; Zhang, Xiang

2013-11-01

Epistasis (gene-gene interaction) detection in large-scale genetic association studies has recently drawn extensive research interests as many complex traits are likely caused by the joint effect of multiple genetic factors. The large number of possible interactions poses both statistical and computational challenges. A variety of approaches have been developed to address the analytical challenges in epistatic interaction detection. These methods usually output the identified genetic interactions and store them in flat file formats. It is highly desirable to develop an effective visualization tool to further investigate the detected interactions and unravel hidden interaction patterns. We have developed EINVis, a novel visualization tool that is specifically designed to analyze and explore genetic interactions. EINVis displays interactions among genetic markers as a network. It utilizes a circular layout (specially, a tree ring view) to simultaneously visualize the hierarchical interactions between single nucleotide polymorphisms (SNPs), genes, and chromosomes, and the network structure formed by these interactions. Using EINVis, the user can distinguish marginal effects from interactions, track interactions involving more than two markers, visualize interactions at different levels, and detect proxy SNPs based on linkage disequilibrium. EINVis is an effective and user-friendly free visualization tool for analyzing and exploring genetic interactions. It is publicly available with detailed documentation and online tutorial on the web at http://filer.case.edu/yxw407/einvis/. © 2013 WILEY PERIODICALS, INC.

The Development and Evaluation of a Computer-Based System for Managing the Design and Pilot-Testing of Interactive Videodisc Programs. Training and Development Research Center, Project Number Forty-Three.

ERIC Educational Resources Information Center

Sayre, Scott Alan

The purpose of this study was to develop and validate a computer-based system that would allow interactive video developers to integrate and manage the design components prior to production. These components of an interactive video (IVD) program include visual information in a variety of formats, audio information, and instructional techniques,…

Drug-nutrient interaction in clinical nutrition.

PubMed

Chan, Lingtak-Neander

2002-05-01

Drug-nutrient interactions have been recognized for decades. It is known that improper management of some of these interactions may lead to therapeutic failure or cause serious adverse effects to the patients. While most of the known drug-nutrient interactions involve changes in oral bioavailabilities and absorption of the offending compounds, recent investigations suggest that different mechanisms also exist. A mechanism-derived classification system for drug-nutrient interactions has only recently been developed. This system should facilitate the future research and development of practice guidelines in the identification and management of important interactions.

Developing the Understanding of the Role of Interpersonal Interaction in Early Literacy Development: A Case Study of a Thai Public Preschool

ERIC Educational Resources Information Center

Klibthong, Sunanta

2012-01-01

This study focuses on the role of interpersonal interaction in early literacy development in one public preschool school in Bangkok, Thailand. Specifically, it explores and analyses the nature of interpersonal interaction and collaborative activities the teachers employ in teaching literacy to children. The study involves observation of 82…

Development of an Educational Interactive Video-DVD on Dairy Health Management Practices

ERIC Educational Resources Information Center

Vidya, P.; Manivannan, C.

2010-01-01

A study was carried out to design, develop and test an educational interactive video-DVD on dairy health management practices. Design for the provision of menus and sub-menus in the developed video-DVD facilitated interactivity by means of branching navigation to different chapters in the video content. A total of 60 dairy farmers owning DVD…

Analysis of Mother-Infant Interaction in Infants with Down Syndrome and Typically Developing Infants

ERIC Educational Resources Information Center

Slonims, Vicky; McConachie, Helen

2006-01-01

Delays in development of early social behaviors in babies with Down syndrome are likely to affect patterns of interaction with their caregivers. We videotaped 23 babies in face-to-face interaction with their mothers at 8 and 20 weeks of age and compared them to 23 typically developing infants and their mothers. Social behaviors, mothers'…

Development of an E-Prime Based Computer Simulation of an Interactive Human Rights Violation Negotiation Script (Developpement d’un Programme de Simulation par Ordinateur Fonde sur le Logiciel E Prime pour la Negociation Interactive en cas de Violation des Droits de la Personne)

DTIC Science & Technology

2010-12-01

Base ( CFB ) Kingston. The computer simulation developed in this project is intended to be used for future research and as a possible training platform...DRDC Toronto No. CR 2010-055 Development of an E-Prime based computer simulation of an interactive Human Rights Violation negotiation script...Abstract This report describes the method of developing an E-Prime computer simulation of an interactive Human Rights Violation (HRV) negotiation. An

Interactive radio: distance education in the classroom.

PubMed

1988-01-01

The Honduran Association for Socioeconomic Growth and Development (AVANCE) in conjunction with the U.S. Agency for International Development's Radio Learning Project has developed and promoted programs for radio that encourage interactive learning in Latin America. The Second Interamerican Conference on Interactive Radio was recently held in Tela, Honduras where educators and participants came to attend workshops on scriptwriting, instructional design, community support and other related topics. The participants had the opportunity to study the second generation of interactive radio. Beginning in 1973, Nicaragua began an interactive radio program written for early grade mathematics students. Currently, Honduras is marketing a mathematics program entitled, La Familia de los Numeros," or the Family of Numbers to other countries. In Bolivia, an organization called, "Fe y Alegria," or Faith and Happiness is broadcasting educational programs through the use of interactive radio. In Ecuador, testing has begun to study the viability of interactive radio for their educational system, and in Costa Rica, replication of Honduras' "Familia de los Numeros" has begun. Teachers have noted an improved grasp of subject matter and better attentiveness through the use of interactive radio programs. The programs present 30 minutes of mathematics information and 30 minutes of language information. For each grade, 170 programs have been developed.

A method for creating interactive content for the iPod, and its potential use as a learning tool: Technical Advances

PubMed Central

Palmer, Edward J; Devitt, Peter G

2007-01-01

Background Podcasting is currently a popular means of delivery of information with a large number of podcasts specifically tailored for educational purposes. It can be argued that the passive nature of this teaching methodology limits the educational benefit that can be derived from podcasts. This paper describes the development and construction of interactive material for the iPod, and a survey of student attitudes towards this type of learning material. Methods The development of interactive material for an iPod is described in detail. This material was developed and demonstrated to 50 medical students. These students completed a paper-based survey on the potential uses of this technology, before and after a 20 minute presentation in class of an interactive case-study on an iPod. Results A technical description of how to develop interactive content for the iPod was created. The results of the student survey indicate a favourable shift in student attitudes after viewing the interactive case. Despite only 15% of the students owning an iPod, 57% of the students were positive about having access to interactive iPod content and 59% believed they would use it whilst travelling. The percentage of students who felt podcasting was a useful means of learning increased from 9% to 41%. Conclusion The development of interactive content for the iPod is feasible. There are indications that students view interactive iPod cases as having value as an additional learning resource. PMID:17888168

Associations Between Hormonal Biomarkers and Cognitive, Motor, and Language Developmental Status in Very Low Birth Weight Infants.

PubMed

Cho, June; Holditch-Davis, Diane; Su, Xiaogang; Phillips, Vivien; Biasini, Fred; Carlo, Waldemar A

Male infants are more prone to health problems and developmental delays than female infants. On the basis of theories of gender differences in brain development and social relationships, we explored associations between testosterone and cortisol levels with infant cognitive, motor, and language development ("infant development") in very low birth weight (VLBW) infants, controlling for mother-infant interactions, characteristics of mothers and infants, and days of saliva collection after birth. A total of 62 mother-VLBW infant pairs were recruited from the newborn intensive care unit of a tertiary medical center in the Southeast United States. Data were collected through infant medical record review, biochemical measurement, observation of mother-infant interactions, and standard questionnaires. Infant development was assessed at 6 months corrected age (CA), and mother-infant interactions were observed at 3 and 6 months CA. General linear regression with separate analyses for each infant gender showed that high testosterone levels were positively associated with language development of male infants after controlling for mother-infant interactions and other covariates, whereas high cortisol levels were negatively associated with motor development of female infants after controlling for mother-infant interactions. Steroid hormonal levels may well be more fundamental factors for assessing infant development than infant gender or mother-infant interactions at 6 months CA.

Young friendship in HFASD and typical development: friend versus non-friend comparisons.

PubMed

Bauminger-Zviely, Nirit; Agam-Ben-Artzi, Galit

2014-07-01

This study conducted comparative assessment of friendship in preschoolers with high-functioning autism spectrum disorder (HFASD, n = 29) versus preschoolers with typical development (n = 30), focusing on interactions with friends versus acquaintances. Groups were matched on SES, verbal/nonverbal MA, IQ, and CA. Multidimensional assessments included: mothers' and teachers' reports about friends' and friendship characteristics and observed individual and dyadic behaviors throughout interactions with friends versus non-friends during construction, drawing, and free-play situations. Findings revealed group differences in peer interaction favoring the typical development group, thus supporting the neuropsychological profile of HFASD. However, both groups' interactions with friends surpassed interactions with acquaintances on several key socio-communicative and intersubjective capabilities, thus suggesting that friendship may contribute to enhancement and practice of social interaction in HFASD.

Free software to analyse the clinical relevance of drug interactions with antiretroviral agents (SIMARV®) in patients with HIV/AIDS.

PubMed

Giraldo, N A; Amariles, P; Monsalve, M; Faus, M J

Highly active antiretroviral therapy has extended the expected lifespan of patients with HIV/AIDS. However, the therapeutic benefits of some drugs used simultaneously with highly active antiretroviral therapy may be adversely affected by drug interactions. The goal was to design and develop a free software to facilitate analysis, assessment, and clinical decision making according to the clinical relevance of drug interactions in patients with HIV/AIDS. A comprehensive Medline/PubMed database search of drug interactions was performed. Articles that recognized any drug interactions in HIV disease were selected. The publications accessed were limited to human studies in English or Spanish, with full texts retrieved. Drug interactions were analyzed, assessed, and grouped into four levels of clinical relevance according to gravity and probability. Software to systematize the information regarding drug interactions and their clinical relevance was designed and developed. Overall, 952 different references were retrieved and 446 selected; in addition, 67 articles were selected from the citation lists of identified articles. A total of 2119 pairs of drug interactions were identified; of this group, 2006 (94.7%) were drug-drug interactions, 1982 (93.5%) had an identified pharmacokinetic mechanism, and 1409 (66.5%) were mediated by enzyme inhibition. In terms of clinical relevance, 1285 (60.6%) drug interactions were clinically significant in patients with HIV (levels 1 and 2). With this information, a software program that facilitates identification and assessment of the clinical relevance of antiretroviral drug interactions (SIMARV ® ) was developed. A free software package with information on 2119 pairs of antiretroviral drug interactions was designed and developed that could facilitate analysis, assessment, and clinical decision making according to the clinical relevance of drug interactions in patients with HIV/AIDS. Copyright © 2016 Elsevier Inc. All rights reserved.

Broadening the horizon – level 2.5 of the HUPO-PSI format for molecular interactions

PubMed Central

Kerrien, Samuel; Orchard, Sandra; Montecchi-Palazzi, Luisa; Aranda, Bruno; Quinn, Antony F; Vinod, Nisha; Bader, Gary D; Xenarios, Ioannis; Wojcik, Jérôme; Sherman, David; Tyers, Mike; Salama, John J; Moore, Susan; Ceol, Arnaud; Chatr-aryamontri, Andrew; Oesterheld, Matthias; Stümpflen, Volker; Salwinski, Lukasz; Nerothin, Jason; Cerami, Ethan; Cusick, Michael E; Vidal, Marc; Gilson, Michael; Armstrong, John; Woollard, Peter; Hogue, Christopher; Eisenberg, David; Cesareni, Gianni; Apweiler, Rolf; Hermjakob, Henning

2007-01-01

Background Molecular interaction Information is a key resource in modern biomedical research. Publicly available data have previously been provided in a broad array of diverse formats, making access to this very difficult. The publication and wide implementation of the Human Proteome Organisation Proteomics Standards Initiative Molecular Interactions (HUPO PSI-MI) format in 2004 was a major step towards the establishment of a single, unified format by which molecular interactions should be presented, but focused purely on protein-protein interactions. Results The HUPO-PSI has further developed the PSI-MI XML schema to enable the description of interactions between a wider range of molecular types, for example nucleic acids, chemical entities, and molecular complexes. Extensive details about each supported molecular interaction can now be captured, including the biological role of each molecule within that interaction, detailed description of interacting domains, and the kinetic parameters of the interaction. The format is supported by data management and analysis tools and has been adopted by major interaction data providers. Additionally, a simpler, tab-delimited format MITAB2.5 has been developed for the benefit of users who require only minimal information in an easy to access configuration. Conclusion The PSI-MI XML2.5 and MITAB2.5 formats have been jointly developed by interaction data producers and providers from both the academic and commercial sector, and are already widely implemented and well supported by an active development community. PSI-MI XML2.5 enables the description of highly detailed molecular interaction data and facilitates data exchange between databases and users without loss of information. MITAB2.5 is a simpler format appropriate for fast Perl parsing or loading into Microsoft Excel. PMID:17925023

Empirical Methods for Identifying Specific Peptide-protein Interactions for Smart Reagent Development

DTIC Science & Technology

2012-09-01

orientated immobilization of proteins,” Biotechnology Progress, 22(2), 401-405 ( 2006 ). [26] J. M. Kogot, D. A. Sarkes , I. Val-Addo et al...Empirical Methods for Identifying Specific Peptide-protein Interactions for Smart Reagent Development by Joshua M. Kogot, Deborah A. Sarkes ...Peptide-protein Interactions for Smart Reagent Development Joshua M. Kogot, Deborah A. Sarkes , Dimitra N. Stratis-Cullum, and Paul M

Interplay of Languaging and Gameplay: Player-Game Interactions as Ecologies for Languaging and Situated L2 Development

ERIC Educational Resources Information Center

Ibrahim, Karim Hesham Shaker

2016-01-01

The field of game-mediated L2 learning has grown exponentially, and much has been discovered about the potentials of game-mediated interactions for L2 development, yet the fine-grained dynamics of player-game interactions and how they come to facilitate and afford L2 development are still largely underexplored. To address this gap in the…

Interactive Multimedia Package in Ameliorating Communicative Skill in English

ERIC Educational Resources Information Center

Singaravelu, G.

2011-01-01

The study enlightens the effectiveness of Interactive-Multimedia Package in developing communicative skill in English at standard VI. Present methods of developing communicative skill are ineffective to the students in improving their communicative competencies in English. Challenging interactive Multimedia Package helps to enhance the…

Academic-Centered Peer Interactions and Retention in Undergraduate Mathematics Programs

ERIC Educational Resources Information Center

Callahan, Kadian M.

2009-01-01

Peer interactions are a critical component of students' academic success and retention in undergraduate programs. Scholars argue that peer interactions influence students' cognitive development, identity development, self-confidence and self-efficacy, and social and academic integration into the university environment (Pascarella & Terenzini,…

Socio-Technical Perspective on Interdisciplinary Interactions During the Development of Complex Engineered Systems

NASA Technical Reports Server (NTRS)

McGowan, Anna-Maria R.; Daly, Shanna; Baker, Wayne; Papalambros, panos; Seifert, Colleen

2013-01-01

This study investigates interdisciplinary interactions that take place during the research, development, and early conceptual design phases in the design of large-scale complex engineered systems (LaCES) such as aerospace vehicles. These interactions, that take place throughout a large engineering development organization, become the initial conditions of the systems engineering process that ultimately leads to the development of a viable system. This paper summarizes some of the challenges and opportunities regarding social and organizational issues that emerged from a qualitative study using ethnographic and survey data. The analysis reveals several socio-technical couplings between the engineered system and the organization that creates it. Survey respondents noted the importance of interdisciplinary interactions and their benefits to the engineered system as well as substantial challenges in interdisciplinary interactions. Noted benefits included enhanced knowledge and problem mitigation and noted obstacles centered on organizational and human dynamics. Findings suggest that addressing the social challenges may be a critical need in enabling interdisciplinary interactions

The impact of telecommunications on science teacher professional development

NASA Astrophysics Data System (ADS)

Hatton, Mary E.

National education reform places emphasis on teachers moving towards empowering themselves and accepting responsibility for their own professional growth. Successful teacher in-service programs foster professional development by providing support in the school context (Baird, Ellis and Kuerbis, 1989; Lieberman, 1990). Research on national reform indicates that many teachers rely on communities of networks to sustain the assistance they need (McLaughlin & Talbert, 1993). Communities of teachers develop relationships with one another to enhance their personal and professional development while collaborating with colleagues (Lieberman, 1990). However, teachers within a school or the same district rarely have opportunities for collegial interactions because of schedules, lack of support for such interactions, or lack of interest among colleagues. This research study evaluates teachers interacting as a community via the Internet. Internet technology overcomes geographic barriers and time constraints, which limit the effectiveness of professional development programs (Gal, 1993). The communication opportunities in a network, together with the coordination of program staff, create an environment that provides teachers with support following a summer program (Gal, 1993). This case study examines the structure and change in three groups of science teachers who attended summer institutes and maintained interactions through a commercial network. The activities and interactions among members in the group, and the ways in which the members interacted with one another to create a community were studied. The network provided opportunities to interact with colleagues, both privately and publicly. Dialogue from these interactions were analyzed to determine patterns of teacher discourse that evolved following an in-service program. Teachers requested support for using program materials, shared experiences, shared resources, interacted socially, and reflected on their practice. This study demonstrates that professional growth can occur when teachers interact collaboratively using telecommunications. Teachers from different summer institutes, who had never met, interacted as a community, sharing experiences, requesting assistance, and reflecting on their practice for two or more years following a summer in-service program. The findings suggest that telecommunications is an effective option for sustaining collegial interactions and providing support, as advocated by current models of professional development.

A protein interaction map for cell polarity development

PubMed Central

Drees, Becky L.; Sundin, Bryan; Brazeau, Elizabeth; Caviston, Juliane P.; Chen, Guang-Chao; Guo, Wei; Kozminski, Keith G.; Lau, Michelle W.; Moskow, John J.; Tong, Amy; Schenkman, Laura R.; McKenzie, Amos; Brennwald, Patrick; Longtine, Mark; Bi, Erfei; Chan, Clarence; Novick, Peter; Boone, Charles; Pringle, John R.; Davis, Trisha N.; Fields, Stanley; Drubin, David G.

2001-01-01

Many genes required for cell polarity development in budding yeast have been identified and arranged into a functional hierarchy. Core elements of the hierarchy are widely conserved, underlying cell polarity development in diverse eukaryotes. To enumerate more fully the protein–protein interactions that mediate cell polarity development, and to uncover novel mechanisms that coordinate the numerous events involved, we carried out a large-scale two-hybrid experiment. 68 Gal4 DNA binding domain fusions of yeast proteins associated with the actin cytoskeleton, septins, the secretory apparatus, and Rho-type GTPases were used to screen an array of yeast transformants that express ∼90% of the predicted Saccharomyces cerevisiae open reading frames as Gal4 activation domain fusions. 191 protein–protein interactions were detected, of which 128 had not been described previously. 44 interactions implicated 20 previously uncharacterized proteins in cell polarity development. Further insights into possible roles of 13 of these proteins were revealed by their multiple two-hybrid interactions and by subcellular localization. Included in the interaction network were associations of Cdc42 and Rho1 pathways with proteins involved in exocytosis, septin organization, actin assembly, microtubule organization, autophagy, cytokinesis, and cell wall synthesis. Other interactions suggested direct connections between Rho1- and Cdc42-regulated pathways; the secretory apparatus and regulators of polarity establishment; actin assembly and the morphogenesis checkpoint; and the exocytic and endocytic machinery. In total, a network of interactions that provide an integrated response of signaling proteins, the cytoskeleton, and organelles to the spatial cues that direct polarity development was revealed. PMID:11489916

Batch mode grid generation: An endangered species

NASA Technical Reports Server (NTRS)

Schuster, David M.

1992-01-01

Non-interactive grid generation schemes should thrive as emphasis shifts from development of numerical analysis and design methods to application of these tools to real engineering problems. A strong case is presented for the continued development and application of non-interactive geometry modeling methods. Guidelines, strategies, and techniques for developing and implementing these tools are presented using current non-interactive grid generation methods as examples. These schemes play an important role in the development of multidisciplinary analysis methods and some of these applications are also discussed.

Interactive real time flow simulations

NASA Technical Reports Server (NTRS)

Sadrehaghighi, I.; Tiwari, S. N.

1990-01-01

An interactive real time flow simulation technique is developed for an unsteady channel flow. A finite-volume algorithm in conjunction with a Runge-Kutta time stepping scheme was developed for two-dimensional Euler equations. A global time step was used to accelerate convergence of steady-state calculations. A raster image generation routine was developed for high speed image transmission which allows the user to have direct interaction with the solution development. In addition to theory and results, the hardware and software requirements are discussed.

Development of the Enzyme-Substrate Interactions Concept Inventory

ERIC Educational Resources Information Center

Bretz, Stacey Lowery; Linenberger, Kimberly J.

2012-01-01

Enzyme function is central to student understanding of multiple topics within the biochemistry curriculum. In particular, students must understand how enzymes and substrates interact with one another. This manuscript describes the development of a 15-item Enzyme-Substrate Interactions Concept Inventory (ESICI) that measures student understanding…

Developing Students' Environmental Knowledge through Interactive Worksheets.

ERIC Educational Resources Information Center

Ballantyne, Roy; Witney, Eve; Tulip, David

1998-01-01

Environmental education is often characterized by a concern with developing attitudes and behavior rather than developing environmental knowledge and concepts. Students may thus unknowingly hold and later teach environmental misconceptions. Discusses the use of interactive worksheets to provide a time-effective means of developing students'…

Uncertainty quantification of effective nuclear interactions

DOE PAGES

Pérez, R. Navarro; Amaro, J. E.; Arriola, E. Ruiz

2016-03-02

We give a brief review on the development of phenomenological NN interactions and the corresponding quanti cation of statistical uncertainties. We look into the uncertainty of effective interactions broadly used in mean eld calculations through the Skyrme parameters and effective eld theory counter-terms by estimating both statistical and systematic uncertainties stemming from the NN interaction. We also comment on the role played by different tting strategies on the light of recent developments.

Uncertainty quantification of effective nuclear interactions

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

Pérez, R. Navarro; Amaro, J. E.; Arriola, E. Ruiz

We give a brief review on the development of phenomenological NN interactions and the corresponding quanti cation of statistical uncertainties. We look into the uncertainty of effective interactions broadly used in mean eld calculations through the Skyrme parameters and effective eld theory counter-terms by estimating both statistical and systematic uncertainties stemming from the NN interaction. We also comment on the role played by different tting strategies on the light of recent developments.

Development and Implementation of an Interactive Uniform Regulations Manual for the United States Marine Corps

DTIC Science & Technology

2006-09-01

IMPLEMENTATION OF AN INTERACTIVE UNIFORM REGULATIONS MANUAL FOR THE UNITED STATES MARINE CORPS by Michael H. Villar Carsten Krause...SUBTITLE: Development and Implementation of an Interactive Uniform Regulations Manual for the United States Marine Corps 6. AUTHOR(S) Michael H. Villar...IMPLEMENTATION OF AN INTERACTIVE UNIFORM REGULATIONS MANUAL FOR THE UNITED STATES MARINE CORPS Michael H. Villar Major, United States Marine Corps B.A

How to Develop Electrochemistry SETS-Based Interactive E-Book?

NASA Astrophysics Data System (ADS)

Munawwarah, M.; Anwar, S.; Sunarya, Y.

2017-09-01

This study aims to develop SETS-based interactive e-book teaching material through 4S TMD methode. The research methode in this study is the Development Research (RD) Richey and Klein that consists of design, phase, and evaluation. The design step was to analyze and plan the types of teaching materials instructional developed. There are 12 indicators from 3 standard competences that produced in selection step based new curriculum, the compatibility subject matter and indicators, and the relations between value and subject matter. Structuring steps yield concept map, macro structure, and multiple representation that were arranged to be first draft of teaching material that was used for develop the instruments for characterization step. Chatacterization test have been done to students in 12nd grades with 68 texts. Characterization results indicated that there were some texts included to difficult text. Difficult texts have been reduced with the ways back to qualitative steps and particulation. The second draft of teaching material was arranged based the results of didactic reduction of difficult texts. This draft was used for arranged interactive e-book. The characteristics of this SETS-based interactive e-book that developed were mention about the connection between science with environment, technology, and society. This interactive e-book consists of animation, task, and quizes that taken the interaction of students directly.

Receptor Tyrosine Kinase MET Interactome and Neurodevelopmental Disorder Partners at the Developing Synapse

PubMed Central

Xie, Zhihui; Li, Jing; Baker, Jonathan; Eagleson, Kathie L.; Coba, Marcelo P.; Levitt, Pat

2016-01-01

Background Atypical synapse development and plasticity are implicated in many neurodevelopmental disorders (NDDs). NDD-associated, high confidence risk genes have been identified, yet little is known about functional relationships at the level of protein-protein interactions, which are the dominant molecular bases responsible for mediating circuit development. Methods Proteomics in three independent developing neocortical synaptosomal preparations identified putative interacting proteins of the ligand-activated MET receptor tyrosine kinase, an autism risk gene that mediates synapse development. The candidates were translated into interactome networks and analyzed bioinformatically. Additionally, three independent quantitative proximity ligation assays (PLA) in cultured neurons and four independent immunoprecipitation analyses of synaptosomes validated protein interactions. Results Approximately 11% (8/72) of MET-interacting proteins, including SHANK3, SYNGAP1 and GRIN2B, are associated with NDDs. Proteins in the MET interactome were translated into a novel MET interactome network based on human protein-protein interaction databases. High confidence genes from different NDD datasets that encode synaptosomal proteins were analyzed for being enriched in MET interactome proteins. This was found for autism, but not schizophrenia, bipolar disorder, major depressive disorder or attentional deficit hyperactivity disorder. There is correlated gene expression between MET and its interactive partners in developing human temporal and visual neocortices, but not with highly expressed genes that are not in the interactome. PLA and biochemical analyses demonstrate that MET-protein partner interactions are dynamically regulated by receptor activation. Conclusions The results provide a novel molecular framework for deciphering the functional relations of key regulators of synaptogenesis that contribute to both typical cortical development and to NDDs. PMID:27086544

Technology-Enhanced Storytelling Stimulating Parent-Child Interaction and Preschool Children's Vocabulary Knowledge

ERIC Educational Resources Information Center

Teepe, R. C.; Molenaar, I.; Verhoeven, L.

2017-01-01

Preschool children's vocabulary mainly develops verbal through interaction. Therefore, the technology-enhanced storytelling (TES) activity Jeffy's Journey is developed to support parent-child interaction and vocabulary in preschool children. TES entails shared verbal storytelling supported by a story structure and real-time visual, auditory and…

Using Interactive Video to Develop Preservice Teachers' Classroom Awareness

ERIC Educational Resources Information Center

Fadde, Peter; Sullivan, Patricia

2013-01-01

This study investigates the use of interactive video in teacher education as a way of laying the cognitive groundwork for developing teacher self-reflection. Two interactive video approaches were designed to help early preservice teachers (novices) align what they observed in classroom teaching videos of other preservice teachers with what…

Some Basic Concepts of Wave-Particle Interactions in Collisionless Plasmas

NASA Technical Reports Server (NTRS)

Lakhina, Gurbax S.; Tsurutani, Bruce T.

1997-01-01

The physical concepts of wave-particle interactions in a collisionless plasma are developed from first principles. Using the Lorentz force, starting with the concepts of gyromotion, particle mirroring and the loss-cone, normal and anomalous cyclotron resonant interactions, pitch-angle scattering, and cross-field diffusion are developed.

BIND: the Biomolecular Interaction Network Database

PubMed Central

Bader, Gary D.; Betel, Doron; Hogue, Christopher W. V.

2003-01-01

The Biomolecular Interaction Network Database (BIND: http://bind.ca) archives biomolecular interaction, complex and pathway information. A web-based system is available to query, view and submit records. BIND continues to grow with the addition of individual submissions as well as interaction data from the PDB and a number of large-scale interaction and complex mapping experiments using yeast two hybrid, mass spectrometry, genetic interactions and phage display. We have developed a new graphical analysis tool that provides users with a view of the domain composition of proteins in interaction and complex records to help relate functional domains to protein interactions. An interaction network clustering tool has also been developed to help focus on regions of interest. Continued input from users has helped further mature the BIND data specification, which now includes the ability to store detailed information about genetic interactions. The BIND data specification is available as ASN.1 and XML DTD. PMID:12519993

PodNet, a protein-protein interaction network of the podocyte.

PubMed

Warsow, Gregor; Endlich, Nicole; Schordan, Eric; Schordan, Sandra; Chilukoti, Ravi K; Homuth, Georg; Moeller, Marcus J; Fuellen, Georg; Endlich, Karlhans

2013-07-01

Interactions between proteins crucially determine cellular structure and function. Differential analysis of the interactome may help elucidate molecular mechanisms during disease development; however, this analysis necessitates mapping of expression data on protein-protein interaction networks. These networks do not exist for the podocyte; therefore, we built PodNet, a literature-based mouse podocyte network in Cytoscape format. Using database protein-protein interactions, we expanded PodNet to XPodNet with enhanced connectivity. In order to test the performance of XPodNet in differential interactome analysis, we examined podocyte developmental differentiation and the effect of cell culture. Transcriptomes of podocytes in 10 different states were mapped on XPodNet and analyzed with the Cytoscape plugin ExprEssence, based on the law of mass action. Interactions between slit diaphragm proteins are most significantly upregulated during podocyte development and most significantly downregulated in culture. On the other hand, our analysis revealed that interactions lost during podocyte differentiation are not regained in culture, suggesting a loss rather than a reversal of differentiation for podocytes in culture. Thus, we have developed PodNet as a valuable tool for differential interactome analysis in podocytes, and we have identified established and unexplored regulated interactions in developing and cultured podocytes.

Identification of protein-interacting nucleotides in a RNA sequence using composition profile of tri-nucleotides.

PubMed

Panwar, Bharat; Raghava, Gajendra P S

2015-04-01

The RNA-protein interactions play a diverse role in the cells, thus identification of RNA-protein interface is essential for the biologist to understand their function. In the past, several methods have been developed for predicting RNA interacting residues in proteins, but limited efforts have been made for the identification of protein-interacting nucleotides in RNAs. In order to discriminate protein-interacting and non-interacting nucleotides, we used various classifiers (NaiveBayes, NaiveBayesMultinomial, BayesNet, ComplementNaiveBayes, MultilayerPerceptron, J48, SMO, RandomForest, SMO and SVM(light)) for prediction model development using various features and achieved highest 83.92% sensitivity, 84.82 specificity, 84.62% accuracy and 0.62 Matthew's correlation coefficient by SVM(light) based models. We observed that certain tri-nucleotides like ACA, ACC, AGA, CAC, CCA, GAG, UGA, and UUU preferred in protein-interaction. All the models have been developed using a non-redundant dataset and are evaluated using five-fold cross validation technique. A web-server called RNApin has been developed for the scientific community (http://crdd.osdd.net/raghava/rnapin/). Copyright © 2015 Elsevier Inc. All rights reserved.

Development of an Alert System to Detect Drug Interactions with Herbal Supplements using Medical Record Data.

PubMed

Archer, Melissa; Proulx, Joshua; Shane-McWhorter, Laura; Bray, Bruce E; Zeng-Treitler, Qing

2014-01-01

While potential medication-to-medication interaction alerting engines exist in many clinical applications, few systems exist to automatically alert on potential medication to herbal supplement interactions. We have developed a preliminary knowledge base and rules alerting engine that detects 259 potential interactions between 9 supplements, 62 cardiac medications, and 19 drug classes. The rules engine takes into consideration 12 patient risk factors and 30 interaction warning signs to help determine which of three different alert levels to categorize each potential interaction. A formative evaluation was conducted with two clinicians to set initial thresholds for each alert level. Additional work is planned add more supplement interactions, risk factors, and warning signs as well as to continue to set and adjust the inputs and thresholds for each potential interaction.

Interactive Contributions of Attribution Biases and Emotional Intensity to Child-Friend Interaction Quality During Preadolescence.

PubMed

Chen, Xi; McElwain, Nancy L; Lansford, Jennifer E

2017-12-20

Using data from a subsample of 913 study children and their friends who participated in the NICHD Study of Early Child Care and Youth Development, the interactive contributions of child-reported attribution biases and teacher-reported child emotional intensity (EI) at Grade 4 (M = 9.9 years) to observed child-friend interaction at Grade 6 (M = 11.9 years) were examined. Study children's hostile attribution bias, combined with high EI, predicted more negative child-friend interaction. In contrast, benign attribution bias, combined with high EI, predicted more positive child-friend interaction. The findings are discussed in light of the "fuel" interpretation of EI, in which high-intensity emotions may motivate children to act on their cognitive biases for better or for worse. © 2017 The Authors. Child Development © 2017 Society for Research in Child Development, Inc.

Studies of HZE particle interactions and transport for space radiation protection purposes

NASA Technical Reports Server (NTRS)

Townsend, Lawrence W.; Wilson, John W.; Schimmerling, Walter; Wong, Mervyn

1987-01-01

The main emphasis is on developing general methods for accurately predicting high-energy heavy ion (HZE) particle interactions and transport for use by researchers in mission planning studies, in evaluating astronaut self-shielding factors, and in spacecraft shield design and optimization studies. The two research tasks are: (1) to develop computationally fast and accurate solutions to the Boltzmann (transport) equation; and (2) to develop accurate HZE interaction models, from fundamental physical considerations, for use as inputs into these transport codes. Accurate solutions to the HZE transport problem have been formulated through a combination of analytical and numerical techniques. In addition, theoretical models for the input interaction parameters are under development: stopping powers, nuclear absorption cross sections, and fragmentation parameters.

Interspecies interactions that result in Bacillus subtilis forming biofilms are mediated mainly by members of its own genus.

PubMed

Shank, Elizabeth A; Klepac-Ceraj, Vanja; Collado-Torres, Leonardo; Powers, Gordon E; Losick, Richard; Kolter, Roberto

2011-11-29

Many different systems of bacterial interactions have been described. However, relatively few studies have explored how interactions between different microorganisms might influence bacterial development. To explore such interspecies interactions, we focused on Bacillus subtilis, which characteristically develops into matrix-producing cannibals before entering sporulation. We investigated whether organisms from the natural environment of B. subtilis--the soil--were able to alter the development of B. subtilis. To test this possibility, we developed a coculture microcolony screen in which we used fluorescent reporters to identify soil bacteria able to induce matrix production in B. subtilis. Most of the bacteria that influence matrix production in B. subtilis are members of the genus Bacillus, suggesting that such interactions may be predominantly with close relatives. The interactions we observed were mediated via two different mechanisms. One resulted in increased expression of matrix genes via the activation of a sensor histidine kinase, KinD. The second was kinase independent and conceivably functions by altering the relative subpopulations of B. subtilis cell types by preferentially killing noncannibals. These two mechanisms were grouped according to the inducing strain's relatedness to B. subtilis. Our results suggest that bacteria preferentially alter their development in response to secreted molecules from closely related bacteria and do so using mechanisms that depend on the phylogenetic relatedness of the interacting bacteria.

Enabling Accessibility Through Model-Based User Interface Development.

PubMed

Ziegler, Daniel; Peissner, Matthias

2017-01-01

Adaptive user interfaces (AUIs) can increase the accessibility of interactive systems. They provide personalized display and interaction modes to fit individual user needs. Most AUI approaches rely on model-based development, which is considered relatively demanding. This paper explores strategies to make model-based development more attractive for mainstream developers.

Using Interactive Problem-Solving Techniques to Enhance Control Systems Education for Non English-Speakers

ERIC Educational Resources Information Center

Lamont, L. A.; Chaar, L.; Toms, C.

2010-01-01

Interactive learning is beneficial to students in that it allows the continual development and testing of many skills. An interactive approach enables students to improve their technical capabilities, as well as developing both verbal and written communicative ability. Problem solving and communication skills are vital for engineering students; in…

Exploring the Quality of Teacher-Child Interactions: The Soka Discourse in Practice

ERIC Educational Resources Information Center

Ikegami, Kiiko; Rivalland, Corine

2016-01-01

Numerous research has shown that quality of interactions between early childhood teachers and children contribute significantly to children's holistic development. Most literature on this topic comes from developed/Western countries and little is known about the kind of interactions occurring within the Soka kindergarten model. This article, based…

Bilingual Lexical Interactions in an Unsupervised Neural Network Model

ERIC Educational Resources Information Center

Zhao, Xiaowei; Li, Ping

2010-01-01

In this paper we present an unsupervised neural network model of bilingual lexical development and interaction. We focus on how the representational structures of the bilingual lexicons can emerge, develop, and interact with each other as a function of the learning history. The results show that: (1) distinct representations for the two lexicons…

Developing the Second Language Writing Process through Social Media-Based Interaction Tasks

ERIC Educational Resources Information Center

Gómez, Julian Esteban Zapata

2015-01-01

This paper depicts the results from a qualitative research study focused on finding out the effect of interaction through social media on the development of second language learners' written production from a private school in Medellín, Antioquia, Colombia. The study was framed within concepts such as "social interaction," "digital…

Interactive Video Training and Development Activity.

ERIC Educational Resources Information Center

Troy State Univ., AL.

The Interactive Video Training and Development Activity of Troy State University (Troy, Alabama) is described in this report. The project has trained more than 30 people in the production of interactive video programs since its inception in 1983. Since 1985, training programs have been offered twice a year to individuals within and outside the…

The Development of Group Interaction Patterns: How Groups become Adaptive, Generative, and Transformative Learners

ERIC Educational Resources Information Center

London, Manuel; Sessa, Valerie I.

2007-01-01

This article integrates the literature on group interaction process analysis and group learning, providing a framework for understanding how patterns of interaction develop. The model proposes how adaptive, generative, and transformative learning processes evolve and vary in their functionality. Environmental triggers for learning, the group's…

Perceived live interaction modulates the developing social brain.

PubMed

Rice, Katherine; Moraczewski, Dustin; Redcay, Elizabeth

2016-09-01

Although children's social development is embedded in social interaction, most developmental neuroscience studies have examined responses to non-interactive social stimuli (e.g. photographs of faces). The neural mechanisms of real-world social behavior are of special interest during middle childhood (roughly ages 7-13), a time of increased social complexity and competence coinciding with structural and functional social brain development. Evidence from adult neuroscience studies suggests that social interaction may alter neural processing, but no neuroimaging studies in children have directly examined the effects of live social-interactive context on social cognition. In the current study of middle childhood, we compare the processing of two types of speech: speech that children believed was presented over a real-time audio-feed by a social partner and speech that they believed was recorded. Although in reality all speech was prerecorded, perceived live speech resulted in significantly greater neural activation in regions associated with social cognitive processing. These findings underscore the importance of using ecologically-valid and interactive methods to understand the developing social brain. © The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Differences in social interaction- vs. cocaine reward in mouse vs. rat.

PubMed

Kummer, Kai K; Hofhansel, Lena; Barwitz, Constanze M; Schardl, Aurelia; Prast, Janine M; Salti, Ahmad; El Rawas, Rana; Zernig, Gerald

2014-01-01

We previously developed rat experimental models based on the conditioned place preference (CPP) paradigm in which only four 15-min episodes of dyadic social interaction with a sex- and weight-matched male Sprague Dawley (SD) rat (1) reversed CPP from cocaine to social interaction despite continuing cocaine training, and (2) prevented the reacquisition/re-expression of cocaine CPP. In a concurrent conditioning schedule, pairing one compartment with social interaction and the other compartment with 15 mg/kg cocaine injections, rats spent the same amount of time in both compartments and the most rewarding sensory component of the composite stimulus social interaction was touch (taction). In the present study, we validated our experimental paradigm in C57BL/6 mice to investigate if our experimental paradigm may be useful for the considerable number of genetically modified mouse models. Only 71% of the tested mice developed place preference for social interaction, whereas 85% of the rats did. Accordingly, 29% of the mice developed conditioned place aversion (CPA) to social interaction, whereas this was true for only 15% of the rats. In support of the lesser likelihood of mice to develop a preference for social interaction, the average amount of time spent in direct contact was 17% for mice vs. 79% for rats. In animals that were concurrently conditioned for social interaction vs. cocaine, the relative reward strength for cocaine was 300-fold higher in mice than in rats. Considering that human addicts regularly prefer drugs of abuse to drug-free social interaction, the present findings suggest that our experimental paradigm of concurrent CPP for cocaine vs. social interaction is of even greater translational power if performed in C57BL/6 mice, the genetic background for most transgenic rodent models, than in rats.

Identifying functional cancer-specific miRNA-mRNA interactions in testicular germ cell tumor.

PubMed

Sedaghat, Nafiseh; Fathy, Mahmood; Modarressi, Mohammad Hossein; Shojaie, Ali

2016-09-07

Testicular cancer is the most common cancer in men aged between 15 and 35 and more than 90% of testicular neoplasms are originated at germ cells. Recent research has shown the impact of microRNAs (miRNAs) in different types of cancer, including testicular germ cell tumor (TGCT). MicroRNAs are small non-coding RNAs which affect the development and progression of cancer cells by binding to mRNAs and regulating their expressions. The identification of functional miRNA-mRNA interactions in cancers, i.e. those that alter the expression of genes in cancer cells, can help delineate post-regulatory mechanisms and may lead to new treatments to control the progression of cancer. A number of sequence-based methods have been developed to predict miRNA-mRNA interactions based on the complementarity of sequences. While necessary, sequence complementarity is, however, not sufficient for presence of functional interactions. Alternative methods have thus been developed to refine the sequence-based interactions using concurrent expression profiles of miRNAs and mRNAs. This study aims to find functional cancer-specific miRNA-mRNA interactions in TGCT. To this end, the sequence-based predicted interactions are first refined using an ensemble learning method, based on two well-known methods of learning miRNA-mRNA interactions, namely, TaLasso and GenMiR++. Additional functional analyses were then used to identify a subset of interactions to be most likely functional and specific to TGCT. The final list of 13 miRNA-mRNA interactions can be potential targets for identifying TGCT-specific interactions and future laboratory experiments to develop new therapies. Copyright © 2016 Elsevier Ltd. All rights reserved.

Receptor Tyrosine Kinase MET Interactome and Neurodevelopmental Disorder Partners at the Developing Synapse.

PubMed

Xie, Zhihui; Li, Jing; Baker, Jonathan; Eagleson, Kathie L; Coba, Marcelo P; Levitt, Pat

2016-12-15

Atypical synapse development and plasticity are implicated in many neurodevelopmental disorders (NDDs). NDD-associated, high-confidence risk genes have been identified, yet little is known about functional relationships at the level of protein-protein interactions, which are the dominant molecular bases responsible for mediating circuit development. Proteomics in three independent developing neocortical synaptosomal preparations identified putative interacting proteins of the ligand-activated MET receptor tyrosine kinase, an autism risk gene that mediates synapse development. The candidates were translated into interactome networks and analyzed bioinformatically. Additionally, three independent quantitative proximity ligation assays in cultured neurons and four independent immunoprecipitation analyses of synaptosomes validated protein interactions. Approximately 11% (8/72) of MET-interacting proteins, including SHANK3, SYNGAP1, and GRIN2B, are associated with NDDs. Proteins in the MET interactome were translated into a novel MET interactome network based on human protein-protein interaction databases. High-confidence genes from different NDD datasets that encode synaptosomal proteins were analyzed for being enriched in MET interactome proteins. This was found for autism but not schizophrenia, bipolar disorder, major depressive disorder, or attention-deficit/hyperactivity disorder. There is correlated gene expression between MET and its interactive partners in developing human temporal and visual neocortices but not with highly expressed genes that are not in the interactome. Proximity ligation assays and biochemical analyses demonstrate that MET-protein partner interactions are dynamically regulated by receptor activation. The results provide a novel molecular framework for deciphering the functional relations of key regulators of synaptogenesis that contribute to both typical cortical development and to NDDs. Copyright © 2016 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

An Interactive Software System for Computer-Assisted Testing

ERIC Educational Resources Information Center

Howze, Glenn

1978-01-01

This paper describes an interactive computer software system developed at Tuskegee Institute which is designed to allow flexibility in the development, administration, and scoring of examinations. (Author)

HB-EGF function in cardiac valve development requires interaction with heparan sulfate proteoglycans.

PubMed

Iwamoto, Ryo; Mine, Naoki; Kawaguchi, Taichiro; Minami, Seigo; Saeki, Kazuko; Mekada, Eisuke

2010-07-01

HB-EGF, a member of the EGF family of growth factors, plays an important role in cardiac valve development by suppressing mesenchymal cell proliferation. Here, we show that HB-EGF must interact with heparan sulfate proteoglycans (HSPGs) to properly function in this process. In developing valves, HB-EGF is synthesized in endocardial cells but accumulates in the mesenchyme by interacting with HSPGs. Disrupting the interaction between HB-EGF and HSPGs in an ex vivo model of endocardial cushion explants resulted in increased mesenchymal cell proliferation. Moreover, homozygous knock-in mice (HB(Delta)(hb/)(Delta)(hb)) expressing a mutant HB-EGF that cannot bind to HSPGs developed enlarged cardiac valves with hyperproliferation of mesenchymal cells; this resulted in a phenotype that resembled that of Hbegf-null mice. Interestingly, although Hbegf-null mice had abnormal heart chambers and lung alveoli, HB(Delta)(hb/)(Delta)(hb) mice did not exhibit these defects. These results indicate that interactions with HSPGs are essential for the function of HB-EGF, especially in cardiac valve development, in which HB-EGF suppresses mesenchymal cell proliferation.

Statistical mechanics of neocortical interactions. Derivation of short-term-memory capacity

NASA Astrophysics Data System (ADS)

Ingber, Lester

1984-06-01

A theory developed by the author to describe macroscopic neocortical interactions demonstrates that empirical values of chemical and electrical parameters of synaptic interactions establish several minima of the path-integral Lagrangian as a function of excitatory and inhibitory columnar firings. The number of possible minima, their time scales of hysteresis and probable reverberations, and their nearest-neighbor columnar interactions are all consistent with well-established empirical rules of human short-term memory. Thus, aspects of conscious experience are derived from neuronal firing patterns, using modern methods of nonlinear nonequilibrium statistical mechanics to develop realistic explicit synaptic interactions.

Teacher Reactions to Classroom Responses of Male and Female Students.

ERIC Educational Resources Information Center

Sadker, David; And Others

The 3-year research and development project described in this paper was conducted (1) to develop new knowledge about sex equity in classroom interactions, and (2) to develop successful techniques for reducing or eliminating sex-biased interaction. Two interventions were developed to train teachers in more equitable instructional behaviors. In the…

An Integrative-Interactive Conceptual Model for Curriculum Development.

ERIC Educational Resources Information Center

Al-Ibrahim, Abdul Rahman H.

1982-01-01

The Integrative-Interactive Conceptual Model for Curriculum Development calls for curriculum reform and innovation to be cybernetic so that all aspects of curriculum planning get adequate attention. (CJ)

Interactional Competence in Japanese as an Additional Language. Pragmatics & Interaction. Volume 4

ERIC Educational Resources Information Center

Greer, Tim, Ed.; Ishida, Midori, Ed.; Tateyama, Yumiko, Ed.

2017-01-01

In the research literature on interactional competence in talk among second language speakers and their coparticipants, this volume of "Pragmatics & Interaction" is the first to focus on interaction in Japanese. The chapters examine the use and development of interactional practices in a wide range of social settings, from everyday…

Utilizing a Low-Cost, Laser-Driven Interactive System (LaDIS) to Improve Learning in Developing Rural Regions

ERIC Educational Resources Information Center

Liou, Wei-Kai; Chang, Chun-Yen

2014-01-01

This study proposes an innovation Laser-Driven Interactive System (LaDIS), utilizing general IWBs (Interactive Whiteboard) didactics, to support student learning for rural and developing regions. LaDIS is a system made to support traditional classroom practices between an instructor and a group of students. This invention effectively transforms a…

Teaching Communicative Turn Taking Using the IPAD© to Promote Social Interaction for Preschool Children with Complex Communication Needs and Their Peers

ERIC Educational Resources Information Center

Therrien, Michelle Christine Stephen

2016-01-01

Positive interactions with peers impact future success in many domains, including language development and relationship development. Children with complex communication needs (CCN), especially those with characteristics of autism spectrum disorder (ASD), confront many barriers to successful interactions with peers. These include personal barriers,…

Using Interactive Videodiscs in Open University Courses. I.E.T. Papers on Broadcasting No. 218.

ERIC Educational Resources Information Center

Fuller, Robert G., Ed.

This nine-paper collection from a June 1983 Open University (OU) campus workshop in Milton Keynes, England, describes an interactive video project developed for an OU undergraduate course, T252, Introduction to Engineering Materials, and discusses varied aspects of interactive videodisc program development. The following papers are included:…

The Effects of Parent-Child Mediated Learning Experience (MLE) Interaction on Young Children's Cognitive Development

ERIC Educational Resources Information Center

Russell, Christina; Amod, Zaytoon; Rosenthal, Lesley

2008-01-01

This study addressed the effect of parent-child Mediated Learning Experience (MLE) interaction on cognitive development in early childhood. It measured the MLE interactions of 14 parents with their preschool children in the contexts of free-play and structured tasks. The children were assessed for their manifest cognitive performance and learning…

Emotional Development and Construction of Teacher Identity: Narrative Interactions about the Pre-Service Teachers' Practicum Experiences

ERIC Educational Resources Information Center

Teng, Mark Feng

2017-01-01

Pre-service teacher identity research has directed limited attention to the construction and development of professional teacher identity through narrative interaction. An analysis of narrative interactions among pre-service teachers in the present study explored the ways in which they negotiated emotional flux in the process of training to become…

BioPlex Display: An Interactive Suite for Large-Scale AP-MS Protein-Protein Interaction Data.

PubMed

Schweppe, Devin K; Huttlin, Edward L; Harper, J Wade; Gygi, Steven P

2018-01-05

The development of large-scale data sets requires a new means to display and disseminate research studies to large audiences. Knowledge of protein-protein interaction (PPI) networks has become a principle interest of many groups within the field of proteomics. At the confluence of technologies, such as cross-linking mass spectrometry, yeast two-hybrid, protein cofractionation, and affinity purification mass spectrometry (AP-MS), detection of PPIs can uncover novel biological inferences at a high-throughput. Thus new platforms to provide community access to large data sets are necessary. To this end, we have developed a web application that enables exploration and dissemination of the growing BioPlex interaction network. BioPlex is a large-scale interactome data set based on AP-MS of baits from the human ORFeome. The latest BioPlex data set release (BioPlex 2.0) contains 56 553 interactions from 5891 AP-MS experiments. To improve community access to this vast compendium of interactions, we developed BioPlex Display, which integrates individual protein querying, access to empirical data, and on-the-fly annotation of networks within an easy-to-use and mobile web application. BioPlex Display enables rapid acquisition of data from BioPlex and development of hypotheses based on protein interactions.

Skype me! Socially contingent interactions help toddlers learn language.

PubMed

Roseberry, Sarah; Hirsh-Pasek, Kathy; Golinkoff, Roberta M

2014-01-01

Language learning takes place in the context of social interactions, yet the mechanisms that render social interactions useful for learning language remain unclear. This study focuses on whether social contingency might support word learning. Toddlers aged 24-30 months (N = 36) were exposed to novel verbs in one of three conditions: live interaction training, socially contingent video training over video chat, and noncontingent video training (yoked video). Results suggest that children only learned novel verbs in socially contingent interactions (live interactions and video chat). This study highlights the importance of social contingency in interactions for language learning and informs the literature on learning through screen media as the first study to examine word learning through video chat technology. © 2013 The Authors. Child Development © 2013 Society for Research in Child Development, Inc.

Characterizing Topology of Probabilistic Biological Networks.

PubMed

Todor, Andrei; Dobra, Alin; Kahveci, Tamer

2013-09-06

Biological interactions are often uncertain events, that may or may not take place with some probability. Existing studies analyze the degree distribution of biological networks by assuming that all the given interactions take place under all circumstances. This strong and often incorrect assumption can lead to misleading results. Here, we address this problem and develop a sound mathematical basis to characterize networks in the presence of uncertain interactions. We develop a method that accurately describes the degree distribution of such networks. We also extend our method to accurately compute the joint degree distributions of node pairs connected by edges. The number of possible network topologies grows exponentially with the number of uncertain interactions. However, the mathematical model we develop allows us to compute these degree distributions in polynomial time in the number of interactions. It also helps us find an adequate mathematical model using maximum likelihood estimation. Our results demonstrate that power law and log-normal models best describe degree distributions for probabilistic networks. The inverse correlation of degrees of neighboring nodes shows that, in probabilistic networks, nodes with large number of interactions prefer to interact with those with small number of interactions more frequently than expected.

Split luciferase complementation assay to detect regulated protein-protein interactions in rice protoplasts in a large-scale format

PubMed Central

2014-01-01

Background The rice interactome, in which a network of protein-protein interactions has been elucidated in rice, is a useful resource to identify functional modules of rice signal transduction pathways. Protein-protein interactions occur in cells in two ways, constitutive and regulative. While a yeast-based high-throughput method has been widely used to identify the constitutive interactions, a method to detect the regulated interactions is rarely developed for a large-scale analysis. Results A split luciferase complementation assay was applied to detect the regulated interactions in rice. A transformation method of rice protoplasts in a 96-well plate was first established for a large-scale analysis. In addition, an antibody that specifically recognizes a carboxyl-terminal fragment of Renilla luciferase was newly developed. A pair of antibodies that recognize amino- and carboxyl- terminal fragments of Renilla luciferase, respectively, was then used to monitor quality and quantity of interacting recombinant-proteins accumulated in the cells. For a proof-of-concept, the method was applied to detect the gibberellin-dependent interaction between GIBBERELLIN INSENSITIVE DWARF1 and SLENDER RICE 1. Conclusions A method to detect regulated protein-protein interactions was developed towards establishment of the rice interactome. PMID:24987490

[Characteristics of interactions between mentally ill parents and their young children].

PubMed

Deneke, Christiane; Lüders, Bettina

2003-03-01

Disturbed parent infant interactions are frequently seen in cases of parental mental illness. They are indicating possible risks of the infant's development. Regular and illness-specific patterns are not found. Therefore the interaction has to be observed and classified in each individual case to recognize the relevance of the parental illness to the child. Different interaction patterns and their impact on the child's development are described and illustrated by case vignettes. The importance of preventive intervention is highlighted.

Physicochemical interactions in solid dosage forms.

PubMed

Narang, Ajit S; Desai, Divyakant; Badawy, Sherif

2012-10-01

Complete characterization and mechanistic understanding of physicochemical interactions in solid dosage forms are not only important for consistent manufacturability, stability, and bioavailability of the drug product, but are also expected under the quality-by-design paradigm of drug development. Lack of this understanding can impact successful and timely development, scale-up, and commercial manufacture of dosage forms. This article highlights the stability and bioavailability implications of physicochemical interactions in dosage forms citing a couple of examples where such interactions necessitated the recall of commercial drug products.

Interactive display/graphics systems for remote sensor data analysis.

NASA Technical Reports Server (NTRS)

Eppler, W. G.; Loe, D. L.; Wilson, E. L.; Whitley, S. L.; Sachen, R. J.

1971-01-01

Using a color-television display system and interactive graphics equipment on-line to an IBM 360/44 computer, investigators at the Manned Spacecraft Center have developed a variety of interactive displays which aid in analyzing remote sensor data. This paper describes how such interactive displays are used to: (1) analyze data from a multispectral scanner, (2) develop automatic pattern recognition systems based on multispectral scanner measurements, and (3) analyze data from nonimaging sensors such as the infrared radiometer and microwave scatterometer.

Effects of exurban development on trophic interactions in a desert landscape

USDA-ARS?s Scientific Manuscript database

Context Mechanisms of ecosystem change in urbanizing landscapes are poorly understood, especially in exurban areas featuring residential or commercial development set in a matrix of modified and natural vegetation. We asked how development altered trophic interactions and ecosystem processes in the ...

Dynamic Assessment and the "Interactive Examination"

ERIC Educational Resources Information Center

Jonsson, Anders; Mattheos, Nikos; Svingby, Gunilla; Attstrom, Rolf

2007-01-01

To assess own actions and define individual learning needs is fundamental for professional development. The development of self-assessment skills requires practice and feedback during the course of studies. The "Interactive Examination" is a methodology aiming to assist students developing their self-assessment skills. The present study…

Development of scales to assess patients' perception of physicians' cultural competence in health care interactions.

PubMed

Ahmed, Rukhsana; Bates, Benjamin R

2012-07-01

This study describes the development of scales to measure patients' perception of physicians' cultural competence in health care interactions and thus contributes to promoting awareness of physician-patient intercultural interaction processes. Surveys were administrated to a total of 682 participants. Exploratory factor analyses were employed to assess emergent scales and subscales to develop reliable instruments. The first two phases were devoted to formative research and pilot study. The third phase was devoted to scale development, which resulted in a five-factor solution to measure patient perception of physicians' cultural competence for patient satisfaction.

Oxytocin and Parent-Child Interaction in the Development of Empathy among Children at Risk for Autism

PubMed Central

McDonald, Nicole M.; Baker, Jason K.; Messinger, Daniel S.

2016-01-01

This longitudinal study investigated whether variation in the oxytocin receptor gene (OXTR) and early parent-child interactions predicted later empathic behavior in 84 toddlers at high or low familial risk for ASD. Two well-studied OXTR single nucleotide polymorphisms (SNPs), rs53576 and rs2254298, were examined. Parent-child interaction was measured at 15 and 18 months of age during free play sessions. Empathy was measured at 24 and 30 months using a response to parental distress paradigm. While there was no direct association between parent-child interaction quality or OXTR and empathy, rs53576 moderated the relation between interaction quality and empathy. Results suggest that the interplay between OXTR and early parent-child interactions predicts individual differences in empathy in children at varying risk for atypical social development. Findings are consonant with a differential susceptibility model in which an OXTR variant may increase the social salience of interaction processes for specific allele carriers. These results increase our understanding of predictors of empathy development in young children with a wide range of social outcomes. PMID:26998571

An Assessment of Phylogenetic Tools for Analyzing the Interplay Between Interspecific Interactions and Phenotypic Evolution.

PubMed

Drury, J P; Grether, G F; Garland, T; Morlon, H

2018-05-01

Much ecological and evolutionary theory predicts that interspecific interactions often drive phenotypic diversification and that species phenotypes in turn influence species interactions. Several phylogenetic comparative methods have been developed to assess the importance of such processes in nature; however, the statistical properties of these methods have gone largely untested. Focusing mainly on scenarios of competition between closely-related species, we assess the performance of available comparative approaches for analyzing the interplay between interspecific interactions and species phenotypes. We find that many currently used statistical methods often fail to detect the impact of interspecific interactions on trait evolution, that sister-taxa analyses are particularly unreliable in general, and that recently developed process-based models have more satisfactory statistical properties. Methods for detecting predictors of species interactions are generally more reliable than methods for detecting character displacement. In weighing the strengths and weaknesses of different approaches, we hope to provide a clear guide for empiricists testing hypotheses about the reciprocal effect of interspecific interactions and species phenotypes and to inspire further development of process-based models.

Mother, Father, and Infant as an Interactive System.

ERIC Educational Resources Information Center

Pedersen, Frank A.

This study investigates three types of reciprocal interactions among members of the family unit (father, mother and infant): father-infant interaction affecting child's development, father-infant interaction affecting mother's behavior, and husband-wife interaction affecting mother's behavior. Data from a sample of 39 healthy first-born infants…

ODISEES Data Portal Announcement

Atmospheric Science Data Center

2015-11-13

... larger image The Ontology-Driven Interactive Search Environment for Earth Science, developed at the Atmospheric Science Data Center ... The Ontology-Driven Interactive Search Environment for Earth Science, developed at the Atmospheric Science Data Center ...

Insights into the fold organization of TIM barrel from interaction energy based structure networks.

PubMed

Vijayabaskar, M S; Vishveshwara, Saraswathi

2012-01-01

There are many well-known examples of proteins with low sequence similarity, adopting the same structural fold. This aspect of sequence-structure relationship has been extensively studied both experimentally and theoretically, however with limited success. Most of the studies consider remote homology or "sequence conservation" as the basis for their understanding. Recently "interaction energy" based network formalism (Protein Energy Networks (PENs)) was developed to understand the determinants of protein structures. In this paper we have used these PENs to investigate the common non-covalent interactions and their collective features which stabilize the TIM barrel fold. We have also developed a method of aligning PENs in order to understand the spatial conservation of interactions in the fold. We have identified key common interactions responsible for the conservation of the TIM fold, despite high sequence dissimilarity. For instance, the central beta barrel of the TIM fold is stabilized by long-range high energy electrostatic interactions and low-energy contiguous vdW interactions in certain families. The other interfaces like the helix-sheet or the helix-helix seem to be devoid of any high energy conserved interactions. Conserved interactions in the loop regions around the catalytic site of the TIM fold have also been identified, pointing out their significance in both structural and functional evolution. Based on these investigations, we have developed a novel network based phylogenetic analysis for remote homologues, which can perform better than sequence based phylogeny. Such an analysis is more meaningful from both structural and functional evolutionary perspective. We believe that the information obtained through the "interaction conservation" viewpoint and the subsequently developed method of structure network alignment, can shed new light in the fields of fold organization and de novo computational protein design.

Measuring neural and behavioral activity during ongoing computerized social interactions: an examination of event-related brain potentials.

PubMed

Themanson, Jason R

2014-11-15

Social exclusion is a complex social phenomenon with powerful negative consequences. Given the impact of social exclusion on mental and emotional health, an understanding of how perceptions of social exclusion develop over the course of a social interaction is important for advancing treatments aimed at lessening the harmful costs of being excluded. To date, most scientific examinations of social exclusion have looked at exclusion after a social interaction has been completed. While this has been very helpful in developing an understanding of what happens to a person following exclusion, it has not helped to clarify the moment-to-moment dynamics of the process of social exclusion. Accordingly, the current protocol was developed to obtain an improved understanding of social exclusion by examining the patterns of event-related brain activation that are present during social interactions. This protocol allows greater precision and sensitivity in detailing the social processes that lead people to feel as though they have been excluded from a social interaction. Importantly, the current protocol can be adapted to include research projects that vary the nature of exclusionary social interactions by altering how frequently participants are included, how long the periods of exclusion will last in each interaction, and when exclusion will take place during the social interactions. Further, the current protocol can be used to examine variables and constructs beyond those related to social exclusion. This capability to address a variety of applications across psychology by obtaining both neural and behavioral data during ongoing social interactions suggests the present protocol could be at the core of a developing area of scientific inquiry related to social interactions.

Inverse colloidal crystal membranes for hydrophobic interaction membrane chromatography.

PubMed

Vu, Anh T; Wang, Xinying; Wickramasinghe, S Ranil; Yu, Bing; Yuan, Hua; Cong, Hailin; Luo, Yongli; Tang, Jianguo

2015-08-01

Hydrophobic interaction membrane chromatography has gained interest due to its excellent performance in the purification of humanized monoclonal antibodies. The membrane material used in hydrophobic interaction membrane chromatography has typically been commercially available polyvinylidene fluoride. In this contribution, newly developed inverse colloidal crystal membranes that have uniform pores, high porosity and, therefore, high surface area for protein binding are used as hydrophobic interaction membrane chromatography membranes for humanized monoclonal antibody immunoglobulin G purification. The capacity of the inverse colloidal crystal membranes developed here is up to ten times greater than commercially available polyvinylidene fluoride membranes with a similar pore size. This work highlights the importance of developing uniform pore size high porosity membranes in order to maximize the capacity of hydrophobic interaction membrane chromatography. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.